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| Condition | Survey questions |
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| ADHD, depression, anxiety problem, behavioral or conduct problem | (a) Has a doctor or other health care provider ever told you that child had (the condition)?
(b) Does the child currently have (the condition)? |
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| Neighborhood amenities | Please tell me if the following places and things are available to children in your neighborhood, even if (child) does not actually use them
(1) Sidewalks or walking paths?
(2) A park or playground area?
(3) A recreation center, community center, or boys’ or girls’ club?
(4) A library or bookmobile? |
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| Neighborhood detracting elements | In your neighborhood,
(1) Is there litter or garbage on the street or sidewalk?
(2) How about poorly kept or rundown housing?
(3) How about vandalism such as broken windows or graffiti? |
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| Supportive neighborhood | How much you agree or disagree with each of these statements about your neighborhood or community?
(1) “People in this neighborhood help each other out.”
(2) “We watch out for each other’s children in this neighborhood.”
(3) “There are people I can count on in this neighborhood.”
(4) “If my child were outside playing and got hurt or scared, there are adults nearby who I trust to help my child.” |
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| Neighborhood safety | How often do you feel the child is safe in your community or neighborhood? Would you say never, sometimes, usually, or always? |
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| School safety | How often do you feel (he/she) is safe at school? Would you say never, sometimes, usually, or always? |
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| Adverse childhood experience | (1) How often is it hard to get by on your family’s income?
(2) Did child ever see or hear any parents, guardians, or any other adults in his/her home slap, hit, kick, punch, or beat each other up?
(3) Was child ever treated or judged unfairly because of race or ethnic group?
(4) Was child ever the victim of violence or witnessed any violence in his/her neighborhood?
Did child ever live with a parent or guardian:
(5) Who got divorced or separated after the child was born?
(6) With a parent or guardian who died?
(7) With a parent or guardian who served time in jail or prison after the child was born?
(8) With anyone who was mentally ill or suicidal, or severely depressed for more than a couple of weeks?
(9) With anyone who had a problem with alcohol or drugs? |
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