Screening Questionnaire

To determine if you qualify, please answer the short survey below. Your responses will help us ensure that participants meet the criteria required for this study.

Participation is voluntary and responses are kept confidential.

  • Note: Adverse childhood experiences (ACEs) are potential traumatic experiences that occur in childhood when one is younger than 18 years old. Their effects on health, behavior, and well-being can be long-lived. Those early experiences of trauma will most likely come under three categories:

    • Abuse: physical, emotional, or sexual harm.
    • Neglect: caregivers neglect emotional or physical needs.
    • Household Dysfunction: being raised in an environment with substance misuse, psychological disorders, domestic abuse, parental separation or divorce, or imprisonment of a family member.

    Note: The area examined in this study includes Southeast region states from the U.S. Census Bureau. However, the U.S. Census Bureau’s is a combined list of the South Atlantic and East, South-Central divisions. For the purpose of this research, I will focus on the following Southeast region states: Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, and West Virginia (U.S. Census Bureau, n.d.).