Engender Health

Form approved
OMB No. 0990-0382
Exp. Date:

FOLLOW-UP QUESTIONNAIRE

Engender Health

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it
displays a valid OMB control number. The valid OMB control number for this information collection is 0990-0382. The time required
to complete this information collection is estimated to average 36 minutes per response, including the time to review instructions
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INTRODUCTION
INTERVIEWERS: INSTRUCTIONS TO YOU ARE IN BLUE BOLD CAPS. DO NOT READ TEXT IN
BLUE BOLD CAPS ALOUD. INSTRUCTIONS ARE ALSO WRITTEN IN BLACK ITALICS. ALSO DO
NOT READ TEXT IN BLACK ITALICS TO RESPONDENTS. READ RESPONSES ONLY WHEN
INSTRUCTED TO.
GET RESPONDENT ON PHONE
Hello. My name is ____________________, and I’m calling from Mathematica Policy Research. Could I
speak with [RESPONDENT’S NAME] please?
RESOLVE ANY QUESTIONS AND ATTEMPT TO GET RESPONDENT ON PHONE OR MAKE
APPOINTMENT TO CALL BACK.
INTRODUCTION WITH RESPONDENT
[Hello. My name is ____________________, and I’m calling from Mathematica Policy Research.]
I’m calling as part of the research study that you agreed to participate in called Gender Matters or GEN.M,
a youth development program that encourages youth to engage in positive relationships. You might
remember filling out a survey about 6 months ago. I’m calling to do the current survey with you, which is
very similar. It will ask about you, your family and friends, your views and your behaviors.
START
Before we begin the survey, I need to tell you that your participation in this study is voluntary, and we want
you to know that:


The answers you give to this survey will never be identified as yours. All of your responses will
be kept private and will not be shared with anyone.



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



And, we will send you a $25 gift card after we complete the survey.

Some of the questions we ask could be considered sensitive. Are you somewhere you can freely answer
questions?
Do you have any questions before we begin?
**YOUR RESPONSE TO ANY QUESTIONS ABOUT SURVEY CONTENT SHOULD BE:
“JUST ANSWER THE QUESTION THE BEST YOU CAN”.

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1

SECTION 1: YOU AND YOUR BACKGROUND
1.1. In what month and year were you born?
MARK (X) ONE MONTH AND 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

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1.2. What grade are you in? [IF NECESSARY, READ: If you are currently on vacation between grades,
please indicate the grade you will be in when you go back to school.]
MARK (X) ONE

6th
7th
8th
9th
10th
11th
12th
Ungraded
College/technical school

GO TO 1.4

Not currently in school

1.3. What high school do you attend?
MARK (X) ONE

Akins H S
Anderson H S
Austin H S
Bowie H S
John B Connally H S
Crockett H S
Del Valle H S
Eastside Memorial H S
Elgin H S
Hendrickson H S
Lanier H S
LBJ High School
Manor H S
Mccallum H S
Mcneil H S
Pflugerville H S
Reagan H S
Travis H S
Other PRINT NAME OF SCHOOL:

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1.4. Are you male or female?
MARK (X) ONE

Male
Female

1.5. Are you Hispanic or Latino?
MARK (X) ONE

Yes
No

1.6. What is your race? [READ CHOICES]
YOU MAY MARK (X) MORE THAN ONE ANSWER

American Indian or Alaska Native
Asian
Black or African-American
Native Hawaiian or Other Pacific Islander or
White

1.7. The next series of questions is about whether you have received any information or learned
anything about a few topics.
In the past 12 months, have you received any information or learned about …
MARK (X) ONE FOR EACH QUESTION

YES

NO

a. Relationships, dating, marriage, or family life ................................................................................................
b. [REPEAT STEM] Abstinence from sex .........................................................................................................
c. [REPEAT STEM] Methods of birth control ....................................................................................................
d. Where to get birth control...............................................................................................................................
e. Sexually transmitted diseases, also known as STDs ....................................................................................
f.

How to talk to a partner about whether to have sex or whether to use birth control .....................................

g. [REPEAT STEM] How to say no to sex ........................................................................................................
h. How babies are made ....................................................................................................................................

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1.7b. INTERVIEWER: DID THE RESPONDENT SAY “YES” TO ANY ITEM IN 1.7 ABOVE?
MARK (X) ONE

Yes
No

GO TO 1.11

1.8. Now I am going to ask you about the number of times you got information on relationships,
abstinence, birth control, or sexually transmitted diseases from various places in the past
12 months. Your answer choices are [READ ANSWER CHOICES].
In the past 12 months, how many times did you get information on relationships, abstinence,
birth control, or sexually transmitted diseases from…
MARK (X) ONE FOR EACH

NEVER

1-3 TIMES

4-9 TIMES

10 OR MORE
TIMES

a. A school class [READ CHOICES] ...................................................................................................................
b. [REPEAT STEM] A church, synagogue, mosque,
or religious classes outside of school [READ CHOICES] ...............................................................................
c. A community center, youth organization, or
after-school activity ..........................................................................................................................................
d. [REPEAT STEM] A Doctor, nurse, or clinic ....................................................................................................
e. Your friends......................................................................................................................................................
f.

Your parents or other relatives or family members..........................................................................................

g. The Internet or media ......................................................................................................................................
h. [REPEAT STEM] A summer youth program ...................................................................................................
i.

Another person or place PRINT OTHER SOURCE

.................................................................................

1.9. Was ANY of the information you received helpful to you?
MARK (X) ONE

Yes
No

GO TO 1.11

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1.10. Thinking about the past 12 months, where did you get information on relationships, abstinence,
birth control, or sexually transmitted diseases that was helpful to you? [READ ANSWER
CHOICES]
SELECT ONE OR MORE

A school class
A church, synagogue, mosque or religious classes outside of school
A community center, youth organization, or after-school activity
A doctor, nurse, or clinic
Your friends
Your parents or other relatives or family members
The internet or media
A summer youth program
Another person or place PRINT OTHER SOURCE

1.11. The next series of questions is about how strongly you agree or disagree with a list of
statements. Your answer choices are [READ CHOICES].
How strongly do you agree or disagree that…
MARK (X) ONE FOR EACH

STRONGLY
AGREE

AGREE

DISAGREE

STRONGLY
DISAGREE

a. You can do things now that will help you to be
healthy when you are an adult [READ CHOICES].....................................................................................
b. [REPEAT STEM] Nothing you do as a teen will affect
how healthy you are as an adult [READ CHOICES] ..................................................................................
c.

Taking risks as a teen, like drinking and drugs, does
not really matter for your health in the long run .............................................................................................

d. The good and bad decisions you make as a teen will
affect your health as an adult .........................................................................................................................

1.12. In the past 30 days, how often have you felt that you were unable to control the important
things in your life? [READ ANSWER CHOICES]
MARK (X) ONE

Never
Almost never
Sometimes
Fairly often
Very often

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1.13. In the past 30 days, how often have you felt difficulties were piling up so high that you could
not overcome them? [READ ANSWER CHOICES]
MARK (X) ONE

Never
Almost never
Sometimes
Fairly often
Very often

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SECTION 2: FAMILY
The next questions are about where you live and who lives with you.
2.1. Which of the following best describes where you live? [READ ANSWER CHOICES]
MARK (X) ONE

You live in one home

GO TO 2.2

You live in two or more homes and go back and forth

OTHER

GO TO 2.3

GO TO 2.4

2.2. This question is about who lives with you in your home. I will read a list of people, and you can
tell me if they live with you in your home.
Does…[READ FIRST CHOICE] live with you in your home?
MARK (X) ALL THAT APPLY

Your biological mother
[INSERT RESPONSE IN STEM] Your biological father
A stepmother or adoptive mother
A foster mother
A stepfather or adoptive father
[INSERT RESPONSE IN STEM] A foster father
Your parent’s partner, boyfriend, or girlfriend
Any grandmothers
Any grandfathers
Any older brothers or sisters
Any younger brothers or sisters
Any aunts, uncles, or other relatives
Any other people you are not related to

2.2a.

AFTER ANSWERING

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GO TO 2.4

8

2.3. This question is about who lives with you in each of your homes. First, I will read a list of
people, and you can tell me if they live with you in your main home. Then we will cover your
other home or homes.
Does…[READ FIRST CHOICE] live with you in your main home?
[REPEAT SERIES FOR OTHER HOME WITH THIS STEM:]
Does…[READ FIRST CHOICE] live with you in your other home or homes?
MARK (X) ALL THAT APPLY

MAIN HOME

OTHER HOME(S)

Mark (X) all the people who live with you in your
MAIN home

Mark (X) all the people who live with you in your
OTHER home(s)

Your biological mother

Your biological mother

[REPEAT STEM] Your biological father

[REPEAT 2ND STEM] 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

[REPEAT STEM] A foster father

[READ 2ND STEM] 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

READ ‘OTHER HOME’ LIST WITH 2ND STEM

MOTHER
2.4. Now we have some questions about your mother, or the person you think of as your mother.
Is this person… [READ ANSWER CHOICES]
MARK (X) 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 or
You don’t have a mother or person you think of as your mother

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GO TO 2.9

9

2.5. Please answer the following questions about the person you just said in the last question is
your mother or the person you think of as your mother.
Is she working now? Here are the options. [READ ANSWER CHOICES]
MARK (X) 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 you don’t know how many hours or
You don’t know if she is working

2.6. How comfortable are you sharing ideas or talking with her about things that are important to
you? [READ ANSWER CHOICES]
MARK (X) ONE

Not at all comfortable
Somewhat comfortable
Comfortable
Very comfortable

2.7. Now thinking about your biological mother, that is, the woman who gave birth to you, how old
is she, or would she be if she were alive?
NUMBER OF YEARS OLD – Your best guess is fine.
I do not know about my biological mother

GO TO 2.9

2.8. Again thinking about your biological mother and all the children she has ever had—how old is
the oldest one? If the oldest one is not alive, how old would that child be if he or she was still
living?
NUMBER OF YEARS OLD – Your best guess is fine.
I do not know about my biological mother

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FATHER
2.9. Next we have some questions about your father, or the person you think of as your father. Is
this person…[READ ANSWER CHOICES]
MARK (X) 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 or
You don’t have a father or person you think of as your father

GO TO 2.12

2.10. Please answer the following questions about the person you just said in the last question is
your father or the person you think of as your father.
Is he working now? Here are the options. [READ ANSWER CHOICES]
MARK (X) 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 you don’t know how many hours or
You don’t know if he is working

2.11. How comfortable are you sharing ideas or talking with him about things that are important to
you? [READ ANSWER CHOICES]
MARK (X) ONE

Not at all comfortable
Somewhat comfortable
Comfortable
Very comfortable

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2.12.

Which of the following best describes the relationship between your biological mother and
biological father? If one or both of your biological parents have died, please answer about
their relationship when both were alive. [READ ANSWER CHOICES]
MARK (X) ONE

They are married to each other
They were married to each other, but then separated
They were married to each other, but then divorced
They were never married to each other
You don’t know

2.13. The next series of questions is about how many times you have talked with at least one of your
parents or guardians about certain things in the last 12 months. Your answer choices are
[READ CHOICES].
In the past 12 months, how many TIMES have you talked with at least one of your parents or
guardians about…
MARK (X) ONE FOR EACH QUESTION

NEVER

1-2
TIMES

3-9
TIMES

10 OR
MORE
TIME
S

a. How things are going with school work or
with your grades [READ CHOICES]
..........................................................................................................................................................................................
b. [REPEAT STEM] A personal problem you were having [READ

CHOICES]
..........................................................................................................................................................................................
c. How to have good romantic relationships [READ

CHOICES]
..........................................................................................................................................................................................
d. Strategies for safe
dating
..........................................................................................................................................................................................
e. How to resist pressures to have
sex
..........................................................................................................................................................................................
f. [REPEAT STEM] Avoiding drugs and alcohol [READ

CHOICES]
..........................................................................................................................................................................................
g. Pregnancy or
birth
..........................................................................................................................................................................................

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h. Sexually transmitted diseases,
also known as STDs, HIV, or
AIDS
..........................................................................................................................................................................................

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PARENTS
2.14.

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.
Thinking about the past month, how often did your parents know where you were after
school? [READ ANSWER CHOICES]
MARK (X) ONE

Always
Usually
Sometimes
Rarely
Never

2.15.

Thinking about the past month, how often did your parents know who you were going to be
with before you went out? [READ ANSWER CHOICES]
MARK (X) ONE

Always
Usually
Sometimes
Rarely
Never
You did not go out

2.16.

Thinking about the past month, how often did your parents know where you were when you
went out at night? [READ ANSWER CHOICES]
MARK (X) ONE

Always
Usually
Sometimes
Rarely
Never
You did not go out at night

2.17.

If you were going to be home late, would your parents expect you to call?
MARK (X) ONE

Yes
No

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SECTION 3: VIEWS AND PERCEPTIONS
3.1. The next series of questions is about your views on sexual intercourse. In this survey, when we
ask about sexual intercourse, we mean a male putting his penis into a female’s vagina. Your
answer choices are [READ CHOICES].
How strongly do you agree or disagree that…?
MARK (X) ONE FOR EACH QUESTION

STRONGLY
AGREE

AGREE

DISAGREE

STRONGLY
DISAGREE

a. Having sexual intercourse is a good thing for you to
do at your age [READ CHOICES] ..................................................................................................................
b. [REPEAT STEM] At your age right now, having sexual intercourse
would create problems [READ CHOICES] ....................................................................................................
c. [REPEAT STEM] At your age right now, not having sexual
intercourse is important for you to be safe and healthy ..................................................................................
d. At your age right now, it is okay for you to have sexual
intercourse if you use birth control, like a condom .........................................................................................
e. It is against your values to have sexual intercourse
before marriage...............................................................................................................................................

3.2. The next questions are about what sex means to boys and girls your age. Your answer choices
are [READ CHOICES].
How strongly do you agree or disagree that…?
MARK (X) ONE FOR EACH

STRONGLY
AGREE

AGREE

DISAGREE

STRONGLY
DISAGREE

a. It is embarrassing for a 16-year old boy if he has never
had sexual intercourse [READ CHOICES] ...................................................................................................
b. [REPEAT STEM] It is alright for a boy to pressure a girl to
have sex if she has had sex with him in the past ..........................................................................................
c. [REPEAT STEM] When a girl says no to sex, she expects
the boy to keep trying ....................................................................................................................................
d. One way for a guy to prove he is a real man is to have
sex with a lot of girls ......................................................................................................................................
e. A guy should have sexual intercourse as early as he
can in his life
f.

[REPEAT STEM] It is alright for a boy to pressure a girl to
start having sex if they have been dating for nine months ............................................................................

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3.3. The next series of questions is about how likely it is that you will do certain things. Your
answer choices are [READ CHOICES]. For these questions, imagine you are alone with
someone you like very much.
How likely is it that you could…
MARK (X) ONE FOR EACH QUESTION

NOT AT
ALL
LIKELY

A LITTLE
BIT LIKELY

SOMEWHAT
LIKELY

VERY
LIKELY

a. FOR GIRLS: Stop them if they wanted to touch your
chest and you did not want them to do that [READ CHOICES] ...............................................................................
b. [REPEAT STEM] Stop them if they wanted to touch your private parts
below the waist, meaning the parts of the body covered by
underwear, and you did not want them to do that [READ CHOICES] ......................................................................
c. [REPEAT STEM] Avoid having sexual intercourse if you didn’t want
to [READ CHOICES]

3.4. These questions are about what happens if a girl gets pregnant around your age, or a boy gets
a girl pregnant. Your answer choices are [READ CHOICES].
How strongly do you agree or disagree that…
MARK (X) ONE FOR EACH QUESTION

STRONGLY
AGREE

AGREE

DISAGREE

STRONGLY
DISAGREE

a. Getting pregnant or getting a girl pregnant in the
next year or two would hurt your chances of
being successful in life [READ CHOICES] ....................................................................................................
b. [REPEAT STEM] If a girl and boy have sex, the girl is more responsible
for preventing pregnancy than the boy [READ CHOICES] ...........................................................................
c. [REPEAT STEM] If you got pregnant or got a girl pregnant
in the next year or two you would have to become a
responsible adult before you wanted to .........................................................................................................
d. If you got pregnant or got a girl pregnant in the next year
or two, your life would become a lot better ....................................................................................................

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3.5. These questions are about boys and girls. Your answer choices are again [READ CHOICES].
How strongly do you agree or disagree that…?
MARK (X) ONE FOR EACH QUESTION

STRONGLY
AGREE

AGREE

DISAGREE

STRONGLY
DISAGREE

a. The best way for a boy to show he is strong is to act
tough [READ CHOICES] ...............................................................................................................................
b. Boys should let it show when their feelings are hurt [READ CHOICES] ......................................................
c. In a good dating relationship the boy gets his way
most of the time .............................................................................................................................................
d. A girl who really likes a guy needs to have sex with him
to prevent him from finding someone else .....................................................................................................
e. It’s embarrassing for a boy when he needs to ask for help ...........................................................................

3.6. FOR GIRLS ONLY
These questions are about how girls feel. Your answer choices are again [READ CHOICES].
How strongly do you agree or disagree that…?
MARK (X) ONE FOR EACH QUESTION

STRONGLY
AGREE

AGREE

DISAGREE

STRONGLY
DISAGREE

a. Teenage girls who have a boyfriend feel better about themselves
than girls who don’t have a boyfriend [READ CHOICES] ...................................................................................
b. When a teenage girl has a boyfriend, other girls look
up to her ...............................................................................................................................................................
c. A girl is likely to feel bad about herself if she has never
had a boyfriend ....................................................................................................................................................

3.7. FOR GIRLS ONLY
If you got pregnant now, how would you feel? [READ CHOICES].
MARK (X) ONE

Very happy
A little happy
Neither happy nor upset
A little upset
Very upset

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3.8. FOR BOYS ONLY
If you got someone pregnant now, how would you feel? [READ CHOICES].
MARK (X) ONE

Very happy
A little happy
Neither happy nor upset
A little upset
Very upset

3.9. The next series of questions is about condom use. Your answer choices are [READ CHOICES].
How strongly do you agree or disagree that…?
MARK (X) ONE FOR EACH QUESTION

STRONGLY
AGREE

AGREE

NEITHER
AGREE
NOR
DISAGREE

DISAGREE

STRONGLY
DISAGREE

a. Condoms should always be used if a person
your age has sexual intercourse [READ CHOICES] ..............................................................................................
b. [REPEAT STEM] Using condoms means you
don’t trust your partner [READ CHOICES] .............................................................................................................
c. [REPEAT STEM] Condoms are important to make sex safer ................................................................................
d. Condoms are a hassle to use ..................................................................................................................................
e. Using a condom is one way for a boy to
show he cares about his partner .............................................................................................................................
f. Using condoms is morally wrong [READ CHOICES] ..............................................................................................
g. [REPEAT STEM] If two people love each other they don’t
have to use condoms...............................................................................................................................................
h. Girls who carry condoms get bad
reputations ...............................................................................................................................................................
i. Condoms are pretty easy to get ..............................................................................................................................
j. If a girl asks a boy to use a condom it
means she doesn’t trust him [READ CHOICES] ....................................................................................................

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3.10.

The next series of questions is about condoms, birth control pills, pregnancy and sexually
transmitted diseases, also known as STDs.
If condoms are used correctly and consistently, how much can they reduce the risk of
pregnancy? [READ CHOICES].
MARK (X) ONE

Not at all
A little
A lot
Completely
You don’t know

GO TO 3.11

3.10a. How confident are you that your answer to the last question is correct? [READ
CHOICES].
MARK (X) ONE

Not at all confident
A little confident
Somewhat confident
Very confident

3.11.

If condoms are used correctly and consistently, how much can they reduce the risk of getting
HIV, the virus that causes AIDS? [READ CHOICES].
MARK (X) ONE

Not at all
A little
A lot
Completely
You don’t know

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3.12.

If birth control pills are used correctly and consistently, how much can they decrease the risk
of pregnancy? [READ CHOICES].
MARK (X) ONE

Not at all
A little
A lot
Completely
You don’t know

GO TO 3.13

3.12a. How confident are you that your answer to the last question is correct? [READ
CHOICES].
MARK (X) ONE

Not at all confident
A little confident
Somewhat confident
Very confident

3.13.

If birth control pills are used correctly and consistently, how much can they reduce the risk of
getting HIV, the virus that causes AIDS? [READ CHOICES].
MARK (X) ONE

Not at all
A little
A lot
Completely
You don’t know

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3.14. The next series of questions is about other methods of birth control, NOT including condoms.
Your answer choices will be [READ CHOICES].
How strongly do you agree or disagree that…?
MARK (X) ONE FOR EACH

STRONGLY
AGREE

AGREE

NEITHER
AGREE
NOR
DISAGREE

DISAGREE

STRONGLY
DISAGREE

a. Birth control should always be used if a person
your age has sexual intercourse [READ CHOICES] .....................................................................................................
b. [REPEAT STEM] Birth control is a hassle to use [READ CHOICES] ...........................................................................
c. [REPEAT STEM] Birth control is pretty easy to get .......................................................................................................
d. Birth control is important to make sex safer ...................................................................................................................
e. Birth control has too many negative side effects ...........................................................................................................
f. [REPEAT STEM] Using birth control is morally wrong ..................................................................................................

3.15. The following questions are about how you can get birth control where you live. Your answer
choices are [READ CHOICES].
How true do you think it is that…?
MARK (X) ONE FOR EACH

DEFINITELY
TRUE

PROBABLY
TRUE

PROBABLY
FALSE

DEFINITELY
FALSE

DON’T
KNOW

a. In Texas, teenage girls can get a birth
control method like the pill or the shot at a
family planning or health clinic without
their parent’s permission [READ
CHOICES]......................................................................................................................................................
b. [REPEAT STEM] You would know where to
go for birth control methods like the pill or
the shot for you or your partner [READ
CHOICES]......................................................................................................................................................
c. You would know where to go if you
wanted to get tested for a sexually
transmitted disease or STD [READ
CHOICES]......................................................................................................................................................
d. You would have enough money to pay for
birth control pills for you or your partner ........................................................................................................

3.16. In the past 3 months, how many TIMES have you gone out on a date?
Zero or None

GO TO 3.18

NUMBER OF TIMES – Your best guess is fine.

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3.17. Thinking about these dates in the past 3 months, how many DIFFERENT PEOPLE did you go
out on a date with?
NUMBER OF PEOPLE – Your best guess is fine.

3.18. In the past 6 months, have you had a boyfriend or girlfriend?
MARK (X) ONE

Yes
No

GO TO 3.20

3.19. In the past 6 months, how many different boyfriends or girlfriends have you had?
NUMBER OF PEOPLE – Your best guess is fine.

3.20. Do you intend to have sexual intercourse in the next year, if you have the chance? [READ
CHOICES].
MARK (X) ONE

Yes, definitely
Yes, probably
No, probably not
No, definitely not

3.21. If you were to have sexual intercourse in the next year, do you intend to use or have your
partner use a condom? [READ CHOICES].
MARK (X) ONE

Yes, definitely
Yes, probably
No, probably not
No, definitely not

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3.22. The next question is about your intention to use other methods of birth control, NOT including
condoms: [READ METHODS].







Birth control pills
The shot or Depo-Provera
The patch
The ring or NuvaRing
IUD or Mirena or Paragard
Implants or Implanon

If you were to have sexual intercourse in the next year, do you intend to use, or have your
partner use, any of these other methods of birth control? [READ CHOICES].
MARK (X) ONE

Yes, definitely
Yes, probably
No, probably not
No, definitely not

3.23. Do you intend to have sexual intercourse without being married? [READ CHOICES].
MARK (X) ONE

Yes, definitely
Yes, probably
No, probably not
No, definitely not

3.24. Have you ever had sexual intercourse?
Yes
No

GO TO 4.17

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SECTION 4.1
4.1. The next questions are about sexual intercourse. By sexual intercourse, we mean a male putting
his penis into a female’s vagina. Please be as honest as possible. Your answers will be kept
private.

4.2. Have you had sexual intercourse more than one time?
MARK (X) ONE

Yes

GO TO 4.4

No

4.3a. When you had sexual intercourse, what month and year was it?
MARK (X) ONE MONTH AND ONE YEAR

Month of Sexual
Intercourse

Year of Sexual
Intercourse

January

2013

February

2012

March

2011

April

2010

May

2009

June

2008

July

2007

August

2006

September

2005

October

2004

November

2003

December

2002
2001
2000 or earlier

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24

4.3b. When you had sexual intercourse, how old were you?
NUMBER OF YEARS OLD YOU WERE – Your best guess is fine.

4.3c. When you had sexual intercourse, how old was your partner? [READ CHOICES].
MARK (X) ONE

Three or more years younger than you
A year or two younger than you
The same age as you
A year or two older than you or
Three or more years older than you

4.3d. Birth control methods are something used to reduce the risk of pregnancy, and some can reduce
the risk of sexually transmitted diseases, also known as STDs.
When you had sexual intercourse, did you or your partner use any type of birth control—
including condoms or any other method?
MARK (X) ONE

Yes
No

GO TO 4.13a

4.3e. When you had sexual intercourse, did you or your partner use…?
MARK (X) ONE FOR EACH QUESTION

YES
NO
a. Condoms .......................................................................................................................................................
b. Birth control pills or the patch ........................................................................................................................
c. Depo-Provera or other injectable birth control ...............................................................................................
d. NuvaRing or the ring ......................................................................................................................................
e. Withdrawal or pulling out ...............................................................................................................................
f.

4.3f.

Another method? PRINT OTHER METHOD USED

AFTER ANSWERING 4.3e

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..............................................................................

GO TO 4.13a

25

4.4. The very first time you had sexual intercourse, how old were you?
NUMBER OF YEARS OLD – Your best guess is fine.

4.5. The very first time you had sexual intercourse, how old was your partner? [READ CHOICES].
MARK (X) ONE

Three or more years younger than you
A year or two younger than you
The same age as you
A year or two older than you or
Three or more years older than you

4.6. Birth control methods are something used to reduce the risk of pregnancy, and some can reduce
the risk of sexually transmitted diseases, also known as STDs.
The first time you had sexual intercourse, did you or your partner use any type of birth control—
including condoms or any other method?
MARK (X) ONE

Yes
No

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4.7. Now I would like to ask you about the most recent time you had sexual intercourse.
The most recent time you had sexual intercourse, what month and year was it?
MARK (X) ONE MONTH AND ONE YEAR

Month of Most Recent
Sexual Intercourse

Year of Most Recent
Sexual Intercourse

January

2013

February

2012

March

2011

April

2010

May

2009

June

2008

July

2007

August

2006

September

2005

October

2004

November

2003

December

2002
2001
2000 or earlier

4.7b. The most recent time you had sexual intercourse, did you or your partner use…?
MARK (X) ONE FOR EACH QUESTION

YES
NO
a. Condoms .......................................................................................................................................................
b. Birth control pills or the patch ........................................................................................................................
c. Depo-Provera or other injectable birth control ...............................................................................................
d. NuvaRing or the ring ......................................................................................................................................
e. Withdrawal or pulling out ...............................................................................................................................
f.

Another method PRINT OTHER METHOD USED

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................................................................................

27

4.8. How many DIFFERENT PEOPLE have you ever had sexual intercourse with, even if only one
time?
NUMBER OF PEOPLE – Your best guess is fine.

4.9. Now please think about the past 3 months. In the past 3 months, how many TIMES have you had
sexual intercourse?
None

GO TO 4.13a

NUMBER OF TIMES – Your best guess is fine.

4.10. In the past 3 months, how many TIMES have you had sexual intercourse without using a
condom?
None
NUMBER OF TIMES – Your best guess is fine.

4.11. The next question is about your use of the following methods of birth control: [READ METHODS].








Condoms
Birth control pills
The shot or Depo-Provera
The patch
The ring or NuvaRing
IUD or Mirena or Paragard
Implants or Implanon

In the past 3 months, how many TIMES have you had sexual intercourse without using any of
these methods of birth control?
None
NUMBER OF TIMES – Your best guess is fine.

4.12. Now think about when you had sexual intercourse in the past 3 months and WERE using birth
control. In the past 3 months, how many TIMES did you have intercourse when you used a
condom AND were using another method of birth control in the list I read?
None
NUMBER OF TIMES – Your best guess is fine.

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28

4.13.a.

To the best of your knowledge, have you ever been pregnant or gotten someone pregnant,
even if no child was born?
MARK (X) ONE

Yes
No

b.

GO TO 4.14

To the best of your knowledge, how many TIMES have you been pregnant or gotten someone
pregnant?
None
NUMBER OF TIMES – Your best guess is fine.

c.

Have you ever had a baby or has anyone you got pregnant actually had the baby?
MARK (X) ONE

Yes
No
Don’t know

4.14. In the past 12 months, have you spoken with a doctor or nurse about having sex, birth control or
sexually transmitted diseases, also known as STDs?
MARK (X) ONE

Yes
No

4.15. In the past 12 months, have you been tested by a doctor or nurse for a sexually transmitted
disease or STD, like gonorrhea, Chlamydia, syphilis, or HIV?
MARK (X) ONE

Yes
No

4.16. In the past 12 months, have you been told by a doctor or nurse that you had a sexually
transmitted disease or STD?
MARK (X) ONE

Yes
No

4.16b.

AFTER ANSWERING 4.16

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GO TO 5.1

29

SECTION 4.2
4.17. THESE QUESTIONS ARE FOR YOUTH WHO HAVE NOT HAD SEX.
The next two questions are about your schooling.
Do you expect that you will graduate from high school? [READ CHOICES].
MARK (X) ONE

Yes
You already graduated from high school or
No

GO TO 4.19

4.18. IF YES: In what month and year do you expect to graduate from high school?
IF THEY ALREADY GRADUATED: In what month and year did you graduate from high school?
MARK (X) ONE MONTH AND 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

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4.19. In how many homes, places, or households do you live: one, two, or three or more?
MARK (X) ONE

1 home

GO TO 4.23

2 homes
3 or more homes

4.20. Do you consider one of these homes to be your main home?
MARK (X) ONE

Yes
No

4.21. The next question is about the number of nights you spent in each home in the past 30 days.
Thinking about the past 30 days, how many nights did you spend at home number 1?
Thinking about the past 30 days, how many nights did you spend at home number 2?
Thinking about the past 30 days, how many nights did you spend at any other home or homes?
FILL IN TWO OR THREE NUMBERS

Number of nights at home #1 – Your best guess is fine.
Number of nights at home #2 – Your best guess is fine.
Number of nights at another home or other homes – Your best guess is fine.

4.22. Is there anyone who moves with you from home to home?
MARK (X) ONE

Yes
No

4.23. IF THEY ONLY HAVE 1 HOME: Is your home a group home or halfway house?
IF THEY HAVE 2 OR MORE HOMES: Are any of your homes a group home or halfway house?
MARK (X) ONE

Yes
No

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4.24. This question is about who lives with you in your home. If you have more than one home, please
think about your main home.
How many people usually live in your home, including all children and anyone who normally
lives there even if they are not there now, like someone who is away traveling or in a hospital?
NUMBER OF PEOPLE

4.25. These next few questions are about you and your friends. Your answer choices are [READ
CHOICES].
How strongly do you agree or disagree that…?
MARK (X) ONE FOR EACH QUESTION

STRONGLY
AGREE

AGREE

DISAGREE

STRONGLY
DISAGREE

a. You have friends who will give you good advice [READ CHOICES] ............................................................................
b. [REPEAT STEM] You have a friend who cares about you [READ CHOICES] ...............................................................
c. You have a friend you can talk to when you need to..................................................................................................
d. You have someone who you can call your best friend ...............................................................................................

4.26. How strongly do you agree or disagree that…?
MARK (X) ONE FOR EACH QUESTION

STRONGLY
STRONGLY
AGREE
AGREE DISAGREE DISAGREE

a. When you start a project, you finish it [READ CHOICES].............................................................................................
b. [REPEAT STEM] You only work as hard as you have to [READ CHOICES] .................................................................
c. You are someone people can count on ......................................................................................................................
d. When you do work, you do a good job .......................................................................................................................

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4.27. The next series of questions is about reasons people your age might choose NOT to have sexual
intercourse and how important these reasons are to you. Your answer choices are [READ
CHOICES].
How important is this reason to you?
MARK (X) ONE FOR EACH QUESTION

VERY
SOMEWHAT
NOT TOO
NOT AT ALL
IMPORTANT IMPORTANT IMPORTANT IMPORTANT

a. You don’t want to get a sexually transmitted disease,
also known as an STD? [READ CHOICES] ............................................................................................................
b. [REPEAT STEM] You don’t want to disappoint your parents [READ CHOICES] ......................................................
c. You are too young to have sex ..............................................................................................................................
d. Your boyfriend or girlfriend doesn’t want
to have sex ............................................................................................................................................................
e. [REPEAT STEM] You want to wait until you’re married [READ CHOICES] ..............................................................
f. It is against your personal values ..........................................................................................................................
g. You haven’t met the right person yet .....................................................................................................................
h. You haven’t had the chance ..................................................................................................................................
i. You don’t want to [READ CHOICES] .......................................................................................................................
j. FOR GIRLS You do not want to get pregnant .......................................................................................................
k. FOR BOYS You do not want to get a girl pregnant ...............................................................................................

4.28. Have you ever done any of the following?
MARK (X) ONE FOR EACH QUESTION

YES

NO

a. Kissed someone on the lips .........................................................................................................................
b. French kissed, that is put your tongue in someone’s mouth while kissing ..................................................
c. Touched another person’s private parts ......................................................................................................
d. Let someone touch your private parts .........................................................................................................

4.29. In the past 12 months, have you spoken with a doctor or nurse about sex, birth control or sexually
transmitted diseases, also known as STDs?
MARK (X) ONE

Yes
No

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4.30. If you decided to have sexual intercourse outside of marriage, how likely is it that you would use
a condom or other contraceptive method? [READ CHOICES]
MARK (X) ONE

Not at all likely
A little bit likely
Somewhat likely
Very likely or
You don’t plan to have sexual intercourse outside of marriage

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SECTION 5: ALCOHOL AND DRUG USE – FOR ALL RESPONDENTS
5.1. The next questions are about alcohol and drugs. Please be as honest as possible, and remember
that everything you tell me will be kept private.
Have you ever had an alcoholic drink, such as beer, wine or other liquor, NOT counting any times
you just had a sip?
MARK (X) ONE

Yes
No

GO TO 5.5

5.2. The very first time you had an alcoholic drink, how old were you?
NUMBER OF YEARS OLD YOU WERE – Your best guess is fine.

5.3. During the past 30 days, not including any times you just had a sip, on how many days did you
have one or more alcoholic beverages? [READ CHOICES STARTING FROM BOTTOM]
MARK (X) ONE

Other
5 to 25 days
1 to 4 days or
0 days

5.4. During the past 30 days, on how many days did you have 5 or more drinks in a row? [READ
CHOICES STARTING FROM BOTTOM]
MARK (X) ONE

Other
5 to 25 days
1 to 4 days or
0 days

5.5. Have you ever used marijuana, also called weed or pot?
MARK (X) ONE

Yes
No

5.6. Have you ever used any other type of illegal drug, prescription drug, or inhalant that was not
prescribed for you?
MARK (X) ONE

Yes
No

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SECTION 6: FRIENDS AND RELATIONSHIPS– FOR ALL RESPONDENTS
6.1. The next series of questions is about how many of your friends think certain things. Your answer
choices are [READ CHOICES]. Your best guess is fine.
How many of your friends who are your age think …?
MARK (X) ONE FOR EACH

NONE

SOME

HALF

MOST

ALL

DON’T
KNOW

a. Having sexual intercourse is a good thing
for them to do at their age [READ CHOICES] ...............................................................................................................
b. [REPEAT STEM] It would be okay for them to
have sexual intercourse as long as they used
birth control, like a condom [READ CHOICES] ............................................................................................................
c. [REPEAT STEM] It would be okay for them to
have sexual intercourse if they were
dating the same person for a long time .......................................................................................................................
d. They should wait until they are older
to have sexual intercourse ..........................................................................................................................................
e. They should wait until marriage to
have sexual intercourse ..............................................................................................................................................

6.2. How many of your friends who are your age have had sexual intercourse? [READ CHOICES]
MARK (X) ONE

None
Some
Half
Most
All
Don’t know

6.3. In general, how much pressure, if any, do you feel from your friends to have sexual intercourse?
[READ CHOICES]
MARK (X) ONE

A lot of pressure
Some pressure
A little pressure or
No pressure

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6.4. How much do you feel that your friends care about you? [READ CHOICES]
MARK (X) ONE

Do not care at all
Care a little bit
Care somewhat or
Care very much

6.5. DETERMINE WHETHER THE RESPONDENT IS IN THE TREATMENT OR CONTROL GROUP AND
GO TO THE CORRECT QUESTION.
TREATMENT

GO TO 7.1

CONTROL

GO TO 7.6

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37

FOR TREATMENT GROUP ONLY
7.1. How many other people do you know of at your high school who participated in Gen.M this past
summer?
None

GO TO 7.3
NUMBER OF PEOPLE – Your best guess is fine.

7.2. How often do you hang out with any of those kids? [READ CHOICES]
MARK (X) ONE

A lot
Sometimes
Rarely
Never

7.3. Did you attend an event sponsored by Gen.M after you completed your summer Gen.M group?
MARK (X) ONE

Yes
No

7.4. If a friend asked, how likely would you be to recommend Gen.M to them? [READ CHOICES]
MARK (X) ONE

Not at all likely
A little likely
Somewhat likely
Very likely

7.5. The next series of questions is about how many times have you done the following things in the
past six months. Your answer choices are [READ CHOICES].
In the past six months, how many times have you …
MARK (X) ONE FOR EACH

0 times

1-2
times

3-5
times

6-10 MORE THAN
times
10 times

a. Gotten together with members of your
Gen.M group [READ CHOICES]................................................................................................................................
b. [REPEAT STEM] Texted members of your Gen.M group [READ CHOICES] .......................................................
c. Spoken to a member of your group on
the phone .......................................................................................................................................................................
d. Friended somebody from your group
on Facebook ..................................................................................................................................................................
e. Been in touch with members of your
group in any other way [READ CHOICES] ................................................................................................................

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7.6. Okay, that was the end of our survey. Thank you so much for your help with this study.
I’d like to confirm your address, so that we are sure you will receive your $25 gift card.
CONFIRM ADDRESS AND UPDATE IF NECESSARY.
I would also like to confirm your other contact information, so that we will be able to reach you
for the final of our three Gender Matters surveys, 12 months from now.
CONFIRM OR ADD CELL PHONE NUMBER/S AND OTHER PHONE NUMBERS. BE SURE TO
INDICATE WHETHER THE PHONE IS A CELL PHONE AND WHOSE PHONE IT IS.
CONFIRM OR ADD EMAIL ADDRESS, AND ADDRESS, AND UPDATE IF NECESSARY.
CONFIRM CONTACTS’ CONTACT INFORMATION AS WELL, AND UPDATE IF NECESSARY.
That’s it. Thank you so much again!
Good-bye.

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