0990-Girls at riskAppendix G-Items and Sources for GEARS proposed JD-HIV Instruments July 12 2010

Appendix G

Questionnaire Items with Sources for OMB Information

Page-Item #	Source/Rationale	Gender Specific? Yes/No	OWH Core Category
	Section 1: Information About You
P2-1	“How old are you now? I am ___ years old. What year were you born?” Age of participant is important for developing/assessing correlations with risk behavior. Previous studies have found that sexual risk behaviors increase with age (Semands & Simono, 1996). It was decided to inquire the age instead of date of birth to exclude identifying information. Month and year is also asked in order to determine a more approximate age. The first part of this item was developed at the evaluation meeting and the other parts were taken from the CSAP National Youth Survey.
P2-2	“Is at least one of your parents Hispanic or Latino?” This demographic question was added during the evaluation meeting with grantees based on the belief that some kids would not consider themselves as Hispanic or Latino even though one of their parents was. This question is only on the pre-test questionnaire. Not included in the post and follow up versions.
P2-3	“Are you Hispanic or Latino?” This demographic question was taken from the Center for Substance Abuse Prevention (CSAP) National Youth Survey Baseline questionnaire. It is an important question as race/ethnicity plays a major role in factors that affect the level of sexual risk behavior (e.g., gender roles, locus of control, socioeconomic status, perceived social norms, etc.) (Harrison, D.F, Wamback, K.G., Byers, J.B., et al.). Not included in the post and follow up versions.
P2-4	“What else do you call yourself?” This demographic question was taken from the CSAP National Youth Survey Baseline questionnaire. It is an important question as race/ethnicity plays a major role in factors that affect the level of sexual risk behavior (e.g., gender roles, locus of control, socioeconomic status, perceived social norms, etc.) (Harrison, D.F, Wamback, K.G., Byers, J.B., et al.). This question is only on the pre-test questionnaire. Not included in the post and follow up versions.
P2-5/6	“What language do your parents or other people who are raising you speak?”/ Not included in the post and follow up versions. “What languages do you speak where you live now?” These items were created based on an item from the CSAP National Youth Survey Baseline questionnaire (What languages do your parents or other people who are raising you speak at home?) and adapted for use in this evaluation. It was decided during the evaluation meeting with programs that “at home” should not be kept as part of the first question because some of the program participants did not have a stable living situation and one program in particular is a boarding school so this question would not necessarily apply to that group. So the question was split to ensure that all information about language use was captured. This item also assesses the participant’s level of comfort with and understanding of the language used for the intervention which could greatly impact the amount of information the participant captures.
P2-7	“Where do you live now?” This question was adapted from an item in the CSAP National Youth Survey Baseline questionnaire (Where are you living now, what adults live with you?) Again, this question was edited because of the transient nature of program participants’ living situation.
P3-8	“Have you moved in the past 6 months?” This item was added after the evaluation meeting in response to a discussion around the importance of measuring the stability, or lack thereof, of the program participants’ home life.
P3-9	“In general, is there an adult that you can talk to?” This question was added to supplement question 10. Our Subject Matter Expertise felt that asking this question would give us an idea of whether or not the participant has a stable support system.
P3-10	“How often do you talk to an adult about what you are doing or thinking?” This item was taken from the CSAP National Youth Survey Baseline questionnaire.
P3-11	“How often do you do chores (cleaning, laundry, baby sitting, cooking)?” This item was taken from the CSAP National Youth Survey Baseline questionnaire. It was reworded to accommodate participants who reside in a boarding school.
P3-12	“How often do you watch TV on school days?” This item was added to measure time spent on idle/non-educational activities outside of school. A similar item can be found in the 2009 National Youth Risk Behavior Survey (On an average school day, how many hours do you watch TV?). Constructive activities have been found to be a protective factor against juvenile delinquency. Linville, Deanna C. and Huebner, Angela J. (2005). Journal of Youth and Adolescence, Vol. 34, No. 5 October 2005. Pp.483-492.
P3-13	“How often do you spend time on the internet for non educational activities on school days?” This item was included per recommendation of our Subject Matter Expertise who felt the need to capture the media and extensive internet use.
P4-14	“How often do you spend time texting or talking on the phone for non educational activities on school days?” This item was included per recommendation of our Subject Matter Expertise who felt the need to capture the extensive phone use.
P4-15	“How often do you participate in activities involving members of your own racial or cultural group?” This item was taken from the CSAP National Youth Survey Baseline questionnaire. It is a combination of two questions that ask how often the participants attend cultural activities and participate in activities involving members of their own cultural or spiritual group. The Subject Matter Expertise felt that these two questions were synonymous for out participants. This item was added per the decision to include questions that will measure involvement in cultural activities. Participating in cultural activities is a protective factor against juvenile delinquency. Lescano, Celia M., Brown, Larry K, Raffaelli, Marcela, Lima, Lori-Ann. Cultural factors and Family-Based HIV Prevention Intervention for Latino Youth. Journal of pediatric Psychology 34(10)pp.1041-105
P4-16	“How often do you take lessons or classes out of school, including this after school program?” This item was taken from the CSAP National Youth Survey Baseline questionnaire. It is a combination of two questions that asked about students afterschool activities. They were combined per recommendation of our Subject Matter Experts who felt that both questions asked about constructive activities. Constructive activities have been found to be a protective factor against juvenile delinquency. Linville, Deanna C. and Huebner, Angela J. (2005). Journal of Youth and Adolescence, Vol. 34, No. 5 October 2005. Pp.483-492
P4-17	“Last summer how often did you go to a summer program for learning or fun?” This item was taken from the CSAP National Youth Survey Baseline questionnaire. Constructive activities have been found to be a protective factor against juvenile delinquency. Linville, Deanna C. and Huebner, Angela J. (2005). Journal of Youth and Adolescence, Vol. 34, No. 5 October 2005. Pp.483-492.
P4-18	“How often do you volunteer?” This item is not included in the questionnaire for the 9-11 year olds. Constructive activities have been found to be a protective factor against juvenile delinquency. Linville, Deanna C. and Huebner, Angela J. (2005). Journal of Youth and Adolescence, Vol. 34, No. 5 October 2005. Pp.483-492
P4-19	“Do you consider yourself a religious or spiritual person?” Again, this item was added per the decision to include questions that will measure involvement in cultural activities. Participating in cultural activities is a protective factor against juvenile delinquency. Lescano, Celia M., Brown, Larry K, Raffaelli, Marcela, Lima, Lori-Ann. Cultural factors and Family-Based HIV Prevention Intervention for Latino Youth. Journal of pediatric Psychology 34(10)pp.1041-1052
P5-20	“How often are you supervised or monitored by an adult?” This item was added per recommendation of the Subject Matter Experts to measure how much time participants spend outside of adult supervision.
P5-21	“When was the last time you were enrolled in school?” This item was taken from the CSAP National Youth Survey Baseline questionnaire. However, it was slightly reworded to better match the reading level of the program participant. This item was not included on the Sage versions of the questionnaire. This item is not included in the questionnaire for the 9-11 year olds.
P5-22	“What is the highest grade you have completed?” This item was slightly reworded to match the reading level of the program participant. This item was taken from the CSAP National Youth Survey Baseline questionnaire. It was slightly reworded for ease of understanding for the target population.
P5-23	“How interesting are most of your school subjects to you?” This item was slightly reworded to match the reading level of the program participant. This item was taken from the School Bonding/ Commitment Scale which has been found to correlate with ATOD and other problem behaviors.
P5-24	“How important do you think things you are learning in school are going to be for you later in life?” This item was taken from the School Bonding/Commitment Scale which has been found to correlate with ATOD and other problem behaviors. The word “meaningful” was substituted with “useful” for ease of understanding for the target population. Arthur, M. W., Hawkins, J. D., Pollard, J. A., Catalano, R. F., & Baglioni, A. J. (2001). Measuring risk and protective factors for substance use, delinquency, and other adolescent problem behaviors: The communities that care youth survey. This item is not included in the questionnaire for the 9-11 year olds.
	“How often do you feel that the school work you are assigned is useful and important?” This item was taken from the School Bonding/Commitment Scale which has been found to correlate with ATOD and other problem behaviors. The word “meaningful” was substituted with “useful” for ease of understanding for the target population. Arthur, M. W., Hawkins, J. D., Pollard, J. A., Catalano, R. F., & Baglioni, A. J. (2001). Measuring risk and protective factors for substance use, delinquency, and other adolescent problem behaviors: The communities that care youth survey. This item is not included in the questionnaire for the 12-17 year olds.
P5-25	“Now thinking back over the past year in school, how often did you enjoy being in school?” This item was taken from the School Bonding/Commitment Scale which has been found to correlate with ATOD and other problem behaviors.
P6-26	“Now thinking back over the past year in school, how often did you try to do your best in school?” This item was taken from the School Bonding/Commitment Scale which has been found to correlate with ATOD and other problem behaviors.
P6-27	“During the last month, how many whole days of school have you missed because of illness?” This item was taken from the School Bonding/Commitment Scale which has been found to correlate with ATOD and other problem behaviors. The words” four weeks” were substituted with “month” to meet the developmental level of the participants.
P6-28	“During the last month, how many whole days of school have you missed because you skipped or cut?” (To miss school means you did not attend all your classes and you have unexcused absences.)This item was taken from the School Bonding/Commitment Scale which has been found to correlate with ATOD and other problem behaviors. The words” four weeks” were substituted with “month” to meet the developmental level of the participants.
P6-29	“During the last month, how many whole days of school have you missed for other reasons?” This item was taken from the School Bonding/Commitment Scale which has been found to correlate with ATOD and other problem behaviors. The format of the question was slightly changed to be more appropriate for the target population. The words” four weeks” were substituted with “month” to meet the developmental level of the participants.
P7-30	“Putting all your grades together, what were your grades like last year?” This question was added to asses program participant’s achievement in school. A similar item can be found in the CSAP National Youth Survey Baseline questionnaire (How are your grades in school? Please pick the answer that best describes how you do in general.)
P7-31	“Do you have a full-time job for pay?” This item was taken from the CSAP National Youth Survey Baseline questionnaire. This item is not included in the questionnaire for the 9-11 year olds.
P7-32	“For how many months have you had this job?” This item was taken from the CSAP National Youth Survey Baseline questionnaire. This item is not included in the questionnaire for the 9-11 year olds.
	Neighborhood Environment Scale		Violence: Neighborhood Context
	17 item scale (Elliot, D., Huizinga, D., & Ageton, S. (1985). Explaining delinquency and drug use. Beverly Hills: Sage) that measures exposure to deviant behavior in the neighborhood, including violent crime, drug use and sale, racism, and prejudice.
P7-1	Within walking distance of my house, there is a park or playground where I like to walk and enjoy myself, playing sports or games.
P7-2	There are plenty of safe places to walk or play outdoors in my neighborhood.
P7-3	Every few weeks, some kid in my neighborhood gets beat-up, jumped or robbed. This item was slightly reworded to match the reading level of the program participant.
P7-4	Every few weeks, some adult gets beat-up or mugged in my neighborhood. This item was slightly reworded to match the reading level of the program participant.
P7-5	In my neighborhood, I see signs of racism and prejudice at least once a week.
P7-6	I have seen people using or selling drugs in my neighborhood.
P7-7	In the morning, or later in the day, I often see drunk people on the street in my neighborhood.
P7-8	Most adults in my neighborhood respect the law.
P8-9	There are abandoned or boarded up buildings in my neighborhood.
P8-10	I feel safe when I walk around my neighborhood by myself.
P8-11	The people who live in my neighborhood often damage or steal each other’s property.
P8-12	The people who live in my neighborhood always take care of each other and protect each other from crime.
P8-13	Almost every day I see homeless people walking or sitting around in my neighborhood.
P8-14	In my neighborhood, the people with the most money are the drug dealers.
P8-15	In my neighborhood, there are a lot of poor people who don’t have enough money for food and basic needs.
P8-16	For many people in my neighborhood, going to church on Sunday or religious days is an important activity.
P8-17	The people in my neighborhood are the best people in the world.
	Exposure to Gangs – Houston School Cohort Survey; Houston Community Demonstration Project (1993). Houston, TX: City of Houston Health and Human Services Department. Internal consistency=0.52		Violence: Gangs
	6-item scale that measure exposure to gangs and gang membership. One item was added to the post test to assess length of time in a gang. They were changed into statements to keep response sets consistent in order to avoid confusion by the participants.
P8-18	There are gangs in my neighborhood.
P8-19	Gang members are troublemakers.
P8-20	I have friends that are gang members.
P8-21	Are there gang members in this school?
P8-22	I would like to be a gang member.
P8-23	I am a gang member.
P8-24	If you are a gang member, when did you join the gang?
	Problem Solving Scale – This scale was used previously by GEARS in the Healthy Choice Project evaluation with urban, middle school youth. Internal Consistency=0.76		Problem Solving
	11-item scale that measures how participants respond to problems with classmates and friends. The questions were changed to statements and the response sets adjusted for consistency.
P8-1	When I have a problem: I think about the different things I could do before I do anything.
P8-2	When I have a problem: I think about the different ways of solving the problem and what good or bad things could happen.
P9-3	When I have a problem: I get information I need to deal with the problem.
P9-4	When I have a problem: I compromise (meet halfway or work it out) to get something positive from the situation.
P9-5	When I have a problem: I think about which of the different ways that I could solve the problem is really the best way.
P9-6	When I have a problem: I try to listen to the other person, even if I do not agree with him or her.
P9-7	When I have a problem: I take steps to solve the problem instead of complaining about it to everyone else.
P9-8	When I have a problem: I give into the other person without giving an opinion.
P9-9	When I have a problem: I tell the other person what I think no matter how they feel.
P9-10	When I have a problem: I usually wait until the problem goes away by itself, instead of trying to solve it.
P9-11	When I have a problem: I like to get everything out in the open so that the problem can be solved as quickly as possible.
	Adolescent Femininity Ideology Scale (AFIS) – Inauthentic Self in Relationships Subscale; Tolman & Porche, 2000.		Healthy Relationships
	9-item scale that measures the ability to be authentic in expressing one’s thoughts and feelings towards others and therefore mutuality in close relationships.
P9-1	I would tell a friend I think she looks nice, even if I think she shouldn’t go out of the house dressed like that.	Y
P9-2	I worry that I make others feel bad if I am successful.	Y
P9-3	I would not change the way I do things in order to please someone else.	Y
P9-4	I tell my friends what I honestly think even when it is an unpopular idea.	Y
P9-5	Often I look happy on the outside in order to please others, even if I don’t feel happy on the inside.	Y
P9-6	I wish I could say what I feel more often than I do.	Y
P9-7	I feel like it’s my fault when I have disagreements with my friends.	Y
P10-8	When my friends ignore my feelings, I think that my feelings weren’t very important anyway.	Y
P10-9	I usually tell my friends when they hurt my feelings.	Y
	Adolescent Femininity Ideology Scale (AFIS) – Objectified Relationship with Body Subscale; Tolman & Porche, 2000.		Self-Esteem
	8-item scale that assesses females’ negative body image.
P10-10	The way that I can tell that I am a good weight is when I fit into a small size.	Y
P10-11	I often wish my body were different.	Y
P10-12	I think that a girl has to be thin to be beautiful.	Y
P10-13	I think that a girl has to have a light complexion and delicate features to be thought of as beautiful.	Y
P10-14	I am more concerned about how my body looks than how my body feels.	Y
P10-15	I often feel uncomfortable in my body.	Y
P10-16	There are times when I have really good feelings in my body.	Y
P10-17	The way I decide I am at a good weight is when I feel healthy.	Y
	Rosenberg Self-Esteem Scale; Rosenberg, M. (1965). Society and the adolescent self-image. Princeton, NJ: Princeton University Press.		Self-Esteem
	10-item Likert scale that assesses participant’s general feelings about themselves.
P10-18	On the whole, I am satisfied with myself.
P10-19	At times, I think I am no good at all.
P10-20	I feel that I have a number of good qualities.
P10-21	I am able to do things as well as most other people.
P10-22	I feel I do not have much to be proud of.
P10-23	I certainly feel useless at times.
P10-24	I feel that I’m a person of worth, at least on an equal plane with others.
P10-25	I wish I could have more respect for myself.
P10-26	All in all, I am inclined to feel that I am a failure.
P10-27	I take a positive attitude toward myself.
	CES Depression Scale (CES-DC) NIMH Radloff, L.S. (1977) 'The CES-D scale: A self report depression scale for research for children'. Applied Psychological Measurement 1: 385-401.		Mental Health
	20-item scale used to measure depression. The general version of this scale is used in the questionnaire for the 12-17 year olds.
	During the past week… I was bothered by things that usually don’t bother me.
	During the past week… I did not feel like eating, I wasn’t very hungry
	During the past week…. I wasn’t able to feel happy, even when my family or friends tried to help me feel better.
	During the past week… I felt I was just as good as other kids.
	During the past week… I felt like I couldn’t pay attention to what I was doing.
	During the past week… I felt down and unhappy.
	During the past week… I felt like I was too tired to do things.
	During the past week… I felt like something good was going to happen.
	During the past week… I felt like things I did before didn’t work out right.
	During the past week… I felt scared.
	During the past week… I didn’t sleep as well as I usually sleep.
	During the past week… I was happy.
	During the past week… I was more quiet than usual.
	During the past week… I felt lonely, like I didn’t have any friends.
	During the past week… I felt like kids I know were not friendly or that they didn’t want to be with me.
	During the past week… I had a good time.
	During the past week… I felt like crying.
	During the past week… I felt sad.
	During the past week… I felt that people didn’t like me.
	During the past week… It was hard to get started doing things.
	CES Depression Scale (CES-D) NIMH Radloff, L.S. (1977) 'The CES-D scale: A self report depression scale for research in the general population'. Applied Psychological Measurement 1: 385-401.
	20-item scale used to measure depression. The children’s version of this scale is included in the questionnaire for the 9-11 year olds.
P10-1.	During the past week… I was bothered by things that usually don’t bother me.
P10-2.	During the past week… I did not feel like eating; my appetite was poor.
P11-3.	During the past week… I felt that I could not shake off the blues even with help from my family or friends.
P11-4.	During the past week… I felt I was just as good as other people.
P11-5.	During the past week… I had trouble keeping my mind on what I was doing.
P11-6.	During the past week… I felt depressed.
P11-7.	During the past week… I felt that everything I did was an effort.
P11-8.	During the past week… I felt hopeful about the future.
P11-9.	During the past week… I thought my life had been a failure.
P11-10.	During the past week… I felt fearful.
P11-11.	During the past week… My sleep was restless.
P11-12.	During the past week… I was happy.
P11-13.	During the past week… I talked less than usual.
P11-14.	During the past week… I felt lonely.
P11-15.	During the past week… People were unfriendly.
P11-16.	During the past week… I enjoyed life.
P11-17.	During the past week… I had crying spells.
P11-18.	During the past week… I felt sad.
P11-19.	During the past week… I felt that people dislike me.
P11-20.	During the past week… I could not get “going”.
	HIV Knowledge Questionnaire, Adolescent Girls (HIV-KQ AG); Volpe, Nelson, Kraus & Morrison-Beedy (2007). Adaptation and refinement of the HIV Knowledge Questionnaire for Use with Adolescent Girls. Journal of the Association of Nurses in AIDS Care, 18(5), 57-63.
	18-item scale to measure adolescent’s HIV knowledge. A different version of this scale was used in a previous OWH study with college women. According to our Subject Matter Experts, out of the 18 items only the following 7 items were developmentally appropriate for 9-11 age group. The wording was also altered to accommodate this age group. The full version of this scale is found in the questionnaire for the 12-17 year olds.
	Can you get HIV by sharing a glass of water with someone who has HIV?		P14-1
	Will all pregnant women infected with HIV have babies born with HIV?	Y	P14-4
	Can you tell if someone has HIV by looking at them?		P14-5
	Is there a vaccine (shot) that can stop people from getting HIV?		P14-6
	Can you get HIV by deep kissing (putting their tongue in their partner’s mouth) if their partner has HIV?		P14-7
	Will taking a test for HIV one week after having sex tell a person if she or he has HIV?		P14-12
	Can you get HIV by sitting in a hot tub or swimming pool with a person who has HIV?		P14-13
	Intentions for Safer Sex Scale; Lux & Petosa, (1994). Using the Health Belief Model to Predict Safer Sex Intentions of Incarcerated Youth. Health Education & Behavior, 21(4), 487-497.
	6-item scale that assess participant’s intentions for safer sex. This scale was not included in the questionnaires for 9 to 11 year olds. The page and item numbers reflect the 12-17 year olds pretest questionnaire.
P11-1	I will make sure a condom is used when I have sex.
P11-2	I will only have one sexual relationship at a time.
P11-3	I do not plan on having sex until I am married.
P11-4	I would only have sex with a person who I have a long term relationship with.
P11-5	I will not have sex with someone who refuses to use a condom.
P11-6	I do not plan on having sex until I am at least eighteen years old.
	HIV Knowledge Questionnaire, Adolescent Girls (HIV-KQ AG); Volpe, Nelson, Kraus & Morrison-Beedy (2007). Adaptation and refinement of the HIV Knowledge Questionnaire for Use with Adolescent Girls. Journal of the Association of Nurses in AIDS Care, 18(5), 57-63.
	18-item scale to measure adolescent’s HIV knowledge. A different version of this scale was used in a previous OWH study with college women.
P12-1	Can a person get HIV by sharing a glass of water with someone who has HIV?
P12-2	Does pulling out the penis before a man climaxes (cums) keep a woman from getting HIV during sex?
P12-3	Can a woman get HIV if she has anal sex (penis inside the buttocks) with a man?
P12-4	Will all pregnant women infected with HIV have babies born with HIV?
P12-5	Do all people who have been infected with HIV quickly show serious signs of being infected?
P12-6	Is there a vaccine (shot) that can stop people from getting HIV?
P12-7	Are people likely to get HIV by deep kissing (putting their tongue in their partner’s mouth) if their partner has HIV?
P12-8	Can a woman get HIV if she has sex during her period?
P12-9	Is there a female condom that can help decrease a woman’s chance of getting HIV?
P12-10	Does a natural skin condom work better against HIV than a latex condom?
P12-11	Can a person get HIV if she is taking antibiotics?
P12-12	Will taking a test for HIV one week after having sex tell a person if she or he has HIV?
P12-13	Can a person get HIV by sitting in a hot tub or swimming pool with a person who has HIV?
P12-14	Can a person get HIV by having oral sex (mouth on penis) with a man?
P12-15	Does using Vaseline or baby oil with condoms increase the chance of getting HIV?
P12-16	Are women always tested for HIV during their Pap smears?
P12-17	Does douching after sex keep a woman from getting HIV?
P12-18	Is it possible to get HIV when a person gets a tattoo?
	HIV 102 Advanced Knowledge Questionnaire – This scale was created by GEARS for use in this evaluation
	16-item scale to measure knowledge of HIV beyond what is usually taught in interventions. This scale was not included in the questionnaires for 9 to 11 year olds.
P13-19	Does it take three to six months for the body to make enough antibodies to be found by the HIV antibody test?
P13-20	Is viral load used to measure the amount of HIV in the body?
P13-21	Can the currently available HIV drugs cure people of HIV infection or AIDS?
P13-22	Can drugs and alcohol reduce your ability to practice safe sex?
P13-23	Can sunlight, heat and friction damage a latex condom?
P13-24	If you are at risk for HIV from sex, are you then also at risk for other sexually transmitted infections?
P13-25	Can HIV infected people who are taking antiretroviral therapy infect others through unprotected sex and needle-sharing?
P13-26	Do sexually transmitted infections (STIs) such as genital herpes, affect a woman’s risk of being infected with HIV?
P13-27	Do girls have double the chance of getting infected with HIV through unprotected heterosexual sex than men?
P13-28	Can people who are already infected with one type of HIV contract another type of HIV?
P13-29	Can a person be infected with HIV for years without having AIDS?
P13-30	Does HIV die outside of the body?
P13-31	Are HIV transmissions in women likely to occur through the vagina and cervix?
P13-32	Is the risk of transmitting HIV from men to women higher because the vagina and the cervix have a much larger surface than the penis?
	STI knowledge 101 – This scale was created by GEARS for use in this evaluation. Questions were developed after reviewing STI information covered in programs’ curricula.
	10-item scale to measure knowledge of STI causes, symptoms, and risks. This scale was not included in the questionnaires for 9 to 11 year olds. The page and item numbers reflect the 12-17 year olds pretest questionnaire.
P13-33	Are Cancroids, Chlamydia, Gonorrhea, and Syphilis caused by bacteria?
P13-34	Can a person, who has engaged in oral sex, be infected with a sexually transmitted infection?
P13-35	Do all sexually transmitted infections have symptoms, especially in females, and can only be detected by a medical test?
P13-36	Once a person has been cured of Gonorrhea, can she/he contract it again?
P13-37	Can Human Papilloma Virus (HPV) be spread by skin-on-skin contact?
P13-38	Are all sexually transmitted infections curable?
P14-39	Should girls always worry about itching around the vagina, sores or smelly discharge from the vagina?
P14-40	Can Pubic lice (“crabs”) and Scabies (two skin diseases) be transmitted by the intimate bodily contact of sex?
P14-41	Can cervical cancer, pelvic inflammatory disease, and infertility/pregnancy problems be caused by sexually transmitted infection?
P14-42.	Are women are at a higher risk than men of getting infected with Gonorrhea?
	Attitudes Toward Gangs; Nadel, H., Spellman, M., Alvarex-Canino, T., Lausell-Bryant, L., & Landsberg, G. (1996). The cycle of violence and victimization: A study of the school-based intervention of a multidisciplinary youth prevention program. American Journal of Prevention Medicine, 12(5 supp), 109-119.		Violence: Gangs
	9-item scale that measures attitudes toward gangs. Respondents are asked to indicate how true certain statements about gangs are for them.
P15-1	I think you are safer, and have protection, if you join a gang.
P15-2	I will probably join a gang.
P15-3	Some of my friends at school belong to gangs.
P15-4	I think it’s cool to be in a gang.
P15-5	My friends would think less of me if I joined a gang.
P15-6	I believe it is dangerous to join a gang; you will probably end up getting hurt or killed if you belong to a gang.
P15-7	I think being in a gang makes it more likely that you will get into trouble.
P15-8	Some people in my family belong to a gang, or used to belong in a gang.
P15-9	I belong to a gang.
	Acceptance of Couple Violence; Foshee, V., Fothergill, K., & Stuart, J. (1992). Results from the Teenage Dating Abuse Study conducted in Githens Middle School and Southern High Schools. Technical Report. Chapel Hill, NC: University of North Carolina. (Unpublished). Internal Consistency=0.74, 0.71 and 0.73		Violence: Dating
	11-item scale that measure acceptance of couple violence. Certain items were reworded so that questions could apply to male on female, female on male, or female on female violence. This scale was not included in the questionnaires for 9 to 11 year olds. This scale was not included in the questionnaires for 9 to 11 year olds.
P15-10	A person angry enough to hit his or her girlfriend must love her very much	Y
P15-11	Violence between dating partners can improve the relationship
P15-12	Girls sometimes deserve to be hit by the boys they date	Y
P15-13	A girl who makes her boyfriend jealous on purpose deserves to be hit.	Y
P15-14	Boys sometimes deserve to be hit by the girls they date.	Y
P15-15	A girl angry enough to hit her boyfriend must love him very much	Y
P15-16	There are times when violence between dating partners is okay.
P16-17	A boy who makes his girlfriend jealous on purpose deserves to be hit.	Y
P16-18	Sometimes violence is the only way to express your feelings.
P16-19	Some couples must use violence to solve their problems.
P16-20	Violence between dating partners is a personal matter and people should not interfere.
	Original Conflict Tactics Scale (CTSI, Form R, 1985);		Conflict Resolution/ Communication
	18-item scale used to assess reasoning, verbal aggression, and minor and severe violence in relationships.
P17-1	Discussed an issue calmly.
P17-2	Got information to back up your side of things.
P17-3	Brought in, or tried to bring in, someone to settle things.
P17-4	Insulted or swore at him/her.
P17-5	Sulked or refused to talk about an issue.
P17-6	Stomped out of the room or house or yard.
P17-7	Cried.
P17-8	Did or said something to spite him/her.
P17-9	Threatened to hit or throw something at him/her.
P17-10	Threw or smashed or hit or kicked something.
P17-11	Pushed, grabbed or shoved him/her.
P17-12	Slapped him/her.
P17-13	Kicked, bit, or hit him/her with a fist.
P17-14	Hit or tried to hit him/her with something.
P17-15	Beat him/her up.
P17-16	Choked him/her.
P17-17	Threatened him/her with a knife or gun.
P17-18	Used a knife or fired a gun.
	Physical Fighting – Youth Risk Behavior Survey; Division of Adolescent and School Health (DASH), Center for Chronic Disease Prevention and Health Promotion (1993). New York City Youth Violence Survey. Atlanta, GA: Centers for Disease Control and Prevention. Reliability/Validity: Kappas range from 50.5% and 68.2%. High stability over time.		Violence: Fighting
	4-item scale used to measure frequency of physical fighting and injuries from fights within the past 30 days. The time frame was changed to be consistent with the rest of the scales in the instrument.
P18-1	During the past 30 days, how many times were you in a physical fight?
P18-2	The last time you were in a physical fight, with whom did you fight?
P18-3	During the past 30 days, how many times were you in a physical fight in which you were injured and had to be treated by a doctor or nurse?
P18-4	During the past 30 days, how many times were you in a physical fight on school property?
	Self-Reported Delinquency – Rochester Youth Development Study; Thornberry, T. P., Krohn, M. D., Lizotte, A. J., Smith, C. A., & Tobin, K. (2003). Gangs and delinquency in developmental perspective. New York: Cambridge University Press.		Delinquency/ Personal Violence
	36-item scale used to measure self-reported frequency of delinquent acts. Respondents are asked to indicate if they have engaged in a variety of problem or delinquent behaviors in the past month. It was slightly reworded to better match the reading level of the program participant. Also, only the following 14 items were found age appropriate for the 9-11 age group. “Have you ever been bullied?” was added by the Subject Matter Experts due to its indication for future delinquent behavior.
	Have you ever…Been bullied?
	Have you ever… Run away from home?
	Have you ever… Skipped classes without an excuse?
	Have you ever … Carried a hidden weapon?
	Have you ever … Been loud or rowdy in a public place where somebody complained and you got in trouble?
	Have you ever … Made obscene telephone calls, such as calling someone and saying dirty things?
	Have you ever … Ridden in a car or motorcycle that was taken without the owner’s permission?
	Have you ever… Shoplifted or taken something from a store on purpose (including anything you already told me about)?
	Have you ever … Attacked someone with a weapon with the idea of seriously hurting or killing them?
	Have you ever … Hit someone with the idea of hurting them?
	Have you ever … Been involved in gang or posse fights?
	Have you ever … Thrown objects such as rocks or bottles at people (other than what you have already mentioned)?
	Have you ever … Sold marijuana, reefer or pot?
	Have you ever … Sold hard drugs such as crack, heroin, cocaine, LSD or acid?
	Self-Reported Delinquency – Rochester Youth Development Study; Thornberry, T. P., Krohn, M. D., Lizotte, A. J., Smith, C. A., & Tobin, K. (2003). Gangs and delinquency in developmental perspective. New York: Cambridge University Press.
	36-item scale used to measure self-reported frequency of delinquent acts. Respondents are asked to indicate if they have engaged in a variety of problem or delinquent behaviors in the past month. Item #1 “Have you ever been bullied?” was added by the Subject Matter Experts because bullying have shown to be an indicator for delinquent behavior. The page and item numbers reflect the pre-test questionnaires for the 12-17.
P19-1	In the last 30 days, have you …Been bullied?
P19-2	In the last 30 days, have you… Run away from home?
P19-3	In the last 30 days, have you… Skipped classes without an excuse?
P19-4	In the last 30 days, have you… Lied about your age to get into someplace or to buy something (for example, lying about your age to get into a movie or to buy alcohol)?
P19-5	In the last 30 days, have you… Hitchhiked a ride with a stranger?
P19-6	In the last 30 days, have you… Carried a hidden weapon?
P19-7	In the last 30 days, have you… Been loud or rowdy in a public place where somebody complained and you got in trouble?
P19-8	In the last 30 days, have you… Begged for money or things from strangers?
P19-9	In the last 30 days, have you… Made obscene telephone calls, such as calling someone and saying dirty things?
P19-10	In the last 30 days, have you… Been drunk in a public place?
P19-11	In the last 30 days, have you… Damaged, destroyed or marked up somebody else’s property on purpose?
P19-12	In the last 30 days, have you… Set fire on purpose or tried to set fire to a house, building, or car?
P19-13	In the last 30 days, have you… Avoided paying for things, like a movie, taking bus rides, using a computer, or anything else (including video games)?
P19-14	In the last 30 days, have you… Gone into or tried to go into a building to steal or damage something?
P19-15	In the last 30 days, have you… Tried to steal or actually stolen money or things worth $5 or less?
P19-16	In the last 30 days, have you… How about between $5 and $50?
P19-17	In the last 30 days, have you… How about between $50 and $100?
P19-18	In the last 30 days, have you… How about over $100?
P19-19	In the last 30 days, have you… Shoplifted or taken something from a store on purpose (including anything you already told me about)?
P19-20	In the last 30 days, have you… Stolen someone’s purse or wallet or picked someone’s pocket?
P19-21	In the last 30 days, have you… Stolen something from a car that did not belong to you?
P19-22	In the last 30 days, have you… Tried to buy or sell things that were stolen?
P19-23	In the last 30 days, have you… Taken a car or motorcycle for a ride without the owner’s permission?
P19-24	In the last 30 days, have you… Stolen or tried to steal a car or other motor vehicle?
P19-25	In the last 30 days, have you… Forged a check or used fake money to pay for something?
P19-26	In the last 30 days, have you… Used or tried to use a credit card, bank card, or automatic teller card without permission?
P19-27	In the last 30 days, have you… Tried to cheat someone by selling them something that was not what you said it was or that was worthless?
P19-28	In the last 30 days, have you… Attacked someone with a weapon or with the idea of seriously hurting or killing them?
P20-29	In the last 30 days, have you… Hit someone with the idea of hurting them (other than what you have already mentioned)?
P20-30	In the last 30 days, have you… Been involved in gang or posse fights?
P20-31	In the last 30 days, have you… Thrown objects such as rocks or bottles at people (other than what you have already mentioned)?
P20-32	In the last 30 days, have you… Used a weapon of force to make someone give you money or things?
P20-33	In the last 30 days, have you… Been paid for having sexual relations with someone?
P20-34	In the last 30 days, have you… Physically hurt or threatened to hurt someone to get them to have sex with you?
P20-35	In the last 30 days, have you… Had or tried to have sexual relations with someone against their will (other than what you have already mentioned)?
P20-36	In the last 30 days, have you… Sold marijuana, reefer or pot?
P20-37	In the last 30 days, have you… Sold hard drugs such as crack, heroin, cocaine, LSD or acid?
	Victimization in Dating Relationships; Foshe, V. A., Linder, F., Bauman, K. E., et al. (1996). The safe dates project: Theoretical basis, evaluation design, and selected baseline findings. American Journal of Preventive Medicine, 12(5), 39-47. Internal consistency=0.90
	18-item scale used to measure self-reported victimization of physical violence within dating relationships. Two additional items were added by GEARS to address grantees’ concerns about the scale not measuring verbal violence. These items are not included in the questionnaire for the 9-11 year olds.
P20-1	In the last 30 days, how many times has any person that you have been on a date with done the following things to you?... Scratched me
P210-2	…Slapped me
P20-3	…Physically twisted my arm
P20-4	…Slammed me or held me against a wall
P20-5	…Kicked me
P20-6	…Bent my fingers
P20-7	…Bit me
P20-8	…Tried to choke me
P20-9	…Pushed, grabbed, or shoved me
P20-10	…Dumped me out of a car
P21-11	…Threw something at me that hit me
P21-12	…Forced me to have sex
P21-13	…Forced me to do other sexual things that I did not want to do
P21-14	…Burned me
P21-15	…Hit me with a fist
P21-16	…Hit me with something hard besides a fist
P21-17	…Beat me up
P21-18	…Assaulted me with a knife or gun
P21-19	…Said mean or hurtful things that made me feel bad
P21-20	…Yelled or screamed at me.
	The next 5 items were taken from Crick & Grotpeter Aggression Scale to measure participants’ relational aggression. They were added to make the instrument more gender specific. Relational Aggression, Gender, and Social-Psychological Adjustment. Crick, Nicki R., and Grotpeter, Jennifer K. CHILD DEVELOPMENT, 1995, 66, 710-722. Cronbach alpha = .85.	y
P21-1	Some kids tell lies about a classmate so that the other kids won’t like the classmate anymore. How often do you do this?
P21-2	Some kids try to keep certain people from being in their group when it is time to play or do an activity. How often do you do this?
P21-3	When they are mad at someone, some kids get back at the person by not letting the person be in their group anymore. How often do you do this?
P21-4	Some kids tell their friends that they will stop liking them unless the friends do what they say. How often do you tell friends this?
P21-5	Some kids try to keep others from liking a classmate by saying mean things about the classmate. How often do you do this?
	The next 4 items were included to measure participants’ sexual readiness. The following 4 items were developed by GEARS and its Subject Matter Experts for the 9-11 age group.		Sexual Readiness
	When is a good age to have sex? _______ years old.
	How old do your friends think you should be to have sex? _______ years old.
	Do you think you have to have sex to be popular?
	Do you think boys have to have sex to be popular?
	The next 10 items were included to measure participants’ sexual experience. The first nine (9) items were taken from a previous OMB approved OWH HIV study with college women. Wording and the structure of certain items was revised to be more appropriate for the target population. The last item was developed by GEARS to assess how participants define “long-term” relationships. Only found in the questionnaire for the 12-17 year olds.
P22-1	Have you ever had sex?
P22-2	The first time sex happened (Check the best one) (You wanted to have sex, You did it to belong to a gang, You did it to please someone you like, You were pressured, forced or/and frightened by someone into having sex)
P22-3	If you were pressured, forced, or/and frightened into doing something sexual you did not want, what relation to you was the person responsible for this? Check all that apply. ( I was never forced to have sex or do something sexual, A friend or boyfriend, Friend of the family, Relative (uncle, brother, cousin, grandfather), Biological or Adoptive father, Step or Foster father, Mom’s boyfriend, Stranger, Other(specify), Prefer not to answer) This question was added after discussion with the grantees and Subject Matter Experts regarding participants’ first sexual experience often not being consensual. The question was added to capture the participants’ sexual agency or lack of it.
P22-4	How old were you when you first had sex or the first time sex happened?
P22-5	Have you ever had? Oral sex, Vaginal, anal sex, I have never had oral, vaginal, or anal sex.
P23-6	How old were you when you first: Gave oral sex, received oral sex, had vaginal sex, had anal sex? (I have never…)
P23-7	About how old was your sexual partner when you first: Gave oral sex, received oral sex, had vaginal sex, had anal sex? (I have never…)
P23-8	How many sexual partners have you had?
P23-9	When you have, you have sex with: Boys, girls, Both, neither- I have never…
P23-10	Have you had sex in the past 30 days?
P23-11	In the past 30 days, how often did you use condoms when you had sex? This item was included to assess their risk behavior
P23-12	How would you describe yourself?
P24-13	For you, how long is a long-term relationship? This item was developed at the OWH evaluation meeting with grantees.
	ATOD Use Age of First Use Scale; This scale has also been used in another GEARS evaluation with urban adolescents		Substance Use
	7-item scale that measures the age at which participants first used Alcohol, Tobacco and other drugs. One item was added to measure age of first use for intravenous drug use following a discussion at the evaluation meeting with grantees. Since items 4, 5, 6, and 8 were not age appropriate, they were excluded from the questionnaire for the 9-11 year olds.
P24-1	How old were you the first time you smoked a cigarette, even one or two puffs?
P24-2	How old were you the first time you had a drink of any alcoholic beverage?
P24-3	How old were you the first time you used marijuana or hashish?
P24-4	How old were you the first time you used cocaine, in any form? Not included in the questionnaires for 9 to 11 year olds.
P24-5	How old were you the first time you used heroin? Not included in the questionnaires for 9 to 11 year olds.
P24-6	How old were you the first time you used LSD, PCP, or any other hallucinogen? Not included in the questionnaires for 9 to 11 year olds.
P24-7	How old were you the first time you used an inhalant for kicks or to get high?
P24-8	How old were you the first time you used needles to inject drugs? Question was added after a discussion at the evaluation meeting to include a question about needle use as a risk factor for HIV. Not included in the questionnaires for 9 to 11 year olds.
	ATOD Use 30-day Use Scale This scale has also been used in another GEARS evaluation with urban adolescents.		Substance Use
	12-item scale that measures the amount of Alcohol, Tobacco and other drug use in the last 30 days. Two items was added to measure intravenous drug use and binge drinking in the last 30 days following a discussion at the evaluation meeting with grantees. Certain questions were slightly reworded to accommodate the reading level of the participant.
P25-1	How many cigarettes have you smoked during the last 30 days?
P25-2	How often have you taken smokeless tobacco during the last 30 days?
P25-3	To be more precise, during the past 30 days about how many cigarettes have you smoked per day? Not included in the questionnaire for the 9-11 year olds.
P25-4	How many times during the past 30 days have you had alcoholic beverages to drink (more than just a few sips)?
P26-5	How many times during the last 30 days (if any) have you been drunk or very high from drinking alcoholic beverages?
P26-6	How many drinks do you drink at one time?
P26-7	How many times during the last 30 days (if any) have you used marijuana (grass, pot, blunt) or hashish (hash, hash oil)?
P26-8	During the last 30 days, about how many marijuana cigarettes (joints, reefers), or the equivalent, did you smoke a day, on the average? (If you shared them with other people, count only the amount YOU smoked.)
P27-9	How many times during the last 30 days (if any) have you sniffed glue, or breathed the contents of aerosol spray cans, or inhaled any other gases or sprays in order to get high?
P27-10	How many times (if any) during the last 30 days have you taken LSD (“acid”)? Not included in the questionnaire for the 9-11 year olds.
P27-10	How many times (if any) during the last 30 days have you taken amphetamines on your own – that is, without a doctor telling you to take them? Not included in the questionnaire for the 9-11 year olds.
P27-11	How many times (if any) during the last 30 days have you taken “crack” (cocaine in chunk or rock form)?
P27-12	How many times (if any) during the last 30 days have you taken “crack” (cocaine in chunk or rock form)? Not included in the questionnaire for the 9-11 years old.
P28-13	How many times (if any) during the last 30 days have you taken cocaine in any other form (like cocaine powder)? Not included in the questionnaire for the 9-11 years old.
P28-14	During the last 30 days have you used needles to inject drugs? Not included in the questionnaire for the 9-11 years old.
	Participants’ expectation of program. This item is only included in the pre-test versions of both questionnaires.
	What are you most looking forward to in the program?
	Program Satisfaction Scale – This scale was developed by GEARS. Has been used in a previous OWH study with college women.
	5-item scale used to measure participant’s satisfaction. Wording was adapted to better relate to the present study. This scale is only on the post-test versions of the questionnaire for the 9-11 age group.
	How helpful was the information that was told to you?
	How safe did you feel to share your personal thoughts and feelings?
	How easy was it for you to understand the information presented?
	How much did the information help you as a girl living in your neighborhood?
	Over all, What grade would you give this program?
	Please tell us what you have learned from the program?
	Program Satisfaction Scale – This scale was developed by GEARS and has been used in a previous OWH study with college women.
	6-item scale used to measure participant’s satisfaction. Wording was adapted to better relate to the present study. This scale is only on the post-test versions of the questionnaire for the 12-17 year olds.
	How helpful was the information you received?
	How satisfied are you with the information that you have received?
	How safe did you feel to share your personal thoughts and feelings?
	How easy was it for you to understand the information presented?
	How much did the information help you as a girl living in your neighborhood?
	Over all, what grade would you give this program?
	Please tell us what you have learned from the program?
	The following items are found in the follow-up versions of the questionnaires. They were created by GEARS and its Subject Matter Experts.
	How did this program help you?
	Would you tell your friends to join this program?

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