ATTACHMENT
b
YOUTH BASELINE and follow-up SURVEY
Question BY Question JUSTIFICATION
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This document lists each question on the STREAMS youth baseline and follow-up surveys, along with its source(s). Many questions are required to be collected for either the Applicant Characteristics Survey (ACS) or the Pre-Program Survey (PPS) of the Fatherhood and Marriage Local Evaluation and (FaMLE) Cross-Site Project (OMB control 0970-0460). New questions added for the STREAMS youth survey beyond the required ACS and PPS items are indicated in the table and justified under the “Additional Information” column.
Q # |
Question text |
Required for FaMLE Cross-Site |
Question added for STREAMS |
Additional information |
Section A |
||||
A1 |
Are you male or female? |
x |
|
Source: Required item A1 from FaMLE Cross-Site ACS. |
A2 |
What is your date of birth? |
X |
|
Source: Required item A2 from FaMLE Cross-Site ACS. |
A3 |
What is your ethnicity? |
x |
|
Source: Required item A4 from FaMLE Cross-Site ACS. |
A4 |
Where were you born? |
x |
|
Source: Required item A5a from FaMLE Cross-Site ACS. Not included on follow-up survey. |
A5 |
Where was your mother born? |
x |
|
Source: Required item A5b from FaMLE Cross-Site ACS. Not included on follow-up survey. |
A6 |
Where was your father born? |
x |
|
Source: Required item A5c from FaMLE Cross-Site ACS. Not included on follow-up survey. |
A7 |
Which one best describes your race? |
x |
|
Source: Required item A3 from FaMLE Cross-Site ACS. |
A8 |
Which language is spoken in your home most of the time? |
x |
|
Source: Required item A6a from FaMLE Cross-Site ACS. Not included on follow-up survey. |
A9 |
How well do you speak English? |
x |
|
Source: Required item A6b from FaMLE Cross-Site ACS. Not included on follow-up survey. |
A10 |
What is your current grade? |
x |
|
Source: Required item B4 from FaMLE Cross-Site ACS. |
A11 |
What kind of grades do you usually get in school? |
|
X |
Source: Personal Responsibility Education Program (PREP) Multi-Component Evaluation. Added as a potential moderator of relationship education impacts. |
A12 |
How many times have you ever been suspended or expelled from school? |
|
X |
Source: Personal Responsibility Education Program (PREP) Multi-Component Evaluation. Added as a potential moderator of relationship education impacts. |
A13 |
On a scale of 1-5, where 1 is low and 5 is high, how much do you want to go to college? |
|
X |
Source: The National Longitudinal Study of Adolescent to Adult Health (Add Health). Added as a potential moderator of relationship education impacts. |
A14 |
On a scale of 1-5, where 1 is low and 5 is high, how likely is it that you will go to college? |
|
X |
Source: The National Longitudinal Study of Adolescent to Adult Health (Add Health). Added as a potential moderator of relationship education impacts. |
A15 |
What is your current employment status? |
X |
|
Source: Required item B6a from FaMLE Cross-Site ACS. Not included on follow-up survey. |
A16 |
How much do you agree or disagree with the following statement? I have specific goals for my future career. |
|
X |
Source: Adapted from the Career Commitment Measure (CCM) (Carson, K. and A.G. Bedeian. 1994; Diemer and Blustein 2007). Added as a potential outcome for programs addressing adolescent development topics. |
A17 |
How much do you agree or disagree with the following statement? I have a plan for reaching my future career goals. |
|
X |
Source: Adapted from the Career Commitment Measure (CCM) (Carson, K. and A.G. Bedeian. 1994; Diemer and Blustein 2007). Added as a potential outcome for programs addressing adolescent development topics. |
A18 |
How much do you agree or disagree with the following statement? Planning a career is not worth the effort. |
|
X |
Source: Adapted from the Career Commitment Measure (CCM) (Carson, K. and A.G. Bedeian. 1994; Diemer and Blustein 2007). Added as a potential outcome for programs addressing adolescent development topics. |
A19 |
How much do you agree or disagree with the following statement? I haven’t thought much about my future career. |
|
X |
Source: Adapted from the Career Commitment Measure (CCM) (Carson, K. and A.G. Bedeian. 1994; Diemer and Blustein 2007). Added as a potential outcome for programs addressing adolescent development topics. |
A20 |
How much do you agree or disagree with the following statement? If I have a career, I won’t be able to enjoy other things in life. |
|
X |
Source: Adapted from the Career Commitment Measure (CCM) (Carson, K. and A.G. Bedeian. 1994; Diemer and Blustein 2007). Added as a potential outcome for programs addressing adolescent development topics. |
A21 |
How much do you agree or disagree with the following statement? Going to college is important for getting a good job. |
|
X |
Source: Adapted from the Career Commitment Measure (CCM) (Carson, K. and A.G. Bedeian. 1994; Diemer and Blustein 2007). Added as a potential outcome for programs addressing adolescent development topics. |
A22 |
In the past 12 months, how often did you attend religious services or activities? |
|
X |
Source: Personal Responsibility Education Program (PREP) Multi-Component Evaluation. Added as a potential moderator of relationship education impacts. Not included on follow-up survey. |
A23 |
In general, how would you describe your health? |
X |
|
Source: Required item D1 from FaMLE Cross-Site ACS. |
Section B |
||||
B1 |
The next few questions ask about your biological parents. Do you live with your biological mother? |
|
X |
Source: Personal Responsibility Education Program (PREP) Multi-Component Evaluation. Added as a potential moderator of relationship education impacts. |
B2 |
Do you live with your biological father? |
|
X |
Source: Personal Responsibility Education Program (PREP) Multi-Component Evaluation. Added as a potential moderator of relationship education impacts. |
B3 |
Which of the following best describes the relationship between your biological mother and biological father? |
|
X |
Source: Personal Responsibility Education Program (PREP) Multi-Component Evaluation. Added as a potential moderator of relationship education impacts. |
B4 |
What is your current living situation? |
X |
|
Source: Required item B2 from FaMLE Cross-Site ACS. Not included on follow-up survey. |
B5 |
Have you even been in foster care? |
X |
|
Source: Required item C9 from FaMLE Cross-Site ACS. Not included on follow-up survey. |
B5a |
What are you currently in foster care? |
X |
|
Source: Required item C9 from FaMLE Cross-Site ACS. Not included on follow-up survey. |
B5b. |
Did you leave foster care in the past 6 months? |
X |
|
Source: Required item C9 from FaMLE Cross-Site ACS. Not included on follow-up survey. |
B6 |
In the past month, how often did you feel like you could count on at least one of your parents to be there when you needed them? |
|
X |
Source: Parent-adolescent relationship scale (Lippman et al. 2014). Added as a potential outcome of relationship education programming. |
B7 |
In the past month, how often did you feel like you could talk with your parent(s) about things that really matter? |
|
X |
Source: Parent-adolescent relationship scale (Lippman et al. 2014). Added as a potential outcome of relationship education programming. |
B8 |
In the past month, how often did you feel like you could share your thoughts and feelings with your parent(s)? |
|
X |
Source: Parent-adolescent relationship scale (Lippman et al. 2014). Added as a potential outcome of relationship education programming. |
B9 |
In the past month, how often did you feel like you could count on your friends to be there when you needed them? |
|
X |
Source: Parent-adolescent relationship scale (Lippman et al. 2014). Added as a potential outcome of relationship education programming. |
B10 |
In the past month, how often did you feel like you could talk with your friends about things that really matter? |
|
X |
Source: Parent-adolescent relationship scale (Lippman et al. 2014). Added as a potential outcome of relationship education programming. |
B11 |
In the past month, how often did you feel like you could share your thoughts and feelings with your friends? |
|
X |
Source: Parent-adolescent relationship scale (Lippman et al. 2014). Added as a potential outcome of relationship education programming. |
Section C |
||||
C1 |
In the past 12 months, did you have any classes on romantic relationships or dating? |
|
X |
Source: Adapted from Personal Responsibility Education Program (PREP) Multi-Component Evaluation. Added to measure exposure to program information. |
C2 |
In the past 12 months, did you have any classes on dating violence? |
|
X |
Source: Adapted from Personal Responsibility Education Program (PREP) Multi-Component Evaluation. Added to measure exposure to program information. |
C3 |
In the past 12 months, did you have any classes on teen pregnancy or sexually transmitted infections? |
|
X |
Source: Adapted from Personal Responsibility Education Program (PREP) Multi-Component Evaluation. Added to measure exposure to program information. |
C4 |
In the past 12 months, did you have any classes on marriage? |
|
X |
Source: Adapted from Personal Responsibility Education Program (PREP) Multi-Component Evaluation. Added to measure exposure to program information. |
C4a |
In the past 12 months, did you have any classes on career planning or job readiness? |
|
X |
Source: Adapted from Personal Responsibility Education Program (PREP) Multi-Component Evaluation. Added to follow-up survey to measure exposure to program content on career planning and job readiness. |
C5 |
In the past 12 months, did any of your friends have any classes on romantic relationships or dating? |
|
X |
Source: Adapted from Personal Responsibility Education Program (PREP) Multi-Component Evaluation. Added to measure exposure to program information. |
C6 |
In the past 12 months, did any of your friends have any classes on dating violence? |
|
X |
Source: Adapted from Personal Responsibility Education Program (PREP) Multi-Component Evaluation. Added to measure exposure to program information. |
C7 |
In the past 12 months, did any of your friends have any classes on teen pregnancy or sexually transmitted infections? |
|
X |
Source: Adapted from Personal Responsibility Education Program (PREP) Multi-Component Evaluation. Added to measure exposure to program information. |
C8 |
In the past 12 months, did any of your friends have any classes on marriage? |
|
X |
Source: Adapted from Personal Responsibility Education Program (PREP) Multi-Component Evaluation. Added to measure exposure to program information. |
C8a |
In the past 12 months, did any of your friends have any classes on career planning or job readiness? |
|
X |
Source: Adapted from Personal Responsibility Education Program (PREP) Multi-Component Evaluation. Added to follow-up survey to measure exposure to program content on career planning and job readiness. |
C9 |
How much do you agree or disagree with the following statement? Marriages are happy or unhappy and there is not much you can do to change it. |
X |
|
Source: Required item A1a from FaMLE Cross-Site PPS. |
C10 |
How much do you agree or disagree with the following statement? If you are happily married, you don’t need to work on your relationship. |
X |
|
Source: Required item A1b from FaMLE Cross-Site PPS. |
C11 |
How much do you agree or disagree with the following statement? There is only one true love out there who is right for me to marry. |
|
X |
Source: Faulty relationship beliefs scale (Kerpelman et al. 2009; Cobb, Larson, and Watson 2003). Added as potential outcome of relationship education programming. |
C12 |
How much do you agree or disagree with the following statement? In the end, feelings of love should be enough to sustain a happy marriage. |
|
X |
Source: Faulty relationship beliefs scale (Kerpelman et al. 2009; Cobb, Larson, and Watson 2003). Added as potential outcome of relationship education programming. |
C13 |
How much do you agree or disagree with the following statement? Living together before marriage will improve a couple’s chances of remaining happily married. |
|
X |
Source: Faulty relationship beliefs scale (Kerpelman et al. 2009; Cobb, Larson, and Watson 2003). Added as potential outcome of relationship education programming. |
C14 |
How much do you agree or disagree with the following statement? A boy angry enough to hit his girlfriend must love her very much. |
|
X |
Source: Acceptance of male on female violence scale (Foshee et al. 1992). Added as a potential outcome of relationship education programming. |
C15 |
How much do you agree or disagree with the following statement? Girls sometimes deserve to be hit by the boys they date. |
|
X |
Source: Acceptance of male on female violence scale (Foshee et al. 1992). Added as a potential outcome of relationship education programming. |
C16 |
How much do you agree or disagree with the following statement? A girl who makes her boyfriend jealous on purpose deserves to be hit. |
|
X |
Source: Acceptance of male on female violence scale (Foshee et al. 1992). Added as a potential outcome of relationship education programming. |
C17 |
How much do you agree or disagree with the following statement? Boys sometimes deserve to be hit by the girls they date. |
|
X |
Source: Acceptance of female on male violence scale (Foshee et al. 1992). Added as a potential outcome of relationship education programming. |
C18 |
How much do you agree or disagree with the following statement? A girl angry enough to hit her boyfriend must love him very much. |
|
X |
Source: Acceptance of female on male violence scale (Foshee et al. 1992). Added as a potential outcome of relationship education programming. |
C19 |
How much do you agree or disagree with the following statement? A boy who makes his girlfriend jealous on purpose deserves to be hit. |
|
X |
Source: Acceptance of female on male violence scale (Foshee et al. 1992). Added as a potential outcome of relationship education programming. |
C20 |
How much do you agree or disagree with the following statement? Violence between dating partners can improve the relationship. |
|
X |
Source: Acceptance of general dating violence scale (Foshee et al. 1992). Added as a potential outcome of relationship education programming. |
C21 |
How much do you agree or disagree with the following statement? There are times when violence between dating partners is ok. |
|
X |
Source: Acceptance of general dating violence scale (Foshee et al. 1992). Added as a potential outcome of relationship education programming. |
C21a |
How much do you agree or disagree with the following statement? It’s okay to stay in a relationship even if you’re afraid of your dating partner. |
X |
|
Source: Required item A5d from FaMLE Cross-Site PPS. |
C22 |
How much do you agree or disagree with the following statement? Sometimes violence is the only way to express your feelings. |
|
X |
Source: Acceptance of general dating violence scale (Foshee et al. 1992). Added as a potential outcome of relationship education programming. |
C23 |
How much do you agree or disagree with the following statement? Some couples must use violence to solve their problems. |
|
X |
Source: Acceptance of general dating violence scale (Foshee et al. 1992). Added as a potential outcome of relationship education programming. |
C24 |
How much do you agree or disagree with the following statement? Violence between dating partners is a personal matter and people should not interfere. |
|
X |
Source: Acceptance of general dating violence scale (Foshee et al. 1992). Added as a potential outcome of relationship education programming. |
C25 |
How much do you agree or disagree with the following statement? Two people who are in love do not need to use condoms/birth control. |
X |
|
Source: Required item B1a from FaMLE Cross-Site PPS. |
C26 |
How much do you agree or disagree with the following statement? At my age right now, it is okay to have sexual intercourse if I use protection, like a condom, the pill, etc. |
X |
|
Source: Required item B1g from FaMLE Cross-Site PPS. |
C26a |
How much do you agree or disagree with the following statement? If my dating partner wanted to have sex, but I didn’t, I would find it pretty hard to say “no”. |
X |
|
Source: Required item B2a from FaMLE Cross-Site PPS. |
C26b |
How much do you agree or disagree with the following statement? Getting pregnant/getting a girl pregnant in the next year or two would hurt my chances of being successful in life. |
|
X |
Source: Evaluation of Adolescent Pregnancy Prevention Approaches (Smith et al. 2016). Added to follow-up survey to measure impact of program content on attitudes toward teen pregnancy. |
C26c |
If I got pregnant/got a girl pregnant in the next year or two, I would have to become a responsible adult before I wanted to. |
|
X |
Source: Evaluation of Adolescent Pregnancy Prevention Approaches (Smith et al. 2016). Added to follow-up survey to measure impact of program content on attitudes toward teen pregnancy. |
C26d |
If I got pregnant/got a girl pregnant in the next year or two, my life would become a lot better |
|
X |
Source: Evaluation of Adolescent Pregnancy Prevention Approaches (Smith et al. 2016). Added to follow-up survey to measure impact of program content on attitudes toward teen pregnancy. |
C26e |
Do you think the following statement is true or false? All sexually transmitted infections (STIs) can be cured. |
|
X |
Source: Evaluation of Adolescent Pregnancy Prevention Approaches (Goesling et al. 2015). Added to follow-up survey to measure impact of program content on HIV and STIs. |
C26f |
Do you think the following statement is true or false? A sexually active girl can become pregnant if she forgets to take her birth control pills for several days in a row. |
|
X |
Source: Evaluation of Adolescent Pregnancy Prevention Approaches (Goesling et al. 2015). Added to follow-up survey to measure impact of program content on methods of protection. |
C26g |
Do you think the following statement is true or false? Using a condom can help prevent HIV. |
|
X |
Source: Evaluation of Adolescent Pregnancy Prevention Approaches (Goesling et al. 2015). Added to follow-up survey to measure impact of program content on methods of protection. |
C26h |
Do you think the following statement is true or false? You cannot tell if a person has HIV by looking at them. |
|
X |
Source: Evaluation of Adolescent Pregnancy Prevention Approaches (Goesling et al. 2015). Added to follow-up survey to measure impact of program content on HIV and STIs. |
C26i |
Do you think the following statement is true or false? Latex condoms are 100% effective in preventing pregnancy and STIs (including HIV). |
|
X |
Source: Evaluation of Adolescent Pregnancy Prevention Approaches (Goesling et al. 2015). Added to follow-up survey to measure impact of program content on methods of protection. |
C27 |
When you think of your future, what do you think are the chances that you will get married? |
|
X |
Source: Adapted from FaMLE Cross-Site PPS. Added as a potential outcome of relationship education programming. |
C28 |
When you think of your future, what do you think are the chances that you will be married to one person for life? |
X |
|
Source: Required item A2a from FaMLE Cross-Site PPS. |
C29 |
When you think of your future, what do you think are the chances that you will live with a partner without being married? |
X |
|
Source: Required item A2b from FaMLE Cross-Site PPS. |
C30 |
When you think of your future, what do you think are the chances that you will have children? |
|
X |
Source: Adapted from FaMLE Cross-Site PPS. Added as a potential outcome of relationship education programming. |
C31 |
When you think of your future, what do you think are the chances that you will have a child without being married? |
X |
|
Source: Required item A2c from FaMLE Cross-Site PPS. |
Section D |
||||
D1 |
How much do you agree or disagree with the following statement? I believe I will be able to effectively deal with conflicts that arise in my relationships. |
|
X |
Source: Relationship Confidence Subscale, Relationship Deciding Scale (Vennum and Fincham 2011). Added as a potential outcome of relationship education programming. |
D2 |
How much do you agree or disagree with the following statement? I feel good about my ability to make a romantic relationship last. |
|
X |
Source: Relationship Confidence Subscale, Relationship Deciding Scale (Vennum and Fincham 2011). Added as a potential outcome of relationship education programming. |
D3 |
How much do you agree or disagree with the following statement? I am very confident when I think of having a stable, long term relationship. |
|
X |
Source: Relationship Confidence Subscale, Relationship Deciding Scale (Vennum and Fincham 2011). Added as a potential outcome of relationship education programming. |
D4 |
How much do you agree or disagree with the following statement? I have the skills needed for a lasting stable romantic relationship. |
|
X |
Source: Relationship Confidence Subscale, Relationship Deciding Scale (Vennum and Fincham 2011). Added as a potential outcome of relationship education programming. |
D4a |
How much do you agree or disagree with the following statement? I am able to recognize early on the warning signs in a bad relationship. |
|
X |
Source: Warning Signs Subscale, Relationship Deciding Scale (Vennum and Fincham 2011). Added to follow-up survey to measure impact of program content on avoidance of unhealthy relationships. |
D4b |
How much do you agree or disagree with the following statement? I know what to do when I recognize the warning signs in a bad relationship. |
|
X |
Source: Warning Signs Subscale, Relationship Deciding Scale (Vennum and Fincham 2011). Added to follow-up survey to measure impact of program content on avoidance of unhealthy relationships, |
D5 |
How good are you at admitting that you might be wrong during an argument? |
|
X |
Source: Conflict Management Subscale, Interpersonal Competence Questionnaire (Buhrmester et al. 1988). Added as a potential outcome of relationship education programming. |
D6 |
How good are you at avoiding saying things that could turn an argument into a big fight? |
|
X |
Source: Conflict Management Subscale, Interpersonal Competence Questionnaire (Buhrmester et al. 1988). Added as a potential outcome of relationship education programming. |
D7 |
How good are you accepting another person’s point of view even if you don’t agree with it? |
|
X |
Source: Conflict Management Subscale, Interpersonal Competence Questionnaire (Buhrmester et al. 1988). Added as a potential outcome of relationship education programming. |
D8 |
How good are you at listening to another person’s opinion during an argument? |
|
X |
Source: Conflict Management Subscale, Interpersonal Competence Questionnaire (Buhrmester et al. 1988). Added as a potential outcome of relationship education programming. |
D9 |
How good are you at working through problems without arguing? |
|
X |
Source: Conflict Management Subscale, Interpersonal Competence Questionnaire (Buhrmester et al. 1988). Added as a potential outcome of relationship education programming. |
D10 |
How often do you show respect for teachers and neighbors? |
|
X |
Source: National Survey of Children's Health. Added as a potential outcome for programs addressing pro-social skills. |
D11 |
How often do you get along well with other people your age? |
|
X |
Source: National Survey of Children's Health. Added as a potential outcome for programs addressing pro-social skills. |
D12 |
How often do you try to understand other people’s feelings? |
|
X |
Source: National Survey of Children's Health. Added as a potential outcome for programs addressing pro-social skills. |
D13 |
How often do you try to see things from another person’s point of view? |
|
X |
Source: Child Trends Supporting Healthy Marriage (SHM) Project. Added as a potential outcome for programs addressing pro-social skills. |
D14 |
How often do you work hard to listen to what other people have to say? |
|
X |
Source: Child Trends 3M Project. Added as a potential outcome for programs addressing pro-social skills. |
D15 |
How often do you say thank you when someone does something nice? |
|
X |
Source: Child Trends 3M Project. Added as a potential outcome for programs addressing pro-social skills. |
D16 |
How often do you apologize when you’re wrong? |
|
X |
Source: Child Trends 3M Project. Added as a potential outcome for programs addressing pro-social skills. |
Section E |
||||
E1 |
How would you define your current relationship status? |
|
X |
Source: Personal Responsibility Education Program (PREP) Multi-Component Evaluation. Added as a potential outcome of relationship education programming. |
E2 |
The following questions are about your current relationship. On a scale of 0-10, where 0 is not at all happy and 10 is completely happy, how happy would you say your current relationship is? |
|
X |
Source: Adapted from Building Strong Families (BSF) 15 Month Follow-up. Added as a potential outcome of relationship education programming. |
E3 |
How much do you agree or disagree with the following statement? I am very satisfied with how my partner and I talk to each other. |
|
X |
Source: Relationship satisfaction scale (Kerpelman 2009). Added as a potential outcome of relationship education programming. |
E4 |
How much do you agree or disagree with the following statement? I am very satisfied with how my partner and I treat each other. |
|
X |
Source: Relationship satisfaction scale (Kerpelman 2009). Added as a potential outcome of relationship education programming. |
E5 |
How much do you agree or disagree with the following statement? I can turn to my partner for advice about problems. |
|
X |
Source: Relationship satisfaction scale (Kerpelman 2009). Added as a potential outcome of relationship education programming. |
E5a |
Has your partner ever tried to keep you from seeing or talking with your friends? |
|
X |
Source: Supporting Healthy Marriages (SHM) Evaluation. Added to follow-up survey to measure impact of program content on avoidance of unhealthy relationships, |
E5b |
Has your partner ever made you feel stupid? |
|
X |
Source: Supporting Healthy Marriages (SHM) Evaluation. Added to follow-up survey to measure impact of program content on avoidance of unhealthy relationships, |
E5c |
Has your partner ever made you feel afraid that they might hurt you? |
|
X |
Source: Supporting Healthy Marriages (SHM) Evaluation. Added to follow-up survey to measure impact of program content on avoidance of unhealthy relationships, |
E6 |
How often does your partner criticize your ideas? |
X |
|
Source: Required item C2f from FaMLE Cross-Site PPS. |
E7 |
How often does your partner insult or swear at you? |
|
X |
Source: Conflict Tactics Scale 2, Psychological Aggression Scale (Straus et al. 1996). Added as a potential outcome of relationship education programming. Not included on follow-up survey. |
E8 |
How often does your partner destroy things belonging to you? |
|
X |
Source: Conflict Tactics Scale 2, Psychological Aggression Scale (Straus et al. 1996). Added as a potential outcome of relationship education programming. Not included on follow-up survey. |
E9 |
When you have a serious disagreement with your partner, how often do you end up throwing things or hitting something? |
X |
|
Source: Source: Required item C3c from FaMLE Cross-Site PPS. |
E10 |
How often do you insult or swear at your partner? |
|
X |
Source: Conflict Tactics Scale 2, Psychological Aggression Scale (Straus et al. 1996). Added as a potential outcome of relationship education programming. Not included on follow-up survey. |
E11 |
How often do you destroy things belonging to your partner? |
|
X |
Source: Conflict Tactics Scale 2, Psychological Aggression Scale (Straus et al. 1996). Added as a potential outcome of relationship education programming. Not included on follow-up survey. |
E12 |
Do you consider yourself to be… (Sexual Preferences) |
|
X |
Source: Personal Responsibility Education Program (PREP) Multi-Component Evaluation. Added as a potential moderator of relationship education impacts. |
E13 |
Have you ever had sexual intercourse? |
|
X |
Source: Personal Responsibility Education Program (PREP) Multi-Component Evaluation. Added as a potential outcome of relationship education programming. |
E14 |
In the past 3 months, have you ever had sexual intercourse? |
|
X |
Source: Personal Responsibility Education Program (PREP) Multi-Component Evaluation. Added as a potential outcome of relationship education programming. |
E15 |
In the past 3 months, have you ever had sexual intercourse without using a condom? |
|
X |
Source: Personal Responsibility Education Program (PREP) Multi-Component Evaluation. Added as a potential outcome of relationship education programming. |
E16 |
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, have you had sexual intercourse without using any of these methods of birth control? |
|
X |
Source: Personal Responsibility Education Program (PREP) Multi-Component Evaluation. Added as a potential outcome of relationship education programming. |
E17 |
Are you currently pregnant? |
X |
|
Source: Required item C4a from FaMLE Cross-Site ACS. |
E18 |
Is anyone currently pregnant with your child? |
X |
|
Source: Required item C4b from FaMLE Cross-Site ACS. |
E19 |
How many children do you have? (Do not include current pregnancies) |
X |
|
Source: Required item C5a from FaMLE Cross-Site ACS. Not included on follow-up survey. |
E20 |
Do you have any children of your own living with you in your home? |
X |
|
Source: Required item D1 from FaMLE Cross-Site PPS. Not included on follow-up survey. |
E21 |
When is the last time you saw your youngest child? |
X |
|
Source: Required item D3 from FaMLE Cross-Site PPS. Not included on follow-up survey. |
E22 |
In the past month, how often did you see or visit your youngest child? |
X |
|
Source: Required item D4a from FaMLE Cross-Site PPS. Not included on follow-up survey. |
E23 |
Thinking about your youngest child, how often does the following happen in your family? I am happy being with my child. |
X |
|
Source: Required item E1a from FaMLE Cross-Site PPS. Not included on follow-up survey. |
E24 |
Thinking about your youngest child, how often does the following happen in your family? My child and I are very close to each other. |
X |
|
Source: Required item E1b from FaMLE Cross-Site PPS. Not included on follow-up survey. |
E25 |
Thinking about your youngest child, how often does the following happen in your family? I try to comfort my child when he/she is upset. |
X |
|
Source: Required item E1c from FaMLE Cross-Site PPS. Not included on follow-up survey. |
E26 |
Thinking about the times when your youngest child has done something wrong, how often do you hit, spank, grab, or use physical punishment with your child? |
X |
|
Source: Required item E2a from FaMLE Cross-Site PPS. Not included on follow-up survey. |
E27 |
Thinking about the times when your youngest child has done something wrong, how often do you yell, shout, or scream at your child because you are mad at him/her? |
X |
|
Source: Required item E2b from FaMLE Cross-Site PPS. Not included on follow-up survey. |
E28 |
Thinking about the times when your youngest child has done something wrong, how often do you talk to your child about what he/she did wrong? |
X |
|
Source: Required item E2c from FaMLE Cross-Site PPS. Not included on follow-up survey. |
Section F |
||||
F1 |
The next questions are about how to contact you in the future for your next survey. What is your address? |
|
X |
Source: Evaluation of the Impact of the Youth Build Program 30-Month Followup Modification. Added to collect contact information for survey locating. Not included on follow-up survey. |
F1a |
Before we hang up, can you please provide me with your full name and mailing address so we can mail your gift card? You should receive your card within two weeks. |
|
X |
Source: New item added to follow-up survey for any students who complete the survey by telephone. |
F2 |
What is your cell phone number? |
|
X |
Source: Evaluation of the Impact of the Youth Build Program 30-Month Followup Modification. Added to collect contact information for survey locating. Not included on follow-up survey. |
F2a |
Check here if you don’t have a cell phone |
|
X |
Source: Evaluation of the Impact of the YouthBuild Program 30-Month Followup Modification. Added to collect contact information for survey locating. Not included on follow-up survey. |
F3 |
May we send you text messages? Message and data rates may apply. |
|
X |
Source: Evaluation of the Impact of the YouthBuild Program 30-Month Followup Modification. Added to collect contact information for survey locating. Not included on follow-up survey. |
F4 |
What is another phone number where you can be reached? |
|
X |
Source: Evaluation of the Impact of the Youthbuild Program 30-Month Followup Modification. Added to collect contact information for survey locating. Not included on follow-up survey. |
F4a |
Check here if you don’t have another phone number |
|
X |
Source: Evaluation of the Impact of the YouthBuild Program 30-Month Followup Modification. Added to collect contact information for survey locating. Not included on follow-up survey. |
F5 |
Is this number, [F4], for a cell phone? |
|
X |
Source: Evaluation of the Impact of the YouthBuild Program 30-Month Followup Modification. Added to collect contact information for survey locating. Included only on baseline survey. |
F6 |
Whose name is that number listed under? |
|
X |
Source: Evaluation of the Impact of the YouthBuild Program 30-Month Followup Modification. Added to collect contact information for survey locating. Not included on follow-up survey. |
F6a |
Check here if you don’t know |
|
X |
Source: Evaluation of the Impact of the YouthBuild Program 30-Month Followup Modification. Added to collect contact information for survey locating. Not included on follow-up survey. |
F6b |
May we send you text messages at this number: ([FILL F4_phone])? Message and data rates may apply. |
|
X |
Source: Evaluation of the Impact of the YouthBuild Program 30-Month Followup Modification. Added to collect contact information for survey locating. Not included on follow-up survey. |
F7 |
What is the best email address to reach you at? |
|
X |
Source: Evaluation of the Impact of the YouthBuild Program 30-Month Followup Modification. Added to collect contact information for survey locating. Not included on follow-up survey. |
F7a |
Check here if you don’t have an email address |
|
X |
Source: Evaluation of the Impact of the YouthBuild Program 30-Month Followup Modification. Added to collect contact information for survey locating. Not included on follow-up survey. |
F8 |
If you have another email address, what is it? |
|
X |
Source: Evaluation of the Impact of the YouthBuild Program 30-Month Followup Modification. Added to collect contact information for survey locating. Not included on follow-up survey. |
F8a |
Check here if you don’t have another email address |
|
X |
Source: Evaluation of the Impact of the YouthBuild Program 30-Month Followup Modification. Added to collect contact information for survey locating. Not included on follow-up survey. |
F9 |
Do you have a Facebook account? |
|
X |
Source: Evaluation of the Impact of the YouthBuild Program 30-Month Followup Modification. Added to collect contact information for survey locating. Not included on follow-up survey. |
F9a |
What name do you use on Facebook? |
|
X |
Source: Evaluation of the Impact of the YouthBuild Program 30-Month Followup Modification. Added to collect contact information for survey locating. Not included on follow-up survey. |
F10 |
Do you have an Instagram account? |
|
X |
Source: Evaluation of the Impact of the YouthBuild Program 30-Month Followup Modification. Added to collect contact information for survey locating. Not included on follow-up survey. |
F10a |
What name do you use on Instagram? |
|
X |
Source: Evaluation of the Impact of the YouthBuild Program 30-Month Followup Modification. Added to collect contact information for survey locating. Not included on follow-up survey. |
F11 |
Do you have a Twitter account? |
|
X |
Source: Evaluation of the Impact of the YouthBuild Program 30-Month Followup Modification. Added to collect contact information for survey locating. Not included on follow-up survey. |
F11a |
What user name or handle do you use on Twitter? |
|
X |
Source: Evaluation of the Impact of the YouthBuild Program 30-Month Followup Modification. Added to collect contact information for survey locating. Not included on follow-up survey. |
F12 |
Do you have a social networking account other than Facebook, Instagram, or Twitter? |
|
X |
Source: Evaluation of the Impact of the YouthBuild Program 30-Month Followup Modification. Added to collect contact information for survey locating. Not included on follow-up survey. |
F12a |
What other social networking provider do you use? |
|
X |
Source: Evaluation of the Impact of the YouthBuild Program 30-Month Followup Modification. Added to collect contact information for survey locating. Not included on follow-up survey. |
F12b |
What name do you use on this social networking account? |
|
X |
Source: Evaluation of the Impact of the YouthBuild Program 30-Month Followup Modification. Added to collect contact information for survey locating. Not included on follow-up survey. |
F13 |
FIRST PERSON: As part of the study, we will contact you again in a year. In case you move, we would like the name, address and telephone number of up to two relatives (such as your parents or grandparents) or other adults who would know where you are. We will only contact them if we have trouble getting in touch with you directly. What is the name of the first person who will know where you are? SECOND PERSON: What is the name of another relative or adult who will know how to contact you a year from now? |
|
X |
Source: Evaluation of the Impact of the YouthBuild Program 30-Month Followup Modification. Added to collect contact information for survey locating. Not included on follow-up survey. |
F13a |
Check here is there is no one [else] who will know how to contact you |
|
X |
Source: Evaluation of the Impact of the YouthBuild Program 30-Month Followup Modification. Added to collect contact information for survey locating. Not included on follow-up survey. |
F14 |
What is [FILL NAME]’s relationship to you? |
|
X |
Source: Evaluation of the Impact of the YouthBuild Program 30-Month Followup Modification. Added to collect contact information for survey locating. Not included on follow-up survey. |
F15 |
What is [FILL NAME]’s telephone number? |
|
X |
Source: Evaluation of the Impact of the YouthBuild Program 30-Month Followup Modification. Added to collect contact information for survey locating. Not included on follow-up survey. |
F15a |
Check here if you can’t find the number |
|
X |
Source: Evaluation of the Impact of the YouthBuild Program 30-Month Followup Modification. Added to collect contact information for survey locating. Not included on follow-up survey. |
F16 |
What is [FILL NAME]’s address? |
|
X |
Source: Evaluation of the Impact of the YouthBuild Program 30-Month Followup Modification. Added to collect contact information for survey locating. Not included on follow-up survey. |
F17 |
The last questions are about the best ways to reach you for future surveys. How would you like to be contacted in the future about upcoming surveys? |
|
X |
Source: Evaluation of the Impact of the YouthBuild Program 30-Month Followup Modification. Added to collect contact information for survey locating. Not included on follow-up survey. |
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
Author | BCollette |
File Modified | 0000-00-00 |
File Created | 2021-01-20 |