ATTACHMENT F
Form Approved
OMB No. 0990-
Exp. Date XX/XX/20XX
TPP
Replication Study
FOLLOW-UP
QUESTIONNAIRE
(Reducing
the Risk and ¡Cuidate!:
Non-sexually Active Youth)
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
1.1. In what month and year were you born? |
SELECT ONE MONTH AND SELECT ONE YEAR |
Month born |
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Year born |
January |
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2002 |
February |
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2001 |
March |
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2000 |
April |
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1999 |
May |
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1998 |
June |
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1997 |
July |
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1996 |
August |
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1995 |
September |
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1994 |
October |
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1993 |
November |
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1992 |
December |
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1991 |
1.2. What grade are you in? |
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SELECT ONE |
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6th |
11th |
7th |
12th |
8th |
Ungraded |
9th |
College/Technical school |
10th |
No currently in school |
1.3. Are you male or female? |
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SELECT ONE |
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Male |
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Female |
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1.4. Are you Hispanic / Latino? |
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SELECT ONE |
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Yes |
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No |
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1.5. What is your race? |
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YOU MAY SELECT MORE THAN ONE ANSWER |
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American Indian or Alaska Native |
Native Hawaiian or Other Pacific Islander |
Asian |
White |
Black or African American |
Some other race (PRINT OTHER RACE)
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1.6. In the past 12 months, have you received any information or learned about any of the following? |
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SELECT ONE FOR EACH |
Yes |
No |
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1.6a. Did you say “yes” to any item a through j in question 1.6 above? |
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SELECT ONE |
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Yes |
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No GO TO 1.8 |
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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? |
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SELECT ONE FOR EACH |
VERY OFTEN |
OFTEN |
SOMETIMES |
RARELY |
NEVER |
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1.8. In the past 30 days, how often have you felt that you were unable to control the important things in your life? |
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SELECT ONE |
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Always |
Rarely |
Most of the time |
Never |
Sometimes |
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1.9. In the past 30 days, how often have you felt difficulties were piling up so high that you could not overcome them? |
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SELECT ONE |
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Always |
Rarely |
Most of the time |
Never |
Sometimes |
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1.10. How likely is it that you will do each of the following things? |
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SELECT ONE FOR EACH |
NOT AT ALL LIKELY |
A LITTLE BIT LIKELY |
SOMEWHAT LIKELY |
VERY LIKELY |
a. Graduate from high school |
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b. Go to a technical or vocational school after high school |
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c. Go to college |
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d. Graduate from a 2-year or community college program |
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e. Graduate from a 4-year college program |
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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.
2.1. Read each statement below and check the answer that fits best. |
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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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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? |
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SELECT ONE |
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Not at all |
Completely |
A little |
Don’t Know GO TO 2.5 |
A lot |
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2.3. If condoms are used correctly and consistently, how much can they decrease the risk of getting HIV, the virus that causes AIDS? |
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SELECT ONE |
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Not at all |
Completely |
A little |
Don’t Know |
A lot |
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2.4. If condoms are used correctly and consistently, how much can they decrease the risk of getting gonorrhea? |
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SELECT ONE |
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Not at all |
Completely |
A little |
Don’t Know |
A lot |
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2.5. How strongly do you agree or disagree with the following statements? |
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SELECT ONE FOR EACH |
STRONGLY AGREE |
AGREE |
DISAGREE |
STRONGLY DISAGREE |
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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? |
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SELECT ONE |
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Not at all |
Completely |
A little |
Don’t Know GO TO 2.9 |
A lot |
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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? |
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SELECT ONE |
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Not at all |
Completely |
A little |
Don’t Know |
A lot |
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2.8. If birth control pills are used correctly and consistently, how much can they decrease the risk of getting gonorrhea? |
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SELECT ONE |
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Not at all |
Completely |
A little |
Don’t Know |
A lot |
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The next question asks about birth control, including condoms.
2.9. What, if anything, would persuade you to use birth control? |
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CHECK ALL THAT APPLY |
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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? |
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SELECT ONE FOR EACH |
STRONGLY AGREE |
AGREE |
DISAGREE |
STRONGLY DISAGREE |
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Now we’d like to know more about your views on engaging in sex.
2.11. It’s OK to have sex with someone…? |
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PLEASE CHECK ALL THAT APPLY |
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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? |
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SELECT ONE FOR EACH |
STRONGLY AGREE |
AGREE |
DISAGREE |
STRONGLY DISAGREE |
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2.13. How sure are you that you would be able to say no to having sexual intercourse.... |
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SELECT ONE FOR EACH |
I’M SURE I COULD |
I PROBABLY COULD |
I PROBABLY COULD NOT |
I’M SURE I COULD NOT |
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2.14. If you were going to have sex could you... |
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SELECT ONE FOR EACH |
I’M SURE I COULD |
I PROBABLY COULD |
I PROBABLY COULD NOT |
I’M SURE I COULD NOT |
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2.15. Which, if any, of the following worries you or makes you anxious when it comes to sex? |
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PLEASE CHECK ALL THAT APPLY |
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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? |
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SELECT ONE |
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Not at all important |
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A little important |
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Somewhat important |
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Very important |
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2.17. How likely is it that you will get pregnant (or get someone pregnant) between now and age 20? |
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SELECT ONE |
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Not at all likely |
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A little likely |
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Somewhat likely |
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Very likely |
2.18. How likely is it that you will get pregnant (or get someone pregnant) before getting married? |
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SELECT ONE |
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Not at all likely |
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A little likely |
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Somewhat likely |
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Very likely |
2.19. Which of the following best describes how you would feel if you were to get {GUYS: someone} pregnant right now? |
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SELECT ONE |
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It would be a disaster |
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It would be challenging, and I'm not sure how I would manage |
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It would be challenging, but I could manage |
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My life wouldn't change much |
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It would make my life better |
2.20. How strongly do you agree or disagree with the following statements? |
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SELECT ONE FOR EACH |
STRONGLY AGREE |
AGREE |
DISAGREE |
STRONGLY DISAGREE |
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2.21. Thinking about the future, how likely do you think it is that you will get HIV? |
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SELECT ONE |
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Not at all likely |
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A little likely |
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Somewhat likely |
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Very likely |
2.22. How likely do you think it is that you will get an STD/STI other than HIV? |
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SELECT ONE |
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Not at all likely |
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A little likely |
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Somewhat likely |
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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? |
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SELECT ONE |
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Yes, definitely |
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Yes, probably |
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No, probably not |
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No, definitely not |
2.24. Do you intend to have sexual intercourse in the next year, if you have the chance? |
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SELECT ONE |
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Yes, definitely |
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Yes, probably |
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No, probably not |
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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? |
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SELECT ONE |
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Yes, definitely |
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Yes, probably |
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No, probably not |
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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? |
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SELECT ONE |
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Yes, definitely |
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Yes, probably |
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No, probably not |
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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? |
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SELECT ONE |
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I am only attracted to males |
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I am attracted to both males and females |
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I am only attracted to females |
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I am not attracted to either males or females |
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I am not sure |
2.28. Right now, do you have a boyfriend or girlfriend—someone in particular you are going out with? |
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SELECT ONE |
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Yes |
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No |
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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 |
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SELECT ONE FOR EACH |
10 OR MORE TIMES |
3 – 9 TIMES |
1-2 TIMES |
NEVER |
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2.29. Have you ever had any of the following: sexual intercourse, oral sex or anal sex? |
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SELECT ONE |
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Yes GO TO PART B1 |
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No GO TO PART B2 |
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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.
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? |
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SELECT ONE |
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Yes STOP! GO TO PART B1 INSTSEAD |
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No CONTINUE WITH THIS BOOKLET |
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The first two questions in this booklet are about your schooling.
3.2. Do you expect that you will graduate from high school? |
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SELECT ONE |
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Yes |
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I already graduated from high school |
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No GO TO QUESTION 3.4 |
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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?) |
SELECT ONE MONTH AND SELECT ONE YEAR |
Month of Graduation |
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Year of Graduation |
January |
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2018 or later |
February |
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2017 |
March |
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2016 |
April |
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2015 |
May |
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2014 |
June |
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2013 |
July |
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2012 |
August |
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2011 |
September |
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2010 |
October |
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2009 |
November |
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2008 |
December |
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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? |
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SELECT ONE FOR EACH |
VERY IMPORTANT |
SOMEWHAT IMPORTANT |
NOT TOO IMPORTANT |
NOT AT ALL IMPORTANT |
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3.5. What do you think are the benefits of waiting to have sexual intercourse? |
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SELECT ONE FOR EACH |
STRONGLY AGREE |
AGREE |
DISAGREE |
STRONGLY DISAGREE |
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3.6. Do people need religion to have good values? |
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SELECT ONE |
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Yes |
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No |
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3.7. Should religious teachings be obeyed in every situation? |
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SELECT ONE |
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Yes |
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No |
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3.8. Do you pray every day? |
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SELECT ONE |
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Yes |
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No |
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3.9. Do you think it’s embarrassing for people your age to admit they are virgins? |
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SELECT ONE |
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Yes |
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No |
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3.10. Do you think it’s embarrassing for girls your age to get pregnant? |
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SELECT ONE |
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Yes |
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No |
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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? |
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SELECT ONE |
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Very important |
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Not too important |
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Not important at all |
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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? |
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SELECT ONE |
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Yes |
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No |
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3.13. Do your parents have any rules about…? |
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SELECT ONE FOR EACH |
YES |
NO |
NOT APPLICABLE |
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3.14. Do your parents have any rules about what you are allowed to watch on TV? |
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SELECT ONE |
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Yes |
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No |
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3.15. Do your parents have any rules about what sites you can access on the internet? |
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SELECT ONE |
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Yes |
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No |
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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? |
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SELECT ONE FOR EACH |
NOT COMMON AT ALL |
NOT VERY COMMON |
FAIRLY COMMON |
VERY COMMON |
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3.17. Have you ever sent or posted a sexy message, picture, or video of yourself by email, IM or text? |
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SELECT ONE |
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Yes |
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No GO TO 3.19 |
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3.18. Which of the following reasons did you have for sending or posting a sexy message, picture or video of yourself? |
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SELECT ONE FOR EACH |
YES |
NO |
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3.19. Have you ever received a sexy text message, or a picture or video of someone you know? |
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SELECT ONE |
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Yes |
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No GO TO 3.21 |
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3.20. Have you ever shared or forwarded a sexy text message, or picture or video of someone you know? |
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SELECT ONE |
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Yes |
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No |
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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…? |
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SELECT ONE FOR EACH |
ALWAYS |
MOST OF THE TIME |
SOMETIMES |
RARELY |
NEVER |
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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? |
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SELECT ONE |
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Never |
Most of the time |
Rarely |
Always |
Sometimes |
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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? |
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SELECT ONE |
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Never |
Most of the time |
Rarely |
Always |
Sometimes |
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4.3. How often do you feel safe in your community or neighborhood? |
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SELECT ONE |
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Never |
Most of the time |
Rarely |
Always |
Sometimes |
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4.4. How often do you feel safe at school? |
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SELECT ONE |
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Never |
Most of the time |
Rarely |
Always |
Sometimes |
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4.5. How often do you feel safe at home? |
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SELECT ONE |
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Never |
Most of the time |
Rarely |
Always |
Sometimes |
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4.6. During the past 12 months, were you on a sports team or did you take sports lessons after school or on weekends? |
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SELECT ONE |
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Yes |
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No |
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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? |
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SELECT ONE |
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Yes |
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No |
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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.
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? |
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SELECT ONE |
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0 (zero) days GO TO 5.4 |
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1 to 4 days |
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5 to 10 days |
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11 to 25 days |
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More than 25 days |
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5.2. During the last 30 days, on how many days did you have 5 or more drinks in a row? |
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SELECT ONE |
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0 (zero) days |
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1 to 4 days |
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5 to 10 days |
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11 to 25 days |
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More than 25 days |
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5.3. During the past 30 days, on how many days did you get drunk or wasted? |
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SELECT ONE |
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0 (zero) days |
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1 to 4 days |
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5 to 10 days |
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11 to 25 days |
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More than 25 days |
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5.4. During the last 30 days, on how many days did you use marijuana, also called weed or pot? |
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SELECT ONE |
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0 (zero) days |
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1 to 4 days |
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5 to 10 days |
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11 to 25 days |
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More than 25 days |
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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? |
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SELECT ONE |
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0 (zero) days |
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1 to 4 days |
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5 to 10 days |
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11 to 25 days |
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More than 25 days |
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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.
6.1. In general, how much pressure, if any, do you feel from your friends to have sexual intercourse? |
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SELECT ONE |
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A lot of pressure |
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Some pressure |
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A little pressure |
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No pressure |
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6.2. How often is each of the following statements true for you? |
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SELECT ONE FOR EACH |
NEVER TRUE |
SOMETIMES TRUE |
OFTEN TRUE |
ALMOST ALWAYS TRUE |
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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? |
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SELECT ONE |
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Always |
Rarely |
Most of the time |
Never |
Sometimes |
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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? |
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SELECT ONE |
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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? |
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SELECT ONE |
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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? |
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SELECT ONE |
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Yes |
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No |
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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? |
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SELECT ONE FOR EACH |
10 OR MORE TIMES |
3 – 9 TIMES |
1-2 TIMES |
NEVER |
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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…? |
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SELECT ONE |
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Your biological mother, that is, the woman who gave birth to you |
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Your stepmother or adoptive mother |
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Your foster mother |
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Your grandmother |
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Your aunt or your older sister |
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Some other adult |
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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? |
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SELECT ONE |
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Not at all well |
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Not very well |
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Somewhat well |
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Very well |
6.10. Is she working now? |
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SELECT ONE |
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She is not working at a paid job |
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Yes, she is working part-time or less than 30 hours a week |
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Yes, she is working full-time or at more than one job for 30 hours a week or more |
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Yes, she works, but I don’t know how many hours |
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Don’t know if she is working |
6.11. Is the person you think of as your father…? |
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SELECT ONE |
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Your biological father, that is, the man who is genetically related to you |
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Your stepfather or adoptive father |
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Your foster father |
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Your grandfather |
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Your uncle or your older brother |
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Some other adult |
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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? |
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SELECT ONE |
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Not at all well |
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Not very well |
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Somewhat well |
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Very well |
6.13. Is he working now? |
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SELECT ONE |
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He is not working at a paid job |
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Yes, he is working part-time or less than 30 hours a week |
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Yes, he is working full-time or at more than one job for 30 hours a week or more |
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Yes, he works, but I don’t know how many hours |
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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. |
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SELECT ONE |
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They are married to each other |
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They used to be married to each other, but are now separated |
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They used to be married to each other, but are now divorced |
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They have never been married to each other |
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I don’t know |
6.15. Do your biological mother and biological father live together now? |
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SELECT ONE |
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Yes |
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No |
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One or both of my biological parents have passed away |
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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? |
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SELECT ONE |
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You live in one home GO TO 6.17 |
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You live in two or more homes, and go back and forth GO TO 6.18 |
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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? |
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SELECT ALL THAT APPLY |
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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? |
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SELECT ALL THAT APPLY |
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MAIN HOME SELECT
all
the people who live with you in your |
OTHER HOME(S) SELECT
all
the people who live with you in your |
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 |
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Thank you for completing this survey!
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | PPA Baseline Questionnaire - Part A Concordance |
Subject | SAQ |
Author | Melissa Thomas |
File Modified | 0000-00-00 |
File Created | 2021-01-30 |