APPENDIX A.2: Youth Survey- 36m
HTE 36-MONTH RHODE ISLAND
YOUTH SURVEY
INSTRUCTIONS AND PRACTICE ITEMS
INTRO1. Hello! During this interview you will hear questions over the headphones, and also see them on the computer screen, just as you are seeing and hearing this message now. You will be asked to answer each question by typing in the number of the answer that best expresses how you feel. After you type your answer, press the “Enter” key. To help you find this key, it has a green sticker on it. When you press “Enter,” you’ll go to the next question.
We’re going to ask a few questions for practice to see how this works. The interviewer will assist you if you need help. But, please be assured that the interviewer will never see your answers once the real interview begins.
The first practice question is:
Do you like chocolate?
1 Yes
2 No
Press the “Enter” key with the green dot to go to the next question.
INTRO2. Good! For the second practice question, please select the number that most closely matches your feeling or opinion. The question is:
How often do you eat ice cream?
1 Never
2 Rarely
3 Sometimes
4 Very often
Press the “Enter” key with the green dot to go to the next question.
INTRO3. Great! The next type of question asks you to specify an amount, for example, how many days something happened. Sometimes you have to press more than one key to answer the question. This is OK. Just remember to press “Enter” after you type in your answer.
The third practice question is:
How many months are in a year? There are 12 months in a year, so press “12” – that is, “1” than “2.” Then press “Enter” when you are done.
INTRO4a. Very good! Some of the questions will have 2 parts. You’ll need to remember the first part of the question to answer the second part. Let’s do a practice question like this. I’m going to read you 2 sentences describing 2 different kinds of kids. Think about which one describes you best.
Some kids like to go swimming
BUT
Other kids don’t like to go swimming.
Are you more like the first kids or the second kids?
1 First
2 Second
Press the “Enter” key with the green dot to go to the next question.
INTRO4b. Now, the second part of the question…
Are you sort of like those kids or really like those kids?
1 Sort of like those kids
2 Really like those kids
Press the “Enter” key with the green dot to go to the next question.
INTRO5. Good! Next, we’ll do just a couple other things, then you’ll be ready to get started.
If you want to hear an item repeated, simply wait. The computer will read it to you again. If you want to go to the next question without answering, press the key with the letter F and the number 10 on it. This F10 key is located in the top row and has a yellow sticker on it.
Please locate and press the F10 key now. If you cannot find it, please ask the interviewer to help you. After you press F10, press the “Enter” key to continue.
INTRO6. Everyone hits the wrong key at times. If this happens, an Error Message Box will pop up. To make it go away, press the “Enter” key with the green dot. Then re-enter your answer, making sure to pick one that’s listed.
Let’s see how this works.
For the next question, we’re going to press the wrong key on purpose so the Error Message Box will pop up. Then, we’ll fix it. Let’s say I asked you, “Are you wearing black shoes?” then instructed you to pres “1” for “Yes” and “2” for “No.”
Remember, after you see the Error Message Box, you have to press the “Enter” key with the green dot to make it go away. To see an Error Message Box, press any number other than 1 or 2. After the Error Message Box goes away, press the correct answer for you.
Press the “Enter” key with the green dot to go to the next question.
INTRO7. One more thing…
You do not have to listen to the entire recording before you answer the question. When you put in your answer and press the “Enter” key, you’ll go to the next question and the recording for that question will start.
If you want to read the questions and answers on your own, you can work at your own speed.
Congratulations! You are ready to begin the interview. Please press “1” to begin.
SECTION JJ: ACADEMICS
JJ1. OMITTED
JJ1a. Are you Hispanic or Latino?
1 YES
2 NO
JJ1b. Which of the following best describes your race? Please select one or more.
1 American Indian or Alaska Native
2 Asian
3 Black or African American
4 Native Hawaiian or Other Pacific Islander
5 White
9 NA
JJ2. Are you going to school this year? If it is in the summer, did you go to school last year?
1 YES
2 NO
9 NA
JJ3a. Are you being home-schooled this year? If it is summer, were you home-schooled last year?
1 YES
2 NO
9 NA
JJ3. CATI: ASK IF JJ2 = 1 OR JJ3a = 1, ELSE GO TO JJ4.M.
What grade or level are you in? If it is the summer, what grade were you in?
_______
GRADE
99 NA – No Answer
CATI: GO TO JJ6.INTRO
JJ4.M. What month did you last attend school?
01 JANUARY
02 FEBRUARY
03 MARCH
04 APRIL
05 MAY
06 JUNE
07 JULY
08 AUGUST
09 SEPTEMBER
10 OCTOBER
11 NOVEMBER
12 DECEMBER
99 NA – No Answer
JJ4.Y. What year was that?
__ __ __ __
YEAR
9999 NA – No Answer
JJ5. Why are you not in school?
1 You dropped out
2 You were expelled
3 You graduated
4 Some other reason
9 NA – No Answer
CATI: GO TO KK.INTRO.
JJ6.INTRO
How well do you think you are doing in your school work this year? If you are answering these questions in the summer, think back to the school year that you last completed. Your answer choices are: not well at all, below average, average, well, or very well.
How did you do in: |
Not well at all |
Below Average |
Average |
Well |
Very |
NA (DON’T READ) |
JJ6a. English?
|
1 |
2 |
3 |
4 |
5 |
9 |
JJ6b. Mathematics?
|
1 |
2 |
3 |
4 |
5 |
9 |
JJ6c. Science?
|
1 |
2 |
3 |
4 |
5 |
9 |
JJ6d. All your subjects,
|
1 |
2 |
3 |
4 |
5 |
9 |
SECTION KK: SOCIAL SKILLS
KK.INTRO
These next questions list a lot of things that people your age may do. As you read each sentence, please think about yourself and decide how often you do the behavior described.
CATI: FOR KK 1 – KK 39 USE THIS SETUP:
a. READ ITEM,
Press “1” if you never do this.
Press “2” if you sometimes do this.
Press “3” if you do this very often.
RE-READ ITEM.
USE 9 FOR NA ON ALL ITEMS. IF NA TO “a”, GO TO NEXT “a.”
|
a. How Often? |
||
Never |
Some- times |
Very Often |
|
KK7. How often do you ignore other children when they tease you or call you names? |
1 |
2 |
3 |
KK10. How often do you disagree with adults without fighting or arguing? |
1 |
2 |
3 |
KK11. How often do you avoid doing things with others that may get you in trouble with adults? |
1 |
2 |
3 |
KK15. How often do you do nice things for your parents like helping with household chores without being asked? |
1 |
2 |
3 |
KK18. How often do you compromise with parents or teachers when you have disagreements? |
1 |
2 |
3 |
KK19. How often do you ignore classmates who are clowning around in class. CATI: SKIP IF JJ3a =1. |
1 |
2 |
3 |
KK22. How often do you end fights with your parents calmly? |
1 |
2 |
3 |
KK32. How often do you control your temper when people are angry with you? |
1 |
2 |
3 |
KK34. How often do you take corrections given by your parents without getting angry? |
1 |
2 |
3 |
SECTION LL: SELF-ESTEEM
LL1-LL6. OMITTED
Now we have some questions about what you are like. There are two sentences describing two different kinds of kids. Think about which one describes you best.
CAPI: PRESENT EACH PAIR AND ASK:
a. “Are you more like the first kids or the second kids.”
1 First
2 Second
9 NA – No Answer
THEN ASK
b. “Are you sort of like those kids or really like those kids?”
1 Sort of like those kids?
2 Really like those kids?
9 NA – No Answer
USE 9 FOR ALL NA. IF ITEM “a” = 9, GO TO NEXT “a”
LL8. OMITTED
LL9. Some kids feel that they BUT Other kids worry about whether
are very good at their they can do the school work
school work assigned to them.
LL10. Some kids are happy BUT Other kids are not happy
with the way they look with they way they look.
LL11. OMITTED
LL12. Some kids feel that they BUT Other kids aren’t so sure
are just as smart as and wonder if they are
other kids their age as smart.
LL13. Some kids are happy BUT Other kids wish their
with their height and height and weight were
weight different.
LL14. OMITTED
LL15. Some kids are pretty BUT Other kids can do their
slow in finishing their school work quickly.
school work
LL16. Some kids wish their BUT Other kids like their
body was different body the way it is.
LL17. OMITTED
LL18. Some kids often forget BUT Other kids can
what they learn remember things easily.
LL19. Some kids wish their BUT Other kids like their
physical appearance (how physical appearance the
they look) was different way it is.
LL20. OMITTED
LL21. Some kids do very well BUT Other kids don’t do
at their classwork very well at their classwork.
LL22. Some kids wish BUT Other kids like their face
something about their and hair the way they are.
face or hair looked different
LL23. Some kids are very BUT Other kids wish they
happy being the way were different.
they are
LL24. Some kids have trouble BUT Other kids almost
figuring out the answers always can figure out
in school the answers.
LL25. Some kids think that BUT Other kids think that they
they are good looking are not very good looking.
LL26. OMITTED
SECTION MM: PARENT-CHILD RELATIONSHIP
MM.INTRO
Okay, now we have some questions about your life at home, especially with your mother, or the person who acts as your mother now. Think about how true, in general, the following statements are about your relationship with her. Your answer choices are: Not at all true, hardly ever true, sometimes true, true most of the time or always true.
Your mother is what you think a perfect mother should be.
Not at all true
Hardly ever true
Sometimes true
True most of the time
Always true
9 NA – No Answer
You have to keep quiet or leave the house to keep peace at home.
Not at all true
Hardly ever true
Sometimes true
True most of the time
Always true
9 NA – No Answer
Your mother tries to understand your problems and worries.
Not at all true
Hardly ever true
Sometimes true
True most of the time
Always true
9 NA – No Answer
Your mother spends a lot of time talking about things with you.
Not at all true
Hardly ever true
Sometimes true
True most of the time
Always true
9 NA – No Answer
You are happy when you are at home.
Not at all true
Hardly ever true
Sometimes true
True most of the time
Always true
9 NA – No Answer
You talk over important plans with your mother.
Not at all true
Hardly ever true
Sometimes true
True most of the time
Always true
9 NA – No Answer
You often have good times at home with your mother.
Not at all true
Hardly ever true
Sometimes true
True most of the time
Always true
9 NA – No Answer
You and your mother think very differently about a lot of things.
Not at all true
Hardly ever true
Sometimes true
True most of the time
Always true
9 NA – No Answer
You feel that your mother is proud of you.
Not at all true
Hardly ever true
Sometimes true
True most of the time
Always true
9 NA – No Answer
Your mother usually treats you fairly.
Not at all true
Hardly ever true
Sometimes true
True most of the time
Always true
9 NA – No Answer
You feel close to your mother.
Not at all true
Hardly ever true
Sometimes true
True most of the time
Always true
9 NA – No Answer
Your mother nags at you.
Not at all true
Hardly ever true
Sometimes true
True most of the time
Always true
9 NA – No Answer
You know that your mother is your friend.
Not at all true
Hardly ever true
Sometimes true
True most of the time
Always true
9 NA – No Answer
It is hard for you to be pleasant and happy when your mother is around.
Not at all true
Hardly ever true
Sometimes true
True most of the time
Always true
9 NA – No Answer
Your mother tells other people things about you that you think should not be mentioned.
Not at all true
Hardly ever true
Sometimes true
True most of the time
Always true
9 NA – No Answer
There is real love and affection for you at home.
Not at all true
Hardly ever true
Sometimes true
True most of the time
Always true
9 NA – No Answer
OMITTED.
Now we’d like to ask you a couple of questions about the time you spend with your mother.
Does she spend enough time with you?
Not enough time, but you don’t want more
Not enough time. You wish she spent more time with you
She spends enough time with you
9 NA
How often do you fight with her?
Never
Hardly ever
Sometimes
Often
9 NA
Now we’re going to read a number of statements describing the way different parents act towards their children. Please answer these questions about your mother with whom you live, or the person who acts as your mother now, by saying whether you agree or disagree with them.
Remember, there is no right or wrong answer to any statements so be as honest as you can. Respond to each statement the way you feel your mother really is, rather than the way you might like her to be. Your answer choices are strongly agree, agree, disagree, or strongly disagree.
|
Strongly Agree |
Agree |
Disagree |
Strongly Disagree |
NA |
MM21. You can count on your mother to help you out, if you have some kind of problem. |
1 |
2 |
3 |
4 |
9 |
MM22. Your mother says that you shouldn’t argue with adults. |
1 |
2 |
3 |
4 |
9 |
MM23. Your mother keeps pushing you to do your best in whatever you do. |
1 |
2 |
3 |
4 |
9 |
MM24. Your mother says that you should give in on arguments rather than make people angry. |
1 |
2 |
3 |
4 |
9 |
MM25. Your mother keeps pushing you to think on your own. |
1 |
2 |
3 |
4 |
9 |
MM26. When you get a poor grade in school, your mother makes your life miserable. |
1 |
2 |
3 |
4 |
9 |
MM27. Your mother helps you with your school work if there is something you don’t understand. |
1 |
2 |
3 |
4 |
9 |
MM28. Your mother tells you that her ideas are correct and that you should not question them. |
1 |
2 |
3 |
4 |
9 |
MM29. When your mother wants you to do something she tells you why. |
1 |
2 |
3 |
4 |
9 |
MM30. Whenever you argue with your mother, she says things like, “You’ll know better when you grow up.” |
1 |
2 |
3 |
4 |
9 |
|
Strongly Agree |
Agree |
Disagree |
Strongly Disagree |
NA |
MM31. When you get a poor grade in school, your mother encourages you to try harder. |
1 |
2 |
3 |
4 |
9 |
MM32. Your mother lets you make your own plans for things you want to do. |
1 |
2 |
3 |
4 |
9 |
MM33. Your mother knows who your friends are.
|
1 |
2 |
3 |
4 |
9 |
MM34. Your mother acts cold and unfriendly if you do something she doesn’t like. |
1 |
2 |
3 |
4 |
9 |
MM35. Your mother spends time just talking with you.
|
1 |
2 |
3 |
4 |
9 |
MM36. When you get a poor grade in school, your mother makes you feel guilty. |
1 |
2 |
3 |
4 |
9 |
MM37. Your mother and you do fun things together.
|
1 |
2 |
3 |
4 |
9 |
MM38. Your mother won’t let you do things with her when you do something she doesn’t like. |
1 |
2 |
3 |
4 |
9 |
MM39. Now please answer some questions about how much you think your mother, or the person who acts as your mother now, might know about various activities you may do. Your answer choices are never, rarely, sometimes, often or always.
MM40. Does your mother know what you do after school or during your free time?
1 Never
2 Rarely
3 Sometimes
4 Often
5 Always
9 NA – No Answer
MM41. Does your mother know who you have as friends?
1 Never
2 Rarely
3 Sometimes
4 Often
5 Always
9 NA – No Answer
MM42. Does your mother know where you go when you are out at night?
1 Never
2 Rarely
3 Sometimes
4 Often
5 Always
9 NA – No Answer
MM43. Does your mother usually know about things at school, like what type of homework you have or how you are doing in different subjects?
1 Never
2 Rarely
3 Sometimes
4 Often
5 Always
9 NA – No Answer
MM44-MM48. OMITTED
MM49. On average, how much time do you spend after school each day at home with no adult there?
1 None, never happens
2 Less than 1 hour
3 1-2 hours
4 2-3 hours
5 More than 3 hours
9 NA – No Answer
MM50. On average, how much time do you spend after school each day with your mom?
0 0 hours
1 1-2 hours
2 2-4 hours
3 4-6 hours
4 6 hours or more
9 NA – No Answer
MM51. On average, how much time do you spend on a weekend day with your mom?
0 0 hours
1 1-2 hours
2 2-4 hours
3 4-6 hours
4 6-8 hours
5 8 hours or more
9 NA – No Answer
SECTION NN: MENTAL HEALTH
NN.INTRO
Different kids feel different ways at certain times. These next questions are about how you might have been feeling or acting recently. For each question, please check how much you have felt or acted this way in the past two weeks.
If a sentence was not true about you, pick NOT TRUE.
If it was only sometimes true, pick SOMETIMES.
If a sentence was true about you most of the time, pick TRUE.
|
Not True |
Some-times |
True |
NA |
NN1. You felt miserable or unhappy.
|
1 |
2 |
3 |
9 |
NN2. You didn’t enjoy anything at all.
|
1 |
2 |
3 |
9 |
NN3. You were less hungry than usual.
|
1 |
2 |
3 |
9 |
NN4. You ate more than usual.
|
1 |
2 |
3 |
9 |
NN5. You felt so tired you just sat around and did nothing.
|
1 |
2 |
3 |
9 |
NN6. You were moving and walking more slowly than usual.
|
1 |
2 |
3 |
9 |
NN7. You were very restless, had trouble sitting still.
|
1 |
2 |
3 |
9 |
NN8. You felt you were no good anymore.
|
1 |
2 |
3 |
9 |
NN9. You blamed yourself for things that weren’t your fault.
|
1 |
2 |
3 |
9 |
NN10. It was hard for you to make up your mind.
|
1 |
2 |
3 |
9 |
NN11. You felt upset or mad with your parents.
|
1 |
2 |
3 |
9 |
NN12. You felt like talking less than usual.
|
1 |
2 |
3 |
9 |
NN13. You were talking more slowly than usual.
|
1 |
2 |
3 |
9 |
NN14. You cried a lot.
|
1 |
2 |
3 |
9 |
NN15. You thought there was nothing good for you in the future.
|
1 |
2 |
3 |
9 |
NN16. You thought that life wasn’t worth living.
|
1 |
2 |
3 |
9 |
NN17. You thought about death and dying.
|
1 |
2 |
3 |
9 |
NN18. You thought your family would be better off without you.
|
1 |
2 |
3 |
9 |
|
Not True |
Some-times |
True |
NA |
NN19. You thought about killing yourself.
|
1 |
2 |
3 |
9 |
NN20. You didn’t want to see your friends.
|
1 |
2 |
3 |
9 |
NN21. You found it hard to think properly or concentrate.
|
1 |
2 |
3 |
9 |
NN22. You thought bad things would happen to you.
|
1 |
2 |
3 |
9 |
NN23. You hated yourself.
|
1 |
2 |
3 |
9 |
NN24. You felt you were a bad person.
|
1 |
2 |
3 |
9 |
NN25. You thought you looked ugly.
|
1 |
2 |
3 |
9 |
NN26. You worried about aches and pains.
|
1 |
2 |
3 |
9 |
NN27. You felt lonely.
|
1 |
2 |
3 |
9 |
NN28. You thought nobody really loved you.
|
1 |
2 |
3 |
9 |
NN29. You didn’t have any fun at school.
|
1 |
2 |
3 |
9 |
NN30. You thought you could never be as good as other kids.
|
1 |
2 |
3 |
9 |
NN31. You did everything wrong.
|
1 |
2 |
3 |
9 |
NN32. You didn’t sleep as well as you usually sleep.
|
1 |
2 |
3 |
9 |
NN33. You slept a lot more than usual.
|
1 |
2 |
3 |
9 |
NN34. Here are some more questions. Your answer choices are now: Never true, Hardly ever true, Sometimes true, True most of the time, or Always true.
NN35. It’s easy for you to make new friends.
1 Never true
2 Hardly ever true
3 Sometimes true
4 True most of the time
5 Always true
9 NA – No Answer
NN36. You have no one to talk to.
1 Never true
2 Hardly ever true
3 Sometimes true
4 True most of the time
5 Always true
9 NA – No Answer
NN37. You are good at working with other kids.
1 Never true
2 Hardly ever true
3 Sometimes true
4 True most of the time
5 Always true
9 NA – No Answer
NN38. It’s hard for you to make friends.
1 Never true
2 Hardly ever true
3 Sometimes true
4 True most of the time
5 Always true
9 NA – No Answer
NN39. You have lots of friends.
1 Never true
2 Hardly ever true
3 Sometimes true
4 True most of the time
5 Always true
9 NA – No Answer
NN40. You feel alone.
1 Never true
2 Hardly ever true
3 Sometimes true
4 True most of the time
5 Always true
9 NA – No Answer
NN41. You can find a friend when you need one.
1 Never true
2 Hardly ever true
3 Sometimes true
4 True most of the time
5 Always true
9 NA – No Answer
NN42. It’s hard to get other kids to like you.
1 Never true
2 Hardly ever true
3 Sometimes true
4 True most of the time
5 Always true
9 NA – No Answer
NN43. You don’t have kids to do things with.
1 Never true
2 Hardly ever true
3 Sometimes true
4 True most of the time
5 Always true
9 NA – No Answer
NN44. You get along with other kids.
1 Never true
2 Hardly ever true
3 Sometimes true
4 True most of the time
5 Always true
9 NA – No Answer
NN45. You feel left out of things.
1 Never true
2 Hardly ever true
3 Sometimes true
4 True most of the time
5 Always true
9 NA – No Answer
NN46. There are no kids you can go to when you need help.
1 Never true
2 Hardly ever true
3 Sometimes true
4 True most of the time
5 Always true
9 NA – No Answer
NN47. You don’t get along with other kids.
1 Never true
2 Hardly ever true
3 Sometimes true
4 True most of the time
5 Always true
9 NA – No Answer
NN48. You are lonely.
1 Never true
2 Hardly ever true
3 Sometimes true
4 True most of the time
5 Always true
9 NA – No Answer
NN49. You are well liked by other kids.
1 Never true
2 Hardly ever true
3 Sometimes true
4 True most of the time
5 Always true
9 NA – No Answer
NN50. You don’t have any friends.
1 Never true
2 Hardly ever true
3 Sometimes true
4 True most of the time
5 Always true
9 NA – No Answer
NN51. You worry a lot of the time.
1 Never true
2 Hardly ever true
3 Sometimes true
4 True most of the time
5 Always true
9 NA – No Answer
NN52. You are afraid of a lot of things.
1 Never true
2 Hardly ever true
3 Sometimes true
4 True most of the time
5 Always true
9 NA – No Answer
NN53. You are tired a lot.
1 Never true
2 Hardly ever true
3 Sometimes true
4 True most of the time
5 Always true
9 NA – No Answer
NN54. You have trouble going to sleep at night.
1 Never true
2 Hardly ever true
3 Sometimes true
4 True most of the time
5 Always true
9 NA – No Answer
NN55. Other children are happier than you are.
1 Never true
2 Hardly ever true
3 Sometimes true
4 True most of the time
5 Always true
9 NA – No Answer
NN56. You wake up scared some of the time.
1 Never true
2 Hardly ever true
3 Sometimes true
4 True most of the time
5 Always true
9 NA – No Answer
NN57. Now we’re going to ask some questions about how you feel. Your answer choices are never, rarely, sometimes, most of the time, and all of the time.
NN58. How often do you worry when you go to bed at night?
1 Never
2 Rarely
3 Sometimes
4 Most of the time
5 All of the time
9 NA – No Answer
NN59. How often do you feel nervous?
1 Never
2 Rarely
3 Sometimes
4 Most of the time
5 All of the time
9 NA – No Answer
NN60. How often do you have trouble making up your mind?
1 Never
2 Rarely
3 Sometimes
4 Most of the time
5 All of the time
9 NA – No Answer
NN61. How often do you find it hard to keep your mind on your school work?
1 Never
2 Rarely
3 Sometimes
4 Most of the time
5 All of the time
9 NA – No Answer
NN62. How often do you have trouble remembering things?
1 Never
2 Rarely
3 Sometimes
4 Most of the time
5 All of the time
9 NA – No Answer
NN63. How often do others seem to do things easier than you can?
1 Never
2 Rarely
3 Sometimes
4 Most of the time
5 All of the time
9 NA – No Answer
NN64. How often do you have bad dreams?
1 Never
2 Rarely
3 Sometimes
4 Most of the time
5 All of the time
9 NA – No Answer
NN65. For these next questions, pick the one statement that describes you best during the last two weeks.
CAPI: FOR NN66 – NN75.
Which of these best describes you during the last two weeks?
READ ALL 3 STATEMENTS
Press “1” If you: RE-READ STATEMENT 1.
Press “2” If you: RE-READ STATEMENT 2.
Press “3” If you: RE-READ STATEMENT 3.
NN66.
|
|
NN67.
|
|
NN68.
|
|
NN69.
|
|
NN70.
|
|
NN71.
|
|
NN72.
|
|
NN73.
|
|
NN74.
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SECTION OO: RISKY BEHAVIOR
OO.INTRO
Some kids have started using cigarettes or drinking alcohol, while others have not. Please answer the following questions as honestly as you can. Your answers will be kept confidential. This means they are private, and will not be shared with anyone.
OO-1. Have you ever smoked a cigarette?
1 YES
2 NO (GO TO OO-3a)
9 NA (GO TO OO-3a)
OO-2. During the past month, how often have you smoked cigarettes?
1 Not at all (GO TO OO-3)
2 Only a few times (GO TO OO-3)
3 1 or 2 times a week (GO TO OO-3)
4 Several times a week or more
9 NA – No Answer (GO TO OO-3)
OO-2a. On average, how many cigarettes do you smoke a day?
______ CIGARETTES
99 NA – No Answer
OO-3. How old were you when you smoked a whole cigarette for the first time?
______ YEARS
99 NA – No Answer
OO-3a. Do you regularly use any other form of nicotine, such as cigars, chewing tobacco or snuff?
1 YES
2 NO (GO TO OO-4)
9 NA (GO TO OO-4)
OO-3b. During the past month, how often have you used any other form of nicotine?
1 Not at all (GO TO OO-4)
2 Only a few times (GO TO OO-4)
3 1 or 2 times a week (GO TO OO-4)
4 Several times a week or more
9 NA – No Answer (GO TO OO-4)
OO-3c. On average, how many times a day do you use any other form of nicotine?
______ TIMES A DAY
99 NA – No Answer
OO-4. Have you ever had a drink of an alcohol beverage like beer, wine, or liquor, other than just sips?
1 YES
2 NO (GO TO OO-7)
9 NA (GO TO OO-7)
OO-5. How often do you drink alcohol, like beer, wine or liquor?
1 Only a few times ever
2 1 or 2 times a month
3 Several times a month or more
9 NA – No Answer
OO-6. How old were you when you had your first drink of alcohol, other than just sips?
______ YEARS
99 NA – No Answer
OO-7. Do any of your friends drink alcohol like beer, wine or liquor?
1 YES
2 NO (GO TO OO-9.INTRO)
9 NA (GO TO OO-9.INTRO)
OO-8. How many of your friends drink alcohol like beer, wine or liquor?
1 A few
2 Some
3 Most
9 NA – No Answer
OO-9.INTRO
Many teenagers today are beginning to use street drugs such as marijuana, and other hard drugs, while others are not. In order for us to understand more about this, it would be helpful to learn about your use of those drugs.
OO-9. Have you ever used marijuana, pot, grass, or hash?
1 YES
2 NO (GO TO OO-12)
9 NA (GO TO OO-12)
OO-10. How often do you use marijuana?
1 Only a few times ever
2 1 or 2 times a month
3 Several times a month or more
9 NA
OO-11. How old were you when tried marijuana for the first time?
______ YEARS
99 NA
OO-12. Have any of your friends tried marijuana?
1 YES
2 NO (GO TO OO-14)
9 NA (GO TO OO-14)
OO-13. How many of your friends have tried marijuana?
1 A few
2 Some
3 Most
9 NA – No Answer
OO-14. Have you ever tried other hard drugs, like ecstasy, cocaine, crack, snow, LSD, uppers, or downers—even just once?
1 YES
2 NO (GO TO OO-17)
9 NA (GO TO OO-17)
OO-15. How often do you use hard drugs?
1 Only a few times ever
2 1 or 2 times a month
3 Several times a month or more
9 NA
OO-16. How old were you when you first tried hard drugs?
______ YEARS
99 NA
OO-17. Have any of your friends tried hard drugs?
1 YES
2 NO (GO TO PP3)
9 NA (GO TO PP3)
OO-18. How many of your friends have tried hard drugs?
1 A few
2 Some
3 Most
9 NA – No Answer
SECTION PP: HEALTH
PP1. Does you have asthma or asthmatic conditions (like wheezing or trouble breathing)?
1 YES
2 NO (GO TO PP17)
7 DON’T KNOW (GO TO PP17)
8 REFUSED (GO TO PP17)
INTRO PP2. I’d like to ask you about things you may have done to manage your asthma at home during the past 12 months. For each item, please tell me how often you did these things: all of the time, fairly often, not too often, or never. Try to answer as best as you can.
PP2. How often did you take asthma prescription medicine when you were having symptoms or trouble breathing?
NEVER
NOT TOO OFTEN
FAIRLY OFTEN
ALL THE TIME
DON’T KNOW
REFUSED
PP3. How often did you find ways to keep yourself calm when you were having symptoms?
NEVER
NOT TOO OFTEN
FAIRLY OFTEN
ALL THE TIME
DON’T KNOW
REFUSED
PP4. How often did you try to rest or do quiet activities when you were having symptoms?
NEVER
NOT TOO OFTEN
FAIRLY OFTEN
ALL THE TIME
DON’T KNOW
REFUSED
PP5. How often did you separate yourself from what caused the symptoms?
NEVER
NOT TOO OFTEN
FAIRLY OFTEN
ALL THE TIME
DON’T KNOW
REFUSED
PP6. How often did you ask someone for help or advice about how to manage you asthma?
NEVER
NOT TOO OFTEN
FAIRLY OFTEN
ALL THE TIME
DON’T KNOW
REFUSED
PP7. How often did you take asthma medicines before you had contact with something that might cause wheezing or coughing, for example, before entering a smoky restaurant or before you played sports?
NEVER
NOT TOO OFTEN
FAIRLY OFTEN
ALL THE TIME
DON’T KNOW
REFUSED
INTRO PP8. Now I would like to find out about all medicines prescribed by a doctor that you take for his/her asthma.
PP8. In the past 12 months, have you taken any medicines prescribed by a doctor for asthma?
YES
NO (GO TO DDXX)
PP9. What is the name of the medicine, if you know it? ____________________________________________
PP10. How is this medicine taken?
INHALER
NEBULIZER
NASAL SPRAY
ORAL (PILL/SYRUP)
PP11. How many days in the past 14 days did you take this medicine?
___________ # OF DAYS
99 NO LONGER USE MEDICINE
PP12. How many times each day did you take this medicine?
___________ # OF TIMES/DAY
AS NEEDED
DON’T KNOW
PP13. Do you use this medicine only at home, only at school, or both?
HOME ONLY
SCHOOL ONLY
BOTH
DON’T KNOW
PP14. Is this medicine mainly used to relieve symptoms as needed OR taken every day to control symptoms and prevent attacks?
RELIEVE SYMPTOMS
CONTROL ASTHMA AND PREVENT SYMPTOMS
OTHER (SPECIFY:______________________________________________)
DON’T KNOW
PP15. Does you use another form of medicine for their asthma or asthma symptoms?
YES (ASK PP9- PP14 FOR NEXT MEDICINE)
NO
PP16. What things seem to make your asthma worse (i.e. mold, pollen, smoke, pets, etc).
____________________________________________________________________
PP17. Are you a girl or a boy?
1 Girl
2 Boy
9 NA (GO TO PP31a)
PP17a. About how tall are you?
IF R REPORTS FRACTIONS OF A FOOT, USE DECIMAL.
IF MORE THAN WHOLE INCH REPORTED, ROUND TO NEAREST WHOLE
INCH.
__. __ __ __ __
FT INCHES
97 DON’T KNOW
98 REFUSED
PP17b. About how much do you weigh in pounds?
IF MORE THAN WHOLE POUND, ROUND UP.
_____ # POUNDS
997 DON’T KNOW
998 REFUSED
PP18. It is normal for children’s bodies to change as they grow. These changes happen at different times for different children. As you answer each question, please pick the answer that best describes what is happening to you. Please choose only ONE answer for each question.
CAPI: IF PP17 = 2, GO TO PP26
PP19. Have you grown taller in the last 6 months?
1 No
2 Yes, a little
3 Yes, some
4 Yes, a lot
9 NA
PP20. Do you have body hair yet, underarm, or pubic hair in your private area?
1 No
2 Yes, a little
3 Yes, some
4 Yes, a lot
9 NA
PP21. Has your skin started to change, especially pimples?
1 No
2 Yes, a little
3 Yes, some
4 Yes, a lot
9 NA
PP22. Have your breasts begun to grow?
1 No
2 Yes, a little
3 Yes, some
4 Yes, a lot
9 NA
PP23. Do you think these changes to your body are happening any earlier or later than most other girls your age?
1 Much earlier
2 Somewhat earlier
3 About the same
4 Somewhat later
5 Much later
9 NA
PP24. Have you gotten your first period yet?
1 Yes
2 No (GO TO PP31a)
9 NA (GO TO PP31a)
PP25.Y How old were you when you got your first period in years and months? First tell me years.
_______ YEARS
99 NA YEARS
PP25.M And how many months?
_______ MONTHS
99 NA MONTHS
CAPI: IF PP17 = 1, GO TO PP31a.
PP26. Have you grown taller in the last 6 months?
1 No
2 Yes, a little
3 Yes, some
4 Yes, a lot
9 NA
PP27. Do you have body hair yet, underarm, or pubic hair in your private area?
1 No
2 Yes, a little
3 Yes, some
4 Yes, a lot
9 NA
PP28. Has your skin started to change, especially pimples?
1 No
2 Yes, a little
3 Yes, some
4 Yes, a lot
9 NA
PP29. Has your voice become deeper?
1 No
2 Yes, a little
3 Yes, some
4 Yes, a lot
9 NA
PP30. Have you started to grow hair on your face?
1 No
2 Yes, a little
3 Yes, some
4 Yes, a lot
9 NA
PP31. Do you think these changes to your body are happening any earlier or later than most other boys your age?
1 Much earlier
2 Somewhat earlier
3 About the same
4 Somewhat later
5 Much later
9 NA
PP31a. Do you regularly take any form of caffeine such as coffee, tea, caffeinated sodas like cola, or caffeine pills?
1 YES
2 NO (GO TO PP32)
9 NA (GO TO PP32)
PP31b. In the past month, how often have you taken any form of caffeine?
1 Not at all (GO TO PP32)
2 Only a few times (GO TO PP32)
3 1 or 2 times a week (GO TO PP32)
4 Several times a week or more
9 NA – No Answer (GO TO PP32)
PP31c. On average, how many times a day do you take any form of caffeine? If you don’t take in caffeine every day, record an average amount for the days you do take in caffeine.
______ TIMES A DAY
99 NA – No Answer
PP32. Are you 12 years of age or older?
1 Yes
2 No (GO TO PP49)
9 NA (GO TO PP49)
PP33. OMITTED
PP34. Have you ever gone out alone with a boyfriend or girlfriend on a date?
1 Yes
2 No (GO TO PP38)
9 NA (GO TO PP38)
PP35. How old were you when you first went out alone on a date?
_______ YEARS OLD
99 NA
PP36. About how often do you go out alone with a boyfriend or girlfriend on a date?
1 Almost never
2 1 or 2 times a month
3 3 or more times a month
9 NA
PP37. Do you usually go out with the same person on a date?
1 Yes
2 No
9 NA
PP38. Have you ever been involved in “petting” with someone of the opposite sex? By “petting” we mean heavy kissing and touching or being touched.
1 Yes
2 No (GO TO PP43)
9 NA (GO TO PP43)
PP39. At any time in your life have you ever had sexual intercourse? By this we mean have you “gone all the way” or “done it”
1 Yes
2 No (GO TO PP43)
9 NA (GO TO PP43)
PP40. Have you had sexual intercourse during the past three months?
1 Yes
2 No
9 NA
PP41. Have you ever gotten pregnant or gotten someone pregnant?
1 Yes
2 No
9 NA
PP42. On the last occasion you had sexual intercourse, did you use some form of birth control?
1 Yes
2 No
9 NA
CATI: ASK PP42a IF PP17=1 AND PP32=1 (FEMALE, 12+). ELSE GO TO PP43.
PP42a. Do you currently use birth control pills, birth control implant, injection, or the patch?
1 YES
2 NO (GO TO PP43)
9 NA (GO TO PP43)
PP42b. What type of birth control do you use?
1 Birth control pills
2 Implant
3 Injection
4 Patch
9 NA – No Answer
PP43. The next questions ask about sad feelings and attempted suicide. Sometimes people feel so depressed about the future that they may consider attempting suicide, that is, taking some action to end their own life, while others do not.
PP44. During the past 12 months, did you ever feel so sad or hopeless almost every day for two weeks or more in a row that you stopped doing some usual activities?
1 Yes
2 No
9 NA
PP45. During the past 12 months, did you every seriously consider attempting suicide?
1 Yes
2 No (GO TO PP49)
9 NA (GO TO PP49)
PP46. During the past 12 months, did you make a plan about how you would attempt suicide?
1 Yes
2 No (GO TO PP49)
9 NA (GO TO PP49)
PP47. During the past 12 months, how many times did you actually attempt suicide?
0 0 times (GO TO PP49)
1 1 time
2 2 or 3 times
3 4 or 5 times
4 6 or more times
9 NA (GO TO PP49)
PP48. Did any attempt in the past 12 months result in an injury, poisoning, or overdose that had to be treated by a doctor or nurse?
1 Yes
2 No
9 NA
PP49. Thank you for completing the survey. Tell the interviewer that you are done.
| File Type | application/msword |
| File Title | SECTION A: ACADEMICS |
| Author | MDRCER |
| Last Modified By | MDRCER |
| File Modified | 2007-11-14 |
| File Created | 2007-11-14 |