Instrument 1_Participant demographic survey_rev

Instrument 1. Co-Regulation Measures Pilot Study: Youth Screener for Cognitive Interviews and Pilot Survey

OMB No.: 0970-0355

Expiration Date: 08/31/2024

Instrument 1. SRAENE Co-Regulation Measures Pilot Study: Youth Screener for Cognitive Interviews and Pilot Survey

THE PAPERWORK REDUCTION ACT OF 1995

This collection of information is voluntary and will be used to provide the Administration for Children and Families with information to help refine and guide the development of a survey on self- and co-regulation in the area of adolescent pregnancy prevention. Public reporting burden for this collection of information is estimated to average 5 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB number and expiration date for this collection are OMB #: 0970-0355, Exp: 08/31/2024. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to Heather Zaveri at hzaveri@mathematica-mpr.com.

Summer 2024

YOUTH COGNITIVE INTERVIEW FOCUS GROUPS: Thank you for your interest in this research study. We are testing a survey and want your feedback to learn if the questions are clear and easy to understand, if topics are missing, or if there are better ways to ask the questions. If you are selected for the study and choose to join it, you will participate in a 90-minute [in-person/virtual] discussion group. The survey we are testing will be used by the Administration for Children and Families (ACF). ACF is an agency in the federal government within the U.S. Department of Health and Human Services that supports the health and well-being of people. ACF has hired Mathematica, a research company, to do this research study.

• This effort is to refine a measure that is appropriate for youth who have various backgrounds and represent different subpopulations. To ensure we receive feedback from a diverse set of youth, we are asking about certain demographic characteristics.

• If you are selected to participate, joining this study is completely voluntary. This means there are no consequences if you choose to join the study or not.

• The survey questions will ask about how you handle your emotions and make decisions. You do not have to answer any questions that you are not comfortable with. You can also stop at any time. Your answers to these questions will help us improve the survey questions.

• Your survey answers will not be linked with your name and no information will be reported that could identify you. Your survey answers and what is discussed in the discussion group will not be shared with your parents or guardians, teachers, or anyone outside of our research team. We will write a report that tells ACF what we learned from the discussion groups and how to improve the survey questions. We will destroy all data at the end of the study.

YOUTH PILOT SURVEY: Thank you for your interest in this research study. We are testing a survey and want to see how long it takes youth to complete and understand if it works well when administered online. If you are selected for the study and choose to join it, you will participate by completing the survey online. It should take approximately 10 minutes to complete. The survey we are testing will be used by the Administration for Children and Families (ACF). ACF is an agency in the federal government within the U.S. Department of Health and Human Services that supports the health and well-being of people. ACF has hired Mathematica, a research company, to do this research study.

• This effort is to refine a measure that is appropriate for youth who have various backgrounds and represent different subpopulations. To ensure we receive feedback from a diverse set of youth, we are asking about certain demographic characteristics.

• If you are selected to participate, joining this study is completely voluntary. This means there are no consequences if you choose to join the study or not.

• This survey will take about 10 minutes and will ask you some questions about how you handle your emotions and make decisions. You do not have to answer any questions that you are not comfortable with. You can also stop at any time. Your answers to these questions will help us improve the survey questions.

• Your survey answers will not be linked with your name and no information will be reported that could identify you. Your survey answers will not be shared with your parents or guardians, teachers, or anyone outside of our research team. We will write a report that tells ACF what we learned from the discussion groups and how to improve the survey questions. We will destroy all data at the end of the study.

ALL: If you are interested in participating, please complete the following questions. These questions will help us determine if you are eligible for this study.

1. What grade are you in? [If on summer break, which grade did you just finish?]

m 9th 5

m 10th 6

m 11th 7

m 12th 8

m Not enrolled in any school/home-schooled 9 (END; NOT ELIGIBLE)

2. How old are you?

3. Within the last school year, have you taken a class that covers topics related to pregnancy prevention, sexual health, or healthy relationships? This might be part of a health class at school or a separate class that you take after school or at another location, such as church or a community center.

m Yes 1

m No 2

m I don’t know d

4. Which of the following best describes how you currently think of yourself?

Select all that apply

□ Female 1

□ Male 2

□ Nonbinary 3

□ I use a different term (please describe) 4

m I prefer not to answer n

5. What is your race and/or ethnicity?

Select all that apply

□ American Indian or Alaska Native 1

For example, Navajo Nation, Blackfeet Tribe of the Blackfeet Indian Reservation of Montana, Native Village of Barrow Inupiat Traditional Government, Nome Eskimo Community, Aztec, Maya, etc.

□ Asian 2

For example, Chinese, Asian Indian, Filipino, Vietnamese, Korean, Japanese, etc.

□ Black or African American 3

For example, African American, Jamaican, Haitian, Nigerian, Ethiopian, Somali, etc.

□ Hispanic or Latino 4

For example, Mexican, Puerto Rican, Salvadoran, Cuban, Dominican, Guatemalan, etc.

□ Middle Eastern or North African 5

For example, Lebanese, Iranian, Egyptian, Syrian, Iraqi, Israeli, etc.

□ Native Hawaiian or other Pacific Islander 6

For example, Native Hawaiian, Samoan, Chamorro, Tongan, Fijan, Marshallese, etc.

□ White 7

For example, English, German, Irish, Italian, Polish, Scottish, etc.

6. What state do you live in?

7. How would you describe the area where you live?

m Urban (for example, you live in a large city such as New York City, Chicago,

Atlanta, Los Angeles, etc.) 1

m Suburban (for example, you live in an area near to, but outside of a large city) 2

m Rural (for example, you live in a small town) 3

COGNITIVE INTERVIEW FOCUS GROUP RECRUITMENT: ASK Q8a.

8a. Are you interested in participating in an in-person, small group discussion with 3-4 other teenagers? You will take a short survey and then talk about the survey questions with the group. The survey will ask you about how you handle your emotions and make decisions. We want to hear your thoughts on the survey questions, for example were they clear, easy to understand, or confusing. The discussion group will take one and a half hours. If you are eligible and participate, you will receive $100.

m Yes, interested 1 END1

m No, not interested 2 END2

YOUTH PILOT SURVEY RECRUITMENT: ASK Q8b

8b. Are you interested in joining this research study? If selected, you will take a short, 10-minute survey. The survey will ask you about how you handle your emotions and make decisions. If you are eligible and participate, you will receive XX points.

m Yes, interested 1 END1

m No, not interested 2 END2

END1. Thank you. We have recorded that you are interested in participating. If you are eligible, we will contact you with next steps.

END2. Thank you. We have recorded that you are not interested in participating.

[Please click the SUBMIT button.]