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Instrument 5
ICR 201107-0970-003 · OMB 0970-0360 · Object 25948301.
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EVALUATION OF ADOLESCENT PREGNANCY PREVENTION APPROACHES SUMMARY TABLE, SITE- SPECIFIC BASELINE SURVEY, AND CONSENT AND ASSENT FORMS: LIVE THE LIFE (LTL) The LTL survey instrument is divided into three sections: PART A – FOR ALL YOUTH (this section ends with a question on whether the adolescent has had sex, in which case the adolescent chooses to continue to either PART B1 or B2) PART B1 – FOR SEXUALLY-ACTIVE YOUTH PART B2 – FOR NON-SEXUALLY-ACTIVE YOUTH SUMMARY OF DIFFERENCES BETWEEN THE BASELINE CONCORDANCE INSTRUMENT AND THE LIVE THE LIFE SURVEY Concordance # Live the Life # Items are listed in the order in which they appear on the Live the Life baseline instrument. The number for the corresponding baseline concordance item is listed in the “Concordance #” column. Items in Part A are listed first, followed by items in Section 4, Part B1 (for sexually active respondents), items in Section 4, Part B2 (for non-sexually active respondents) and items in Sections 5 and 6, Parts B1 and B2 (these sections are the same for sexually active and non-sexually active respondents). Items found on the concordance instrument that are not on the Live the Life instrument are listed at the bottom of the table. • Modifications to an existing baseline concordance item are listed in the “Modifications” column; otherwise, the question text on the Live the Life instrument is the same as that on the baseline concordance instrument. • If an item is specific to the Live the Life instrument, it is indicated by an “N/A” in the “Concordance #” column and the question text is noted in the “Modifications” column. Baseline Concordance Question text Modified for Live the Life PART A (Sections 1 – 3): All items in Part A are the same for sexually active and non-sexually active respondents. 1.1 1.1 In what month and year were you born? MARK (X) ONE MONTH AND ONE YEAR 1 Live the Life # Concordance # 1.2 1.2 1.3 1.4 Baseline Concordance Question text Modified for Live the Life What grade are you in? MARK (X) ONE 1.3 □ 6th □ 7th □ 8th □ 9th □ 10th □ 11th □ 12th □ Not currently in school Are you male or female? 1.4 MARK (X) ONE □ Male □ Female Are you Hispanic/Latino? MARK (X) ONE □ Yes □ No 2 Live the Life # Concordance # Baseline Concordance Question text 1.5 1.5 What is your race? Modified for Live the Life YOU MAY MARK (X) MORE THAN ONE ANSWER □ American Indian or Alaska Native □ Asian □ Black or African-American □ Native Hawaiian or Other Pacific Islander □ White □ Some other race PRINT OTHER RACE 1.6 1.6a What is the main language you speak at home? □ □ □ □ 1.7 1.7 English Spanish Chinese language such as Mandarin or Cantonese Some other language PRINT OTHER LANGUAGE ____________________________ In the past 12 months, how often did you attend religious services or activities? MARK (X) ONE □ □ □ □ □ Never Less than once a month 1-3 times per month Once a week More than once a week 3 What is the main language you speak at home? □ □ □ English Spanish Some other language PRINT OTHER LANGUAGE Live the Life # Concordance # 1.8 1.8 Baseline Concordance Question text How important is religion in your life? MARK (X) ONE □ □ □ 1.9 1.9 Modified for Live the Life Not at all important Somewhat important Very important In the past 12 months, have you received any information or learned about any of the following? MARK (X) ONE FOR EACH QUESTION Yes, No a. b. c. d. e. f. g. h. Relationships, dating, marriage, or family life Abstinence from sex Methods of birth control Where to get birth control Sexually transmitted diseases, also known as STDs How to talk to your partner about whether to have sex or whether to use birth control How to say no to sex How babies are made 4 Live the Life # Concordance # 1.10 1.11 Baseline Concordance Question text Modified for Live the Life How likely is it that you will do each of the following things? MARK (X) ONE Not at all likely, A little bit likely, Somewhat likely, Very likely a. b. c. d. e. Graduate from high school Go to a technical or vocational school after high school Go to college Graduate from a 2-year or community college program Graduate from a 4-year college program 5 Live the Life # Concordance # Baseline Concordance Question text 2.1 2.1 The next question is about where you live and who lives with you. Modified for Live the Life Which of the following best describes where you live? □ You live in one home – GO TO 2.2 □ You live in two or more homes and go back and forth – GO TO 2.3 □ You are homeless (living on the street, in a car or shelter, staying with friends/relatives) – GO TO 2.4 2.2 2.2 Who lives with you in your home? MARK ALL THAT APPLY □ □ □ □ □ □ □ □ □ □ □ □ □ □ Your biological mother Your biological father A stepmother or adoptive mother A foster mother A stepfather or adoptive father A foster father Your parent’s partner, boyfriend, or girlfriend Any grandmothers Any grandfathers Any older brothers or sisters Any younger brothers or sisters Any aunts, uncles, or other relatives Any other people you are not related to You live by yourself 6 Live the Life # Concordance # Baseline Concordance Question text 2.3 2.3 Who lives with you in each of your homes? Modified for Live the Life Mark all of the people who live with you in your MAIN home, and then mark all of the people who live with you in your OTHER homes. MARK ALL THAT APPLY (List appears for both the MAIN home and the OTHER home(s)) □ □ □ □ □ □ □ □ □ □ □ □ □ □ Your biological mother Your biological father A stepmother or adoptive mother A foster mother A stepfather or adoptive father A foster father Your parent’s partner, boyfriend, or girlfriend Any grandmothers Any grandfathers Any older brothers or sisters Any younger brothers or sisters Any aunts, uncles, or other relatives Any other people you are not related to You live by yourself 7 Live the Life # Concordance # 2.4 2.6 Baseline Concordance Question text Modified for Live the Life Now we have some questions about your mother, or the person you think of as your mother. Is this person… MARK (X) ONE □ □ □ □ □ □ □ 2.5 2.7 Your biological mother, that is, the woman who gave birth to you Your stepmother or adoptive mother Your foster mother Your grandmother Your aunt or your older sister Some other adult Don’t have a mother or person I think of as a mother GO TO 2.12 The following questions are about the person you marked as your mother or the person you think of as your mother. Did she graduate from high school? MARK (X) ONE □ □ □ 2.6 2.8 Yes No Don’t know Did she graduate from a 4-year college? MARK (X) ONE □ □ □ Yes No Don’t know 8 Live the Life # Concordance # 2.7 2.9 2.8 2.10 Baseline Concordance Question text Modified for Live the Life Is she working now? MARK (X) ONE □ She is not working at a paid job □ Yes, she is working part-time or less than 30 hours a week □ Yes, she is working full-time or at more than one job for 30 hours a week or more □ Yes, she works, but I don’t know how many hours □ Don’t know if she is working How close do you feel to your mother or the person you think of as your mother? MARK (X) ONE □ □ □ □ 2.9 2.11 Not at all close A little close Somewhat close Very close In general, how much do you think she cares about you? MARK (X) ONE □ □ □ □ Does not care at all Cares a little bit Cares somewhat Cares very much 9 Live the Life # Concordance # 2.10 2.12 Baseline Concordance Question text Modified for Live the Life Whether you have done this or not, how would she feel about you having sex at this time in your life? MARK (X) ONE □ □ □ □ □ 2.11 2.13 Strongly approve Approve Neither approve nor disapprove Disapprove Strongly disapprove How would she feel about you having a baby at this time in your life? MARK (X) ONE □ □ □ □ □ Strongly approve Approve Neither approve nor disapprove Disapprove Strongly disapprove 10 Live the Life # Concordance # 2.12 2.14 Baseline Concordance Question text Modified for Live the Life Next we have some questions about your father, or the person you think of as your father. Is this person… MARK (X) ONE □ 2.13 2.15 Your biological father, that is, the man who is genetically related to you □ Your stepfather or adoptive father □ Your foster father □ Your grandfather □ Your uncle or your older brother □ Some other adult □ Don’t have a father or person I think of as a father GO TO 2.20 The following questions are about the person you marked as your father or the person you think of as your father. Did he graduate from high school? MARK (X) ONE □ □ □ 2.14 2.16 Yes No Don’t know Did he graduate from a 4-year college? MARK (X) ONE □ □ □ Yes No Don’t know 11 Live the Life # Concordance # Baseline Concordance Question text 2.15 2.17 Is he working now? 2.18 MARK (X) ONE □ He is not working at a paid job □ Yes, he is working part-time or less than 30 hours a week □ Yes, he is working full-time or at more than one job for 30 hours a week or more □ Yes, he works, but I don’t know how many hours □ Don’t know if he is working How close do you feel to your father or the person you think of as your father? 2.16 Modified for Live the Life MARK (X) ONE □ Not at all close □ A little close □ Somewhat close □ Very close 2.17 2.19 In general, how much do you think he cares about you? MARK (X) ONE □ □ □ □ Does not care at all Cares a little bit Cares somewhat Cares very much 12 Live the Life # Concordance # 2.18 2.20 Baseline Concordance Question text Modified for Live the Life Whether you have done this or not, how would he feel about you having sex at this time in your life? MARK (X) ONE □ □ □ □ □ 2.19 2.21 Strongly approve Approve Neither approve nor disapprove Disapprove Strongly disapprove How would he feel about you having a baby at this time in your life? MARK (X) ONE □ □ □ □ □ 2.20 2.22a Strongly approve Approve Neither approve nor disapprove Disapprove Strongly disapprove Which of the following best describes the relationship between your biological mother and biological father? If one or both of your biological parents have passed away, please answer about their relationship when both were alive. MARK (X) ONE o o o o o They are married to each other They used to be married to each other, but are now separated They used to be married to each other, but are now divorced They have never been married to each other I don’t know 13 Live the Life # Concordance # Baseline Concordance Question text 2.21 2.22b Do your biological mother and biological father live together now? Modified for Live the Life MARK (X) ONE o o o o 2.22 2.23 Yes No One or both of my biological parents have passed away I don’t know The next questions are about the parents or guardians you live with most of the time. Thinking about the past month, how often did your parents know where you were after school? MARK (X) ONE □ Always □ Usually □ Sometimes □ Rarely □ Never 2.23 2.24 Thinking about the past month, how often did your parents know who you were going to be with before you went out? MARK (X) ONE □ Always □ Usually □ Sometimes □ Rarely □ Never □ I did not go out 14 Live the Life # Concordance # 2.24 2.27 Baseline Concordance Question text Modified for Live the Life In the past 12 months, how many times have you talked with at least one of your parents or guardians about . . . MARK (X) ONE FOR EACH QUESTION Never, 1-2 Times, 3-9 Times, 10 or more times a. b. c. d. e. f. g. h. How things are going with school work or with your grades A personal problem you were having How to have good romantic relationships Strategies for safe dating How to resist pressures to have sex Avoiding drugs and alcohol Pregnancy or birth Sexually transmitted diseases (also called STDs), HIV, or AIDS 15 Live the Life # Concordance # 3.1 3.1 Baseline Concordance Question text Modified for Live the Life The next series of questions is about your views on sexual intercourse. In this survey, when we ask about sexual intercourse we mean a male putting his penis into a female’s vagina. How strongly do you agree or disagree that . . . MARK (X) ONE FOR EACH QUESTION The next series of questions is about your views on sexual intercourse. In this survey, when we ask about sexual intercourse we mean a male putting his penis into a female’s vagina. How strongly do you agree or disagree that . . . Strongly Agree, Agree, Disagree, Strongly Disagree MARK (X) ONE FOR EACH a. b. c. Strongly Agree, Agree, Disagree, Strongly Disagree d. e. Having sexual intercourse is a good thing for you to do at your age At your age right now, having sexual intercourse would create problems At your age right now, not having sexual intercourse is important for you to be safe and healthy At your age right now, it is okay for you to have sexual intercourse if you use birth control, like a condom It is against your values to have sexual intercourse before marriage a. b. c. d. e. f. g. h. 16 Having sexual intercourse is a good thing for you to do at your age At your age right now, having sexual intercourse would create problems At your age right now, not having sexual intercourse is important for you to be safe and healthy At your age right now, it is okay for you to have sexual intercourse if you use birth control, like a condom If you have sexual intercourse as a teen, it will not do any harm You would feel guilty having sexual intercourse as a teen You would feel embarrassed to say no to a boyfriend or girlfriend who wanted to have sexual intercourse with you You would not want to disappoint a boyfriend or girlfriend who wanted to have sexual intercourse with you Live the Life # Concordance # 3.2 N/A Baseline Concordance Question text Modified for Live the Life The next series of questions is about your views on sexual intercourse before marriage. How strongly do you agree or disagree that… MARK (X) ONE FOR EACH Strongly Agree, Agree, Disagree, Strongly Disagree a. b. c. d. e. f. g. h. 17 You intend to wait until marriage to have sexual intercourse It would be good for you to wait until marriage to have sexual intercourse Whether or not you wait until marriage to have sexual intercourse is completely up to you It would be difficult for you to wait until marriage to have sexual intercourse It is against your values to have sexual intercourse before marriage You think people who wait until marriage to have sexual intercourse are being safe and responsible It would be unpleasant for you to wait until marriage to have sexual intercourse Most people who are important to you think that you should wait until marriage to have sexual intercourse Live the Life # Concordance # 3.3 3.2 Baseline Concordance Question text Modified for Live the Life FOR GIRLS If you got pregnant now, how would you feel? MARK (X) ONE □ □ □ □ □ 3.3 3.2 Very happy A little happy Neither happy nor upset A little upset Very upset FOR BOYS If you got someone pregnant now, how would you feel? MARK (X) ONE □ □ □ □ □ Very happy A little happy Neither happy nor upset A little upset Very upset 18 Live the Life # Concordance # Baseline Concordance Question text 3.4 3.3 Imagine you are alone with someone you like very much. How likely is it that you could . . . Modified for Live the Life MARK (X) ONE FOR EACH Not at all Likely, A Little Bit Likely, Somewhat Likely, Very Likely a. 3.5 3.4 Stop them if they wanted to touch your chest and you did not want them to do that (FOR GIRLS) b. Stop them if they wanted to touch your private parts below the waist, meaning the parts of the body covered by underwear, and you did not want them to do that c. Avoid having sexual intercourse if you didn’t want to The next series of questions is about condom use. How strongly do you agree or disagree that … MARK (X) ONE FOR EACH Strongly agree, Agree, Neither agree nor disagree, Disagree, Strongly disagree a. Condoms should always be used if a person your age has sexual intercourse b. Condoms are a hassle to use c. Condoms are pretty easy to get d. Condoms are important to make sex safer e. Using condoms means you don’t trust your partner f. Using condoms is morally wrong g. Condoms decrease sexual pleasure 19 a. Condoms should always be used if a person your age has sexual intercourse b. Condoms are a hassle to use c. Condoms don ont protect from the emotional impact of sexual intercourse d. Condoms are important to make sex safer e. Using condoms means you don’t trust your partner f. Using condoms is morally wrong g. Condoms decrease sexual pleasure Live the Life # Concordance # Baseline Concordance Question text 3.6 3.5 If a condom is used correctly, how much can it decrease the risk of pregnancy MARK (X) ONE □ Not at all □ A little □ A lot □ Don’t know 3.6a 3.7 3.8 3.5a 3.6 3.7 Modified for Live the Life GO TO 3.7 How confident are you that your answer is correct? MARK (X) ONE □ Not at all confident □ A little confident □ Somewhat confident □ Very confident If a condom is used correctly, how much can it decrease the risk of getting HIV, the virus that causes AIDS? MARK (X) ONE □ Not at all □ A little □ A lot □ Don’t know If a condom is used correctly, how much can it decrease the risk of getting Chlamydia and gonorrhea? MARK (X) ONE □ Not at all □ A little □ A lot □ Don’t know 20 Live the Life # Concordance # Baseline Concordance Question text 3.9 3.9 If birth control pills are used correctly, how much can they decrease the risk of pregnancy? MARK (X) ONE □ Not at all □ A little □ A lot □ Don’t know 3.9a 3.10 3.9a 3.10 GO TO 3.10 How confident are you that your answer is correct? MARK (X) ONE □ Not at all confident □ A little confident □ Somewhat confident □ Very confident If birth control pills are used correctly, how much can they decrease the risk of getting HIV, the virus that causes AIDS? MARK (X) ONE □ Not at all □ A little □ A lot □ Don’t know 21 Modified for Live the Life The next series of questions is about birth control pills. If birth control pills are used correctly, how much can they decrease the risk of pregnancy? MARK (X) ONE Not at all A little A lot Don’t know GO TO 3.10 Live the Life # Concordance # 3.11 3.11 3.12 3.12 Baseline Concordance Question text If birth control pills are used correctly, how much can they decrease the risk of getting Chlamydia and gonorrhea? MARK (X) ONE □ Not at all □ A little □ A lot □ Don’t know Can you get a sexually transmitted disease, or STD, from having oral sex? MARK (X) ONE □ □ □ 3.12 a 3.12a 3.13 3.13 Modified for Live the Life Yes No Don’t know GO TO 3.13 How confident are you that your answer is correct? MARK (X) ONE □ Not at all confident □ A little confident □ Somewhat confident □ Very confident In the past 3 months, how many TIMES have you gone out on a date? □ Zero or None GO TO 3.15 | | | NUMBER OF TIMES - Your best guess is fine 3.14 3.14 Thinking about these dates in the past 3 months, how many DIFFERENT PEOPLE did you go out on a date with? □ Zero or None | | | NUMBER OF PEOPLE - Your best guess is fine. 22 Live the Life # Concordance # Baseline Concordance Question text 3.15 3.15 Do you intend to have oral sex in the next year? o o o o 3.16 3.16 3.17 Yes, definitely Yes, probably No, probably not No, definitely not Do you intend to have sexual intercourse in the next year? o o o o 3.17 Modified for Live the Life Yes, definitely Yes, probably No, probably not No, definitely not If you have sexual intercourse in the next year, do you intend to use a condom? o o o o Yes, definitely Yes, probably No, probably not No, definitely not 23 Live the Life # Concordance # 3.18 3.18 Baseline Concordance Question text Modified for Live the Life The next question is about your intention to use other methods of birth control, NOT including condoms: • Birth control pills • The shot (Depo Provera) • The patch • The ring (NuvaRing) • IUD (Mirena or Paragard) • Implants (Implanaon) If you have sexual intercourse in the next year, do you intend to use any of these other methods of birth control? o Yes, definitely o Yes, probably o No, probably not o No, definitely not 3.19 3.19 Do you intend to have sexual intercourse without being married? o o o o 3.20 3.20 Yes, definitely Yes, probably No, probably not No, definitely not Have you ever had sexual intercourse, oral sex, or anal sex? Have you ever had sexual intercourse or oral sex? □ YES: GO TO PART B1 AND PUT THIS BOOKLET BACK IN THE ENVELOPE □ NO: GO TO PART B2 AND PUT THIS BOOKLET BACK IN THE ENVELOPE PART B1: The items in Section 4, Part B1 are specifically for sexually active respondents. Items in Sections 5 and 6, Part B1 are the same as the items in Sections 5 and 6, Part B2 (for non-sexually active respondents). 24 Live the Life # Concordance # 4.1 Part B1 4.1 Part B1 4.2 Part B1 4.2 Part B1 4.3 Part B1 4.3 Part B1 4.4 Part B1 4.4 Part B1 Baseline Concordance Question text Modified for Live the Life The next questions are about your sexual behaviors and experiences. Please be as honest as possible. Your answers are confidential and everything you say will be kept private. Just to confirm, have you ever had sexual intercourse, oral sex, or anal sex? The next questions are about your sexual behaviors and experiences. Please be as honest as possible. Your answers are confidential and everything you say will be kept private. □ No STOP AND GO TO PART B2 □ Yes CONTINUE WITH THIS BOOKLET. Just to confirm, have you ever had sexual intercourse or oral sex? The first questions are about sexual intercourse. By sexual intercourse, we mean a male putting his penis into a female’s vagina. Have you ever had sexual intercourse? MARK (X) ONE □ Yes □ No GO TO 4.14 The very first time you had sexual intercourse, what month and year was it? MARK (X) ONE MONTH AND ONE YEAR The very first time you had sexual intercourse, how old were you? | | | NUMBER OF YEARS OLD YOU WERE - Your best guess is fine. 25 □ No STOP AND GO TO PART B2 □ Yes CONTINUE WITH THIS BOOKLET. Live the Life # Concordance # 4.5 Part B1 4.5 Part B1 The very first time you had sexual intercourse, how old was your partner? 4.6 Part B1 4.6 Part B1 The very first time you had sexual intercourse, would you say that it was voluntary or not voluntary? Baseline Concordance Question text MARK (X) ONE □ □ □ □ □ 4.7 Part B1 A year or two younger than you Three or more years younger than you The same age as you A year or two older than you Three or more years older than you MARK (X) ONE □ □ 4.7 Part B1 Modified for Live the Life Voluntary Not voluntary Birth control methods are something used to reduce the risk of pregnancy, and some can reduce the risk of sexually transmitted diseases, also called STDs. The first time you had sexual intercourse, did you or your partner use any type of birth control, including condoms or any other method? MARK (X) ONE □ □ Yes No GO TO 4.9 26 Live the Life # Concordance # 4.8 Part B1 4.8 Part B1 Baseline Concordance Question text Modified for Live the Life The first time you had sexual intercourse, did you or your partner use … MARK (X) ONE FOR EACH MARK (X) ONE FOR EACH ITEM YES, NO a. b. c. d. e. f. 4.9 Part B1 4.10 Part B1 4.11 Part B1 4.9 Part B1 4.10 Part B1 4.11 Part B1 Condoms Birth control pills or the patch Depo-Provera, the shot, or other injectable birth control Nuva ring or the ring Withdrawal or pulling out Another method PRINT OTHER METHOD USED Have you had sexual intercourse more than one time? MARK (X) ONE □ Yes □ No GO TO 4.14 How many DIFFERENT PEOPLE have you ever had sexual intercourse with, even if only one time? | | | NUMBER OF PEOPLE - Your best guess is fine. Now please think about the past 3 months. In the past 3 months, how many TIMES have you had sexual intercourse? □ None GO TO 4.14 | | | NUMBER OF TIMES - Your best guess is fine. 27 Live the Life # Concordance # 4.12 Part B1 4.12 Part B1 In the past 3 months, how many TIMES did have sexual intercourse without using a condom? 4.13 Part B1 4.13 Part B1 The next question is about your use of the following methods of birth control: Baseline Concordance Question text Modified for Live the Life □ None | | | NUMBER OF TIMES - Your best guess is fine. • • • • • • • Condoms Birth control pills The shot (Depo Provera) The patch The ring (NuvaRing) IUD (Mirena or Paragard) Implants (Implanaon) In the past 3 months, how many TIMES have you had sexual intercourse without using any of these methods of birth control? □ None | | | NUMBER OF TIMES - Your best guess is fine. 4.14 Part B1 4.14 Part B1 Oral sex is when someone puts his or her mouth on another person’s penis or vagina, OR lets someone else put his or her mouth on their penis or vagina. Have you ever had oral sex? MARK (X) ONE □ □ Yes No GO TO 4.18 28 Live the Life # Concordance # 4.15 Part B1 4.15 Part B1 The very first time you had oral sex, what month and year was it? 4.16 Part B1 4.16 Part B1 How many DIFFERENT PEOPLE have you ever had oral sex with, even if only one time? 4.17 Part B1 4.17 Part B1 Now please think about the past 3 months. In the past 3 months, how many TIMES have you had oral sex? 4.18 a Part B1 4.24a Part B1 FOR GIRLS a. Have you ever had your period, that is, your menstrual period? 4.18 b Part B1 4.24b Part B1 Baseline Concordance Question text Modified for Live the Life MARK (X) ONE MONTH AND ONE YEAR | | | NUMBER OF PEOPLE - Your best guess is fine. □ None | | | NUMBER OF TIMES - Your best guess is fine. □ MARK (X) ONE □ Yes □ No GO TO 4.27 How old were you when you had your first period, that is, your first menstrual period? | | | NUMBER OF YEARS OLD YOU WERE - Your best guess is fine. 29 No GO TO 4.19 Live the Life # Concordance # 4.18 a Part B1 4.25a Part B1 Baseline Concordance Question text Modified for Live the Life FOR BOYS □ These changes have not yet started GO TO 4.19 People reach puberty at different ages. Signs of puberty for males include physical changes such as developing pubic or facial hair, or the voice cracking or lowering. Which of the following best describes these changes for you? MARK (X) ONE □ These changes have not yet started GO TO 4.27 □ These changes have barely started □ These changes are definitely underway □ These changes seem complete 4.18 b Part B1 4.19 a Part B1 4.25b Part B1 How old were you when these changes started? 4.26a FOR BOYS AND GIRLS | | | NUMBER OF YEARS OLD YOU WERE - Your best guess is fine. □ No GO TO 4.20 a. To the best of your knowledge, have you ever been pregnant or gotten someone pregnant, even if no child was born? MARK (X) ONE □ Yes □ No GO TO 4.26 4.19 b Part B1 4.26b To the best of your knowledge, how many times have you been pregnant or gotten someone pregnant? □ None | | | NUMBER OF TIMES To the best of your knowledge, how many times have you been pregnant or gotten someone pregnant? | 30 | | NUMBER OF TIMES Live the Life # Concordance # Baseline Concordance Question text 4.19 c Part B1 4.26c Have you ever had a baby or has anyone you got pregnant actually had the baby? 4.20 Part B1 4.27 Part B1 MARK (X) ONE □ Yes □ No □ Don’t know In the past 12 months, have you spoken with a doctor or nurse about sex, birth control or sexually transmitted diseases, also known as STDs? MARK (X) ONE □ □ 4.21 Part B1 Modified for Live the Life 4.28 Part B1 Yes No In the past 12 months, have you been tested by a doctor or nurse for a sexually transmitted disease (STD), like gonorrhea, Chlamydia, syphilis, or HIV? MARK (X) ONE □ □ Yes No 31 Live the Life # Concordance # 4.22 Part B1 4.29 Part B1 Baseline Concordance Question text In the past 12 months, have you been told by a doctor or nurse that you had a sexually transmitted disease (STD)? MARK (X) ONE □ □ □ 4.23 Part B1 4.31 Part B1 Modified for Live the Life Yes No Don’t know Have you ever been in a situation where someone touched you in a sexual way that you did not want, or someone forced you to touch him or her in a sexual way that you did not want to? MARK (X) ONE □ □ Yes No PART B2: The items in Section 4, Part B2 are specifically for non-sexually active respondents. Items in Sections 5 and 6, Part B1 are the same as the items in Sections 5 and 6, Part B2 (for non-sexually active respondents). 4.1 Part B2 4.1 Part B2 This booklet is for youth who have not had sex. We want to be sure you are in the correct booklet. We know we asked this before but… Just to confirm, have you ever had sexual intercourse, oral sex, or anal sex? MARK (X) ONE □ Yes STOP AND GO TO PART B1 □ No CONTINUE WITH THIS BOOKLET This booklet is for youth who have not had sex. We want to be sure you are in the correct booklet. We know we asked this before but… Just to confirm, have you ever had sexual intercourse or oral sex? MARK (X) ONE □ Yes STOP AND GO TO PART B1 □ No CONTINUE WITH THIS BOOKLET 32 Live the Life # Concordance # 4.2 Part B2 4.2 Part B2 Baseline Concordance Question text Modified for Live the Life The first two questions in this booklet are about your schooling. Do you expect that you will graduate from high school? MARK (X) ONE □ □ □ Yes I already graduated from high school No GO TO 4.4 4.3 Part B2 4.3 Part B2 In what month and year do you expect to graduate from high school? (If you already graduated, in what month and year did you graduate from high school?) 4.4 Part B2 4.4 Part B2 The next questions are about where you live. MARK (X) ONE MONTH AND ONE YEAR In the last 7 days, did you spend any nights somewhere like a shelter, someone else’s home, in a car, on the street or in any other temporary housing because you did not have a regular place to stay? MARK (X) ONE □ □ 4.5 Part B2 4.5 Part B2 Yes GO TO 4.8 No In how many homes, places, or households do you live: one, two, or three or more? MARK (X) ONE □ 1 home GO TO 4.8 □ 2 homes □ 3 or more homes 33 Live the Life # Concordance # 4.6 Part B2 4.6 Part B2 Do you consider one of these homes to be your main home? 4.7 Part B2 4.7 Part B2 Thinking about the past 30 days, how many nights did you spend in each home? 4.8 Part B2 4.11a Part B2 Baseline Concordance Question text Modified for Live the Life MARK (X) ONE □ Yes □ No FILL IN TWO OR THREE NUMBERS | | | Number of nights at home #1 – Your best guess is fine. | | | Number of nights at home #2 – Your best guess is fine. | | | Number of nights at another home or other homes – Your best guess is fine. These next few questions are about you and your friends. How strongly do you agree or disagree that . . . These next few questions are about you and your friends. How strongly do you agree or disagree that you have friends who will give you good advice? MARK (X) ONE FOR EACH QUESTION Strongly agree, Agree, Disagree, Strongly disagree MARK (X) ONE a. b. c. d. You have friends who will give you good advice You have a friend who cares about you You have a friend you can talk to when you need to You have someone who you can call your best friend □ Strongly Agree □ Agree □ Disagree □ Strongly disagree 34 Live the Life # Concordance # 4.9 Part B2 4.11b Part B2 4.10 Part B2 4.11 Part B2 4.11c Part B2 4.11d Part B2 Baseline Concordance Question text Modified for Live the Life These next few questions are about you and your friends. How strongly do you agree or disagree that . . . MARK (X) ONE FOR EACH QUESTION Strongly agree, Agree, Disagree, Strongly disagree MARK (X) ONE a. You have friends who will give you good advice b. You have a friend who cares about you c. You have a friend you can talk to when you need to d. You have someone who you can call your best friend These next few questions are about you and your friends. How strongly do you agree or disagree that . . . MARK (X) ONE FOR EACH QUESTION Strongly agree, Agree, Disagree, Strongly disagree □ Strongly Agree □ Agree □ Disagree □ Strongly disagree How strongly do you agree or disagree that you have a friend you can talk to when you need to? MARK (X) ONE a. You have friends who will give you good advice b. You have a friend who cares about you c. You have a friend you can talk to when you need to d. You have someone who you can call your best friend These next few questions are about you and your friends. How strongly do you agree or disagree that . . . MARK (X) ONE FOR EACH QUESTION Strongly agree, Agree, Disagree, Strongly disagree a. b. c. d. How strongly do you agree or disagree that you have a friend who cares about you? □ Strongly Agree □ Agree □ Disagree □ Strongly disagree How strongly do you agree or disagree that you have someone who you can call your best friend? MARK (X) ONE □ Strongly Agree □ Agree □ Disagree □ Strongly disagree You have friends who will give you good advice You have a friend who cares about you You have a friend you can talk to when you need to You have someone who you can call your best friend 35 Live the Life # Concordance # 4.12 Part B2 4.12a Part B2 Baseline Concordance Question text Modified for Live the Life The next series of questions is about effort. How strongly do you agree or disagree that . . . These next few questions are about you. How strongly do you agree or disagree that when you start a project, you finish it? MARK (X) ONE FOR EACH QUESTION Strongly agree, Agree, Disagree, Strongly disagree MARK (X) ONE a. b. c. d. 4.13 Part B2 4.12b Part B2 4.12c Part B2 □ Strongly Agree □ Agree □ Disagree □ Strongly disagree The next series of questions is about effort. How strongly do you agree or disagree that . . . MARK (X) ONE FOR EACH QUESTION Strongly agree, Agree, Disagree, Strongly disagree a. b. c. d. 4.14 Part B2 When you start a project, you finish it You only work as hard as you have to You are someone people can count on When you work, you do a good job MARK (X) ONE □ Strongly Agree □ Agree □ Disagree □ Strongly disagree When you start a project, you finish it You only work as hard as you have to You are someone people can count on When you work, you do a good job The next series of questions is about effort. How strongly do you agree or disagree that . . . How strongly do you agree or disagree that you are someone people can count on? MARK (X) ONE MARK (X) ONE FOR EACH QUESTION Strongly agree, Agree, Disagree, Strongly disagree a. b. c. d. How strongly do you agree or disagree that that you only work as hard as you have to? □ Strongly Agree □ Agree □ Disagree □ Strongly disagree When you start a project, you finish it You only work as hard as you have to You are someone people can count on When you work, you do a good job 36 Live the Life # Concordance # 4.15 Part B2 4.12d Part B2 4.16 Part B2 4.13 Part B2 Baseline Concordance Question text Modified for Live the Life The next series of questions is about effort. How strongly do you agree or disagree that . . . How strongly do you agree or disagree that when you do work, you do a good job? MARK (X) ONE FOR EACH QUESTION Strongly agree, Agree, Disagree, Strongly disagree MARK (X) ONE a. When you start a project, you finish it b. You only work as hard as you have to c. You are someone people can count on d. When you work, you do a good job Here are some reasons people your age might choose NOT to have sexual intercourse. How important is each of these reasons to YOU? MARK (X) ONE FOR EACH QUESTION Very Important, Somewhat Important, Not Too Important, Not At All Important a. b. c. d. e. f. g. h. i. j. k. I don’t want to get a sexually transmitted disease, also known as an STD I don’t want to disappoint my parents I am too young to have sex My boyfriend or girlfriend doesn’t want to have sex I want to wait until I’m married It is against my personal values I haven’t met the right person yet I haven’t had the chance I don’t want to FOR GIRLS: I do not want to get pregnant FOR BOYS: I do not want to get a girl pregnant □ Strongly Agree □ Agree □ Disagree □ Strongly disagree a. b. c. d. e. f. g. h. i. j. k. l. 37 I believe it is better for my longterm health and well-being I don’t want to get a sexually transmitted disease, also known as an STD I don’t want to disappoint my parents I am too young to have sex My boyfriend or girlfriend doesn’t want to have sex I want to wait until I’m married It is against my personal values I haven’t met the right person yet I haven’t had the chance I don’t want to FOR GIRLS: I do not want to get pregnant FOR BOYS: I do not want to get a girl pregnant Live the Life # Concordance # 4.17 a Part B2 4.14 a Part B2 4.17 b Part B2 4.14b Part B2 4.18 a Part B2 4.15a Part B2 Baseline Concordance Question text Modified for Live the Life FOR GIRLS ONLY- Have you ever had your period, that is, your menstrual period? MARK (X) ONE □ Yes □ No GO TO 4.19 FOR GIRLS ONLY- How old were you when you had your first period, that is, your first menstrual period? | | | NUMBER OF YEARS OLD YOU WERE - Your best guess is fine. FOR BOYS ONLY People reach puberty at different ages. Signs of puberty for males include physical changes such as developing pubic or facial hair, or the voice cracking or lowering. Which of the following best describes these changes for you? MARK (X) ONE □ □ □ □ 4.18 b Part B2 4.15b Part B2 These changes have not yet started These changes have barely started These changes are definitely underway These changes seem complete GO TO 4.19 FOR BOYS: How old were you when these changes started? | | | NUMBER OF YEARS OLD YOU WERE 38 Live the Life # Concordance # 4.19 Part B2 4.16a Part B2 4.20 Part B2 4.16b Part B2 Baseline Concordance Question text Modified for Live the Life Have you ever done any of the following? Have you ever kissed someone on the lips? Yes, No MARK (X) ONE a. Kissed someone on the lips b. French kissed, that is put your tongue in someone’s mouth while kissing c. Touched another person’s private parts d. Let someone touch your private parts Have you ever done any of the following? Yes, No □ Yes □ No GO TO 4.21 Have you ever French kissed, that is put your tongue in someone’s mouth while kissing? MARK (X) ONE 4.21 Part B2 4.16c Part B2 a. Kissed someone on the lips b. French kissed, that is put your tongue in someone’s mouth while kissing c. Touched another person’s private parts d. Let someone touch your private parts Have you ever done any of the following? Yes, No □ Yes □ No Have you ever touched another person’s private parts? MARK (X) ONE 4.22 Part B2 4.16d Part B2 a. Kissed someone on the lips b. French kissed, that is put your tongue in someone’s mouth while kissing c. Touched another person’s private parts d. Let someone touch your private parts Have you ever done any of the following? Yes, No □ Yes □ No Have you ever let someone touch your private parts? MARK (X) ONE a. Kissed someone on the lips b. French kissed, that is put your tongue in someone’s mouth while kissing c. Touched another person’s private parts d. Let someone touch your private parts 39 □ Yes □ No Live the Life # Concordance # 4.23 Part B2 4.17 Part B2 4.24 Part B2 4.20 Part B2 Baseline Concordance Question text Modified for Live the Life Have you ever been in a situation where someone touched you in a sexual way that you did not want, or someone forced you to touch him or her in a sexual way that you did not want to? MARK (X) ONE □ Yes □ No If you decided to have sexual intercourse outside of marriage, how likely is it you would use a condom or other contraceptive method? MARK (X) ONE □ Not at all likely □ A little bit likely □ Somewhat likely □ Very likely □ Don’t plan to have sexual intercourse outside of marriage If you decided to have sexual intercourse outside of marriage, how likely is it you would use a condom or other contraceptive method? MARK (X) ONE □ Don’t plan to have sexual intercourse outside of marriage □ Not at all likely □ A little bit likely □ Somewhat likely □ Very likely Sections 5 and 6 (Parts B1 and B2) – these items are the same for sexually active and non-sexually active respondents. 5.1 5.4 The next questions are about alcohol and drugs. Please be as honest as possible, and remember that everything you tell us will be kept private. Have you ever had an alcoholic drink, such as beer, wine or other liquor, NOT counting any times you just had a sip? MARK (X) ONE □ □ Yes No GO TO 5.8 40 Live the Life # Concordance # Baseline Concordance Question text 5.2 5.5 The very first time you had an alcoholic drink, how old were you? | 5.3 5.6 | Modified for Live the Life | NUMBER OF YEARS OLD YOU WERE - Your best guess is fine. During the past 30 days, on how many days did you have one or more alcoholic drink, such as beer, wine or other liquor, NOT counting any times you just had a sip? MARK (X) ONE □ □ □ □ 5.4 5.5 More than 25 days 5 to 25 days 1 to 4 days 0 (zero) days 5.7 During the past 30 days, on how many days did you have 5 or more drinks in a row? 5.8 MARK (X) ONE □ More than 25 days □ 5 to 25 days □ 1 to 4 days □ 0 (zero) days Have you ever used marijuana, also called weed or pot? MARK (X) ONE □ □ Yes No GO TO 5.10 41 Live the Life # Concordance # Baseline Concordance Question text 5.6 5.9 During the past 30 days, on how many days did you use marijuana? 5.7 5.10 Modified for Live the Life MARK (X) ONE □ More than 25 days □ 5 to 25 days □ 1 to 4 days □ 0 (zero) days Have you ever used any other type of illegal drug, for example Methamphetamine, speed, PCP, ecstasy, or any form of cocaine, such as crack? MARK (X) ONE □ Yes □ No 42 Live the Life # Concordance # Baseline Concordance Question text 6.1 6.1 How many of your friends who are your age think the following things? Your best guess is fine MARK (X) ONE FOR EACH QUESTION None, Some, Half, Most, All, Don’t Know a. b. c. d. e. 6.2 6.2 How many of your friends who are your age think the following things? Your best guess is fine MARK (X) ONE FOR EACH QUESTION None, Some, Half, Most, All, Don’t Know Having sexual intercourse is a good thing for them to do at their age. It would be okay for them to have sexual intercourse as long as they used birth control, like a condom. It would be okay for them to have sexual intercourse if they were dating the same person for a long time They should wait until they are older to have sexual intercourse. They should wait until marriage to have sexual intercourse. a. How many of your friends who are your age have done the following things? MARK (X) ONE FOR EACH QUESTION None, Some, Half, Most, All, Don’t Know a. b. Modified for Live the Life Having sexual intercourse is a good thing for them to do at their age. b. It would be okay for them to have sexual intercourse as long as they used birth control, like a condom. c. It would be okay for them to have sexual intercourse if they were dating the same person for a long time d. They should wait until they are older to have sexual intercourse. e. They should wait until marriage to have sexual intercourse. f. It is more important to finish high school than to have sexual intercourse How many of your friends who are your age have done the following things? MARK (X) ONE FOR EACH QUESTION None, Some, Half, Most, All, Don’t Know Had sexual intercourse. Had oral sex. a. b. c. 43 Had sexual intercourse. Had oral sex. Have decided to delay having sexual intercourse until later in life Live the Life # Concordance # Baseline Concordance Question text 6.3 6.3 In general, how much pressure, if any, do you feel from your friends to have sexual intercourse? Modified for Live the Life MARK (X) ONE □ □ □ □ 6.4 6.5 A lot of pressure Some pressure A little pressure No pressure How much do you feel that your friends care about you? MARK (X) ONE □ Do not care at all □ Care a little bit □ Care somewhat □ Care very much DROPPED: The questions listed below are part of the baseline concordance instrument, but are not part of this site-specific baseline instrument. N/A 1.6 When you are at home or with your family, what language or languages do you usually speak? YOU MAY MARK (X) MORE THAN ONE ANSWER □ English □ Spanish □ Chinese language such as Mandarin or Cantonese □ Some other language PRINT OTHER LANGUAGE(S) ____________________________ 44 Live the Life # Concordance # N/A 1.10 Baseline Concordance Question text Modified for Live the Life In an average week last month, including weekends, about how many hours did you spend participating in each of the following? MARK (X) ONE FOR EACH QUESTION Zero Hours Per Week, More Than Zero but Less Than 2 Hours Per Week, 2-5 Hours Per Week, More Than 5 Hours Per Week a. b. c. N/A 2.4 Sports-related clubs, teams, or organizations Lessons, clubs, or performances for art, music, or drama Other clubs, teams, and organizations, such as academic clubs, Scouts, chess clubs, or debating teams d. Services or programs at a church, temple, synagogue, mosque, or other place of worship e. Working at a paid job f. Volunteering On how many days last week did all the family members who live in your household sit down together for a meal? MARK (X) ONE □0 □1 □2 □3 □4 □5 □6 □7 45 Live the Life # Concordance # N/A 2.5 N/A N/A 2.25 2.26 Baseline Concordance Question text Modified for Live the Life On how many days last week did you do something with at least one adult in your family like play a game, watch a movie, go to a sporting event, or work on something you enjoy doing together? MARK (X) ONE □0 □1 □2 □3 □4 □5 □6 □7 Thinking about the past month, how often did your parents know where you were when you went out at night? MARK (X) ONE □ Always □ Usually □ Sometimes □ Rarely □ Never □ I did not go out at night If you were going to be home late, would your parents expect you to call? MARK (X) ONE □ Yes □ No 46 Live the Life # Concordance # N/A 3.8 Baseline Concordance Question text Modified for Live the Life The next series of questions is about other methods of birth control, NOT including condoms. How strongly do you agree or disagree that… MARK (X) ONE Strongly agree, Agree, Neither agree nor disagree, Disagree, Strongly disagree a. Birth control should always be used if a person your age has sexual intercourse b. Birth control is a hassle to use c. Birth control is pretty easy to get d. Birth control is important to make sex safer e. Birth control has too many negative side effects f. Using birth control is morally wrong N/A N/A 4.18 Part B1 4.19 Part B1 In the past 3 months, how many TIMES have you had oral sex without using a condom? □ None | | | NUMBER OF TIMES - Your best guess is fine. Anal sex is when a male puts his penis in someone else’s anus, or their butt, or someone lets a male put his penis in their anus or butt. Have you ever had anal sex? MARK (X) ONE □ □ N/A 4.20 Part B1 Yes No GO TO 4.22 How many DIFFERENT PEOPLE have you ever had anal sex with, even if only one time? | | | NUMBER OF PEOPLE - Your best guess is fine. 47 Live the Life # Concordance # N/A 4.21 Part B1 Now please think about the past 3 months. In the past 3 months, how many TIMES have you had anal sex? 4.22 Part B1 In the past 3 months, how many TIMES have you had anal sex without using a condom? N/A N/A N/A 4.32 Part B1 4.30 Part B1 Baseline Concordance Question text Modified for Live the Life □ None GO TO 4.22 | | | NUMBER OF TIMES - Your best guess is fine. □ None | | | NUMBER OF TIMES - Your best guess is fine. Have you ever been fearful that someone you were dating or having sex with might physically hurt you? MARK (X) ONE □ Yes □ No The next series of questions is about the types of sexually transmitted diseases or STDs you had. In the past 12 months, did you have… Yes, No, Don’t know a. b. c. d. e. f. g. Chlamydia Gonorrhea Genital herpes Syphilis HIV infection or AIDS Human papilloma virus, also called HPV or genital warts Another sexually transmitted disease (STD) PRINT OTHER STD: 48 Live the Life # Concordance # N/A 4.8 Part B2 Is there anyone who moves with you from home to home? 4.9 Part B2 Is your home or any of your homes a group home or halfway house? N/A N/A 4.10 Part B2 Baseline Concordance Question text MARK (X) ONE □ □ 4.18 Part B2 Yes No □ Yes □ No This question is about who lives with you in your home. If you have more than one home, please think about your main home. How many people usually live in your home, including all children and anyone who normally lives there even if they are not there now, like someone who is away traveling or in a hospital? | N/A Modified for Live the Life | | NUMBER OF PEOPLE Have you ever been fearful that someone you were dating or having sex with might physically hurt you? MARK (X) ONE □ □ Yes No 49 Live the Life # Concordance # N/A 4.19 Part B2 N/A N/A 4.23 Part B1 5.2 Baseline Concordance Question text In the past 12 months, have you spoken with a doctor or nurse about sex, birth control or sexually transmitted diseases, also known as STDs? MARK (X) ONE □ Yes □ No Have you ever had oral sex or anal sex with a person the same sex as you? MARK (X) ONE □ Yes □ No The very first time you smoked a cigarette, how old were you? | N/A 5.3 Modified for Live the Life | | NUMBER OF YEARS OLD YOU WERE - Your best guess is fine. During the past 30 days, on how many days did you smoke one or more cigarettes? MARK (X) ONE □ □ □ □ More than 25 days 5 to 25 days 1 to 4 days 0 (zero) days 50 Live the Life # Concordance # N/A 5.11 Baseline Concordance Question text Modified for Live the Life Have you ever used any prescription pills or other prescription drugs that were not prescribed for you? MARK (X) ONE □ Yes □ No N/A N/A 5.12 6.4 Have you ever used an inhalant, such as sniffed glue, breathed the contents of spray cans, or inhaled any paints or solvents to get high? MARK (X) ONE □ Yes □ No People are different in their sexual attraction to other people. Which of the following best describes you? MARK (X) ONE □ □ □ □ □ I am only attracted to males I am attracted to both males and females I am only attracted to females I am not attracted to either males or females I am not sure 51 OMB Control No: Expiration Date: BASELINE QUESTIONNAIRE PART A LIVE THE LIFE CONFIDENTIALITY Thank you for your help with this important study. It will help us understand what things are like for people your age today. Your answers are confidential and everything you say will be kept private. Your name will not be on the questionnaire. Please answer all questions as well as you can. We want you to know that: 1. We hope that you will answer all the questions, but you may skip any questions you do not wish to answer. 2. The answers you give will never be identified as yours. Your responses will be combined with those of other people your age. Mathematica Policy Research THE PAPERWORK REDUCTION ACT OF 1995 Public reporting burden for this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. GENERAL INSTRUCTIONS 1. PLEASE MARK ALL ANSWERS WITHIN THE WHITE BOXES PROVIDED! USE A PEN OR PENCIL. PLEASE READ EACH QUESTION CAREFULLY. There are different ways to answer the questions in this survey. It is important that you follow the instructions when answering each kind of question. Here are some examples. EXAMPLE 1: MARK (X) ONE ANSWER What is the color of your eyes? MARK (X) ONE X Brown Blue If the color of your eyes is brown, you would mark (X) the first box as shown. Green Another color 2. EXAMPLE 2: MARK (X) ONE ANSWER and FILL IN THE BLANK What is the color of your hair? MARK (X) ONE Brown Black If the color of your hair is purple, you would mark (X) the last box and write the word “purple” in the blank as shown. BE SURE TO WRITE CLEARLY. Blond Red X 3. Some other color PRINT OTHER COLOR purple EXAMPLE 3: YOU MAY MARK (X) MORE THAN ONE ANSWER Do you plan to do any of the following next week? YOU MAY MARK (X) MORE THAN ONE ANSWER X Rent a movie X Go to a baseball game If you plan to rent a movie and go to a baseball game next week, you would mark (X) both boxes. Study at a friend’s house PPA Study – Part A – Wait Training 6/28/11 1 4. EXAMPLE 4: QUESTION WITH A SKIP 1. Do you ever eat chocolate? Because you answered “Yes” to question 1, you would continue to question 2 and then question 3. MARK (X) ONE X Yes No GO TO QUESTION 3 If you answered “No” to question 1, you would skip question 2 and go right to question 3. 2. Do you always brush your teeth after eating chocolate? MARK (X) ONE Yes X No 3. Did you do any of the following last week? YOU MAY MARK (X) MORE THAN ONE ANSWER X Went to a play X Went to a movie Attended a sporting event 5. EXAMPLE 5: FILL IN THE NUMBER In the past seven (7) days, how many chocolate bars have you eaten? 0 2 NUMBER OF CHOCOLATE BARS – Your best guess is fine. Fill in the boxes with the correct number. For any number less than 10, put a zero (0) in the first box. For example, if you had eaten 2 chocolate bars in the past 7 days, you would write “0” in the first box and “2” in the second box. If you had eaten 15 chocolate bars, you would write “1” in the first box and “5” in the second box. 6. EXAMPLE 6: MARK (X) ONE ANSWER FOR EACH QUESTION In the past 12 months, have you done any of the following? MARK (X) ONE FOR EACH QUESTION a. b. c. d. e. f. YES NO Walked a dog on a leash? .......................................................................................................................... X Played Frisbee? .......................................................................................................................................... X X Weeded a garden? ..................................................................................................................................... Eaten a piece of fresh fruit?........................................................................................................................ X X Played a piano? .......................................................................................................................................... X Watched a movie? ...................................................................................................................................... Mark (x) either “yes” or “no” for each of the six (6) questions (a–f) by marking (x) one of the of two boxes in each row. PPA Study – Part A – Wait Training 6/28/11 2 7. EXAMPLE 7: MARK (X) ONE MONTH AND ONE YEAR In what month and year did you finish elementary school? MARK (X) ONE MONTH AND ONE YEAR Month finished Year finished January 2010 X February X 8. 2009 March 2008 April 2007 May 2006 June 2005 July 2004 August 2003 September 2002 October 2001 November 2000 December 1999 If you finished elementary school in June of 2009, you would mark (X) the box next to June and mark (X) the box next to 2009. EXAMPLE 8: FOR GIRLS or FOR BOYS 1a. FOR GIRLS Do you want to be a mother someday? MARK (X) ONE Yes No GO TO 2 1b. FOR BOYS Do you want to be a father someday? MARK (X) ONE Yes No 2. Do you have any brothers or sisters? MARK (X) ONE Yes Some questions are just for girls and some questions are just for boys. These questions are marked with FOR GIRLS or FOR BOYS. If a question is not marked specifically FOR GIRLS or FOR BOYS, then it is a question for everyone to answer. In the example, if you are a girl, you would answer 1a (FOR GIRLS), skip 1b (FOR BOYS), and then answer question 2, for everyone. If you are a boy, you would skip 1a (FOR GIRLS), answer 1b (FOR BOYS), and answer question 2, for everyone. No PPA Study – Part A – Wait Training 6/28/11 3 SECTION 1: YOU AND YOUR BACKGROUND 1.1. In what month and year were you born? MARK (X) ONE MONTH AND ONE YEAR Month born Year born January 2002 February 2001 March 2000 April 1999 May 1998 June 1997 July 1996 August 1995 September 1994 October 1993 November 1992 December 1991 1.2. What grade are you in? MARK (X) ONE 6th 7th 8th 9th 10th 11th 12th Not currently in school PPA Study – Part A – Wait Training 6/28/11 4 1.3. Are you male or female? MARK (X) ONE Male Female 1.4. Are you Hispanic/Latino? MARK (X) ONE Yes No 1.5. What is your race? YOU MAY MARK (X) MORE THAN ONE ANSWER American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Some other race PRINT OTHER RACE(S) 1.6. What is the main language you speak at home? MARK (X) ONE English Spanish Some other language PRINT OTHER LANGUAGE PPA Study – Part A – Wait Training 6/28/11 5 1.7. In the past 12 months, how often did you attend religious services or activities? MARK (X) ONE Never Less than once a month 1-3 times per month Once a week More than once a week 1.8. How important is religion in your life? MARK (X) ONE Not at all important Somewhat important Very important 1.9. In the past 12 months, have you received any information or learned about any of the following? MARK (X) ONE FOR EACH YES NO a. Relationships, dating, marriage, or family life ................................................................................................ b. Abstinence from sex ...................................................................................................................................... c. Methods of birth control ................................................................................................................................. d. Where to get birth control .............................................................................................................................. e. Sexually transmitted diseases, also known as STDs .................................................................................... f. How to talk to your partner about whether to have sex or whether to use birth control ................................ g. How to say no to sex...................................................................................................................................... h. How babies are made .................................................................................................................................... 1.10. How likely is it that you will do each of the following things? MARK (X) ONE FOR EACH NOT AT ALL LIKELY A LITTLE BIT LIKELY SOMEWHAT LIKELY VERY LIKELY a. Graduate from high school ............................................................................................................................ b. Go to a technical or vocational school after high school ............................................................................... c. Go to college .................................................................................................................................................. d. Graduate from a 2-year or community college program ................................................................................ e. Graduate from a 4-year college program....................................................................................................... PPA Study – Part A – Wait Training 6/28/11 6 SECTION 2: FAMILY The next questions are about where you live and who lives with you. 2.1. Which of the following best describes where you live? MARK (X) ONE You live in one home 2.2. GO TO 2.2 You live in two or more homes and go back and forth GO TO 2.3 You are homeless, for example, living on the street, in a car or shelter, or staying with friends or relatives GO TO 2.4 Who lives with you in your home? MARK (X) ALL THAT APPLY Your biological mother Your biological father A stepmother or adoptive mother A foster mother A stepfather or adoptive father A foster father Your parent’s partner, boyfriend, or girlfriend Any grandmothers Any grandfathers Any older brothers or sisters Any younger brothers or sisters Any aunts, uncles, or other relatives Any other people you are not related to You live by yourself AFTER ANSWERING PPA Study – Part A – Wait Training 6/28/11 GO TO 2.4 7 2.3. Who lives with you in each of your homes? MARK (X) BOTH COLUMNS Mark (X) everyone you live with in your MAIN home Mark (X) everyone you live with in your OTHER home(s) Your biological mother Your biological mother Your biological father Your biological father A stepmother or adoptive mother A stepmother or adoptive mother A foster mother A foster mother A stepfather or adoptive father A stepfather or adoptive father A foster father A foster father Your parent’s partner, boyfriend, or girlfriend Your parent’s partner, boyfriend, or girlfriend Any grandmothers Any grandmothers Any grandfathers Any grandfathers Any older brothers or sisters Any older brothers or sisters Any younger brothers or sisters Any younger brothers or sisters Any aunts, uncles, or other relatives Any aunts, uncles, or other relatives Any other people you are not related to Any other people you are not related to You live by yourself You live by yourself PPA Study – Part A – Wait Training 6/28/11 8 MOTHER 2.4. Now we have some questions about your mother, or the person you think of as your mother. Is this person… MARK (X) ONE Your biological mother, that is, the woman who gave birth to you Your stepmother or adoptive mother Your foster mother Your grandmother Your aunt or your older sister Some other adult Don’t have a mother or person I think of as my mother GO TO 2.12 2.5. The following questions are about the person you marked as your mother or the person you think of as your mother. Did she graduate from high school? MARK (X) ONE Yes No Don’t know 2.6. Did she graduate from a 4-year college? MARK (X) ONE Yes No Don’t know 2.7. Is she working now? MARK (X) ONE She is not working at a paid job Yes, she is working part-time or less than 30 hours a week Yes, she is working full-time or at more than one job for 30 hours a week or more Yes, she works, but I don’t know how many hours Don’t know if she is working PPA Study – Part A – Wait Training 6/28/11 9 2.8. How close do you feel to your mother or the person you think of as your mother? MARK (X) ONE Not at all close A little close Somewhat close Very close 2.9. In general, how much do you think she cares about you? MARK (X) ONE Does not care at all Cares a little bit Cares somewhat Cares very much 2.10. Whether you have done this or not, how would she feel about you having sex at this time in your life? MARK (X) ONE Strongly approve Approve Neither approve nor disapprove Disapprove Strongly disapprove 2.11. How would she feel about you having a baby at this time in your life? MARK (X) ONE Strongly approve Approve Neither approve nor disapprove Disapprove Strongly disapprove PPA Study – Part A – Wait Training 6/28/11 10 FATHER 2.12. Next we have some questions about your father, or the person you think of as your father. Is this person… MARK (X) ONE Your biological father, that is, the man who is genetically related to you Your stepfather or adoptive father Your foster father Your grandfather Your uncle or your older brother Some other adult Don’t have a father or person I think of as my father GO TO 2.20 2.13. The following questions are about the person you marked as your father or the person you think of as your father. Did he graduate from high school? MARK (X) ONE Yes No Don’t know 2.14. Did he graduate from a 4-year college? MARK (X) ONE Yes No Don’t know 2.15. Is he working now? MARK (X) ONE He is not working at a paid job Yes, he is working part-time or less than 30 hours a week Yes, he is working full-time or at more than one job for 30 hours a week or more Yes, he works, but I don’t know how many hours Don’t know if he is working PPA Study – Part A – Wait Training 6/28/11 11 2.16. How close do you feel to your father or the person you think of as your father? MARK (X) ONE Not at all close A little close Somewhat close Very close 2.17. In general, how much do you think he cares about you? MARK (X) ONE Does not care at all Cares a little bit Cares somewhat Cares very much 2.18. Whether you have done this or not, how would he feel about you having sex at this time in your life? MARK (X) ONE Strongly approve Approve Neither approve nor disapprove Disapprove Strongly disapprove 2.19. How would he feel about you having a baby at this time in your life? MARK (X) ONE Strongly approve Approve Neither approve nor disapprove Disapprove Strongly disapprove PPA Study – Part A – Wait Training 6/28/11 12 PARENTS 2.20. The next two questions are about your biological parents. Which of the following best describes the relationship between your biological mother and biological father? If one or both of your biological parents have passed away, please answer about their relationship when both were alive. MARK (X) ONE They are married to each other They used to be married to each other, but are now separated They used to be married to each other, but are now divorced They have never been married to each other Don’t know 2.21. Do your biological mother and biological father live together now? MARK (X) ONE Yes No One or both of my biological parents have passed away Don’t know 2.22. The next questions are about the parents or guardians you live with most of the time. Thinking about the past month, how often did your parents know where you were after school? MARK (X) ONE Always Usually Sometimes Rarely Never PPA Study – Part A – Wait Training 6/28/11 13 2.23. Thinking about the past month, how often did your parents know who you were going to be with before you went out? MARK (X) ONE Always Usually Sometimes Rarely Never I did not go out 2.24. In the past 12 months, how many times have you talked with at least one of your parents or guardians about… MARK (X) ONE FOR EACH NEVER 1-2 TIMES 3-9 TIMES 10 OR MORE TIMES a. How things are going with school work or with your grades? ....................................................................................................................................... b. A personal problem you were having? ....................................................................................................... c. How to have good romantic relationships?................................................................................................. d. Strategies for safe dating? .......................................................................................................................... e. How to resist pressures to have sex? ......................................................................................................... f. Avoiding drugs and alcohol?....................................................................................................................... g. Pregnancy or birth? .................................................................................................................................... h. Sexually transmitted diseases (also known as STDs), HIV, or AIDS? ........................................................................................................ PPA Study – Part A – Wait Training 6/28/11 14 SECTION 3: VIEWS AND PERCEPTIONS 3.1. The next series of questions is about your views on sexual intercourse. In this survey, when we ask about sexual intercourse, we mean a male putting his penis into a female’s vagina. How strongly do you agree or disagree that… MARK (X) ONE FOR EACH STRONGLY AGREE AGREE DISAGREE STRONGLY DISAGREE a. Having sexual intercourse is a good thing for you to do at your age? .............................................................................................................................................. b. At your age right now, having sexual intercourse would create problems? ........................................................................................................................................... c. At your age right now, not having sexual intercourse is important for you to be safe and healthy? ..................................................................................................... d. At your age right now, it is okay for you to have sexual intercourse if you use birth control, like a condom? ...................................................................................... e. If you have sexual intercourse as a teen, it will not do any harm? ...................................................................................................................................................... f. You would feel guilty having sexual intercourse as a teen? ........................................................................................................................................................... g. You would feel embarrassed to say no to a boyfriend or girlfriend who wanted to have sexual intercourse with you? ........................................................................................................................................................ h. You would not want to disappoint a boyfriend or girlfriend who wanted to have sexual intercourse with you? ......................................................................... 3.2. The next series of questions is about your views on sexual intercourse before marriage. How strongly do you agree or disagree that… MARK (X) ONE FOR EACH STRONGLY AGREE a. AGREE DISAGREE STRONGLY DISAGREE You intend to wait until marriage to have sexual intercourse? ................................................................................................................................................... b. It would be good for you to wait until marriage to have sexual intercourse? ............................................................................................................................... c. Whether or not you wait until marriage to have sexual intercourse is completely up to you? ............................................................................................................. d. It would be difficult for you to wait until marriage to have sexual intercourse? ............................................................................................................................... e. It is against your values to have sexual intercourse before marriage? ........................................................................................................................................... f. You think people who wait until marriage to have sexual intercourse are being safe and responsible?................................................................................................. g. It would be unpleasant for you to wait until marriage to have sexual intercourse? ........................................................................................................................... h. Most people who are important to you think that you should wait until marriage to have sexual intercourse? ................................................................................. PPA Study – Part A – Wait Training 6/28/11 15 3.3. FOR GIRLS If you got pregnant now, how would you feel? MARK (X) ONE Very happy A little happy Neither happy nor upset A little upset Very upset 3.3. FOR BOYS If you got someone pregnant now, how would you feel? MARK (X) ONE Very happy A little happy Neither happy nor upset A little upset Very upset 3.4. Imagine you are alone with someone you like very much. How likely is it that you could… MARK (X) ONE FOR EACH NOT AT ALL LIKELY A LITTLE BIT LIKELY SOMEWHAT LIKELY VERY LIKELY a. Stop them if they wanted to touch your chest and you did not want them to do that (FOR GIRLS)? ............................................................................................ b. Stop them if they wanted to touch your private parts below the waist, meaning the parts of the body covered by underwear, and you did not want them to do that? .................................................................................... c. Avoid having sexual intercourse if you didn’t want to? .................................................................................... PPA Study – Part A – Wait Training 6/28/11 16 3.5. The next series of questions is about condom use. How strongly do you agree or disagree that… MARK (X) ONE FOR EACH STRONGLY AGREE AGREE NEITHER AGREE NOR DISAGREE DISAGREE STRONGLY DISAGREE a. Condoms should always be used if a person your age has sexual intercourse? ...................................................................................................... b. Condoms are a hassle to use? ...................................................................................................................... c. Condoms do not protect from the emotional impact of sexual intercourse? ........................................................................................................................ d. Condoms are important to make sex safer?.................................................................................................. e. Using condoms means you don’t trust your partner? ................................................................................................................................................. f. Using condoms is morally wrong? ................................................................................................................. g. Condoms decrease sexual pleasure? ........................................................................................................... 3.6. If a condom is used correctly, how much can it decrease the risk of pregnancy? MARK (X) ONE Not at all A little A lot Don’t know GO TO 3.7 3.6a. How confident are you that your answer is correct? MARK (X) ONE Not at all confident A little confident Somewhat confident Very confident 3.7. If a condom is used correctly, how much can it decrease the risk of getting HIV, the virus that causes AIDS? MARK (X) ONE Not at all A little A lot Don’t know PPA Study – Part A – Wait Training 6/28/11 17 3.8. If a condom is used correctly, how much can it decrease the risk of getting Chlamydia and gonorrhea? MARK (X) ONE Not at all A little A lot Don’t know 3.9. The next series of questions is about birth control pills. If birth control pills are used correctly, how much can they decrease the risk of pregnancy? MARK (X) ONE Not at all A little A lot Don’t know GO TO 3.10 3.9a. How confident are you that your answer is correct? MARK (X) ONE Not at all confident A little confident Somewhat confident Very confident 3.10. If birth control pills are used correctly, how much can they decrease the risk of getting HIV, the virus that causes AIDS? MARK (X) ONE Not at all A little A lot Don’t know 3.11. If birth control pills are used correctly, how much can they decrease the risk of getting Chlamydia and gonorrhea? MARK (X) ONE Not at all A little A lot Don’t know PPA Study – Part A – Wait Training 6/28/11 18 3.12. Can you get a sexually transmitted disease, or STD, from having oral sex? MARK (X) ONE Yes No Don’t know GO TO 3.13 3.12a. How confident are you that your answer is correct? MARK (X) ONE Not at all confident A little confident Somewhat confident Very confident 3.13. In the past 3 months, how many TIMES have you gone out on a date? Zero or None GO TO 3.15 NUMBER OF TIMES – Your best guess is fine. 3.14. Thinking about these dates in the past 3 months, how many DIFFERENT PEOPLE did you go out on a date with? NUMBER OF PEOPLE – Your best guess is fine. 3.15. Do you intend to have oral sex in the next year? MARK (X) ONE Yes, definitely Yes, probably No, probably not No, definitely not 3.16. Do you intend to have sexual intercourse in the next year? MARK (X) ONE Yes, definitely Yes, probably No, probably not No, definitely not GO TO 3.19 PPA Study – Part A – Wait Training 6/28/11 19 3.17. If you have sexual intercourse in the next year, do you intend to use a condom? MARK (X) ONE Yes, definitely Yes, probably No, probably not No, definitely not 3.18. The next question is about your intention to use other methods of birth control, NOT including condoms: • Birth control pills • The shot (Depo-Provera) • The patch • The ring (NuvaRing) • IUD (Mirena or Paragard) • Implants (Implanon) If you have sexual intercourse in the next year, do you intend to use any of these other methods of birth control? MARK (X) ONE Yes, definitely Yes, probably No, probably not No, definitely not PPA Study – Part A – Wait Training 6/28/11 20 3.19. Do you intend to have sexual intercourse without being married? MARK (X) ONE Yes, definitely Yes, probably No, probably not No, definitely not 3.20. Have you ever had sexual intercourse or oral sex? Yes GO TO PART B1 AND PUT THIS BOOKLET BACK IN THE ENVELOPE No GO TO PART B2 AND PUT THIS BOOKLET BACK IN THE ENVELOPE Complete the correct Part B B1 or B2, but not both. PPA Study – Part A – Wait Training 6/28/11 21 Put this booklet back in the envelope and go to the correct Part B. PPA Study – Part A – Wait Training 6/28/11 22 OMB Control No: Expiration Date: BASELINE QUESTIONNAIRE PART B1 LIVE THE LIFE Please be sure that you have the correct Part B. If you answered “Yes” to the last question of Part A, you have the correct version of Part B. If you answered “No,” please put this version back in your envelope and fill out Part B2 instead. Thank you. Mathematica Policy Research THE PAPERWORK REDUCTION ACT OF 1995 Public reporting burden for this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. PART B 4.1. The next questions are about your sexual behaviors and experiences. Please be as honest as possible. Your answers are confidential and everything you say will be kept private. Just to confirm, have you ever had sexual intercourse or oral sex? MARK (X) ONE No STOP AND GO TO PART B2. Yes CONTINUE WITH THIS BOOKLET. 4.2. The first questions are about sexual intercourse. By sexual intercourse, we mean a male putting his penis into a female’s vagina. Have you ever had sexual intercourse? MARK (X) ONE Yes No GO TO 4.14 4.3. The very first time you had sexual intercourse, what month and year was it? MARK (X) ONE MONTH AND ONE YEAR Month of First Sexual Intercourse Year of First Sexual Intercourse January 2011 February 2010 March 2009 April 2008 May 2007 June 2006 July 2005 August 2004 September 2003 October 2002 November 2001 December 2000 or earlier PPA Study – Part B – Wait Training 6/28/11 1 4.4. The very first time you had sexual intercourse, how old were you? NUMBER OF YEARS OLD YOU WERE – Your best guess is fine. 4.5. The very first time you had sexual intercourse, how old was your partner? MARK (X) ONE Three or more years younger than you A year or two younger than you The same age as you A year or two older than you Three or more years older than you 4.6. The very first time you had sexual intercourse, would you say that it was voluntary or not voluntary? MARK (X) ONE Voluntary Not voluntary 4.7. Birth control methods are something used to reduce the risk of pregnancy, and some can reduce the risk of sexually transmitted diseases, also known as STDs. The first time you had sexual intercourse, did you or your partner use any type of birth control— including condoms or any other method? MARK (X) ONE Yes No GO TO 4.9 4.8. The first time you had sexual intercourse, did you or your partner use… MARK (X) ONE FOR EACH YES NO a. Condoms?...................................................................................................................................................... b. Birth control pills or the patch? ...................................................................................................................... c. Depo-Provera or other injectable birth control? ............................................................................................. d. NuvaRing or the ring? .................................................................................................................................... e. Withdrawal or pulling out? ............................................................................................................................. f. Another method? PRINT OTHER METHOD USED PPA Study – Part B1 – Wait Training 6/28/11 ................................................................................... 2 4.9. Have you had sexual intercourse more than one time? MARK (X) ONE Yes No GO TO 4.14 4.10. How many DIFFERENT PEOPLE have you ever had sexual intercourse with, even if only one time? NUMBER OF PEOPLE – Your best guess is fine. 4.11. Now please think about the past 3 months. In the past 3 months, how many TIMES have you had sexual intercourse? None GO TO 4.14 NUMBER OF TIMES – Your best guess is fine. 4.12. In the past 3 months, how many TIMES have you had sexual intercourse without using a condom? None NUMBER OF TIMES – Your best guess is fine. 4.13. The next question is about your use of the following methods of birth control: • • • • • • • Condoms Birth control pills The shot (Depo-Provera) The patch The ring (NuvaRing) IUD (Mirena or Paragard) Implants (Implanon) In the past 3 months, how many TIMES have you had sexual intercourse without using any of these methods of birth control? None NUMBER OF TIMES – Your best guess is fine. PPA Study – Part B1 – Wait Training 6/28/11 3 4.14. Oral sex is when someone puts his or her mouth on another person’s penis or vagina, OR lets someone else put his or her mouth on their penis or vagina. Have you ever had oral sex? MARK (X) ONE Yes No GO TO 4.18 4.15. The very first time you had oral sex, what month and year was it? MARK (X) ONE MONTH AND MARK (X) ONE YEAR Month of First Oral Sex Year of First Oral Sex January 2011 February 2010 March 2009 April 2008 May 2007 June 2006 July 2005 August 2004 September 2003 October 2002 November 2001 December 2000 or earlier 4.16. How many DIFFERENT PEOPLE have you ever had oral sex with, even if only one time? NUMBER OF PEOPLE – Your best guess is fine. 4.17. Now please think about the past 3 months. In the past 3 months, how many TIMES have you had oral sex? None GO TO 4.18 NUMBER OF TIMES – Your best guess is fine. PPA Study – Part B1 – Wait Training 6/28/11 4 4.18. FOR GIRLS a. Have you ever had your period, that is, your menstrual period? MARK (X) ONE Yes No GO TO 4.19 b. How old were you when you had your first period, that is, your first menstrual period? NUMBER OF YEARS OLD YOU WERE – Your best guess is fine. 4.18. FOR BOYS a. People reach puberty at different ages. Signs of puberty for males include physical changes such as developing pubic or facial hair, or their voices cracking or lowering. Which of the following best describes these changes for you? MARK (X) ONE These changes have not yet started GO TO 4.19 These changes have barely started These changes are definitely underway These changes seem complete b. How old were you when these changes started? NUMBER OF YEARS OLD YOU WERE – Your best guess is fine. 4.19. FOR BOYS AND GIRLS a. To the best of your knowledge, have you ever been pregnant or gotten someone pregnant, even if no child was born? MARK (X) ONE Yes No GO TO 4.20 b. To the best of your knowledge, how many times have you been pregnant or gotten someone pregnant? NUMBER OF TIMES c. Have you ever had a baby or has anyone you got pregnant actually had the baby? MARK (X) ONE Yes No Don’t know PPA Study – Part B1 – Wait Training 6/28/11 5 4.20. In the past 12 months, have you spoken with a doctor or nurse about having sex, birth control or sexually transmitted diseases, also known as STDs? MARK (X) ONE Yes No 4.21. In the past 12 months, have you been tested by a doctor or nurse for a sexually transmitted disease (STD), like gonorrhea, Chlamydia, syphilis, or HIV? MARK (X) ONE Yes No 4.22. In the past 12 months, have you been told by a doctor or nurse that you had a sexually transmitted disease (STD)? MARK (X) ONE Yes No 4.23. Have you ever been in a situation where someone touched you in a sexual way that you did not want, or someone forced you to touch him or her in a sexual way that you did not want to? MARK (X) ONE Yes No PPA Study – Part B1 – Wait Training 6/28/11 6 SECTION 5: ALCOHOL AND DRUG USE 5.1. The next questions are about alcohol and drugs. Please be as honest as possible, and remember that everything you tell us will be kept private. Have you ever had an alcoholic drink, such as beer, wine or other liquor, NOT counting any times you just had a sip? MARK (X) ONE Yes No GO TO 5.5 5.2. The very first time you had an alcoholic drink, how old were you? NUMBER OF YEARS OLD YOU WERE – Your best guess is fine. 5.3. During the past 30 days, not including any times you just had a sip, on how many days did you have one or more alcoholic beverages? MARK (X) ONE More than 25 days 5 to 25 days 1 to 4 days 0 (zero) days 5.4. During the past 30 days, on how many days did you have 5 or more drinks in a row? MARK (X) ONE More than 25 days 5 to 25 days 1 to 4 days 0 (zero) days PPA Study – Part B1 – Wait Training 6/28/11 7 5.5. Have you ever used marijuana, also called weed or pot? MARK (X) ONE Yes No GO TO 5.7 5.6. During the past 30 days, on how many days did you use marijuana? MARK (X) ONE More than 25 days 5 to 25 days 1 to 4 days 0 (zero) days 5.7. Have you ever used any other type of illegal drug, for example, Methamphetamine, speed, PCP, ecstasy or any form of cocaine, such as crack? MARK (X) ONE Yes No PPA Study – Part B1 – Wait Training 6/28/11 8 SECTION 6: FRIENDS AND RELATIONSHIPS 6.1. How many of your friends who are your age think the following things? Your best guess is fine. MARK (X) ONE FOR EACH NONE SOME HALF MOST ALL DON’T KNOW a. Having sexual intercourse is a good thing for them to do at their age .............................................................................................................. b. It would be okay for them to have sexual intercourse as long as they used birth control, like a condom ..................................................................................................................... c. It would be okay for them to have sexual intercourse if they were dating the same person for a long time ........................................................................................................... d. They should wait until they are older to have sexual intercourse ............................................................................................................................... e. They should wait until marriage to have sexual intercourse ................................................................................................................................... f. It is more important to finish high school than to have sexual intercourse ....................................................................................................................... 6.2. How many of your friends who are your age have done the following things? MARK (X) ONE FOR EACH NONE SOME HALF MOST ALL DON’T KNOW a. Had sexual intercourse .................................................................................................................................... b. Had oral sex ..................................................................................................................................................... c. Have decided to delay having sexual intercourse until later in life..................................................................................................................................................................... 6.3. In general, how much pressure, if any, do you feel from your friends to have sexual intercourse? MARK (X) ONE A lot of pressure Some pressure A little pressure No pressure PPA Study – Part B1 – Wait Training 6/28/11 9 6.4. How much do you feel that your friends care about you? MARK (X) ONE Do not care at all Care a little bit Care somewhat Care very much Please put all three parts of the survey back into the envelope and give the envelope back to the moderator. Thank you! PPA Study – Part B1 – Wait Training 6/28/11 10 We thank you for completing this survey! PPA Study – Part B1 – Wait Training 6/28/11 11 OMB Control No: Expiration Date: BASELINE QUESTIONNAIRE PART B2 LIVE THE LIFE Please be sure that you have the correct Part B. If you answered “No” to the last question of Part A, you have the correct version of Part B. If you answered “Yes,” please put this version back in your envelope and fill out Part B1 instead. Thank you. Mathematica Policy Research THE PAPERWORK REDUCTION ACT OF 1995 Public reporting burden for this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. PART B 4.1. This booklet is for youth who have not had sex. We want to be sure you are in the correct booklet. We know we asked this before but… Just to confirm, have you ever had sexual intercourse or oral sex? MARK (X) ONE Yes STOP AND GO TO PART B1. No CONTINUE WITH THIS BOOKLET. 4.2. The first two questions in this booklet are about your schooling. Do you expect that you will graduate from high school? MARK (X) ONE Yes I already graduated from high school No GO TO 4.4 4.3. In what month and year do you expect to graduate from high school? (If you already graduated, in what month and year did you graduate from high school?) MARK (X) ONE MONTH AND ONE YEAR Month of Graduation Year of Graduation January 2018 or later February 2017 March 2016 April 2015 May 2014 June 2013 July 2012 August 2011 September 2010 October 2009 November 2008 December 2007 or earlier PPA Study – Part B – Wait Training 6/28/11 1 4.4. The next questions are about where you live. In the past 7 days, did you spend any nights somewhere like a shelter, someone else’s home, in a car, on the street or in any other temporary housing because you did not have a regular place to stay? MARK (X) ONE Yes GO TO 4.8 No 4.5. In how many homes, places, or households do you live: one, two, or three or more? MARK (X) ONE 1 home GO TO 4.8 2 homes 3 or more homes 4.6. Do you consider one of these homes to be your main home? MARK (X) ONE Yes No 4.7. Thinking about the past 30 days, how many nights did you spend in each home? FILL IN TWO OR THREE NUMBERS Number of nights at home #1 – Your best guess is fine. Number of nights at home #2 – Your best guess is fine. Number of nights at another home or other homes – Your best guess is fine. 4.8. These next few questions are about you and your friends. How strongly do you agree or disagree that you have friends who will give you good advice? MARK (X) ONE Strongly Agree Agree Disagree Strongly disagree PPA Study – Part B – Wait Training 6/28/11 2 4.9. How strongly do you agree or disagree that you have a friend who cares about you? MARK (X) ONE Strongly Agree Agree Disagree Strongly disagree 4.10. How strongly do you agree or disagree that you have a friend you can talk to when you need to? MARK (X) ONE Strongly Agree Agree Disagree Strongly disagree 4.11. How strongly do you agree or disagree that you have someone who you can call your best friend? MARK (X) ONE Strongly Agree Agree Disagree Strongly disagree 4.12. These next few questions are about you. How strongly do you agree or disagree that when you start a project, you finish it? MARK (X) ONE Strongly Agree Agree Disagree Strongly disagree 4.13. How strongly do you agree or disagree that you only work as hard as you have to? MARK (X) ONE Strongly Agree Agree Disagree Strongly disagree PPA Study – Part B1 – Wait Training 6/28/11 3 4.14. How strongly do you agree or disagree that you are someone people can count on? MARK (X) ONE Strongly Agree Agree Disagree Strongly disagree 4.15. How strongly do you agree or disagree that when you do work, you do a good job? MARK (X) ONE Strongly Agree Agree Disagree Strongly disagree 4.16. Here are some reasons people your age might choose NOT to have sexual intercourse. How important is each of these reasons to you? MARK (X) ONE FOR EACH QUESTION VERY IMPORTANT SOMEWHAT IMPORTANT NOT TOO IMPORTANT NOT AT ALL IMPORTANT a. I believe it is better for my long-term health and well-being .............................................................................................................................................. b. I don’t want to get a sexually transmitted disease, also known as an STD .................................................................................................................. c. I don’t want to disappoint my parents .......................................................................................................... d. I am too young to have sex.......................................................................................................................... e. My boyfriend or girlfriend doesn’t want to have sex................................................................................................................................................... f. I want to wait until I’m married ..................................................................................................................... g. It is against my personal values .................................................................................................................. h. I haven’t met the right person yet ................................................................................................................ i. I haven’t had the chance.............................................................................................................................. j. I don’t want to .............................................................................................................................................. k. FOR GIRLS I do not want to get pregnant .................................................................................................. l. FOR BOYS I do not want to get a girl pregnant .......................................................................................... PPA Study – Part B1 – Wait Training 6/28/11 4 4.17. FOR GIRLS a. Have you ever had your period, that is, a menstrual period? MARK (X) ONE Yes No GO TO 4.19 b. How old were you when you had your first period, that is, your first menstrual period? NUMBER OF YEARS OLD YOU WERE – Your best guess is fine. GO TO 4.19 4.18. FOR BOYS a. People reach puberty at different ages. Signs of puberty for males include physical changes such as developing pubic or facial hair, or their voices cracking or lowering. Which of the following best describes these changes for you? MARK (X) ONE These changes have not yet started GO TO 4.19 These changes have barely started These changes are definitely underway These changes seem complete b. How old were you when these changes started? NUMBER OF YEARS OLD YOU WERE – Your best guess is fine. 4.19. Have you ever kissed someone on the lips? MARK (X) ONE Yes No GO TO 4.21 4.20. Have you ever French kissed, that is put your tongue in someone’s mouth while kissing? MARK (X) ONE Yes No PPA Study – Part B1 – Wait Training 6/28/11 5 4.21. Have you ever touched another person’s private parts? MARK (X) ONE Yes No 4.22. Have you ever let someone touch your private parts? MARK (X) ONE Yes No 4.23. Have you ever been in a situation where someone touched you in a sexual way that you did not want, or someone forced you to touch him or her in a sexual way that you did not want to? MARK (X) ONE Yes No 4.24. If you decided to have sexual intercourse outside of marriage, how likely is it that you would use a condom or other method of birth control? MARK (X) ONE Don’t plan to have sexual intercourse outside of marriage Not at all likely A little bit likely Somewhat likely Very likely PPA Study – Part B1 – Wait Training 6/28/11 6 SECTION 5: ALCOHOL AND DRUG USE 5.1. The next questions are about alcohol and drugs. Please be as honest as possible, and remember that everything you tell us will be kept private. Have you ever had an alcoholic drink, such as beer, wine or other liquor, NOT counting any times you just had a sip? MARK (X) ONE Yes No GO TO 5.5 5.2. The very first time you had an alcoholic drink, how old were you? NUMBER OF YEARS OLD YOU WERE - Your best guess is fine. 5.3. During the past 30 days, not including any times you just had a sip, on how many days did you have one or more alcoholic beverages? MARK (X) ONE More than 25 days 5 to 25 days 1 to 4 days 0 (zero) days 5.4. During the past 30 days, on how many days did you have 5 or more drinks in a row? MARK (X) ONE More than 25 days 5 to 25 days 1 to 4 days 0 (zero) days PPA Study – Part B1 – Wait Training 6/28/11 7 5.5. Have you ever used marijuana, also called weed or pot? MARK (X) ONE Yes No GO TO 5.7 5.6. During the past 30 days, on how many days did you use marijuana? MARK (X) ONE More than 25 days 5 to 25 days 1 to 4 days 0 (zero) days 5.7. Have you ever used any other type of illegal drug, for example, Methamphetamine, speed, PCP, ecstasy or any form of cocaine, such as crack? MARK (X) ONE Yes No PPA Study – Part B1 – Wait Training 6/28/11 8 SECTION 6: FRIENDS AND RELATIONSHIPS 6.1. How many of your friends who are your age think the following things? Your best guess is fine. MARK (X) ONE FOR EACH NONE SOME HALF MOST ALL DON’T KNOW a. Having sexual intercourse is a good thing for them to do at their age ...................................................................................................................... b. It would be okay for them to have sexual intercourse as long as they used birth control, like a condom .................................................................................................................... c. It would be okay for them to have sexual intercourse if they were dating the same person for a long time ................................................................................................................................................................. d. They should wait until they are older to have sexual intercourse ..................................................................................................................... e. They should wait until marriage to have sexual intercourse .............................................................................................................................. f. It is more important to finish high school than to have sexual intercourse ...................................................................................................................... 6.2. How many of your friends who are your age have done the following things? MARK (X) ONE FOR EACH NONE SOME HALF MOST ALL DON’T KNOW a. Had sexual intercourse ................................................................................................................................... b. Had oral sex .................................................................................................................................................... c. Have decided to delay having sexual intercourse until later in life..................................................................................................................................................................... 6.3. In general, how much pressure, if any, do you feel from your friends to have sexual intercourse? MARK (X) ONE A lot of pressure Some pressure A little pressure No pressure PPA Study – Part B1 – Wait Training 6/28/11 9 6.4. How much do you feel that your friends care about you? MARK (X) ONE Do not care at all Care a little bit Care somewhat Care very much Please put all three parts of the survey back into the envelope and give the envelope back to the moderator. Thank you! PPA Study – Part B1 – Wait Training 6/28/11 10 We thank you for completing this survey! PPA Study – Part B1 – Wait Training 6/28/11 11
| File Type | application/pdf |
| File Title | Instrument 5 |
| Author | MThomas |
| File Modified | 2011-06-29 |
| File Created | 2011-06-29 |