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  2. 2015
  3. May
  4. T
  5. The Effect of Fatherlessness
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Hello:
You are invited to participate in our survey on [ The Effects of Fatherlessness on individual's ]. In this survey, approximately [100] people will be asked to complete a survey that asks questions about [childhood, general background information, activties and mental state, ]. It will take approximately [15] minutes to complete the questionnaire.

Your participation in this study is completely voluntary. There are no foreseeable risks associated with this project. However, if you feel uncomfortable answering any questions, you can withdraw from the survey at any point. It is very important for us to learn your opinions. Please *ONLY* answer the questions that apply to you.

Your survey responses will be strictly confidential and data from this research will be reported only in the aggregate. Your information will be coded and will remain confidential. If you have questions at any time about the survey or the procedures, you may contact [Lisa Panton] at [914-426-3063] or by email at the email address specified below.

Thank you very much for your time and support. Please start with the survey now by clicking on the Continue button below.

 
 
 
 
* What is your ethnicity?
 
Hispanic or Latino
 
American Indian or Alaska Native
 
Asian
 
African American
 
Native Hawaiian or Other Pacific Islander
 
White
 
Other
 
 
 
* What is your gender?
 
Male
 
Female
 
 
 
Are you married, single, divorced
 
Never married
 
Divorced
 
Widowed
 
Separated
 
Married
 
 
 
What age group are you in?
 
18-21
 
21-30
 
31-40
 
41-50
 
51-60
 
61-70
 
71-80
 
81-90
 
91-100
 
100+
 
 
 
Are you currently employed?
 
Yes
 
No
 
Retired
 
 
 
What is your current salary?
 
<$25
 
$25-34,999
 
$35-49,999
 
$50-74,999
 
$75-99,999
 
$100-149,999
 
$150+
 
 
 
Do you or have you ever lived in poverty?
 
Yes
 
No
 
 
 
If you answered Yes to prev. question, please answer
Approx. how old were you at that time?
 
0-5 years old
 
5-10 years old
 
10-15 years old
 
16-18 years old
 
as an adult
 
as an adult
 
 
 
Have you ever been on Public Assistance?
 
Yes
 
No
 
 
 
Did you graduate from High School?
 
Yes
 
No
 
 
 
If you DID NOT graduate from High School, Did you receive a GED or some other type of vocational training?
 
Yes
 
No
 
 
 
What is the highest grade level you completed?
 
Elementary School
 
Middle School
 
High School
 
Some College
 
Trade/Vocational/Technical
 
Associates
 
Bachelors
 
Masters
 
Professional
 
Doctorate
 
 
 
Were you raised by both parents?
 
Yes
 
No
 
Neither
 
 
 
Are your parents married or divorced?
 
Married
 
Divorced
 
Never married
 
 
 
Were you raised in a single-parent household?
 
Yes
 
No
 
 
 
If you answered yes to the prev. question please answer
Which parent raised you?
 
Mother
 
Father
 
Grandparents
 
Other
 
 
 
At any time during your childhood, were your parents married?
 
Yes
 
No
 
 
 
At anytime during your childhood, were both parents living together in your childhood home?
 
Yes
 
No
 
 
 
Did your parents seperate when you were still a child?
 
Yes
 
No
 
 
 
If you answered yes to the prev. question please answer
What age were you when your parents separated?
 
0-5 years old
 
5-10 years old
 
10-15 years old
 
16-18 years old
 
 
 
Do you have children?
 
Yes
 
No
 
 
 
If yes, How many children do you have?
 
1
 
2
 
3
 
4 or more
 
 
 
Are you a single parent?
 
Yes
 
No
 
 
 
How is your overall outlook on life and your future?
 
Positive outlook
 
Negative outlook
 
Indifferent "I'm just existing"
 
 
 
Do you have a positive self-image?
 
Very positive
 
Positive
 
Negative
 
Very negative
 
 
 
If you answered negative or very negative to the prev. question, please answer
Do you or have ever attribute your negative or very negative self-image to your parent(s)?
 
Yes
 
No
 
 
 
*If you answered positive or very positive to the prev. question, do you attribute your positive self-image to your parents?
 
Yes
 
No
 
 
 
Which parent do you attribute the negative self-image to?
 
Both
 
Mother
 
Father
 
Neither
 
 
 
Which parent do you attribute the positive or very positive self-image to?
 
Mother
 
Father
 
Neither
 
Both
 
 
 
Do you believe the influence of both parents are equally necessary in raising healthy children?
 
Strongly disagree
 
Somewhat disagree
 
Slightly disagree
 
Neither agree nor disagree
 
Slightly agree
 
Somewhat agree
 
Strongly agree
 
 
 
Looking back on your childhood, was it a positive or negative experience?
 
Strongly positive
 
Somewhat positive
 
Strongly negative
 
Somewhat negative
 
 
 
In your opinion, is marriage important in raising children?
 
Very important
 
Somewhat important
 
Important
 
Not important
 
 
 
How important is a father's influence on his children?
 
Very Important
 
Somewhat Important
 
Important
 
Not important
 
Doesn't make any difference
 
 
 
Modeling is learning through imitating the behaviors of someone else,questions 8-12 refer to modeling the behaviors of your parent(s) Do you believe that children "model" the behaviors of their parents?
 
Yes
 
No
 
 
 
Do you believe that you have "modeled" your parent(s) behavior?
 
Yes
 
No
 
 
 
Do you believe that you can "model" the behavior of a parent who has not raised you?
 
Yes
 
No
 
 
 
Which parent do you believe you "model" after?
 
Mother
 
Father
 
Both
 
Neither
 
 
 
Was that parent the one who raised you?
 
Yes
 
No
 
 
 
If you were raised with or by your father, do you believe your life is BETTER because of him?
 
Yes
 
No
 
 
 
If you were raised with or by your father, do you think your life was WORSE because of him?
 
Yes
 
No
 
 
 
If you were NOT raised by your father do you think your life is better because you were NOT raised by him?
 
much better
 
better
 
much worse
 
worse
 
same
 
 
 
If you were NOT raised by your father do you think your life is worse. because you were not raised by him?
 
much worse
 
worse
 
better
 
much better
 
same
 
 
 
Do you think your life would be different, if you had a father/father-figure in your life?
 
Yes
 
No
 
 
 
Do you think your life would be different if you did NOT have a father/father-figure in your life?
 
Yes
 
No
 
 
 
Do you believe you could have accomplished MORE in your life, if you had a father/father-figure?
 
Yes
 
No
 
 
 
Do you think the quality of your life is better/worse because you had a father/father figure in your life?
 
much better
 
better
 
the same
 
worse
 
much worse
 
 
 
If your father DID NOT live in your home, did you have a steady relationship with him?
 
Yes
 
No
 
 
 
Were you raised with your biological father or step-father?
 
Biological
 
Step-father
 
Grandfather
 
Neither
 
 
 
If you were NOT raised by your father, did you often feel like something was missing because he wasn't there?
 
Yes
 
No
 
 
 
Have you ever attributer some BAD CHOICES you made to the fact that you did NOT have a father/father figure to look up to?
 
Yes
 
No
 
 
 
Have you ever attributed some BAD CHOICES you made to the fact, that you DID have a father/father-figure in your life?
 
Yes
 
No
 
 
 
Do you currently or have you ever suffered from low self-esteem?
 
Yes
 
No
 
 
 
Have you ever suffered from Depression?
 
Yes
 
No
 
 
 
Have you ever been arrested?
 
Yes
 
No
 
 
 
Have you EVER used illegal drugs in your life?
 
Yes
 
No
 
 
 
What age did you become sexually active?
 
>10
 
10-13
 
14-17
 
18-21
 
21+
 
 
 
Do you or have you ever engaged in risky sexual behaviors such as promiscuity/multiple partners?
 
Yes
 
No
 
 
 
MALES ONLY** What is your perception of women?
 
I believe women are equal in every way to men, and they deserve respect.
 
I do not believe women are equal to men in every way and they do not deserve respect
 
I respect women, but I don't believe they are equal to men
 
I believe women are equal to men, but I still don't respect them.
 
 
 
MALES ONLY** Do you respect women?
 
Yes
 
No
 
 
 
WOMEN ONLY** What is your perception of men?
 
I believe men are equal to women in every way and deserve respect
 
I do not believe men are equal to women, and they do not deserve respect.
 
I respect men, but I do not believe they are equal to women in every way.
 
I do believe men are equal to women, but I do not respect them
 
 
 
**WOMEN ONLY** Do you respect men?
 
Yes
 
No
 
 
 
Have you ever been in a gang?
 
Yes
 
No
 
 
 
In your view, have you ever believed the gang is the same as the family?
 
Yes, being in a gang is the same as being in a family
 
No, being in a gang is not the same as being in a family
 
 
 
** Only answer if you have children**
Are all of your children by the same partner?
 
Yes
 
No
 
 
 
** ONLY answer if you have children**
Are you currently actively involved in the life of ALL of your children?
 
Yes
 
No
 
for the most part
 
 
 
**ONLY answer if you have children**
Do you have children with more than one partner?
 
No, just one partner
 
Yes, more than one partner
 
 
 
**If you answered (yes, more than one partner) to the prev. question, How many?
 
2
 
3
 
4or more
 
 
 
Have you ever had suicidal thoughts?
 
Yes
 
No
 
 
 
Have you ever attempted suicide?
 
Yes
 
No
 
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