ACE Survey

ACE Survey

While you were growing up, that is during your first 18 years of life…

1. Did you feel safe in your neighborhood?
2. Did you feel people in your neighborhood looked out for each other, stood up for each other, and could be trusted?
3. How often were you bullied by a peer or classmate?
4. How often, if ever did you see or hear someone being beaten up, stabbed, or shot in real life?

Now please think about your childhood, in general, not just your neighborhood or community.

FOR Q5-6: While you were growing up, during your first 18 years of life, how true were each of the following statements?

5. There was someone in your life who helped you feel important or special. Was this:
6. Your family sometimes cut the size of meals or skipped meals because there was not enough money in the budget for food. Was this

Sometimes people are treated badly, not given respect, or are considered inferior because of the color of their skin, because they speak a different language or have an accent, or because they come from a different country or culture.

7. While you were growing up during your first 18 years of life how often did you feel that you were treated badly or unfairly because of your race or ethnicity?
8. Did you live with anyone who was depressed or mentally ill?
9. Did you live with anyone who was suicidal?
10. Did you live with anyone who was a problem drinker or alcoholic?
11. Did you live with anyone who used illegal street drugs or who abused prescription medications?
12. Did you live with anyone who served time or was sentenced to serve time in a prison, jail, or other correctional facility?
13. Were you ever in foster care?

Sometimes physical blows occur between parents or other adults in the house.

While you were growing up, that is during your first 18 years of life…

14. How often, if ever, did you see or hear a parent, step parent or another adult who was helping to raise you being yelled at, screamed at, sworn at, insulted or humiliated?
15. How often, if ever, did you see or hear in your home a parent, step parent or another adult who was helping raise you being slapped, kicked, punched or beaten up?
16. How often, if ever, did you see or hear a parent, step parent or another adult who was helping to raise you being hit or cut with an object, such as a stick or cane, bottle, club, knife, or gun?

While you were growing up, that is during your first 18 years of life, how often, if ever, did a parent, stepparent, or another adult living in your home…

17. Swear at you, insult you, or put you down?
18. Push, grab, shove, or slap you?
19. Hit you so hard that you had marks or were injured?
20. Act in a way that made you afraid that you would be physically hurt?

Some people, while growing up in their first 18 years of life, had a sexual experience with an adult or someone at least five years older than themselves. These experiences may have involved a relative, family friend, or stranger.

During the first 18 years of life, did an adult or older relative, family friend or stranger who was at least five years older than yourself ever…?

21. Touch or fondle you in a sexual way or have you touch their body in a sexual way?
22. Attempt to have or actually have any type of sexual intercourse, oral, anal, or vaginal, with you?

We are almost done with the survey but have a few more questions about your health and well-being over your entire lifetime.

Have you EVER been told by a doctor or other health professional that you have or had any of these medical conditions or illnesses?

How about…?

23. Angina, coronary heart disease, or a heart attack also called a myocardial infarction?
24. A stroke or “small stroke?”
25. Chronic bronchitis or emphysema?
26. Broken any bones?
27. Yellow jaundice, hepatitis, or any liver trouble?
28. A sexually transmitted infection, such as chlamydia, gonorrhea, syphilis, or trichamoniasis (also known as Trich)?

Our next few questions are about your sexual relationships and practices. Remember that your answers will be kept strictly confidential. When we talk about a sex partner, we mean any person, male or female, with whom you had sex, even if it was just once. By sex, we mean oral sex, vaginal sex, or anal sex. The next questions are about your VOLUNTARY sex experiences.

31. How many different sex partners have you ever had? Remember, we are talking about people you had oral, vaginal or anal sex with. If you don’t know the exact number, please give your best estimate.
32. Female: Have you ever been pregnant? Male: Have you ever gotten someone pregnant?
33. Female: When your first pregnancy began, did you intend to get pregnant at that time in your life?/ Male: When you got someone pregnant for the first time, did you intend to get them pregnant at that time in your life?

Now, a few questions about various personal health behaviors.

35. Have you ever used or injected illicit drugs, such as marijuana, cocaine, including crack, hallucinogens, inhalants, heroin, or prescription drugs that were not prescribed for you, including OxyContin, Xanax, or Adderall?
36. In the past year, have you had two or more weeks of being in a depressed mood, that is feeling down, depressed, or hopeless, or had little interest in doing things?
37. Have you ever attempted to commit suicide?

And now, a couple general questions:

38. Did you grow up in the city of Philadelphia?
40. And what city or county did you grow up in?
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