Ontario Child Health Study - Partner self-complete questionnaire (paper) - 2014

For Information onlyThis is an electronic survey example for information purposes only. This is not a working questionnaire.

Table of Contents

Partner self-complete questionnaire (PAR)

Partner self-complete questionnaire (PAR) - Question identifier:PAR_R00

This study is being done with researchers at McMaster University in Hamilton with the purpose of collecting information on the health and well-being of children in Ontario. This study will ask about mental health disorders, access to mental health services, and the relationship between health, family, neighbourhood and school. The information you provide may also be used by Statistics Canada for other statistical and research purposes.

Your answers will be kept strictly confidential. While participation is voluntary, your cooperation is important to ensure that the information collected is as accurate and as comprehensive as possible.

Once finished with the questionnaire please return it in the addressed envelope provided within seven days.

When you answer these questions, you can mark your answers like this X, or write a number in the box, as in the examples below.

Example 1

Q1: Planning family activities is difficult because we misunderstand each other.

X Strongly agree
o Agree
o Disagree
o Strongly disagree

Example 2

Q2: What is your current height without shoes?

166 centimetres

Partner self-complete questionnaire (PAR) - Question identifier:PAR_R01

We'd like to ask you some general background questions about _____________.

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q01

In general, would you say this child's health is...

  • 1: Excellent
  • 2: Very good
  • 3: Good
  • 4: Fair
  • 5: Poor

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q02

During the past six months, how well has he/she gotten along with other kids such as friends or classmates?

  • 1: Very well, no problems
  • 2: Quite well, hardly any problems
  • 3: Pretty well, occasional problems
  • 4: Not too well, frequent problems
  • 5: Not well at all, constant problems

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q03

During the past six months, how well has he/she gotten along with his/her teachers at school?

  • 1: Very well, no problems
  • 2: Quite well, hardly any problems
  • 3: Pretty well, occasional problems
  • 4: Not too well, frequent problems
  • 5: Not well at all, constant problems
  • 6: Not in school

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q04

During the past six months, how well has he/she gotten along with the family?

  • 1: Very well, no problems
  • 2: Quite well, hardly any problems
  • 3: Pretty well, occasional problems
  • 4: Not too well, frequent problems
  • 5: Not well at all, constant problems

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q05

During the past six months, which of the statements below best describes how well he/she has been doing in school?

  • 1: Very well, excellent student
  • 2: Quite well, good student
  • 3: Pretty well, average student
  • 4: Not too well, below average student
  • 5: Not well at all, poor student
  • 6: Not in school

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q06

During the past six months, do you think that he/she has had any emotional or behavioural problems?

  • 1: Yes
  • 2: No

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q07

During that time, did he/she tend to have more emotional or behavioural problems than other boys/girls of his/her age?

  • 1: Yes
  • 2: No

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q08

Do you think that he/she needs or needed any professional help with these problems?

  • 1: Yes
  • 2: No

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q09A

Below is a list of statements that describe some of the feelings and behaviours of children. For each statement, please select the response that best describes your child now or within the past six months. You may only select one response.

Can't concentrate, can't pay attention for long

  • 1: Never or not true
  • 2: Sometimes or somewhat true
  • 3: Often or very true

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q09B

Below is a list of statements that describe some of the feelings and behaviours of children. For each statement, please select the response that best describes your child now or within the past six months. You may only select one response.

Can't sit still, restless or hyperactive

  • 1: Never or not true
  • 2: Sometimes or somewhat true
  • 3: Often or very true

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q09C

Below is a list of statements that describe some of the feelings and behaviours of children. For each statement, please select the response that best describes your child now or within the past six months. You may only select one response.

Cries a lot

  • 1: Never or not true
  • 2: Sometimes or somewhat true
  • 3: Often or very true

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q09D

Below is a list of statements that describe some of the feelings and behaviours of children. For each statement, please select the response that best describes your child now or within the past six months. You may only select one response.

Cruelty, bullying or meanness to others

  • 1: Never or not true
  • 2: Sometimes or somewhat true
  • 3: Often or very true

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q09E

Below is a list of statements that describe some of the feelings and behaviours of children. For each statement, please select the response that best describes your child now or within the past six months. You may only select one response.

Cruelty to animals

  • 1: Never or not true
  • 2: Sometimes or somewhat true
  • 3: Often or very true

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q09F

Below is a list of statements that describe some of the feelings and behaviours of children. For each statement, please select the response that best describes your child now or within the past six months. You may only select one response.

Deliberately harms self or attempts suicide

  • 1: Never or not true
  • 2: Sometimes or somewhat true
  • 3: Often or very true

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q09G

Below is a list of statements that describe some of the feelings and behaviours of children. For each statement, please select the response that best describes your child now or within the past six months. You may only select one response.

Destroys his/her own things

  • 1: Never or not true
  • 2: Sometimes or somewhat true
  • 3: Often or very true

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q09H

Below is a list of statements that describe some of the feelings and behaviours of children. For each statement, please select the response that best describes your child now or within the past six months. You may only select one response.

Destroys things belonging to others

  • 1: Never or not true
  • 2: Sometimes or somewhat true
  • 3: Often or very true

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q09I

Below is a list of statements that describe some of the feelings and behaviours of children. For each statement, please select the response that best describes your child now or within the past six months. You may only select one response.

Disobedient at school

  • 1: Never or not true
  • 2: Sometimes or somewhat true
  • 3: Often or very true

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q09J

Below is a list of statements that describe some of the feelings and behaviours of children. For each statement, please select the response that best describes your child now or within the past six months. You may only select one response.

Gets in many fights

  • 1: Never or not true
  • 2: Sometimes or somewhat true
  • 3: Often or very true

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q09K

Below is a list of statements that describe some of the feelings and behaviours of children. For each statement, please select the response that best describes your child now or within the past six months. You may only select one response.

Impulsive or acts without thinking

  • 1: Never or not true
  • 2: Sometimes or somewhat true
  • 3: Often or very true

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q09L

Below is a list of statements that describe some of the feelings and behaviours of children. For each statement, please select the response that best describes your child now or within the past six months. You may only select one response.

Lying or cheating

  • 1: Never or not true
  • 2: Sometimes or somewhat true
  • 3: Often or very true

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q09M

Below is a list of statements that describe some of the feelings and behaviours of children. For each statement, please select the response that best describes your child now or within the past six months. You may only select one response.

Nervous, high-strung or tense

  • 1: Never or not true
  • 2: Sometimes or somewhat true
  • 3: Often or very true

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q09N

Below is a list of statements that describe some of the feelings and behaviours of children. For each statement, please select the response that best describes your child now or within the past six months. You may only select one response.

Too fearful or anxious

  • 1: Never or not true
  • 2: Sometimes or somewhat true
  • 3: Often or very true

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q09O

Below is a list of statements that describe some of the feelings and behaviours of children. For each statement, please select the response that best describes your child now or within the past six months. You may only select one response.

Physically attacks people

  • 1: Never or not true
  • 2: Sometimes or somewhat true
  • 3: Often or very true

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q09P

Below is a list of statements that describe some of the feelings and behaviours of children. For each statement, please select the response that best describes your child now or within the past six months. You may only select one response.

Runs away from home

  • 1: Never or not true
  • 2: Sometimes or somewhat true
  • 3: Often or very true

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q09Q

Below is a list of statements that describe some of the feelings and behaviours of children. For each statement, please select the response that best describes your child now or within the past six months. You may only select one response.

Sets fires

  • 1: Never or not true
  • 2: Sometimes or somewhat true
  • 3: Often or very true

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q09R

Below is a list of statements that describe some of the feelings and behaviours of children. For each statement, please select the response that best describes your child now or within the past six months. You may only select one response.

Steals at home

  • 1: Never or not true
  • 2: Sometimes or somewhat true
  • 3: Often or very true

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q09S

Below is a list of statements that describe some of the feelings and behaviours of children. For each statement, please select the response that best describes your child now or within the past six months. You may only select one response.

Steals outside the home

  • 1: Never or not true
  • 2: Sometimes or somewhat true
  • 3: Often or very true

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q09T

Below is a list of statements that describe some of the feelings and behaviours of children. For each statement, please select the response that best describes your child now or within the past six months. You may only select one response.

Talks about killing self

  • 1: Never or not true
  • 2: Sometimes or somewhat true
  • 3: Often or very true

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q09U

Below is a list of statements that describe some of the feelings and behaviours of children. For each statement, please select the response that best describes your child now or within the past six months. You may only select one response.

Threatens people

  • 1: Never or not true
  • 2: Sometimes or somewhat true
  • 3: Often or very true

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q09V

Below is a list of statements that describe some of the feelings and behaviours of children. For each statement, please select the response that best describes your child now or within the past six months. You may only select one response.

Truancy, skips school

  • 1: Never or not true
  • 2: Sometimes or somewhat true
  • 3: Often or very true

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q09W

Below is a list of statements that describe some of the feelings and behaviours of children. For each statement, please select the response that best describes your child now or within the past six months. You may only select one response.

Unhappy, sad or depressed

  • 1: Never or not true
  • 2: Sometimes or somewhat true
  • 3: Often or very true

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q09X

Below is a list of statements that describe some of the feelings and behaviours of children. For each statement, please select the response that best describes your child now or within the past six months. You may only select one response.

Vandalism

  • 1: Never or not true
  • 2: Sometimes or somewhat true
  • 3: Often or very true

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q09Y

Below is a list of statements that describe some of the feelings and behaviours of children. For each statement, please select the response that best describes your child now or within the past six months. You may only select one response.

Worrying

  • 1: Never or not true
  • 2: Sometimes or somewhat true
  • 3: Often or very true

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q10A

The next questions are about the problems you marked above or any other problems of behaviour or feelings that the child might have had now or in the past six months. How much have these problems interfered with....

how well he/she gets along with you and the rest of the family?

  • 0: Not at all
  • 1: A little
  • 2: Somewhat
  • 3: A lot
  • 4: A great deal

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q10B

The next questions are about the problems you marked above or any other problems of behaviour or feelings that the child might have had now or in the past six months. How much have these problems interfered with....

making and keeping friends?

  • 0: Not at all
  • 1: A little
  • 2: Somewhat
  • 3: A lot
  • 4: A great deal

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q10C

The next questions are about the problems you marked above or any other problems of behaviour or feelings that the child might have had now or in the past six months. How much have these problems interfered with....

learning or school work?

  • 0: Not at all
  • 1: A little
  • 2: Somewhat
  • 3: A lot
  • 4: A great deal

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q10D

The next questions are about the problems you marked above or any other problems of behaviour or feelings that the child might have had now or in the past six months. How much have these problems interfered with....

playing, hobbies, sports or other leisure activities?

  • 0: Not at all
  • 1: A little
  • 2: Somewhat
  • 3: A lot
  • 4: A great deal

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q11A

Now or in the past six months. To what extent have these problems ....

caused you personal upset, distress or worry?

  • 0: Not at all
  • 1: A little
  • 2: Somewhat
  • 3: A lot
  • 4: A great deal

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q11B

Now or in the past six months. To what extent have these problems ....

interfered with your work, recreational activities or socializing with relatives or friends?

  • 0: Not at all
  • 1: A little
  • 2: Somewhat
  • 3: A lot
  • 4: A great deal

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q11C

Now or in the past six months. To what extent have these problems ....

led to bad feelings or relationships with neighbours?

  • 0: Not at all
  • 1: A little
  • 2: Somewhat
  • 3: A lot
  • 4: A great deal

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q11D

Now or in the past six months. To what extent have these problems ....

put a burden on you or the family as a whole?

  • 0: Not at all
  • 1: A little
  • 2: Somewhat
  • 3: A lot
  • 4: A great deal

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q11E

Now or in the past six months. To what extent have these problems ....

been a source of tension, disagreement or conflict with your spouse or partner?

  • 0: Not at all
  • 1: A little
  • 2: Somewhat
  • 3: A lot
  • 4: A great deal

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q11F

Now or in the past six months. To what extent have these problems ....

led to major arguments or disputes with your spouse or partner about how to deal with these problems?

  • 0: Not at all
  • 1: A little
  • 2: Somewhat
  • 3: A lot
  • 4: A great deal

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q12A

Please read each statement below and mark the circle that most closely describes the way you have acted towards the child during the past six months.

I enjoy doing things with him/her.

  • 1: Never
  • 2: Rarely
  • 3: Sometimes
  • 4: Often
  • 5: Always

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q12B

Please read each statement below and mark the circle that most closely describes the way you have acted towards the child during the past six months.

I cheer him/her up when he/she is sad.

  • 1: Never
  • 2: Rarely
  • 3: Sometimes
  • 4: Often
  • 5: Always

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q12C

Please read each statement below and mark the circle that most closely describes the way you have acted towards the child during the past six months.

I give him/her a lot of care and attention.

  • 1: Never
  • 2: Rarely
  • 3: Sometimes
  • 4: Often
  • 5: Always

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q12D

Please read each statement below and mark the circle that most closely describes the way you have acted towards the child during the past six months.

I listen to his/her ideas and opinions.

  • 1: Never
  • 2: Rarely
  • 3: Sometimes
  • 4: Often
  • 5: Always

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q12E

Please read each statement below and mark the circle that most closely describes the way you have acted towards the child during the past six months.

I speak of the good things he/she does.

  • 1: Never
  • 2: Rarely
  • 3: Sometimes
  • 4: Often
  • 5: Always

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q12F

Please read each statement below and mark the circle that most closely describes the way you have acted towards the child during the past six months.

I nag him/her about little things.

  • 1: Never
  • 2: Rarely
  • 3: Sometimes
  • 4: Often
  • 5: Always

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q12G

Please read each statement below and mark the circle that most closely describes the way you have acted towards the child during the past six months.

I keep rules only when it suits me.

  • 1: Never
  • 2: Rarely
  • 3: Sometimes
  • 4: Often
  • 5: Always

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q12H

Please read each statement below and mark the circle that most closely describes the way you have acted towards the child during the past six months.

I get angry and yell at him/her.

  • 1: Never
  • 2: Rarely
  • 3: Sometimes
  • 4: Often
  • 5: Always

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q12I

Please read each statement below and mark the circle that most closely describes the way you have acted towards the child during the past six months.

I threaten punishment more often than I use it.

  • 1: Never
  • 2: Rarely
  • 3: Sometimes
  • 4: Often
  • 5: Always

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q12J

Please read each statement below and mark the circle that most closely describes the way you have acted towards the child during the past six months.

Whether I keep or do not keep a rule depends on my mood.

  • 1: Never
  • 2: Rarely
  • 3: Sometimes
  • 4: Often
  • 5: Always

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q12K

Please read each statement below and mark the circle that most closely describes the way you have acted towards the child during the past six months.

I say mean things to make him/her feel bad (e.g. sad, mad, guilty).

  • 1: Never
  • 2: Rarely
  • 3: Sometimes
  • 4: Often
  • 5: Always

Partner self-complete questionnaire (PAR) - Question identifier:PAR_R13

These next questions are about your health and early experiences.

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q13

In general, would you say your health is...

  • 1: Excellent
  • 2: Very good
  • 3: Good
  • 4: Fair
  • 5: Poor

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q14A

What is your current height without shoes?

Enter in feet.

Min = 0; Max = 7

Partner self-complete questionnaire (PAR) - Question identifier:PAR_N14B

What is your current height without shoes?

Enter in inches.

Min = 0; Max = 12

Partner self-complete questionnaire (PAR) - Question identifier:PAR_N14C

What is your current height without shoes?

In centimetres only if not already in feet and inches.

Min = 0; Max = 244

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q15A

What is your current weight without shoes on?

Enter In pounds.

Min = 0; Max = 575

Partner self-complete questionnaire (PAR) - Question identifier:PAR_N15B

What is your current weight without shoes on?

In kilograms only if not already in pounds.

Min = 0; Max = 300

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q16

At the present time, do you smoke cigarettes daily, occasionally or not at all?

  • 1: Daily
  • 2: Occasionally
  • 3: Not at all

Partner self-complete questionnaire (PAR) - Question identifier:PAR_R17

The following questions ask about how you have been feeling during the past 30 days. For each question, please mark the circle that best describes how often you had this feeling.

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q17A

During that past 30 days, how often did you feel...

nervous?

  • 1: All of the time
  • 2: Most of the time
  • 3: Some of the time
  • 4: A little of the time
  • 5: None of the time

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q17B

During that past 30 days, how often did you feel...

hopeless?

  • 1: All of the time
  • 2: Most of the time
  • 3: Some of the time
  • 4: A little of the time
  • 5: None of the time

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q17C

During that past 30 days, how often did you feel...

restless or fidgety?

  • 1: All of the time
  • 2: Most of the time
  • 3: Some of the time
  • 4: A little of the time
  • 5: None of the time

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q17D

During that past 30 days, how often did you feel...

so depressed that nothing could cheer you up?

  • 1: All of the time
  • 2: Most of the time
  • 3: Some of the time
  • 4: A little of the time
  • 5: None of the time

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q17E

During that past 30 days, how often did you feel...

that everything was an effort?

  • 1: All of the time
  • 2: Most of the time
  • 3: Some of the time
  • 4: A little of the time
  • 5: None of the time

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q17F

During that past 30 days, how often did you feel...

worthless?

  • 1: All of the time
  • 2: Most of the time
  • 3: Some of the time
  • 4: A little of the time
  • 5: None of the time

Partner self-complete questionnaire (PAR) - Question identifier:PAR_R18

Next are some questions about your contacts with health professionals as well as other people about problems with your emotions, mental health or use of alcohol or drugs.

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q18A

In your lifetime...

did you ever have problems with your emotions, such as intense feelings of sadness, worry, fear, agitation, or anger?

  • 1: Yes
  • 2: No

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q18B

In your lifetime...

did you ever have problems with the use of alcohol or drugs?

  • 1: Yes
  • 2: No

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q18C

In your lifetime...

did you ever break the law repeatedly or do other things that could get you into trouble with the police?

  • 1: Yes
  • 2: No

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q18D

In your lifetime...

did you ever talk to a doctor or counselor about problems with your emotions, mental health or use of alcohol or drugs?

  • 1: Yes
  • 2: No

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q18E

In your lifetime...

did a doctor or counselor ever tell you that you had a specific type of mental health problem, such as depression, anxiety or substance use?

  • 1: Yes
  • 2: No

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q18F

In your lifetime...

have you ever in your lifetime been admitted for an overnight stay in a hospital or other facility to receive help for problems with your emotions, mental health or your use of alcohol or drugs?

  • 1: Yes
  • 2: No

Partner self-complete questionnaire (PAR) - Question identifier:PAR_R19

The next few questions are about things that may have happened to you before the age of 16 in your school, in your neighbourhood, or in your family. These experiences can be important in an individual's life. These questions may be sensitive to some people and may seem intrusive. We think they are important to ask but please skip these questions if you feel uncomfortable.

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q19

Sometimes kids get hassled or picked on by other kids who say hurtful or mean things to them. Before age 16, how many times did this happen to you?

  • 1: Never
  • 2: 1 or 2 times
  • 3: 3 to 5 times
  • 4: 6 to 10 times
  • 5: More than 10 times

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q20

Sometimes kids get pushed around, hit or beaten up by other kids or a group of kids. Before age 16, how many times did this happen to you?

  • 1: Never
  • 2: 1 or 2 times
  • 3: 3 to 5 times
  • 4: 6 to 10 times
  • 5: More than 10 times

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q21

Think about your parents and other caregivers. Before age 16, how many times did they spank you with their hand on your bottom (bum), or slap you on your hand?

  • 1: Never
  • 2: 1 or 2 times
  • 3: 3 to 5 times
  • 4: 6 to 10 times
  • 5: More than 10 times

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q22A

Now think about adults in general. Before age 16, how many times did an adult...

slap you on the face, head or ears or hit or spank you with something hard to hurt you?

  • 1: Never
  • 2: 1 or 2 times
  • 3: 3 to 5 times
  • 4: 6 to 10 times
  • 5: More than 10 times

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q22B

Now think about adults in general. Before age 16, how many times did an adult...

kick, bite, punch, choke, burn you, or physically attack you in some way?

  • 1: Never
  • 2: 1 or 2 times
  • 3: 3 to 5 times
  • 4: 6 to 10 times
  • 5: More than 10 times

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q22C

Now think about adults in general. Before age 16, how many times did an adult...

force you or attempt to force you into any unwanted sexual activity, by threatening you, holding you down or hurting you in some way?

  • 1: Never
  • 2: 1 or 2 times
  • 3: 3 to 5 times
  • 4: 6 to 10 times
  • 5: More than 10 times

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q23

Before age 16, did you ever see or talk to anyone from a child protection organization about difficulties at home?

  • 1: Yes
  • 2: No

Partner self-complete questionnaire (PAR) - Question identifier:PAR_R24A

Thank you for your answers. Now we would like to finish with some questions about your long-term conditions.

Partner self-complete questionnaire (PAR) - Question identifier:PAR_R24B

"Long-term conditions" refer to conditions that have lasted or are expected to last six months or more and have been diagnosed by a health professional.

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q24A

Do you have any of the following long-term conditions...

food or digestive allergies

  • 1: Yes
  • 2: No

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q24B

Do you have any of the following long-term conditions:

respiratory allergies such as hay fever

  • 1: Yes
  • 2: No

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q24C

Do you have any of the following long-term conditions:

any other allergies

  • 1: Yes
  • 2: No

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q24D

Do you have any of the following long-term conditions:

asthma

  • 1: Yes
  • 2: No

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q24E

Do you have any of the following long-term conditions:

arthritis or rheumatism

  • 1: Yes
  • 2: No

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q24F

Do you have any of the following long-term conditions:

back problems excluding arthritis

  • 1: Yes
  • 2: No

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q24G

Do you have any of the following long-term conditions:

high blood pressure

  • 1: Yes
  • 2: No

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q24H

Do you have any of the following long-term conditions:

migraine headaches

  • 1: Yes
  • 2: No

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q24I

Do you have any of the following long-term conditions:

chronic bronchitis or emphysema

  • 1: Yes
  • 2: No

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q24J

Do you have any of the following long-term conditions:

sinusitis

  • 1: Yes
  • 2: No

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q24K

Do you have any of the following long-term conditions:

diabetes

  • 1: Yes
  • 2: No

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q24L

Do you have any of the following long-term conditions:

epilepsy

  • 1: Yes
  • 2: No

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q24M

Do you have any of the following long-term conditions:

heart disease

  • 1: Yes
  • 2: No

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q24N

Do you have any of the following long-term conditions:

liver disease

  • 1: Yes
  • 2: No

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q24O

Do you have any of the following long-term conditions:

cancer

  • 1: Yes
  • 2: No

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q24P

Do you have any of the following long-term conditions:

stomach or intestinal ulcers

  • 1: Yes
  • 2: No

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q24Q

Do you have any of the following long-term conditions:

effects of stroke

  • 1: Yes
  • 2: No

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q24R

Do you have any of the following long-term conditions:

any other long-term conditions

  • 1: Yes
  • 2: No

Partner self-complete questionnaire (PAR) - Question identifier:PAR_R25

The last questions deal with any health limitations that affect your daily activities. In these questions, a difficulty, condition or health problem is one that has lasted or is expected to last six months or more.

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q25

Do you have difficulty hearing, seeing, communicating, walking, climbing steps, bending, learning or doing any similar activities?

  • 1: Yes
  • 2: No

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q26

Are you limited in any way in carrying out normal daily activities at home, at a job or in school, because of a medical condition or health problem?

  • 1: Yes, sometimes
  • 2: Yes, often
  • 3: No

Partner self-complete questionnaire (PAR) - Question identifier:PAR_R27

To avoid duplication of surveys, Statistics Canada has signed an agreement with the Ontario Ministry of Health and Long-Term Care and with McMaster University to share the information that you provided on this questionnaire. They have agreed to keep your information confidential and use it only for statistical purposes.

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q27

Do you agree to share your information with the Ontario Ministry of Health and Long-Term Care?

  • 1: Yes
  • 2: No

Partner self-complete questionnaire (PAR) - Question identifier:PAR_Q28

Do you agree to share your information with McMaster University? Personal identifiers such as your name will not be shared with McMaster University.

  • 1: Yes
  • 2: No
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