Questionnaires for Participants in The Study

This page is for participants already enrolled in the Maternal Vitality Study.

Please complete the questionnaires below, making sure to press “SUBMIT” after each section.

Thank you for being a part of our study. If you have any questions please email research@ohioguidestone.org or call 440-260-8865.

Access ID *

Questions about depression

Please answer these questions thinking about the last two (2) weeks, how often you have been bothered by any of the following problems. *

	Not At All (0)	Several Days (1)	More than Half the Days (2)	Nearly Everyday (3)
Little interest or pleasure in doing things	Not At All (0)Little interest or pleasure in doing things Not At All (0)	Several Days (1)Little interest or pleasure in doing things Several Days (1)	More than Half the Days (2)Little interest or pleasure in doing things More than Half the Days (2)	Nearly Everyday (3)Little interest or pleasure in doing things Nearly Everyday (3)
Feeling down, depressed, or hopeless	Not At All (0)Feeling down, depressed, or hopeless Not At All (0)	Several Days (1)Feeling down, depressed, or hopeless Several Days (1)	More than Half the Days (2)Feeling down, depressed, or hopeless More than Half the Days (2)	Nearly Everyday (3)Feeling down, depressed, or hopeless Nearly Everyday (3)
Trouble falling or staying asleep, or Sleeping too much	Not At All (0)Trouble falling or staying asleep, or Sleeping too much Not At All (0)	Several Days (1)Trouble falling or staying asleep, or Sleeping too much Several Days (1)	More than Half the Days (2)Trouble falling or staying asleep, or Sleeping too much More than Half the Days (2)	Nearly Everyday (3)Trouble falling or staying asleep, or Sleeping too much Nearly Everyday (3)
Feeling tired or having little energy	Not At All (0)Feeling tired or having little energy Not At All (0)	Several Days (1)Feeling tired or having little energy Several Days (1)	More than Half the Days (2)Feeling tired or having little energy More than Half the Days (2)	Nearly Everyday (3)Feeling tired or having little energy Nearly Everyday (3)
Poor appetite or overeating	Not At All (0)Poor appetite or overeating Not At All (0)	Several Days (1)Poor appetite or overeating Several Days (1)	More than Half the Days (2)Poor appetite or overeating More than Half the Days (2)	Nearly Everyday (3)Poor appetite or overeating Nearly Everyday (3)
Feeling bad about yourself or that you are a failure or have let yourself or your family down	Not At All (0)Feeling bad about yourself or that you are a failure or have let yourself or your family down Not At All (0)	Several Days (1)Feeling bad about yourself or that you are a failure or have let yourself or your family down Several Days (1)	More than Half the Days (2)Feeling bad about yourself or that you are a failure or have let yourself or your family down More than Half the Days (2)	Nearly Everyday (3)Feeling bad about yourself or that you are a failure or have let yourself or your family down Nearly Everyday (3)
Trouble concentrating on things, such as reading the newspaper or watching television	Not At All (0)Trouble concentrating on things, such as reading the newspaper or watching television Not At All (0)	Several Days (1)Trouble concentrating on things, such as reading the newspaper or watching television Several Days (1)	More than Half the Days (2)Trouble concentrating on things, such as reading the newspaper or watching television More than Half the Days (2)	Nearly Everyday (3)Trouble concentrating on things, such as reading the newspaper or watching television Nearly Everyday (3)
Moving or speaking so slowly that other people could have noticed. Or, the opposite, being so fidgety or restless that you have been moving around a lot more than usual.	Not At All (0)Moving or speaking so slowly that other people could have noticed. Or, the opposite, being so fidgety or restless that you have been moving around a lot more than usual. Not At All (0)	Several Days (1)Moving or speaking so slowly that other people could have noticed. Or, the opposite, being so fidgety or restless that you have been moving around a lot more than usual. Several Days (1)	More than Half the Days (2)Moving or speaking so slowly that other people could have noticed. Or, the opposite, being so fidgety or restless that you have been moving around a lot more than usual. More than Half the Days (2)	Nearly Everyday (3)Moving or speaking so slowly that other people could have noticed. Or, the opposite, being so fidgety or restless that you have been moving around a lot more than usual. Nearly Everyday (3)
Thoughts that you would be better off dead, or hurting yourself.	Not At All (0)Thoughts that you would be better off dead, or hurting yourself. Not At All (0)	Several Days (1)Thoughts that you would be better off dead, or hurting yourself. Several Days (1)	More than Half the Days (2)Thoughts that you would be better off dead, or hurting yourself. More than Half the Days (2)	Nearly Everyday (3)Thoughts that you would be better off dead, or hurting yourself. Nearly Everyday (3)

Please note that help is available to you through OhioGuidestone's Crisis line at 440-260-8595 -or- the National Mental Health Hotline by calling or texting 9-8-8.

Questions about anxiety and worry

Please answer these questions thinking about the last two (2) weeks, how often you have been bothered by any of the following problems. *

	Not At All (0)	Several Days (1)	More than Half the Days (2)	Nearly Everyday (3)
Feeling nervous, anxious, or on edge.	Not At All (0)Feeling nervous, anxious, or on edge. Not At All (0)	Several Days (1)Feeling nervous, anxious, or on edge. Several Days (1)	More than Half the Days (2)Feeling nervous, anxious, or on edge. More than Half the Days (2)	Nearly Everyday (3)Feeling nervous, anxious, or on edge. Nearly Everyday (3)
Not being able to stop or control worrying.	Not At All (0)Not being able to stop or control worrying. Not At All (0)	Several Days (1)Not being able to stop or control worrying. Several Days (1)	More than Half the Days (2)Not being able to stop or control worrying. More than Half the Days (2)	Nearly Everyday (3)Not being able to stop or control worrying. Nearly Everyday (3)
Worrying too much about different things.	Not At All (0)Worrying too much about different things. Not At All (0)	Several Days (1)Worrying too much about different things. Several Days (1)	More than Half the Days (2)Worrying too much about different things. More than Half the Days (2)	Nearly Everyday (3)Worrying too much about different things. Nearly Everyday (3)
Trouble relaxing.	Not At All (0)Trouble relaxing. Not At All (0)	Several Days (1)Trouble relaxing. Several Days (1)	More than Half the Days (2)Trouble relaxing. More than Half the Days (2)	Nearly Everyday (3)Trouble relaxing. Nearly Everyday (3)
Being so restless that it is hard to sit still.	Not At All (0)Being so restless that it is hard to sit still. Not At All (0)	Several Days (1)Being so restless that it is hard to sit still. Several Days (1)	More than Half the Days (2)Being so restless that it is hard to sit still. More than Half the Days (2)	Nearly Everyday (3)Being so restless that it is hard to sit still. Nearly Everyday (3)
Becoming easily annoyed or irritable.	Not At All (0)Becoming easily annoyed or irritable. Not At All (0)	Several Days (1)Becoming easily annoyed or irritable. Several Days (1)	More than Half the Days (2)Becoming easily annoyed or irritable. More than Half the Days (2)	Nearly Everyday (3)Becoming easily annoyed or irritable. Nearly Everyday (3)
Feeling afraid, as if something awful might happen.	Not At All (0)Feeling afraid, as if something awful might happen. Not At All (0)	Several Days (1)Feeling afraid, as if something awful might happen. Several Days (1)	More than Half the Days (2)Feeling afraid, as if something awful might happen. More than Half the Days (2)	Nearly Everyday (3)Feeling afraid, as if something awful might happen. Nearly Everyday (3)

Questions about mother's experiences and feelings.

Please answer these questions thinking about the past week (7 days).

I have been able to laugh and see the funny side of things. *

• As much as I always could (0)
• Not quite so much now (1)
• Definitely not so much now (2)
• Not at all (3)

I have looked forward with enjoyment to things. *

• As much as I always could (0)
• Not quite so much now (1)
• Definitely not so much now (2)
• Not at all (3)

I have blamed myself unnecessarily when things went wrong. *

• Yes, most of the time (3)
• Yes, some of the time (2)
• Not very often (1)
• No, never (0)

I have been anxious or worried for no good reason. *

• No, not at all (0)
• Hardly ever (1)
• Yes, sometimes (2)
• Yes, very often (3)

I have felt scared or panicky for no good reason. *

• Yes, quite a lot (3)
• Yes, sometimes (2)
• No, not much (1)
• No, not at all (0)

Things have been getting to me. *

• Yes, most of the time I haven't been able to cope at all (3)
• Yes, some times I haven't been coping as well as usual (2)
• No, most of the time I have coped quite well (1)
• No, I have been coping as well as ever (0)

I have been so unhappy that I have had difficulty sleeping. *

• Yes, most of the time (3)
• Yes, sometimes (2)
• No, not very often (1)
• No, not at all (0)

I have felt sad or miserable. *

• Yes, most of the time (3)
• Yes, quite often (2)
• Not very often (1)
• No, not at all (0)

I have been so unhappy that I have been crying. *

• Yes, most of the time (3)
• Yes, quite often (2)
• Only occasionally (1)
• No, never (0)

The thought of harming myself has occurred to me. *

• Yes, quite often (3)
• Sometimes (2)
• Hardly ever (1)
• Never (0)

Please note that help is available to you through OhioGuidestone's Crisis line at 440-260-8595 -or- the National Mental Health Hotline by calling or texting 9-8-8.

Date *

Submit

Access ID *

Brief Questionnaire Section

Index of Race Related Stress – Brief Version (IRSS-B)  Please circle the number on the scale (0 to 4) that indicates the reaction you had to the event at the time it happened. Do not leave any items blank. If an event has happened more than once refer to the first time it happened. If an event did not happen mark 0 and go on to the next item.  *

	Never Happened 0	Happened but did not bother me 1	Happened and I was slightly upset 2	Happened and I was upset 3	Happened and I was extremely upset 4
You notice that crimes committed by White people tend to be romanticized, whereas the same crime committed by a Black person is portrayed as savagery, and the Black person who committed it, as an animal.	Never Happened 0You notice that crimes committed by White people tend to be romanticized, whereas the same crime committed by a Black person is portrayed as savagery, and the Black person who committed it, as an animal.  Never Happened 0	Happened but did not bother me 1You notice that crimes committed by White people tend to be romanticized, whereas the same crime committed by a Black person is portrayed as savagery, and the Black person who committed it, as an animal.  Happened but did not bother me 1	Happened and I was slightly upset 2You notice that crimes committed by White people tend to be romanticized, whereas the same crime committed by a Black person is portrayed as savagery, and the Black person who committed it, as an animal.  Happened and I was slightly upset 2	Happened and I was upset 3You notice that crimes committed by White people tend to be romanticized, whereas the same crime committed by a Black person is portrayed as savagery, and the Black person who committed it, as an animal.  Happened and I was upset 3	Happened and I was extremely upset 4You notice that crimes committed by White people tend to be romanticized, whereas the same crime committed by a Black person is portrayed as savagery, and the Black person who committed it, as an animal.  Happened and I was extremely upset 4
Sales people/clerks did not say thank you or show other forms of courtesy and respect (i.e. put your things in a bag) when you shopped at some White/non-Black owned businesses.	Never Happened 0Sales people/clerks did not say thank you or show other forms of courtesy and respect (i.e. put your things in a bag) when you shopped at some White/non-Black owned businesses.  Never Happened 0	Happened but did not bother me 1Sales people/clerks did not say thank you or show other forms of courtesy and respect (i.e. put your things in a bag) when you shopped at some White/non-Black owned businesses.  Happened but did not bother me 1	Happened and I was slightly upset 2Sales people/clerks did not say thank you or show other forms of courtesy and respect (i.e. put your things in a bag) when you shopped at some White/non-Black owned businesses.  Happened and I was slightly upset 2	Happened and I was upset 3Sales people/clerks did not say thank you or show other forms of courtesy and respect (i.e. put your things in a bag) when you shopped at some White/non-Black owned businesses.  Happened and I was upset 3	Happened and I was extremely upset 4Sales people/clerks did not say thank you or show other forms of courtesy and respect (i.e. put your things in a bag) when you shopped at some White/non-Black owned businesses.  Happened and I was extremely upset 4
You notice that when Black people are killed by the police the media informs the public of the Victim’s criminal record or negative information in their background, suggesting they got what they deserved.	Never Happened 0You notice that when Black people are killed by the police the media informs the public of the Victim’s criminal record or negative information in their background, suggesting they got what they deserved.  Never Happened 0	Happened but did not bother me 1You notice that when Black people are killed by the police the media informs the public of the Victim’s criminal record or negative information in their background, suggesting they got what they deserved.  Happened but did not bother me 1	Happened and I was slightly upset 2You notice that when Black people are killed by the police the media informs the public of the Victim’s criminal record or negative information in their background, suggesting they got what they deserved.  Happened and I was slightly upset 2	Happened and I was upset 3You notice that when Black people are killed by the police the media informs the public of the Victim’s criminal record or negative information in their background, suggesting they got what they deserved.  Happened and I was upset 3	Happened and I was extremely upset 4You notice that when Black people are killed by the police the media informs the public of the Victim’s criminal record or negative information in their background, suggesting they got what they deserved.  Happened and I was extremely upset 4
You have been threatened with physical violence by an individual or group of White/non-Blacks.	Never Happened 0You have been threatened with physical violence by an individual or group of White/non-Blacks. Never Happened 0	Happened but did not bother me 1You have been threatened with physical violence by an individual or group of White/non-Blacks. Happened but did not bother me 1	Happened and I was slightly upset 2You have been threatened with physical violence by an individual or group of White/non-Blacks. Happened and I was slightly upset 2	Happened and I was upset 3You have been threatened with physical violence by an individual or group of White/non-Blacks. Happened and I was upset 3	Happened and I was extremely upset 4You have been threatened with physical violence by an individual or group of White/non-Blacks. Happened and I was extremely upset 4
You have observed that White kids who commit violent crimes are portrayed as “boys being boys”, while Black kids who commit similar crimes are wild animals.	Never Happened 0You have observed that White kids who commit violent crimes are portrayed as “boys being boys”, while Black kids who commit similar crimes are wild animals. Never Happened 0	Happened but did not bother me 1You have observed that White kids who commit violent crimes are portrayed as “boys being boys”, while Black kids who commit similar crimes are wild animals. Happened but did not bother me 1	Happened and I was slightly upset 2You have observed that White kids who commit violent crimes are portrayed as “boys being boys”, while Black kids who commit similar crimes are wild animals. Happened and I was slightly upset 2	Happened and I was upset 3You have observed that White kids who commit violent crimes are portrayed as “boys being boys”, while Black kids who commit similar crimes are wild animals. Happened and I was upset 3	Happened and I was extremely upset 4You have observed that White kids who commit violent crimes are portrayed as “boys being boys”, while Black kids who commit similar crimes are wild animals. Happened and I was extremely upset 4
You seldom hear or read anything positive about Black people on radio, T.V., newspapers, or in history books.	Never Happened 0You seldom hear or read anything positive about Black people on radio, T.V., newspapers, or in history books. Never Happened 0	Happened but did not bother me 1You seldom hear or read anything positive about Black people on radio, T.V., newspapers, or in history books. Happened but did not bother me 1	Happened and I was slightly upset 2You seldom hear or read anything positive about Black people on radio, T.V., newspapers, or in history books. Happened and I was slightly upset 2	Happened and I was upset 3You seldom hear or read anything positive about Black people on radio, T.V., newspapers, or in history books. Happened and I was upset 3	Happened and I was extremely upset 4You seldom hear or read anything positive about Black people on radio, T.V., newspapers, or in history books. Happened and I was extremely upset 4
While shopping at a store the salesclerk assumed that you couldn’t afford certain items (i.e. you were directed toward the items on sale).	Never Happened 0While shopping at a store the salesclerk assumed that you couldn’t afford certain items (i.e. you were directed toward the items on sale).  Never Happened 0	Happened but did not bother me 1While shopping at a store the salesclerk assumed that you couldn’t afford certain items (i.e. you were directed toward the items on sale).  Happened but did not bother me 1	Happened and I was slightly upset 2While shopping at a store the salesclerk assumed that you couldn’t afford certain items (i.e. you were directed toward the items on sale).  Happened and I was slightly upset 2	Happened and I was upset 3While shopping at a store the salesclerk assumed that you couldn’t afford certain items (i.e. you were directed toward the items on sale).  Happened and I was upset 3	Happened and I was extremely upset 4While shopping at a store the salesclerk assumed that you couldn’t afford certain items (i.e. you were directed toward the items on sale).  Happened and I was extremely upset 4
You were the victim of a crime, and the police treated you as if you should just accept it as part of being Black.	Never Happened 0You were the victim of a crime, and the police treated you as if you should just accept it as part of being Black.  Never Happened 0	Happened but did not bother me 1You were the victim of a crime, and the police treated you as if you should just accept it as part of being Black.  Happened but did not bother me 1	Happened and I was slightly upset 2You were the victim of a crime, and the police treated you as if you should just accept it as part of being Black.  Happened and I was slightly upset 2	Happened and I was upset 3You were the victim of a crime, and the police treated you as if you should just accept it as part of being Black.  Happened and I was upset 3	Happened and I was extremely upset 4You were the victim of a crime, and the police treated you as if you should just accept it as part of being Black.  Happened and I was extremely upset 4
You were treated with less respect and courtesy than Whites and other non-Blacks while in a store, restaurant, or other business establishment.	Never Happened 0You were treated with less respect and courtesy than Whites and other non-Blacks while in a store, restaurant, or other business establishment.  Never Happened 0	Happened but did not bother me 1You were treated with less respect and courtesy than Whites and other non-Blacks while in a store, restaurant, or other business establishment.  Happened but did not bother me 1	Happened and I was slightly upset 2You were treated with less respect and courtesy than Whites and other non-Blacks while in a store, restaurant, or other business establishment.  Happened and I was slightly upset 2	Happened and I was upset 3You were treated with less respect and courtesy than Whites and other non-Blacks while in a store, restaurant, or other business establishment.  Happened and I was upset 3	Happened and I was extremely upset 4You were treated with less respect and courtesy than Whites and other non-Blacks while in a store, restaurant, or other business establishment.  Happened and I was extremely upset 4
You were passed over for an important project although you were more qualified and competent than the White/non-Black person given the task.	Never Happened 0You were passed over for an important project although you were more qualified and competent than the White/non-Black person given the task.  Never Happened 0	Happened but did not bother me 1You were passed over for an important project although you were more qualified and competent than the White/non-Black person given the task.  Happened but did not bother me 1	Happened and I was slightly upset 2You were passed over for an important project although you were more qualified and competent than the White/non-Black person given the task.  Happened and I was slightly upset 2	Happened and I was upset 3You were passed over for an important project although you were more qualified and competent than the White/non-Black person given the task.  Happened and I was upset 3	Happened and I was extremely upset 4You were passed over for an important project although you were more qualified and competent than the White/non-Black person given the task.  Happened and I was extremely upset 4
Whites/non-Blacks have stared at you as if you didn’t belong in the same place with them; whether it was at a restaurant, theater, or other place of business.	Never Happened 0Whites/non-Blacks have stared at you as if you didn’t belong in the same place with them; whether it was at a restaurant, theater, or other place of business.  Never Happened 0	Happened but did not bother me 1Whites/non-Blacks have stared at you as if you didn’t belong in the same place with them; whether it was at a restaurant, theater, or other place of business.  Happened but did not bother me 1	Happened and I was slightly upset 2Whites/non-Blacks have stared at you as if you didn’t belong in the same place with them; whether it was at a restaurant, theater, or other place of business.  Happened and I was slightly upset 2	Happened and I was upset 3Whites/non-Blacks have stared at you as if you didn’t belong in the same place with them; whether it was at a restaurant, theater, or other place of business.  Happened and I was upset 3	Happened and I was extremely upset 4Whites/non-Blacks have stared at you as if you didn’t belong in the same place with them; whether it was at a restaurant, theater, or other place of business.  Happened and I was extremely upset 4
You have observed the police treat White/non-Blacks with more respect and dignity than they do Blacks.	Never Happened 0You have observed the police treat White/non-Blacks with more respect and dignity than they do Blacks.  Never Happened 0	Happened but did not bother me 1You have observed the police treat White/non-Blacks with more respect and dignity than they do Blacks.  Happened but did not bother me 1	Happened and I was slightly upset 2You have observed the police treat White/non-Blacks with more respect and dignity than they do Blacks.  Happened and I was slightly upset 2	Happened and I was upset 3You have observed the police treat White/non-Blacks with more respect and dignity than they do Blacks.  Happened and I was upset 3	Happened and I was extremely upset 4You have observed the police treat White/non-Blacks with more respect and dignity than they do Blacks.  Happened and I was extremely upset 4
You have been subjected to racist jokes by Whites/non-Blacks in positions of authority and you did not protest for fear they might have held it against you.	Never Happened 0You have been subjected to racist jokes by Whites/non-Blacks in positions of authority and you did not protest for fear they might have held it against you.  Never Happened 0	Happened but did not bother me 1You have been subjected to racist jokes by Whites/non-Blacks in positions of authority and you did not protest for fear they might have held it against you.  Happened but did not bother me 1	Happened and I was slightly upset 2You have been subjected to racist jokes by Whites/non-Blacks in positions of authority and you did not protest for fear they might have held it against you.  Happened and I was slightly upset 2	Happened and I was upset 3You have been subjected to racist jokes by Whites/non-Blacks in positions of authority and you did not protest for fear they might have held it against you.  Happened and I was upset 3	Happened and I was extremely upset 4You have been subjected to racist jokes by Whites/non-Blacks in positions of authority and you did not protest for fear they might have held it against you.  Happened and I was extremely upset 4
While shopping at a store, or when attempting to make a purchase you were ignored as if you were not a serious customer or didn’t have any money.	Never Happened 0While shopping at a store, or when attempting to make a purchase you were ignored as if you were not a serious customer or didn’t have any money.  Never Happened 0	Happened but did not bother me 1While shopping at a store, or when attempting to make a purchase you were ignored as if you were not a serious customer or didn’t have any money.  Happened but did not bother me 1	Happened and I was slightly upset 2While shopping at a store, or when attempting to make a purchase you were ignored as if you were not a serious customer or didn’t have any money.  Happened and I was slightly upset 2	Happened and I was upset 3While shopping at a store, or when attempting to make a purchase you were ignored as if you were not a serious customer or didn’t have any money.  Happened and I was upset 3	Happened and I was extremely upset 4While shopping at a store, or when attempting to make a purchase you were ignored as if you were not a serious customer or didn’t have any money.  Happened and I was extremely upset 4
You have observed situations where other Blacks were treated harshly or unfairly by Whites/non-Blacks due to their race.	Never Happened 0You have observed situations where other Blacks were treated harshly or unfairly by Whites/non-Blacks due to their race.  Never Happened 0	Happened but did not bother me 1You have observed situations where other Blacks were treated harshly or unfairly by Whites/non-Blacks due to their race.  Happened but did not bother me 1	Happened and I was slightly upset 2You have observed situations where other Blacks were treated harshly or unfairly by Whites/non-Blacks due to their race.  Happened and I was slightly upset 2	Happened and I was upset 3You have observed situations where other Blacks were treated harshly or unfairly by Whites/non-Blacks due to their race.  Happened and I was upset 3	Happened and I was extremely upset 4You have observed situations where other Blacks were treated harshly or unfairly by Whites/non-Blacks due to their race.  Happened and I was extremely upset 4
You have heard reports of White people/non-Blacks who have committed crimes, and in an effort to cover up their deeds falsely reported that a Black man was responsible for the crime.	Never Happened 0You have heard reports of White people/non-Blacks who have committed crimes, and in an effort to cover up their deeds falsely reported that a Black man was responsible for the crime.   Never Happened 0	Happened but did not bother me 1You have heard reports of White people/non-Blacks who have committed crimes, and in an effort to cover up their deeds falsely reported that a Black man was responsible for the crime.   Happened but did not bother me 1	Happened and I was slightly upset 2You have heard reports of White people/non-Blacks who have committed crimes, and in an effort to cover up their deeds falsely reported that a Black man was responsible for the crime.   Happened and I was slightly upset 2	Happened and I was upset 3You have heard reports of White people/non-Blacks who have committed crimes, and in an effort to cover up their deeds falsely reported that a Black man was responsible for the crime.   Happened and I was upset 3	Happened and I was extremely upset 4You have heard reports of White people/non-Blacks who have committed crimes, and in an effort to cover up their deeds falsely reported that a Black man was responsible for the crime.   Happened and I was extremely upset 4
You notice that the media plays up those stories that cast Blacks in negative ways (child, abusers, rapists, muggers, etc. [or as savages] Wild Man of 96th St., Wolf Pack, etc.), usually accompanied by a large picture of a Black person looking angry or disturbed.	Never Happened 0You notice that the media plays up those stories that cast Blacks in negative ways (child, abusers, rapists, muggers, etc. [or as savages] Wild Man of 96th St., Wolf Pack, etc.), usually accompanied by a large picture of a Black person looking angry or disturbed. Never Happened 0	Happened but did not bother me 1You notice that the media plays up those stories that cast Blacks in negative ways (child, abusers, rapists, muggers, etc. [or as savages] Wild Man of 96th St., Wolf Pack, etc.), usually accompanied by a large picture of a Black person looking angry or disturbed. Happened but did not bother me 1	Happened and I was slightly upset 2You notice that the media plays up those stories that cast Blacks in negative ways (child, abusers, rapists, muggers, etc. [or as savages] Wild Man of 96th St., Wolf Pack, etc.), usually accompanied by a large picture of a Black person looking angry or disturbed. Happened and I was slightly upset 2	Happened and I was upset 3You notice that the media plays up those stories that cast Blacks in negative ways (child, abusers, rapists, muggers, etc. [or as savages] Wild Man of 96th St., Wolf Pack, etc.), usually accompanied by a large picture of a Black person looking angry or disturbed. Happened and I was upset 3	Happened and I was extremely upset 4You notice that the media plays up those stories that cast Blacks in negative ways (child, abusers, rapists, muggers, etc. [or as savages] Wild Man of 96th St., Wolf Pack, etc.), usually accompanied by a large picture of a Black person looking angry or disturbed. Happened and I was extremely upset 4
You have heard racists remarks or comments about Black people spoken with impunity by White public officials or other influential White people.	Never Happened 0You have heard racists remarks or comments about Black people spoken with impunity by White public officials or other influential White people. Never Happened 0	Happened but did not bother me 1You have heard racists remarks or comments about Black people spoken with impunity by White public officials or other influential White people. Happened but did not bother me 1	Happened and I was slightly upset 2You have heard racists remarks or comments about Black people spoken with impunity by White public officials or other influential White people. Happened and I was slightly upset 2	Happened and I was upset 3You have heard racists remarks or comments about Black people spoken with impunity by White public officials or other influential White people. Happened and I was upset 3	Happened and I was extremely upset 4You have heard racists remarks or comments about Black people spoken with impunity by White public officials or other influential White people. Happened and I was extremely upset 4
You have been given more work, or the most undesirable jobs at your place of employment while the White/non-Blacks of equal or less seniority and credentials is given less work, and more desirable tasks.	Never Happened 0You have been given more work, or the most undesirable jobs at your place of employment while the White/non-Blacks of equal or less seniority and credentials is given less work, and more desirable tasks.  Never Happened 0	Happened but did not bother me 1You have been given more work, or the most undesirable jobs at your place of employment while the White/non-Blacks of equal or less seniority and credentials is given less work, and more desirable tasks.  Happened but did not bother me 1	Happened and I was slightly upset 2You have been given more work, or the most undesirable jobs at your place of employment while the White/non-Blacks of equal or less seniority and credentials is given less work, and more desirable tasks.  Happened and I was slightly upset 2	Happened and I was upset 3You have been given more work, or the most undesirable jobs at your place of employment while the White/non-Blacks of equal or less seniority and credentials is given less work, and more desirable tasks.  Happened and I was upset 3	Happened and I was extremely upset 4You have been given more work, or the most undesirable jobs at your place of employment while the White/non-Blacks of equal or less seniority and credentials is given less work, and more desirable tasks.  Happened and I was extremely upset 4
You have heard or seen other Black people express the desire to be White or to have White physical characteristics because they disliked being Black or thought it was ugly.	Never Happened 0You have heard or seen other Black people express the desire to be White or to have White physical characteristics because they disliked being Black or thought it was ugly. Never Happened 0	Happened but did not bother me 1You have heard or seen other Black people express the desire to be White or to have White physical characteristics because they disliked being Black or thought it was ugly. Happened but did not bother me 1	Happened and I was slightly upset 2You have heard or seen other Black people express the desire to be White or to have White physical characteristics because they disliked being Black or thought it was ugly. Happened and I was slightly upset 2	Happened and I was upset 3You have heard or seen other Black people express the desire to be White or to have White physical characteristics because they disliked being Black or thought it was ugly. Happened and I was upset 3	Happened and I was extremely upset 4You have heard or seen other Black people express the desire to be White or to have White physical characteristics because they disliked being Black or thought it was ugly. Happened and I was extremely upset 4
White people or other non-Blacks have treated you as if you were unintelligent and needed things explained to you slowly or numerous times.	Never Happened 0White people or other non-Blacks have treated you as if you were unintelligent and needed things explained to you slowly or numerous times.  Never Happened 0	Happened but did not bother me 1White people or other non-Blacks have treated you as if you were unintelligent and needed things explained to you slowly or numerous times.  Happened but did not bother me 1	Happened and I was slightly upset 2White people or other non-Blacks have treated you as if you were unintelligent and needed things explained to you slowly or numerous times.  Happened and I was slightly upset 2	Happened and I was upset 3White people or other non-Blacks have treated you as if you were unintelligent and needed things explained to you slowly or numerous times.  Happened and I was upset 3	Happened and I was extremely upset 4White people or other non-Blacks have treated you as if you were unintelligent and needed things explained to you slowly or numerous times.  Happened and I was extremely upset 4
You were refused an apartment or other housing; you suspect it was because you are Black.	Never Happened 0You were refused an apartment or other housing; you suspect it was because you are Black.  Never Happened 0	Happened but did not bother me 1You were refused an apartment or other housing; you suspect it was because you are Black.  Happened but did not bother me 1	Happened and I was slightly upset 2You were refused an apartment or other housing; you suspect it was because you are Black.  Happened and I was slightly upset 2	Happened and I was upset 3You were refused an apartment or other housing; you suspect it was because you are Black.  Happened and I was upset 3	Happened and I was extremely upset 4You were refused an apartment or other housing; you suspect it was because you are Black.  Happened and I was extremely upset 4

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