Delmel Questionnaire
We would appreciate your cooperation in answering the following questionnaire. What we would like to determine is an individual’s reaction to social situations as well as attitudes towards parents and other relatives, children, and the choice of mates.
Please answer each question as best you can. In some cases you will be required to make a judgement or speculate. In other cases you simply will not have the information. Do not hesitate to use your subjective impressions where necessary.
Please do not give us your name. The data we collect will be kept confidential and will only be used in compiling overall statistics. At a later time, if you contact us, we will be happy to give you a statistical summary of our results.
Please indicate one and only one answer for each question.
DO NOT WRITE ON THIS QUESTIONNAIRE BOOKLET, which we shall collect to be used again. Indicate your answers on the answer sheet provided.
I. Biographical Information
In this first section, we are seeking information about your current situation and that of your relatives. In some cases the answers will be obvious. In other cases, you may not be certain. Please check the most appropriate answer. Be as complete as you can.
1. Sex:
A. Female
B. Male
2. Ethnic or racial group:
A. Caucasian (white)
B. Negro (black)
C. Mexican-American or Spanish decent
D. Oriental
E. Other
3. Age:
A. 16-20
B. 21-24
C. 25-29
D. 30-34
E. 35 or older
4. Marital status:
A. Single (never married)
B. Never married but living with a sexual partner
C. Married
D. Divorced, widowed or separated and living alone
E. Divorced, widowed or separated and living with a sexual partner, whether married or not
5. Approximate size of the city where you have lived or worked most of your life:
A. Less than 10,000
B. 10,001-50,000
C. 50,001-100,000
D. 100,001-250,000
E. Over 250,000
6. Do you consider yourself a “city-person” or a “country-person”:
A. City-person
B. Country-person
7. For most of your childhood, were you reared by:
A. Your biological (blood-related) parents
B. One biological parents and/or a step-parent
C. Close relatives (aunts, uncles, cousins)
D. Adoptive parents
E. Foster family(ies) or institutions
Please answer questions 8-24 to the extent of your knowledge about your
biological family. If no information is available about your biological family, please answer “don’t know” on the following questions.
8. Are your parents:
A. Living together
B. Separated
C. Divorced
D. Deceased (one or both)
E. Don’t know
9. Is your father living?
A. Yes
B. No
C. Don’t know
10. Occupation of your father during his major working years:
A. Unemployed
B. Blue collar
C. Routine white collar
D. Executive or professional, white collar, or self-employed
E. Don’t know
11. Educational level of father:
A. High school or less
B. Some college or trade school
C. Completed college or trade school
D. Advanced graduate degree
E. Don’t know
12. Is your mother living?
A. Yes
B. No
C. Don’t know
13. Occupation of mother during her major working years:
A. Housewife
B. Secretarial or similar position
C. Self-employed or employed with a business or company
D. Professional (requiring an advanced degree)
E. Don’t know
14. Educational level of mother:
A. High school or less
B. Some college or trade school
C. Completed college or trade school
D. Advanced graduate degree
E. Don’t know
15. Number of biological brothers:
A. None
B. One
C. Two
D. Three or more
E. Don’t know
16. Number of biological sisters:
A. None
B. One
C. Two
D. Three or more
E. Don’t know
17. What is your birth order in relationship to your brothers and sisters? You are:
A. First born
B. Second born
C. Third born
D. Fourth born or later
E. Don’t know
18. Number of half-brothers and half-sisters:
A. None
B. One-two
C. Three-four
D. Five
E. Don’t know
19. Total number of father’s brothers and sisters (now living):
A. None
B. One-two
C. Three-four
D. Five or more
E. Don’t know
20. Total number of mother’s brothers and sisters (now living):
A. None
B. One-two
C. Three-four
D. Five or more
E. Don’t know
21. How many first cousins do you have?
A. None
B. One to three
C. Four to eight
D. Nine or more
E. Don’t know
22. How many grandparents do you have still living?
A. None
B. One or two
C. Three
D. Four
E. Don’t know
23. How many nieces and nephews do you have from your biological brothers and sisters?
A. None
B. One to three
C. Four to eight
D. Nine or more
E. Don’t know
24. How many nieces and nephews do you have from your half-brothers and half-sisters?
A. None
B. One to three
C. Four to eight
D. Nine or more
E. Don’t know
25. How many male children do you have?
A. None
B. One
C. Two
D. Three
E. Four or more
26. How many female children do you have?
A. None
B. One
C. Two
D. Three
E. Four or more
II. About Yourself
In this second section we are seeking information more directly about yourself. Please answer to the best of your ability.
27. Level of education you have completed or expect to complete before finishing your education.
A. High school or less
B. Some college or trade school
C. Complete(d) college or trade school
D. Complete(d) an advanced post-graduate degree
E. Don’t know or haven’t decided
28. Estimate your present average income:
A. Less than $5,000.00 per year
B. $5,001.00-$10,000.00 per year
C. $10,001.00-$15,000.00 per year
D. $15,001.00-$30,000.00 per year
E. More than $30,000.00 per year
29. Estimate your future average income when your education or job training is complete:
A. $5,001.00-$10,000.00 per year
B. $10,001.00-$15,000.00 per year
C. $15,001.00-$30,000.00 per year
D. More than $30,000.00 per year
E. Doesn’t apply
30. Are you now:
A. A full-time student without employment
B. A part-time student without employment
C. Working in your chosen profession while attending school
D. Working outside your chosen profession while attending school
31. If you have children, how many of your children live with you the majority of the time?
A. I have no children
B. None
C. One
D. Two
E. Three or more
32. Are you currently:
A. Sexually active with more than one partner
B. Sexually active with one partner exclusively
C. Temporarily sexually inactive (between partners)
D. Sexually inactive by choice
E. Physically or psychologically incapable of sexual activity
33. If or when you are sexually active, upon which method of birth control do you primarily rely?
A. Nothing
B. Rhythm or withdrawal
C. Foam, condoms, or diaphragms
D. The pill, IUD, or hormonal injection
E. Vasectomy or tubal ligation
34. What is your religious affiliation?
A. Jewish
B. Catholic
C. Protestant
D. Eastern (e.g., Hindu, Buddist, Zen)
E. None
35. Do you believe in the immortal soul?
A. No
B. Uncertain
C. Yes
D. Definitely
36. Do you get some form of regular physical exercise other than walking?
A. Never
B. Less than once a week
C. Once or twice a week
D. Several times a week
E. Daily
37. In general, how would you rate your physical health?
A. Poor
B. Fair
C. Good
D. Above average
E. Excellent
38. In general, how would you rate your mental health?
A. Poor
B. Fair
C. Good
D. Above average
E. Excellent
39. In general, how would you rate your energy level?
A. Very low
B. Below average
C. Average
D. Above average
E. Very high
40. Have you ever suffered from diabetes, heart disease, cancer, nervous system disorders, or other major health problems:
A. No
B. Yes, one of the above
C. Yes, two of the above
D. Yes, three of the above
E. Yes, four or more of the above
41. Have you sought or considered seeking professional help for depression, suicidal thoughts or attempts, sexual problems within a relationship, or other psychological problems?
A. No
B. Yes, one of the above
C. Yes, two of the above
D. Yes, three of the above
E. Yes, four of the above
42. In general, how would you rate your physical attractiveness?
A. Low
B. Below average
C. Average
D. Above average
E. High
43. What is your natural hair color?
A. Red
B. Blonde
C. Black or brown
D. Grey or white
44. What is your eye color?
A. Blue
B. Green
C. Brown
D. Hazel
E. Other
45. What is your height?
A. Less than 5’
B. 5’0” – 5’4”
C. 5’5” – 5’9”
D. 5’10” – 6’0”
E. Greater than 6’
46. What is your body weight?
A. Less than 100 lbs.
B. 101-120 lbs.
C. 121-150 lbs.
D. 151-180 lbs.
E. Greater than 180 lbs.
47. In general, you are:
A. Shy and introverted
B. Somewhat reserved
C. Somewhat outgoing
D. Very outgoing
48. Do you have:
A. No friends
B. Few friends
C. Several friends
D. Many friends
49. Compared to others, do you feel that your sex drive is:
A. Low
B. Average
C. High
D. Very high
50. In general, do you respond to personal or social changes:
A. Poorly
B. Without much reaction
C. With average reaction
D. With great reaction
51. In making decisions, would you consider yourself:
A. Very conservative
B. Somewhat conservative
C. Somewhat liberal
D. Very liberal
52. Do you sleep well?
A. No
B. Sometimes
C. Usually
D. Always
53. Do you feel that you are generally socially dominant in opposite-sex relationships?
A. Never
B. Sometimes
C. Usually
D. Always
54. Do you feel you communicate well with others?
A. Never
B. Sometimes
C. Usually
D. Always
III. About your family
In this third section, we are seeking information about your biological family. Again, please be as complete as you can. In some cases your answers will have to be subjective.
55. What is your parents’ approximate income?
A. $5,000.00 - $10,000.00 per year
B. $10,000.00 - $15,000.00 per year
C. $15,000.00 - $30,000.00 per year
D. Greater than $30,000 per year
E. Doesn’t apply
56. Are both of your parents still living?
A. Yes, both parents still living
B. No, my father is deceased
C. No, my mother is deceased
D. No, both of my parents are deceased
E. Don’t know
57. Do you think that most of your brothers and sisters will have children?
A. Yes, I expect all of them to
B. I expect some but not all of them will
C. I don’t expect many of them will
D. None of them probably will
E. Does not apply
58. To the best of your knowledge, do any members of your immediate family (parents, siblings, grandparents) suffer from diabetes, heart disease, cancer, or other major health problems?
A. No
B. Yes, one of the above
C. Yes, two of the above
D. Yes, three of the above
E. Yes, four or more of the above
59. To the best of your knowledge, are there any severe physical or mental disorders that are hereditary in your family?
A. Yes
B. No
C. Don’t know
60. How old is your father? If deceased, what was his age at death?
A. In his 30’s
B. In his 40’s
C. In his 50’s
D. 60 or older
E. Don’t know
61. My father’s physical health is (was) generally:
A. Very poor
B. Fair
C. Good
D. Excellent
E. Don’t know
62. My father’s mental health is (was) generally:
A. Very poor
B. Fair
C. Good
D. Excellent
E. Don’t know
63. How old is your mother? If deceased, what was her ago at death?
A. In her 30’s
B. In her 40’s
C. In her 50’s
D. 60 or older
E. Don’t know
64. My mother’s physical health is (was) generally:
A. Very poor
B. Fair
C. Good
D. Excellent
E. Don’t know
65. My mother’s mental health is (was) generally:
A. Very poor
B. Fair
C. Good
D. Excellent
E. Don’t know
66. My brothers’ and/or sisters’ physical health is generally:
A. Very poor
B. Fair
C. Good
D. Excellent
E. Don’t know, doesn’t apply
67. My brothers’ and/or sisters’ mental health is generally:
A. Very poor
B. Fair
C. Good
D. Excellent
E. Don’t know, doesn’t apply
68. The physical health of the majority of my grandparents, aunts, uncles, and cousins is generally:
A. Very poor
B. Fair
C. Good
D. Excellent
E. Don’t know
69. The mental health of the majority of my grandparents, aunts, uncles, and cousins is generally:
A. Very poor
B. Fair
C. Good
D. Excellent
E. Don’t know
70. Father’s eye color:
A. Blue
B. Green
C. Brown
D. Hazel
E. Don’t know
71. Father’s natural hair color during most of his life:
A. Red
B. Blonde
C. Black or brown
D. Grey or white
E. Don’t know
72. Father’s height
A. Less than 5’5”
B. 5’6” – 5’9”
C. 5’10” – 6’0”
D. 6’1” or taller
E. Don’t know
73. Father’s weight
A. Less than 120 lbs.
B. 121-150 lbs.
C. 151-180 lbs.
D. Greater than 180 lbs.
E. Don’t know
74. Father’s temperament
A. Shy and introverted
B. Somewhat reserved
C. Somewhat outgoing
D. Very outgoing
E. Don’t know
75. Mother’s eye color:
A. Blue
B. Green