Form 3 Reducing the Risk - Inexperienced

TPP Replication Study Follow Up Data Collection

TPP Replication Study Follow-Up Survey Attachment F - RtR_Cuidate Sexually Inexperienced

Reducing the Risk - Inexperienced

OMB: 0990-0405

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ATTACHMENT F

Form Approved

OMB No. 0990-

                Exp. Date XX/XX/20XX




TPP Replication Study

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FOLLOW-UP QUESTIONNAIRE

(Reducing the Risk and ¡Cuidate!:
Non-sexually Active Youth)

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CONFIDENTIALITY

Thank you for your help with this important study. It will help us understand what things are like for people your age today. Your answers are confidential and everything you say will be kept private. Your name will not be on the questionnaire. Please answer all questions as well as you can.

We want you to know that:

1. We hope that you will answer all the questions, but you may skip any questions you do not wish to answer.

2. The answers you give will never be identified as yours. Your responses will be combined with those of other people your age.



THE PAPERWORK REDUCTION ACT OF 1995

Public reporting burden for this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.


Form Approved

OMB No. 0990-

                Exp. Date XX/XX/20XX


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SECTION 1: YOU AND YOUR BACKGROUND

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1.1. In what month and year were you born?

Shape6 Shape5 SELECT ONE MONTH AND SELECT ONE YEAR


Month born


Year born

January


2002

February


2001

March


2000

April


1999

May


1998

June


1997

July


1996

August


1995

September


1994

October


1993

November


1992

December


1991






1.2. What grade are you in?

SELECT ONE


6th

11th

7th

12th

8th

Ungraded

9th

College/Technical school

10th

No currently in school



1.3. Are you male or female?

SELECT ONE


Male


Female




1.4. Are you Hispanic / Latino?

SELECT ONE


Yes


No




1.5. What is your race?

YOU MAY SELECT MORE THAN ONE ANSWER


American Indian or Alaska Native

Native Hawaiian or Other Pacific Islander

Asian

White

Black or African American

Some other race (PRINT OTHER RACE)



1.6. In the past 12 months, have you received any information or learned about any of the following?

SELECT ONE FOR EACH

Yes

No

  1. Relationships or dating

  1. Marriage or family life

  1. Abstinence from sex

  1. Methods of birth control

  1. Where to get birth control

  1. Sexually transmitted diseases(STDs)/ sexually transmitted infections (STIs) or HIV

  1. How to talk to your partner about whether to have sex

  1. How to talk to your partner about whether to use birth control

  1. How to say no to sex

  1. How babies are made


1.6a. Did you say “yes” to any item a through j in question 1.6 above?

SELECT ONE


Yes


No GO TO 1.8




1.7. Thinking about the past 12 months, how often did you get information or learn about relationships, abstinence, birth control, or sexually transmitted diseases (STDs)/ sexually transmitted infections (STIs) or HIV at each of the following places?

SELECT ONE FOR EACH

VERY OFTEN

OFTEN

SOMETIMES

RARELY

NEVER

  1. School class, workshop, or event

  1. Church, synagogue, mosque, or religious classes outside of school

  1. Community center, youth organization, or after-school activity

  1. Doctor, nurse, or clinic

  1. Friends or other students

  1. Parents and other relatives or family members

  1. Internet and media

  1. Other LIST OTHER SOURCE (below):









1.8. In the past 30 days, how often have you felt that you were unable to control the important things in your life?

SELECT ONE


Always

Rarely

Most of the time

Never

Sometimes




1.9. In the past 30 days, how often have you felt difficulties were piling up so high that you could not overcome them?

SELECT ONE


Always

Rarely

Most of the time

Never

Sometimes



1.10. How likely is it that you will do each of the following things?

SELECT ONE FOR EACH

NOT AT ALL LIKELY

A LITTLE BIT LIKELY

SOMEWHAT LIKELY

VERY LIKELY

a. Graduate from high school

b. Go to a technical or vocational school after high school

c. Go to college

d. Graduate from a 2-year or community college program

e. Graduate from a 4-year college program






SECTION 2: KNOWLEDGE, VIEWS AND PERCEPTIONS

In this section, we will ask you about what you know and your ideas about sex, pregnancy, birth control, and preventing sexually transmitted disease (STD)/ sexually transmitted infection (STI) or HIV.

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2.1. Read each statement below and check the answer that fits best.

SELECT ONE FOR EACH

I AM SURE IT’S TRUE

I THINK IT’S TRUE

I DON’T KNOW

I THINK IT’S FALSE

I AM SURE IT’S FALSE

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    1. You can’t get infected with HIV if you have sex only once or twice without a condom

    1. Most high school students are having sex

    1. Once you are infected with HIV, you are infected for life

    1. If a young couple has had unprotected sex a few times and a pregnancy did not happen, then they do not have to worry about her getting pregnant

    1. There is a vaccine or shot available to prevent girls from becoming infected with certain types of HPV (also known as Human Papilloma virus)

    1. A woman is protected from pregnancy the day she begins taking the pill

    1. All STDs/ STIs can be cured by taking medicine

    1. A person with a STD/ STI who looks and feels healthy cannot transmit the infection to others

    1. Some STDs/ STIs put you at a higher risk of getting Infected with HIV

    1. About 1 out of 4 sexually active teenagers get an STD/ STI each year.

    1. The best way to use a condom is to leave some space at the tip for the sperm

    1. A condom should be completely unrolled before it is placed on the penis

    1. You can get a sexually transmitted disease (STD) from having oral sex


The next set of questions is about your views on condom use.

2.2. If condoms are used correctly and consistently, how much can they decrease the risk of pregnancy?

SELECT ONE


Not at all

Completely

A little

Don’t Know GO TO 2.5

A lot




2.3. If condoms are used correctly and consistently, how much can they decrease the risk of getting HIV, the virus that causes AIDS?

SELECT ONE


Not at all

Completely

A little

Don’t Know

A lot




2.4. If condoms are used correctly and consistently, how much can they decrease the risk of getting gonorrhea?

SELECT ONE


Not at all

Completely

A little

Don’t Know

A lot




2.5. How strongly do you agree or disagree with the following statements?

SELECT ONE FOR EACH

STRONGLY AGREE

AGREE

DISAGREE

STRONGLY DISAGREE

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  1. Condoms should always be used if a person your age has sexual intercourse

  1. Condoms are too much trouble to use

  1. Condoms are pretty easy to get

  1. Condoms are important to make sex safer

  1. Using condoms means you don’t trust your partner

  1. Using condoms is morally wrong

  1. Condoms decrease sexual pleasure


The next set of questions is about your views on birth control pills.

2.6. If birth control pills are used correctly and consistently, how much can they decrease the risk of pregnancy?

SELECT ONE


Not at all

Completely

A little

Don’t Know GO TO 2.9

A lot




2.7. If birth control pills are used correctly and consistently, how much can they decrease the risk of getting HIV, the virus that causes AIDS?

SELECT ONE


Not at all

Completely

A little

Don’t Know

A lot




2.8. If birth control pills are used correctly and consistently, how much can they decrease the risk of getting gonorrhea?

SELECT ONE


Not at all

Completely

A little

Don’t Know

A lot



The next question asks about birth control, including condoms.

2.9. What, if anything, would persuade you to use birth control?

CHECK ALL THAT APPLY


Your own desire to prevent an unplanned pregnancy

Your partner insists

To prevent STDs/ STIs or HIV

Someone you know going through an unplanned pregnancy

A pregnancy scare

None of these – you won’t use birth control




The next question is about methods of birth control, NOT including condoms.

2.10. How strongly do you agree or disagree with the following statements?

SELECT ONE FOR EACH

STRONGLY AGREE

AGREE

DISAGREE

STRONGLY DISAGREE

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  1. Birth control should always be used if a person your age has sexual intercourse

  1. Birth control is too much trouble to use

  1. Birth control is pretty easy to get

  1. Birth control is important to make sex safer

  1. Birth control has too many negative side effects

  1. Using birth control is morally wrong


Now we’d like to know more about your views on engaging in sex.

2.11. It’s OK to have sex with someone…?

PLEASE CHECK ALL THAT APPLY


Once you're in a committed relationship

When you know that they are someone else's boyfriend/ girlfriend

Any time as long as you use protection

When you know that neither of you is using protection

On your first date

If you know they're drunk or high

The same night you meet them

With several different people in the same month

If you're drunk or high

None of the above


The following question asks you about your FRIENDS and what they believe. Even if you’re not sure mark the answer that is your best guess of what they think.

2.12. How strongly do your friends agree or disagree with the following statements?

SELECT ONE FOR EACH

STRONGLY AGREE

AGREE

DISAGREE

STRONGLY DISAGREE

  1. It is OK for people my age to have sex with a steady boyfriend or girlfriend

  1. It is OK for people my age to have sex with several different people in the same month

  1. People my age should wait until they are older before they have sex

  1. It is OK for people my age to choose not to have sex

  1. Condoms should always be used if a person my age has sex

  1. Condoms should always be used if a person my age has sex even if the girl uses hormone based birth control

  1. Condoms should always be used if a person my age has sex even if the two people know each other very well



2.13. How sure are you that you would be able to say no to having sexual intercourse....

SELECT ONE FOR EACH

I’M SURE I COULD

I PROBABLY COULD

I PROBABLY COULD NOT

I’M SURE I COULD NOT

  1. If your partner really wanted to, but you were not ready?

  1. If you just met someone you really liked and that person wanted to have sex, but you didn’t?

  1. If you had strong sexual feelings for that person?

  1. If neither you nor your partner had any form of birth control?

  1. If you have dated for a long time?

  1. After you have been drinking alcohol?



2.14. If you were going to have sex could you...

SELECT ONE FOR EACH

I’M SURE I COULD

I PROBABLY COULD

I PROBABLY COULD NOT

I’M SURE I COULD NOT

  1. Get or buy a condom?

  1. Talk about using condoms with your partner before having sex?

  1. Insist on using a condom if your partner didn’t want to use one?

  1. Ask your partner to use condoms even if the two of you had sex before without using condoms?

  1. Use a condom without spoiling the mood?

  1. Ask a new partner to use condoms?

  1. Get a partner to use condoms, even if you’re drunk or high?

  1. Go to a clinic if you needed to get tested for HIV/AIDS or another sexually transmitted disease (STD)/ sexually transmitted infection (STI)?





2.15. Which, if any, of the following worries you or makes you anxious when it comes to sex?

PLEASE CHECK ALL THAT APPLY


Sexually-transmitted diseases (STDs) /sexually transmitted infections (STIs) or HIV

That my feelings will get hurt

Pregnancy

Ruining my reputation

That I won't know what I'm doing

That it will be painful

That my parents or guardians will find out

That my friends will find out

Being compared to his or her other sexual partners

None of these



2.16. Thinking about your life right now, how important is it to you to avoid getting pregnant/ getting someone pregnant?

SELECT ONE


Not at all important


A little important


Somewhat important


Very important



2.17. How likely is it that you will get pregnant (or get someone pregnant) between now and age 20?

SELECT ONE


Not at all likely

A little likely

Somewhat likely

Very likely



2.18. How likely is it that you will get pregnant (or get someone pregnant) before getting married?

SELECT ONE


Not at all likely

A little likely

Somewhat likely

Very likely



2.19. Which of the following best describes how you would feel if you were to get {GUYS: someone} pregnant right now?

SELECT ONE


It would be a disaster

It would be challenging, and I'm not sure how I would manage

It would be challenging, but I could manage

My life wouldn't change much

It would make my life better



2.20. How strongly do you agree or disagree with the following statements?

SELECT ONE FOR EACH

STRONGLY AGREE

AGREE

DISAGREE

STRONGLY DISAGREE

  1. You have goals you want to accomplish before you have a child/another child

  1. It is important for you to finish school before you have a child/another child

  1. It is important for you to have a job and stable income before you have a child/another child

  1. Having a good marriage seems possible for you



2.21. Thinking about the future, how likely do you think it is that you will get HIV?

SELECT ONE


Not at all likely

A little likely

Somewhat likely

Very likely



2.22. How likely do you think it is that you will get an STD/STI other than HIV?

SELECT ONE


Not at all likely

A little likely

Somewhat likely

Very likely

The next series of questions ask you about decisions you may make to engage in sexual activity in the next year.

2.23. Do you intend to have oral sex in the next year, if you have the chance?

SELECT ONE


Yes, definitely

Yes, probably

No, probably not

No, definitely not













2.24. Do you intend to have sexual intercourse in the next year, if you have the chance?

SELECT ONE


Yes, definitely

Yes, probably

No, probably not

No, definitely not



2.25. If you were to have sexual intercourse in the next year, do you intend to use (or have your partner use) a condom?

SELECT ONE


Yes, definitely

Yes, probably

No, probably not

No, definitely not



2.26. If you were to have sexual intercourse in the next year, do you intend to use (or have your partner use) any of these types of birth control?

  • Condoms

  • Birth control pills

  • The shot (Depo-Provera)

  • The patch

  • The ring (NuvaRing)

  • IUD (Mirena or Paragard)

  • Implants (Implanon)

SELECT ONE


Yes, definitely

Yes, probably

No, probably not

No, definitely not



The next series of questions asks you about relationships.

2.27. People are different in their sexual attraction to other people. Which of the following best describes your feelings?

SELECT ONE


I am only attracted to males

I am attracted to both males and females

I am only attracted to females

I am not attracted to either males or females

I am not sure



2.28. Right now, do you have a boyfriend or girlfriend—someone in particular you are going out with?

SELECT ONE


Yes


No




2.28a. For the next question, please indicate how often you have talked about each of the topics listed below with your partner (boyfriend or girlfriend) in the last month?


I didn’t have a partner in the last month. GO TO 2.29

SELECT ONE FOR EACH

10 OR MORE TIMES

3 – 9 TIMES

1-2 TIMES

NEVER

  1. Preventing pregnancy

  1. Birth control

  1. Preventing sexually transmitted diseases (STDs)/sexually transmitted infections (STIs) or HIV

  1. What you feel comfortable doing sexually

  1. What you do not feel comfortable doing sexually







2.29. Have you ever had any of the following: sexual intercourse, oral sex or anal sex?

SELECT ONE


Yes GO TO PART B1


No GO TO PART B2




SECTION 3: ABOUT YOU AND YOUR EXPERIENCES

The next questions are about your ideas and experiences. Please be as honest as possible. Your answers are confidential and will be kept private.



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These next questions are for youth who have not had sex. We want to be sure you are in the correct booklet. We know we asked this before but…

3.1. Just to confirm, have you ever had sexual intercourse, oral sex, or anal sex?

SELECT ONE


Yes STOP! GO TO PART B1 INSTSEAD


No CONTINUE WITH THIS BOOKLET



The first two questions in this booklet are about your schooling.

3.2. Do you expect that you will graduate from high school?

SELECT ONE


Yes


I already graduated from high school


No GO TO QUESTION 3.4




3.3. In what month and year do you expect to graduate from high school? (If you already graduated, in what month and year did you graduate from high school?)

Shape16 Shape15 SELECT ONE MONTH AND SELECT ONE YEAR


Month of Graduation


Year of Graduation

January


2018 or later

February


2017

March


2016

April


2015

May


2014

June


2013

July


2012

August


2011

September


2010

October


2009

November


2008

December


2007 or earlier


3.4. Here are some reasons people your age might choose NOT to have sexual intercourse. How important is each of these reasons to you?

SELECT ONE FOR EACH

VERY IMPORTANT

SOMEWHAT IMPORTANT

NOT TOO IMPORTANT

NOT AT ALL IMPORTANT

  1. I don’t want to get a sexually transmitted disease (STD)/ sexually transmitted infection (STI) or HIV

  1. I don’t want to disappoint my parents

  1. I am too young to have sex

  1. My boyfriend or girlfriend doesn’t want to have sex

  1. I want to wait until I’m married

  1. It is against my personal values

  1. I haven’t met the right person yet

  1. I haven’t had the chance

  1. I don’t want to

  1. FOR GIRLS I do not want to get pregnant

  1. FOR BOYS I do not want to get a girl pregnant



3.5. What do you think are the benefits of waiting to have sexual intercourse?

SELECT ONE FOR EACH

STRONGLY AGREE

AGREE

DISAGREE

STRONGLY DISAGREE

  1. Respect for yourself

  1. Respect from parents

  1. Keeping true to religious values

  1. Respect from friends

  1. Not having to worry about pregnancy

  1. Not having to worry about sexually transmitted diseases (STDs)/ sexually transmitted infections (STIs) or HIV

  1. Better chance for a good marriage in the future

  1. Fewer distractions so you can focus on school work





3.6. Do people need religion to have good values?

SELECT ONE


Yes


No




3.7. Should religious teachings be obeyed in every situation?

SELECT ONE


Yes


No




3.8. Do you pray every day?

SELECT ONE


Yes


No




3.9. Do you think it’s embarrassing for people your age to admit they are virgins?

SELECT ONE


Yes


No




3.10. Do you think it’s embarrassing for girls your age to get pregnant?

SELECT ONE


Yes


No




3.11. In the group you hang out with, how important is it to have a girlfriend or boyfriend or to be going out with someone?

SELECT ONE


Very important


Not too important


Not important at all



The next few questions are about your access to and use of TV, cell phones, computers and other forms of technology.


3.12 Do you personally have a phone, computer, or other device that can connect to the internet?

SELECT ONE


Yes


No




3.13. Do your parents have any rules about…?

SELECT ONE FOR EACH

YES

NO

NOT APPLICABLE

  1. The amount of time or when you can text, talk on the phone, watch TV or be on the computer

  1. Whether or not you can have a profile on a social networking site like MySpace or Facebook



3.14. Do your parents have any rules about what you are allowed to watch on TV?

SELECT ONE


Yes


No




3.15. Do your parents have any rules about what sites you can access on the internet?

SELECT ONE


Yes


No




3.16. Some people exchange sexy text messages, videos, or pictures of themselves or their friends. How common would you say each of the following is among people your age?

SELECT ONE FOR EACH

NOT COMMON AT ALL

NOT VERY COMMON

FAIRLY COMMON

VERY COMMON

  1. Sending or posting sexy text messages

  1. Sending or posting sexy pictures or video



3.17. Have you ever sent or posted a sexy message, picture, or video of yourself by email, IM or text?

SELECT ONE


Yes


No GO TO 3.19








3.18. Which of the following reasons did you have for sending or posting a sexy message, picture or video of yourself?

SELECT ONE FOR EACH

YES

NO

  1. To get or keep a guy’s or girl’s attention

  1. Your boyfriend/girlfriend pressured you to do it

  1. As a “sexy” present for a boyfriend or girlfriend

  1. To get back at someone or cause trouble

  1. Pressure from friends

  1. To be fun or to flirt

  1. Everybody does it

  1. Another reason? PRINT REASON






3.19. Have you ever received a sexy text message, or a picture or video of someone you know?

SELECT ONE


Yes


No GO TO 3.21




3.20. Have you ever shared or forwarded a sexy text message, or picture or video of someone you know?

SELECT ONE


Yes


No




3.21. For the next question please answer how often you do each of the statements below. When you have to make a decision about your sexual behavior, how often do you…?

SELECT ONE FOR EACH

ALWAYS

MOST OF THE TIME

SOMETIMES

RARELY

NEVER

  1. Think of the consequences of each possible choice

  1. First get as much information as you can

  1. Make it on the spot without worrying about the consequences



SECTION 4: YOUR COMMUNITY

The next few questions ask about your feelings about your community and your activities.

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The next few questions ask about your community


4.1. How often do you feel that there are teachers or other adults in your school who really know you and care about you?

SELECT ONE


Never

Most of the time

Rarely

Always

Sometimes




4.2. How often do you feel there are adults in your neighborhood, or in religious or youth organizations, who really know you and care about you?

SELECT ONE


Never

Most of the time

Rarely

Always

Sometimes




4.3. How often do you feel safe in your community or neighborhood?

SELECT ONE


Never

Most of the time

Rarely

Always

Sometimes




4.4. How often do you feel safe at school?

SELECT ONE


Never

Most of the time

Rarely

Always

Sometimes




4.5. How often do you feel safe at home?

SELECT ONE


Never

Most of the time

Rarely

Always

Sometimes



4.6. During the past 12 months, were you on a sports team or did you take sports lessons after school or on weekends?

SELECT ONE


Yes


No




4.7. During the past 12 months, did you participate in any clubs or organizations after school or on weekends, such as Scouts, a religious group, or Boy’s/Girl’s Club?

SELECT ONE


Yes


No












SECTION 5: ALCOHOL AND DRUG USE

The next questions are about alcohol and drug use. Please do as honest as possible, and remember that everything you tell us will be kept private.

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The next questions are about alcohol and drug use. Please be as honest as possible, and remember that everything you tell us will be kept private.

5.1. During the last 30 days, not including any times you just had a sip, on how many days did you have at least one alcoholic beverage?

SELECT ONE


0 (zero) days GO TO 5.4


1 to 4 days


5 to 10 days


11 to 25 days


More than 25 days




5.2. During the last 30 days, on how many days did you have 5 or more drinks in a row?

SELECT ONE


0 (zero) days


1 to 4 days


5 to 10 days


11 to 25 days


More than 25 days




5.3. During the past 30 days, on how many days did you get drunk or wasted?

SELECT ONE


0 (zero) days


1 to 4 days


5 to 10 days


11 to 25 days


More than 25 days






5.4. During the last 30 days, on how many days did you use marijuana, also called weed or pot?

SELECT ONE


0 (zero) days


1 to 4 days


5 to 10 days


11 to 25 days


More than 25 days




5.5. During the past 30 days, on how many days did you use any other type of illegal drugs, an inhalant, or prescription drugs that were not prescribed to you?

SELECT ONE


0 (zero) days


1 to 4 days


5 to 10 days


11 to 25 days


More than 25 days










SECTION 6: FRIENDS AND FAMILY

This section contains questions about your friends and family and your relationships with them. Remember that your answers will be kept private and your friends and family will not see your answers.

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6.1. In general, how much pressure, if any, do you feel from your friends to have sexual intercourse?

SELECT ONE


A lot of pressure


Some pressure


A little pressure


No pressure




6.2. How often is each of the following statements true for you?

SELECT ONE FOR EACH

NEVER TRUE

SOMETIMES TRUE

OFTEN TRUE

ALMOST ALWAYS TRUE

  1. I can trust my friends

  1. My friends want the best for me in my life

  1. My friends care about me

  1. My friends are there for me if I need them

The next questions ask what your parents know about your activities. By parents, we mean the parents or guardians you live with most of the time.

6.3. Thinking about the past month, how often did your parent(s) know where you were after school?

SELECT ONE


Always

Rarely

Most of the time

Never

Sometimes




6.4. Thinking about the past month, how often did your parent(s) know who you were going to be with before you went out?

SELECT ONE


Always

Rarely

Most of the time

Never

Sometimes

I did not go out





6.5. Thinking about the past month, how often did your parent(s) know where you were when you went out at night?

SELECT ONE


Always

Rarely

Most of the time

Never

Sometimes

I did not go out at night



6.6. If you are going to be home late, do you call your parents?

SELECT ONE


Yes


No




6.7. In the last month, how often have you talked about each of the topics listed below with at least one of your parents or guardians?

SELECT ONE FOR EACH

10 OR MORE TIMES

3 – 9 TIMES

1-2 TIMES

NEVER

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  1. Your feelings about engaging in sexual activity

  1. How to resist pressures to have sex

  1. Pregnancy or birth

  1. Getting condoms

  1. Getting birth control

  1. Ways to protect yourself from sexually transmitted diseases (STDs)/sexually transmitted infections (STIs) or HIV

  1. How to have good romantic relationships

This last set of questions, asks about you and your family. You cannot personally be identified by your answers. The information you provide will be combined with the information provided by all the other students completing this survey.

6.8. Is the person you think of as your mother…?

SELECT ONE


Your biological mother, that is, the woman who gave birth to you

Your stepmother or adoptive mother

Your foster mother

Your grandmother

Your aunt or your older sister

Some other adult

Don’t have a mother or person I think of as my mother GO TO 6.11





6.9. How well can you and she talk about things that are important to you?

SELECT ONE


Not at all well

Not very well

Somewhat well

Very well



6.10. Is she working now?

SELECT ONE


She is not working at a paid job

Yes, she is working part-time or less than 30 hours a week

Yes, she is working full-time or at more than one job for 30 hours a week or more

Yes, she works, but I don’t know how many hours

Don’t know if she is working



6.11. Is the person you think of as your father…?

SELECT ONE


Your biological father, that is, the man who is genetically related to you

Your stepfather or adoptive father

Your foster father

Your grandfather

Your uncle or your older brother

Some other adult

Don’t have a father or person I think of as my father GO TO 6.14



6.12. How well can you and he talk about things that are important to you?

SELECT ONE


Not at all well

Not very well

Somewhat well

Very well





6.13. Is he working now?

SELECT ONE


He is not working at a paid job

Yes, he is working part-time or less than 30 hours a week

Yes, he is working full-time or at more than one job for 30 hours a week or more

Yes, he works, but I don’t know how many hours

Don’t know if he is working



6.14. Which of the following best describes the relationship between your biological mother and biological father? If one or both of your biological parents have passed away, please answer about their relationship when both were alive.

SELECT ONE


They are married to each other

They used to be married to each other, but are now separated

They used to be married to each other, but are now divorced

They have never been married to each other

I don’t know



6.15. Do your biological mother and biological father live together now?

SELECT ONE


Yes

No

One or both of my biological parents have passed away

I don’t know

The next questions are about where you live and who lives with you.

6.16. Which of the following best describes where you live?

SELECT ONE


You live in one home GO TO 6.17

You live in two or more homes, and go back and forth GO TO 6.18

You are homeless (living on the street, in a car or shelter, or staying with friends/relatives) YOU HAVE FINISHED THE SURVEY




6.17. Who lives with you in your home?

SELECT ALL THAT APPLY


Your biological mother

Any grandmothers

Your biological father

Any grandfathers

A stepmother or adoptive mother

Any older brothers or sisters

A foster mother

Any younger brothers or sisters

A stepfather or adoptive father

Any aunts, uncles, or other relatives

A foster father

Any other people you are not related to

Your parent’s partner, boyfriend, or girlfriend

You live by yourself

YOU HAVE FINISHED THE SURVEY



6.18. Who lives with you in each of your homes?

SELECT ALL THAT APPLY


MAIN HOME

SELECT all the people who live with you in your
MAIN home

OTHER HOME(S)

SELECT all the people who live with you in your
OTHER home

Your biological mother

Your biological mother

Your biological father

Your biological father

A stepmother or adoptive mother

A stepmother or adoptive mother

A foster mother

A foster mother

A stepfather or adoptive father

A stepfather or adoptive father

A foster father

A foster father

Your parent’s partner, boyfriend, or girlfriend

Your parent’s partner, boyfriend, or girlfriend

Any grandmothers

Any grandmothers

Any grandfathers

Any grandfathers

Any older brothers or sisters

Any older brothers or sisters

Any younger brothers or sisters

Any younger brothers or sisters

Any aunts, uncles, or other relatives

Any aunts, uncles, or other relatives

Any other people you are not related to

Any other people you are not related to

You live by yourself

You live by yourself


Thank you for completing this survey!

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitlePPA Baseline Questionnaire - Part A Concordance
SubjectSAQ
AuthorMelissa Thomas
File Modified0000-00-00
File Created2021-01-30

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