Source list

ATTACHMENT A

QUESTION BY QUESTION SOURCE TABLE FOR THE BASELINE survey

QUESTION BY QUESTION SOURCE LIST FOR the Federal Evaluation of Making Proud Choices! Baseline Survey

This document lists each question on the baseline survey for the Federal Evaluation of Making Proud Choices!, along with each question’s source. Most questions are taken or adapted from items used on the ongoing Pregnancy Assistance Fund: Feasability and Design Study (PAF FADS; OMB Control Number: 0990-0424); the Evaluation of Adolescent Pregnancy Prevention Approaches study (PPA; OMB Control Number: 0990-0382); or the Personal Responsibility Education Program Multi-Component Evaluation (PREP; OMB Control Number: 0970-0398).

Baseline Question #	Question Text	Question Source
1.1	In what month and year were you born?	PAF FADS
1.2	Are you Hispanic /Latino?	PAF FADS
1.3	What is your race?	PAF FADS
1.4	What grade are you currently in?	SDDAP
1.5	How often would you say you skip school?	Adapted from PREP
1.6	How many times have you been suspended or expelled from school?	Adapted from PREP
1.7	How likely is it that you will graduate from high school?	Adapted from PREP
2.1	Do you have someone in your life right now who cares for you as a mother figure?	PAF FADS
2.2	How much of the time do you live with her?	Adapted from PAF FADS
2.3	What is the highest level of education she has achieved?	Adapted from PAF FADS
2.4	How close do you feel to her?	Adapted from PREP
2.5	Do you have someone in your life right now who cares for you as a father figure?	PAF FADS
2.6	How much of the time do you live with him?	Adapted from PAF FADS
2.7	What is the highest level of education he has achieved?	Adapted from PAF FADS
2.8	How close do you feel to him?	Adapted from PREP
2.9	In the past 12 months, how many times have you changed where you live?	PPA
3.1	In the past 12 months, did you attend any classes or sessions about the following? Relationships, dating, or marriage Abstinence from sex Methods of birth control, such as condoms, pills, the patch, the shot, the ring, IUD, or an implant Where to get birth control Sexually transmitted disease, also known as STDs or STIs	PREP
3.2	How strongly do you agree or disagree with each of the following statements? Having sex is a good thing for you to do at your age At your age right now, having sex would create problems At your age right now, not having sex is important for you to be safe and healthy At your age right now, it is okay for you to have sexif you use birth control, such as condoms, pills, the patch, the shot, the ring, IUD, or an implant It is against your beliefs to have sex before marriage It is against your beliefs to use any form of birth control, such as condoms, pills, the patch, the shot, the ring, IUD, or an implant	Adapted from PREP
3.3	In the past 3 months, about how many times have you asked one or both of your parents/guardians questions about sex?	Adapted from Girls Inc
3.4	How comfortable are you talking to your parents/guardians about sex? Please answer for the parent/guardian whom you feel most comfortable talking to.	Adapted from Girls Inc
3.5	Sometimes people don’t want to have sex but have difficulty saying “no.” If you were [fill a-e], how likely is it you would be able to say “no” to having sex? With someone you have known for a few days or less With someone you have dated for a long time With someone with whom you have already had sex With someone who is pushing you to have sex With someone who does not want to use a condom	Adapted from PREP
3.6	The next series of statements is about condom use. How strongly do you agree or disagree with each of these statements? a. Condoms should always be used if a person your age has sexual intercourse b. Condoms decrease sexual pleasure c. Condoms are important to make sex safer. d. Using condoms means you don’t trust your partner e. Using condoms is morally wrong f. Condoms are a hassle to use g. Condoms are pretty easy to get	PPA
3.7	If condoms are used correctly and consistently, how much can they decrease the risk of pregnancy?	PREP
3.8	If condoms are used correctly and consistently, how much can they decrease the risk of getting HIV, the virus that causes AIDS?	PREP
3.9	If birth control pills are used correctly and consistently, how much can they decrease the risk of pregnancy?	PREP
3.10	If birth control pills are used correctly and consistently, how much can they decrease the risk of getting HIV, the virus that causes AIDS?	PREP
3.11	Can you get a sexually transmitted disease, also known as an STD or STI, from having oral sex? Oral sex is when someone puts his or her mouth on another person's penis or vagina, OR lets someone else put his or her mouth on their own penis or vagina.	Adapted from PREP
3.12	Can you get a sexually transmitted disease, also known as an STD or STI, from having anal sex? Anal sex is when a male puts his penis in someone else’s anus, or their butt, or someone lets a male put his penis in their own anus or butt.	Adapted from PREP
3.13	Below are several statements about condoms. Please mark whether you think each statement is true, false, or you don’t know. a. It is okay to use the same condom more than once. b. Condoms have an expiration date. c. When putting on a condom, it is important to leave a space at the tip. d. It is okay to use petroleum jelly or Vaseline as a lubricant when using latex condoms. e. When using a condom, it is important for the man to pull out right after ejaculation. f. Wearing two latex condoms will provide extra protection.	PAF FADS
3.14	Below are several statements about birth control pills. Please mark whether you think each statement is true, false, or you don’t know. a. Birth control pills are effective, even if a woman misses taking them for two or three days in a row. b. Women should “take a break” from the pills every couple of years. c. After a woman stops taking birth control pills, she is unable to get pregnant for at least two months. d. In order to get the birth control pill, a woman must have a pelvic exam. e. Birth control pills can reduce the risk of getting a sexually transmitted disease (STD).	PAF FADS
3.15	The next statements are about about IUDs (such as Mirena, ParaGard, or Skyla). Please select whether you think each statement is true, false, or you don’t know. a. All IUDs are banned from use in the United States b. A woman can use an IUD, even if she has never had a child c. Women who use IUDs cannot use tampons d. A woman can get an IUD without going to a doctor’s office, clinic or medical professional e. An IUD cannot be felt by a woman’s partner during sex f. IUDs can move around in a woman’s body g. An IUD is effective (prevents pregnancy) for at least 3 years	Adapted from PAF FADS and the Fog Zone
3.16	The next statements are about other forms of birth control. Please select whether you think each statement is true, false, or you don’t know. a. Women using the birth control shot, Depo Provera, must get an injection every 3 months b. Even if a woman is late getting her birth control shot, she is still protected from pregnancy for at least 3 more months c. Women using the vaginal ring, NuvaRing, must have it inserted by a doctor or health care provider every month d. Long acting methods like the implant (Implanon or Nexplanon) or IUD(Mirena, ParaGard, or Skyla cannot be removed early, even if a woman changes her mind about wanting to get pregnant e. Long-acting methods like the implant or an IUD can make it more difficult to become pregnant in the future when a woman is no longer using them. f. Long-acting methods like the implant, an IUD, the shot and the ring can reduce the risk of getting a sexually transmitted disease (STD).	Adapted from PAF FADS and the Fog Zone
3.17	The next statements are about pregnancy. Please select whether you think each statement is true, false, or you don’t know. a. The very first time you have sex, you cannot get pregnant b. Douching (washing the vagina) after sex can prevent pregnancy c. Pregnancy is much less likely to occur if a couple has sex standing up d. The only way to completely prevent pregnancy is by not having sex e. During a woman’s monthly cycle, there are certain days when she is more likely to become pregnant if she has sex	Adapted from the Fog Zone
4.1	How do you describe your gender? Male Female Transgender Unsure Other (specify)	Adapted from OAH recommended measure
4.2	People are different in their sexual attraction to other people. Which best describes your feelings? Are you…? Only attracted to females Mostly attracted to females Equally attracted to females and males Mostly attracted to males Only attracted to males Questioning/not sure Other (specify)	Adapted from OAH recommended measure
4.3	Have you ever sent nude or nearly nude pictures or videos of yourself to others?	Adapted from AP-MTV
4.4	Have you ever received nude or nearly nude pictures or videos of someone else?	Adapted from AP-MTV
4.5	Have you ever touched someone’s private parts? Private parts are the parts of the body covered by underwear or a bra.	ETR Associates
4.6	Other than a doctor or a nurse, have you ever let someone touch your private parts?	Adapted from ETR Associates
4.7	The next questions are about vaginal sex. By vaginal sex we mean a male putting his penis into a female’s vagina. Have you ever had vaginal sex?	Adapted from PREP
4.8	The very first time you had vaginal sex, how old were you?	Adapted from PREP
4.9	The first time you had vaginal sex, did your partner use any of these methods of birth control? a. Condoms b. Birth control pills c. The patch, such as Ortho-Evra d. The shot, such as Depo-Provera or other injectable birth control e. The ring, such as NuvaRing f. An IUD, such as Mirena, ParaGard, or Skyla g. An implant, such as Implanon or Nexplanon h. Withdrawal or pulling out i. Emergency contraceptive pills, such as Plan B j. Another method PRINT OTHER METHOD USED	Adapted from PREP
4.10	How many DIFFERENT PEOPLE have you ever had vaginal sex with, even if only one time?	Adapted from PREP
4.11	Now please think about the past 3 months. In the past 3 months, have you had vaginal sex, even once?	Adapted from PREP
4.12	In the past 3 months, how many TIMES have you had vaginal sex?	Adapted from PREP
4.13	The next question is about your use of the following methods of birth control: Condoms Birth control pills The shot (Depo-Provera) The patch The ring (NuvaRing) IUD (Mirena, Paragard, or Skyla) Implant (Implanon or Nexplanon) In the past 3 months, how many TIMES did you have vaginal sex without using any of these methods of birth control?	PAF FADS
4.14	In the past 3 months, how many TIMES have you had vaginal sex without using a condom?	Adapted from PREP
4.15	Do you intend to have vaginal sex in the next year, if you have the chance?	Adapted from PREP
4.16	Oral sex is when someone puts his or her mouth on another person's penis or vagina, OR lets someone else put his or her mouth on their penis or vagina. Have you ever had oral sex?	PREP
4.17	The very first time you had oral sex, how old were you?	PREP
4.18	Now please think about the past 3 months. In the past 3 months, have you had oral sex?	PREP
4.19	In the past 3 months, how many TIMES have you had oral sex?	PREP
4.20	In the past 3 months, how many TIMES have you had oral sex without using a condom?	PREP
4.21	Anal sex is when a male puts his penis in someone else’s anus, or their butt, or someone lets a male put his penis in their anus or butt. Have you ever had anal sex?	Adapted from PREP
4.22	The very first time you had anal sex, how old were you?	Adapted from PREP
4.23	Now please think about the past 3 months. In the past 3 months, have you had anal sex?	Adapted from PREP
4.24	In the past 3 months, how many TIMES have you had anal sex?	Adapted from PREP
4.25	In the past 3 months, how many TIMES have you had anal sex without using a condom?	Adapted from PREP
4.26	Have you ever hung out alone with someone you were attracted to?	Adapted from Girls Inc
4.27	How old were you the first time you hung out alone with someone you were attracted to?	Adapted from Girls Inc
4.28	Have you ever kissed someone you were attracted to on the mouth?	Adapted from Girls Inc
4.29	Have you ever tongue kissed or French kissed someone?	Adapted from Girls Inc
4.30	Have you ever laid down alone with someone you were attracted to?	Adapted from Student Health Questionnaire
4.31	Have you ever had a boyfriend or girlfriend?	Adapted from Student Health Questionnaire
4.32	How many boyfriends or girlfriends have you had?	Adapted from Student Health Questionnaire
4.33	In general, how much pressure, if any, do you feel from your friends to have sexual intercourse?	Adapted from PREP
4.34	How many of your friends who are your age think the following things? Your best guess is fine. Having sex is a good thing for them to do at their age It would be okay for them to have sex as long as they used birth control, like a condom It would be okay for them to have sex if they were dating the same person for a long time They should wait until they are older to have sex They should wait until marriage to have sex	Adapted from PREP
4.35	How many of your friends who are your age have had sex? Your best guess is fine.	Adapted from PREP
4.36	Here are some reasons people your age might choose NOT to have sex. How important is each of these reasons to YOU? I don’t want to get a sexually transmitted disease, also known as an STD or an STI I don’t want to disappoint my parents I am too young to have sex I want to wait until I’m married It is against my personal beliefs I haven’t met the right person yet I haven’t had the chance I do not want to get pregnant or get someone pregnant	Adapted from PREP
4.37	How strongly do you agree or disagree that each of the following statements are benefits to you of waiting to have sexual intercourse? Respect for yourself Keeping true to religious beliefs Respect from friends Better chance for a good marriage in the future	Adapted from PREP
5.1	In the past 12 months, did you receive information from a doctor, nurse, or clinic about any of the following? Methods of birth control, such as condoms, birth control pills, the patch, the shot, the ring, IUD, or an implant Where to get birth control Sexually transmitted diseases, also known as STDs or STIs The HPV vaccine, also known as Gardasil	Adapted from PREP
5.2	In the past 12 months, did you get any type of birth control from a doctor, nurse, or clinic, such as condoms, birth control pills, the patch, the shot, the ring, IUD, or an implant?	Adapted from PREP
5.3	Have you ever been told by a doctor, nurse, or some other health professional that you had any of the following sexually transmitted diseases? a. Chlamydia b. Gonorrhea c. Genital herpes d. Syphilis e. HIV infection or AIDS f. Human papilloma virus, also known as HPV or genital warts g. Another sexually transmitted disease (STD) PRINT OTHER STD	PAF FADS
5.4	Have you ever talked about contraception or sexually transmitted diseases with someone you were attracted to?	AddHealth
5.5	These next few questions are about pregnancy. To the best of your knowledge, are you currently or have you ever been pregnant or have you gotten someone pregnant?	Adapted from PREP
5.6	Do you want to have children in the future?	PREP
5.7	If it were up to just you, what age would you like to have your first child?	PREP
6.1	The next questions are about tobacco, alcohol, drugs, and general health. Please be as honest as possible, and remember that your answers will be kept private and will not be shared with anyone. During the past 30 days, on how many days did you use an electronic vapor product such as blu, NJOY, Vuse, MarkTen, Logic, Vapin Plus, eGo, and Halo? Electronic vapor products include e-cigarettes, e-cigars, e-pipes, vape pipes, vaping pens, e-hookahs, and hookah pens? □ 0 days □ 1 or 2 days □ 3 to 5 days □ 6 to 9 days □ 10 to 19 days □ 20 to 29 days □ All 30 days	Adapted from YRBSS
6.2	During the past 30 days, on how many days did you smoke one or more cigarettes? □ 0 days □ 1 or 2 days □ 3 to 5 days □ 6 to 9 days □ 10 to 19 days □ 20 to 29 days □ All 30 days	Adapted from YRBSS
6.3	The next 2 questions ask about drinking alcohol. This includes drinking beer, wine, wine coolers, and liquor such as rum, gin, vodka, or whiskey. During the past 30 days, on how many days did you have at least one drink of alcohol? □ 0 days □ 1 or 2 days □ 3 to 5 days □ 6 to 9 days □ 10 to 19 days □ 20 to 29 days □ All 30 days	YRBSS
6.4	During the past 30 days, on how many days did you have 5 or more drinks in a row, that is, within a couple hours? □ 0 days □ 1 day 2 days □ 3 to 5 days □ 6 to 9 days □ 10 to 19 days □ 20 or more days	Adapted from YRBSS
6.5	During the past 30 days, on how many days did you use marijuana, also called weed or pot? □ 0 days □ 1 or 2 days □ 3 to 5 days □ 6 to 9 days □ 10 to 19 days □ 20 to 29 days □ All 30 days	Adapted from PAF FADS and YRBSS
6.6	During the past 30 days, on how many days did you use any other type of illegal drug, inhalant, or a prescription drug in a way that was not prescribed? □ 0 days □ 1 or 2 days □ 3 to 5 days □ 6 to 9 days □ 10 to 19 days □ 20 to 29 days □ All 30 days	PAF FADS
6.7	Now thinking about experiences throughout your life, how many times have you experienced the following things? Heard gunshots in your neighborhood Witnessed a shooting Been robbed or mugged Been fearful that someone you are dating might physically hurt you	PAF FADS
7.1	The next questions are about your experiences and attitudes toward relationships and dating. How would you define your current relationship status? Not currently in a relationship or dating Casually dating Seriously dating Engaged Married	Adapted from PREP
7.2	Have you ever been contacted online or through social media by a complete stranger who wanted to meet in-person?	Adapted from 2012 Teens and Privacy Management Survey
7.3	Have you ever contacted a complete stranger online or through social media who you wanted to meet in-person?	Adapted from 2012 Teens and Privacy Management Survey
7.4	How much do you agree or disagree with the following statements? In a good relationship, you don’t always get your own way. There are times when hitting or pushing between people who are dating is okay. A good dating relationship is based on mutual respect, not just sex. People who make their partner jealous deserve to be hit or pushed. It would be easy to trust your partner, even when you’re apart. Avoiding a disagreement with your partner is always better than talking about your problems.	PAF FADS

AddHealth = National Longitudinal Study of Adolescent Health; AP-MTV = Associated Press-MTV Digital Abuse Study; PAF FADS = The Pregnancy Assistance Fund: Feasability and Design Study; PPA = Evaluation of Adolescent Pregnancy Prevention Approaches; PREP = The Personal Responsibility Education Program Evaluation; SDDAP = Evaluation of the School Dropout Demonstration Assistance Program; YRBSS = 2017 Youth Risk Behavior Surveillance System.