Attachment B

ATTACHMENT B

Justification for Topics Covered in the TPP Replication Study

First Follow-up Instrument

Question # Parts A & B – Safer Sex	Question # Parts A & B– RtR & Cuidate		How question data will be used									Purpose
			Tracking	Covariate	Implementation Outcome	Intermediate Outcome		Sexual Risk Outcome		Other
1.1	1.1	Month & year of birth										There are marked differences in sexual activity among teens by age, gender, and race/ethnicity. These differences in sexual behavior are reflected in the large differences in reproductive outcomes such as the pregnancy, birth and abortion rate by teens’ age and race. (Browning et al. 2004; Abma et al. 2004; Guttmacher 2006; Santelli et al. 2000; Blinn-Pike 1999; Watt and Nagy 2000)
NA	1.3	Gender		
1.3, 1.4	1.4, 1.5	Race and ethnicity		
1.5	1.6	Language spoken at home		
1.2	1.2	Grade level										This question is important to determine in what grade the respondent entered the study.
1.12	1.13	Expectation for future education										There is an extensive literature that shows that positive expectations for future education lead to delayed sex, decreased frequency of sex, a decreased number of partners, an increase in condom use, and decreased pregnancy and childbearing. (Beuhring et al., 2000, Halpern, et al., 2000, Lanctot, et al., 2001, Moore, et al., 1998)
1.6, 1.7	1.7, 1.8	Exposure to sexual health education										These questions will be used to assess teens’ exposure to the messages presented in the program (whether through the program or outside sources). These questions will also assess any services received by teens in the control group.
1.8	1.9	Partner communication about sexual health										These questions will be used to assess the program’s effect on teens’ level communication with their partners, which in turn may affect later health risk behaviors. (Catania et al. 1989)
1.9	1.10	Decision-making skills										These questions will be used to assess the program’s effect on teens’ decision-making skills, which in turn may affect their later health risk behaviors.
2.1 - 2.4	2.1 – 2.4	Parental supervision/monitoring										These questions will be used to measure the perceived level of parental supervision. Parental monitoring and supervision have been found to be inversely related to a number of problem behaviors among adolescents, including early sexual debut, number of sexual partners, and pregnancy risk. (Miller et al. 2001; Rodgers 1999; Li et al. 2000; Sieverding et al. 2005)
7.5, 7.8	2.5, 7.5, 7.8	Parent-child communication										There is an extensive literature evaluating the relationship between parent-child connectedness and communication and teen sexual activity. All but a few studies indicate that parent-child closeness and communication is negatively associated with pregnancy risk, early sexual initiation, number of sexual partners and consistent use of contraception. (DiIorio et al. 2003; Miller et al. 2001)
1.10, 1.11	1.10, 1.12	Emotional stress										These questions will be used to assess the program’s effect on teens’ mental health and emotional stress, which in turn may affect their later health risk behaviors.
3.14	3.14	Attitudes towards abstinence and teen sex										Teens’ attitudes about sex and abstinence are associated with the intention to have sex and with early initiation of sexual activity, where a more positive/less permissive attitude towards sex serves as a protective factor. (Buhi and Goodson 2007; Gillmore et al. 2002; Carvajal et al. 1999; Cleveland 2003; DiIorio et al. 2004; Meier 2003)
3.17	3.17, 3.18	Attitudes towards teen pregnancy										Teens with a more positive attitude towards pregnancy are more likely to become pregnant. Attitudes towards teen pregnancy are also related to contraceptive use among females, where those with a higher motivation to avoid pregnancy are more likely to use contraception. (Ryan et al. 2007; Bruckner et al. 2004; Jaccard et al. 2003)
3.18, 3.19	3.19, 3.20	Likelihood of pregnancy										These questions will be used to measure the program’s effects on teens’ intentions to get pregnant (for girls) or cause a pregnancy (for boys), which in turn may shape their future sexual risk behaviors.
3.21, 3.22	3.22, 3.23	Likelihood of contracting an STD										These measures will be used to assess the program’s effect on teens’ perceived likelihood of contracting STDs, which in turn may predict their future involvement in sexual risk behaviors.
3.20	3.21	Future goals and expectations										This measure will be used to assess the program’s effect on their goals for the future, which in turn may influence the decisions they make about sexual risk behaviors.
3.15, 3.16	3.15, 3.16	Negotiation and refusal skills										Adolescent males who received instruction on “how to say no to sex” as part of an AIDS education were more likely to use a condom, had fewer sexual partners and a lower frequency of sexual intercourse. (Ku et al. 1992)
3.12, 3.13	3.12, 3.13	Attitudes towards condom and contraceptive use										Positive attitude towards contraception has been linked to an increased likelihood of contraceptive use among sexually active adolescents (Bruckner et al. 2004; Sheeran et al. 1999; Ryan et al. 2007).
3.1, 3.2 – 3.11	3.1, 3.2 – 3.11	Knowledge of STDs and the effectiveness of contraceptives in reducing risk and teens’ confidence in their knowledge										Findings on the relationship between knowledge of STDs and prevention and teen sexual activity are inconsistent. However, according to Rock et al. 2005, this might be due to the fact that prior studies focused on objective knowledge, and ignored teen’s confidence in their knowledge. (Rock et al. 2005; Boyer et al. 1999; DiClemente et al. 1996; DiClemente et al. 1992)
3.23 – 3.26	3.24 – 3.27	Intention to engage in/abstain from sexual activity; intention to use birth control										Intention to engage in sexual activity is the single most stable predictor of initiation of sexual intercourse and of participation in sexual behavior. (Buhi and Goodson 2007)
3.27-3.29	3.28 – 3.30	Dating status										Dating during early adolescence is associated with an increased likelihood of sexual initiation in adolescence. At the same time more than half of sexually active teens had at least one sexual experience outside of a romantic relationship. (Thornton 1990; Cooksey et al. 2002; Manning et al. 2005).
4.2	4.2	Ever engaged in sexual activity										This question will be used to identify teens with and without prior sexual experience. Sexually inexperienced teens will skip Section 4 of the questionnaire and will not be asked about personal sexual activity.
4.1	4.1	Confirmation - sexual activity										Confirming that respondents are completing the correct sections of Part B.
4.3, 4.4, 4.12, 4.13, 4.17, 4.19	4.3, 4.4, 4.12, 4.13, 4.17 4.19	Initiation of sexual activity										These are the primary outcome measures for the study. They will be used to control for prior sexual experiences. In addition, baseline sexual activity will be used to stratify the sample to allow examination of differential program impact on teens who were sexually experienced vs. inexperienced at baseline.
4.5, 4.7, 4.9, 4.9a, 4.15, 4.15a, 4.20, 4.20a	4.5, 4.7, 4.9, 4.9a, 4.15, 4.15a, 4.20, 4.20a	Frequency of sexual activity						
4.6, 4.14, 4.18	4.6, 4.14, 4.18	Number of sexual partners						
4.8, 4.10, 4.10a, 4.11, 4.11a, 4.16, 4.16a, 4.21, 4.21a	4.8, 4.10, 4.10a, 4.11, 4.11a, 4.16, 4.16a, 4.21, 4.21a	Condom and other contraceptive use
5.1, 5.2a-d	5.1 , 5.2a-d	Pregnancy						
5.3	5.3	Spoken to a doctor about sexual health						
5.4 – 5.6	5.4 – 5.6	STDs						
6.1 – 6.3	6.1 – 6.3	Alcohol use										The consumption of alcohol and other drug use among adolescents is associated with early initiation of sexual activity as well as sexual risk taking. While much of the association can be explained by common risk factors that predispose teens to both alcohol misuse and risky sexual behavior, there exists a direct link between alcohol consumption and post-drinking risky sexual behavior. This direct link is strongest among teens who expect alcohol consumption to lead to risky sex. (Tapert et al. 2001, Li et al. 2001, Boyer et al. 1999; Fergusson and Lynskey 1996; Sen 2002; Dermen 1998 et al.; Santelli et al. 2001)
6.4, 6.5	6.4, 6.5	Other drug use				
7.1, 7.2	7.1, 7.2	Peer Pressure and Support										There is a rich body of research pointing to a strong association between teens’ behavior and the behavior of or the perceived norms of their peers. While some of this observed relationship is the result of teens selecting peers who have similar values, a weaker, but stable relationship remains after taking into account the selection process. These questions will allow us to identify teens under a possible positive or negative influence of their peers as well as the level of involvement with friends. (Jaccard et al. 2005; Buhi and Goodson 2007; Kinsman et al. 1998; Sieving et al. 2006)
NA	3.14a	Peer Norms				
7.3, 7.4, 7.6, 7.7	7.3, 7.4, 7.6, 7.7	Parents’ Employment Status										These questions will be used to construct indicators of socioeconomic status, which will serve as control variables. Socioeconomic status is correlated with the probability that youth will engage in sexual and other high-risk behaviors. (Forste and Haas 2002; Santelli et al. 2000; Miller et al. 2001)
7.10 – 7.13	7.10 – 7.13	Household structure/living situation/marital status of parents										There is a well established link between family structure and the probability that youth will engage in sexual activity. While some researches argue that this relationship can be explained by mediating factors such as mother-child relationship and mother's attitude toward sex, others argue that there is a direct link, independent of such mediating factors. (Sturgeon 2008; Davis and Friel 2001; Pearson et al. 2006)
QUESTIONS FOR NON-SEXUALLY ACTIVE YOUTH (only questions that do not appear in the version for sexually active teens are listed below)
NA	4.2, 4.3	Graduation Expectations										This measure will be used to provide additional information on the characteristics of youth who remain abstinent.
NA	4.4, 4.5	Reasons Not to Have Sex										These measures will be used to provide additional information on the characteristics of youth who remain abstinent.
NA	4.6-4.8	Religious Beliefs										These measures will be used to provide additional information on the characteristics of youth who remain abstinent.
NA	4.9-4.10	Perceived Embarrassment for Teen Virgins/Teen Pregnancy										These measures will be used to provide additional information on the characteristics of youth who remain abstinent.
NA	4.11	Importance of Boyfriend/Girlfriend with Peers										This measure will be used to provide additional information on the characteristics of youth who remain abstinent.
NA	4.12	Access to Electronic Media										This measure will be used to provide additional information on the characteristics of youth who remain abstinent.
NA	4.13-4.15	Parental Monitoring of Use of Electronic Media										These measures will be used to provide additional information on the characteristics of youth who remain abstinent.
NA	4.16	Perceived Frequency of Sexting Among Teens										There is a rich body of research pointing to a strong association between teens’ behavior and the behavior or the perceived norms of their peers.
NA	4.17- 4.20	Frequency of and Reasons For Sexting										The relationship between the use of technology among youth and sexual behavior is an emerging topic of interest that has not yet been heavily researched. Questions will be asked of non-sexually active youth to examine this relationship, and identify potential pathways leading to the transition from non-sexually active to sexually active, and factors affecting the rate of that transition.
NA	5.1, 5.2	Perception of Adult Caring										These measures will be used to provide additional information on the characteristics of youth who remain abstinent.
NA	5.3-5.5	Physical Safety										These measures will be used to provide additional information on the characteristics of youth who remain abstinent.
NA	5.6-5.7	Involvement in Extracurricular Activities										These measures will be used to provide additional information on the characteristics of youth who remain abstinent.

SUPPORTING REFERENCES FOR INCLUSION OF SPECIFIC QUESTIONS

OR GROUPS OF QUESTIONS

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