Prior to your 18th birthday:
Did a parent or adult in your home ever swear at you, insult you, or put you down?	1□Yes 0□No
Not including spanking, did a parent or adult in your home ever hit, beat, kick, or physically hurt you in any way?	1□Yes 0□No
Did you experience sexual abuse by an adult or person at least 5 years older?	1□Yes 0□No
Did you lose a parent through divorce, abandonment, death, or other reason?	1□Yes 0□No
Did your parents or adults in your home ever hit, punch, or beat each other up?	1□Yes 0□No
Did you live with anyone who was a problem drinker, alcoholic, or who used street drugs?	1□Yes 0□No
Did you have someone in your household who was depressed, mentally ill, or attempted suicide?	1□Yes 0□No
Did you have a member of your household who went to prison?	1□Yes 0□No
	Total Yes responses _________