Attachment C - 3M Cognitive Interview Instrument for High School Aged Youth

Cognitive Interview Questionnaire

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Question 1:

Please indicate whether you agree or disagree with the following statements. Would you say you strongly disagree, disagree, are undecided, agree, or strongly agree with each statement?

Question 1	Strongly Disagree	Disagree	Agree	Strongly Agree
I’m too young to be tied down to one person.
Being in love is enough reason to get married.
Marriages are happy or unhappy and there is not much you can do to change it.
If you are happily married, you don’t need to work on your relationship.
Love is important, but not enough to form a lasting relationship
Divorce is never OK.
Marriage is lifelong.
You should stay in a marriage for the kids.
It is ok to live with somebody without being married.
It is okay to live with somebody without a plan to be married.
It is ok to have kids without being married.
It is okay to have kids without a plan to be married.

Question 2:

A healthy relationship is a relationship where:

Question 2	Strongly Disagree	Disagree	Agree	Strongly Agree
They don’t cheat
They don’t call me names
There is no fighting
They give me gifts
They encourage me when life is hard
They support me
We enjoy spending time together
We like to do things with family and friends

Question 3:

Avoiding bad relationships as a teenager will help me:

Question 3	Strongly Disagree	Disagree	Agree	Strongly Agree
Achieve my goals in life.
Have a better life.
Have a healthy marriage someday.

Question 4:

Please indicate whether you agree or disagree with the following statements. Please select strongly disagree, disagree, agree, or strongly agree.

Question 4	Strongly Disagree	Disagree	Agree	Strongly Agree
You can learn from all relationships, even if they end.
Ending a bad relationship is a good thing.
A partner should help me achieve my goals.
A good relationship should bring out the best in me.

Question 5:

Now please indicate whether you strongly disagree, disagree, agree or strongly agree with the statements below.

A teen couple in a relationship should not:

Question 5	Strongly Disagree	Disagree	Agree	Strongly Agree
Date other people
Have sex with other people
Get emotionally involved with other people

Question 6:

Children sometimes live in different types of families. Please indicate how often you think that:

Question 6	All of the time	Most of the time	Some of the time	None of the time
Children should be raised by parents in a stable healthy marriage
Being raised by single parents is hard on kids

Question 7:

When you think of your future:

Question 7	Not at all	A Little	Somewhat	Probably	Definitely
Do you see yourself married to one person for life?
Do you see yourself living with someone without being married?

Question 8:

When you think about you future before age 25:

Question 8	Not at all	A Little	Somewhat	Probably	Definitely
Do you expect to be married?
Do you expect to have kids?
Do you expect to be living with someone without being married?

Question 9:

Question 9	Not at all important	A little important	Somewhat important	Very important
How important do you think being faithful - that is not cheating on your partner by seeing other people - is for you?

Question 10:

Please indicate how much you agree or disagree with the following statements. Would you say you strongly disagree, disagree, agree, or strongly agree that…

Question 10	Strongly Disagree	Disagree	Agree	Strongly Agree
My partner can trust me to keep their secrets.
I lie to my partner.
I listen to my partner when they talk about something that is important to them.
We are able to talk about things that really matter.

Question 11:

Please indicate the degree to which you agree or disagree with the following statements.

Question 11	Strongly Disagree	Disagree	Agree	Strongly Agree
I help my partner when they are feeling down.

Question 12:

Please indicate how often the following things happen with your partner.

Question 12	None of the time	Some of the time	Half of the time	Most of the time	All of the time
My partner makes me feel good about myself.
My partner pressures me to do risky things I don’t want to do.
My partner puts her/his friends before me.
My partner wants to control what I do.
My partner puts down my physical appearance or how I look.
My partner tries to make me look bad.
My partner insults or criticizes my ideas.
My partner blames me for his/her problems.
My partner wants us to do things just the two of us.
My partner doesn’t want to do things with my friends/family.
My partner wants us to do things just the two of us.

Question 13:

In the past week:

Question 13	More than once a day	Once a day	Once every few days	Once	Not at all
How often did you talk to your partner in person?
How often did you communicate with your partner using technology?
How often did you communicate with your partner in other ways?

Question 14:

When you have a serious disagreement or argument how often do you:

Question 14	None of the time	Some of the time	Half of the time	Most of the time	All of the time
Stay mad at one another after an argument
Scream or yell at your partner when you are angry.
Discuss your disagreements respectfully.

Question 15:

When you have a serious disagreement or argument how often are you:

Question 15	None of the time	Some of the time	Half of the time	Most of the time	All of the time
Honest and truthful with your partner.
Good at working out differences between you and your partner.
Mean to your partner when you disagree.
Able to talk about anything with your partner.

Question 16:

When you have a serious disagreement with your partner, how often do you:

Question 16	None of the time	Some of the time	Half of the time	Most of the time	All of the time
Find a way to work things out.
Discuss a problem without making things worse.
Respect your partner’s point of view
Just walk away.
Storm out.
Avoid talking about it.
Feel that there is no point talking about it.
Get so angry you want to break or smash something.
Feel uncomfortable talking about your thoughts and feelings.

Question 17:

Please indicate how much the items below sound like you.

Question 17	Not at all like me	A little like me	Somewhat like me	A lot like me	Exactly like me
I help my partner be the best he/she can be.
I support my partner in doing well in school
I help my partner avoid making mistakes that hurt them in life
I help my partner make good decisions
I help my partner avoid mistakes that get my partner off track
I help my partner achieve their goals in life
I help my partner have a good reputation