Baseline parent survey

Evaluation of the National Abstinence Media Campaign

0990-0311 (2)

Baseline parent survey

OMB: 0990-0311

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Download: doc | pdf

Self-Administered Web Survey

(Baseline and Follow-Up Versions)

Parents Speak Up National Campaign

Parent Baseline Survey


Web screen:


[NOTE: Consent form will precede the questions below, and contains introductory text about purpose of the survey, as well as providing information for informed consent. Consent form is included in the OMB supporting statement appendices.]


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 0990-0311. The time required to complete this information collection is estimated to average 24 minutes per response, including the time to review instructions and complete the information collection. If you have comments concerning the accuracy of the time estimate or suggestions for improving this form, please write to:

U.S. Department of Health & Human Services; OS/OCIO/PRA;

OMB NO.: 200 Independence Ave., S.W., Suite 531-H; Washington D.C. 20201;

EXPIRATION DATE: Attention: PRA Reports Clearance Officer



Q1. Let’s begin the interview now. Once again, your answers will be kept private, and your name will be replaced with an ID number to protect your privacy.


We are interested in your opinion about the parent-child communication and teen sexual activity. If you're not sure, choose an answer that comes closest to what you think might be true for each activity.


Before we start, are you the only one who can see the questions and your answers?


  1. Yes

  2. No (GO TO EXIT SCREEN TO ALLOW PARENT TO CONTINUE ANOTHER TIME)

99 SKIPPED


Q2. Is {CHILD NAME} a boy or girl? [Already asked in screening, Knowledge Networks will confirm whether this info can be delivered from screening or needs to be asked again. Same with age of child]


1. Boy

2. Girl

99 SKIPPED


A. PARENT-CHILD RELATIONSHIP


The first questions are about your relationship with {CHILD NAME}.


Q3. In the past 30 days, how many times have you done the following things with {CHILD NAME}?


At least At least

Once once Less

a week a month Often Never SKIPPED

  1. Gone shopping

  2. Gone to a movie,

sport event,

concert, play,

or museum

  1. Watched an

entire television

show together


Q4. For the following list of activities, indicate whether this is something you and {CHILD NAME} do together at least once a week, at least once a month, less often, or never. How often do you. . .

At least At least

Once once Less

a week a month Often Never SKIPPED

a. Go to religious services or

other religious

activities together 1 2 3 4 99


b. Do homework or school

projects when school

is in session 1 2 3 4 99


c. Attend a party or a family

gathering together 1 2 3 4 99


d. Do volunteer work together

to help other people or

improve your

neighborhood 1 2 3 4 99


e. Play a game or sport

together 1 2 3 4 99


Q5. How often do you feel you miss events or activities that are important to {CHILD NAME}? Is it a lot, sometimes, or almost never?


  1. A lot

  2. Sometimes

  3. Almost never

99. SKIPPED


Q6. About how many close friends does {CHILD NAME} have? By close friends, I mean friends that he/she spends a lot of his/her free time with.


  1. None (SKIP TO Q7)

  2. One

  3. Two to four

  4. Five to eight

  5. Nine to fifteen

  6. Sixteen to twenty-five

  7. Twenty-six or more

99. SKIPPED


Q6a. Do you know (this friend/all of these friends) by sight and by first and last name?


  1. Yes (SKIP TO Q7)

  2. No

99. SKIPPED


Q6b. About how many of these close friends do you know by sight and by first and last name? Is it. . .


  1. All of them

  2. Most of them

  3. Some of them

  4. None of them

99. SKIPPED


Q7. About how often do you know who {CHILD NAME} is with when (he/she) is not at home or in school? Would you say you know who {CHILD NAME} is with. . . .


  1. All the time

  2. Most of the time

  3. Some of the time

  4. Only rarely

99. SKIPPED


Q8. About how often do you know what {CHILD NAME} is doing when (he/she) is not at home or in school? Would you say you know what he/she is doing. . . .


  1. All the time

  2. Most of the time

  3. Some of the time

  4. Only rarely

99. SKIPPED


Q9. How often do you monitor what {CHILD NAME} watches on TV?


  1. Often

  2. Sometimes

  3. Rarely

  4. Never

  5. SKIPPED


Q10. How often do you put restrictions on the music, CDs, or videogames {CHILD NAME} can play?


  1. Often

  2. Sometimes

  3. Rarely

  4. Never

  1. SKIPPED


Q11. Which of the following does {CHILD NAME} have in his/her bedroom?


Yes No SKIPPED

  1. Television

  2. Cable TV connection

  3. Computer

  4. Internet connection

  5. CD player/stereo

  6. iPod

  7. Video games

  8. Other media (specify)_____


Q11. How often would it be true for you to make each of the following statements about {CHILD NAME}?


Always Often Sometimes Seldom Never SKIPPED

  1. You get along well

with him/her 1 2 3 4 5 99

  1. {CHILD NAME} and you

make decisions

about his/her life

together 1 2 3 4 5 99

  1. You just do not

understand him/her 1 2 3 4 5 99

  1. You feel you can

really trust him/her

  1. He/she interferes

with your activities 1 2 3 4 5 99


Q12. How do you think you and {CHILD NAME} communicate with each other?


    1. When {CHILD NAME} asks questions, he/she gets honest answers from you.


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

99 SKIPPED


    1. You help {CHILD NAME} to understand himself/herself better.


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

99 SKIPPED


Q13. During the past 12 months, how many times have you argued or had a fight with {CHILD NAME}?


  1. 0 times

  2. 1 or 2 times

  3. 3 to 5 times

  4. 6 to 9 times

  5. 10 or more times

  1. SKIPPED

B. PARENT ATTITUDES, BELIEFS AND PERCEPTIONS OF TEEN NORMS & OUTCOME EFFICACY


The next questions ask about your opinions about sexual activity and teens. For each of the following, please indicate how much you agree or disagree with the statement:


Q14a. Sexual activity is likely to have harmful psychological effects for teens.


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly Disagree

99 SKIPPED


Q14b. Sexual activity is likely to have harmful physical effects for teens.


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly Disagree

    1. SKIPPED


Q15. When it comes to teens’ decisions about sexual activity, which of the following influences them the most?


  1. Parents

  2. Morals, values, and/or religious beliefs

  3. Friends

  4. The media

  5. Teachers and sex educators

  6. Worries about pregnancy

  7. Worries about STDs

99. SKIPPED


Q16. Waiting to have sex is the most effective way to prevent health risks like unwanted pregnancy or HIV/STDs. Do you. . .


1. Strongly agree

2. Agree

  1. Disagree

  2. Strongly disagree

    1. SKIPPED


Q17. It would be much easier for teens to postpone sexual activity and avoid teen pregnancy if they were able to have more open, honest conversations about these topics with their parents.


1. Strongly agree

  1. Agree

  2. Disagree

  3. Strongly disagree

99 SKIPPED


Q18. Earlier you answered a question about waiting to have sex as the most effective way to prevent health risks like unwanted pregnancy or HIV/STDs. How were you defining sex? Do you include:


Yes No SKIPPED

1. Vaginal sex (sexual intercourse) 1 2 99

2. Oral sex 1 2 99

3. Anal sex 1 2 99

4. Intimate touching (skin-to-skin contact) 1 2 99


Q19. To what age do you think boys should wait before being sexually active—until they are 12, 14, 16, 18, 21, or until they are married?


  1. Until they are 12

  2. Until they are 14

  3. Until they are 16

  4. Until they are 18

  5. Until they are 21

  6. Until they are married

99. SKIPPED


Q20. Do you think most boys will actually wait that long or will most be sexually active earlier?


  1. Will wait

  2. Will have intercourse earlier

99. SKIPPED


Q21. To what age do you think girls should wait before being sexually active—until they are 12, 14, 16, 18, 21, or until they are married?


  1. Until they are 12

  2. Until they are 14

  3. Until they are 16

  4. Until they are 18

  5. Until they are 21

  6. Until they are married

99 SKIPPED


Q22. Do you think most girls will actually wait that long or will most be sexually active earlier?


  1. Will wait

  2. Will have intercourse earlier

99 SKIPPED.


The next questions are about certain topics you may discuss with {CHILD NAME}. Please indicate how sure or unsure you are about this statement.


Q23. How sure are you that you can always explain to {CHILD NAME}. . .


a. . . .why he/she should wait until he/she is older to be sexually active?


  1. Completely sure

  2. Very sure

  3. Somewhat sure

  4. Neither sure nor unsure

  5. Somewhat unsure

  6. Very unsure

  7. Not sure at all

  1. SKIPPED


b. . . .how to make a boy/girl (OPPOSITE SEX OF CHILD) wait until he/she (CHILD’S SEX) is ready to be sexually active?


  1. Completely sure

  2. Very sure

  3. Somewhat sure

  4. Neither sure nor unsure

  5. Somewhat unsure

  6. Very unsure

  7. Not sure at all

  1. SKIPPED


c. . . .how to tell a boy/girl no if he/she does not want to be sexually active?


  1. Completely sure

  2. Very sure

  3. Somewhat sure

  4. Neither sure nor unsure

  5. Somewhat unsure

  6. Very unsure

  7. Not sure at all

    1. SKIPPED


d. . . .ways to have fun with a boy/girl without being sexually active?


1 Completely sure

2 Very sure

3 Somewhat sure

4 Neither sure nor unsure

5 Somewhat unsure

6 Very unsure

7 Not sure at all

99 SKIPPED


Q24. How likely do you think {CHILD NAME} would be to be sexually active if asked by someone he/she was dating as a young teen? Would you say. . . .


  1. Very likely

  2. Somewhat likely

  3. Not very likely

  4. Not at all likely

99 SKIPPED


Q25. What are your expectations about talking with {CHILD NAME}? If you talk early and often with {CHILD NAME} about sexual topics (such as waiting to be sexually active until he/she is older). . . .


  1. . . .{CHILD NAME} will be less likely to be sexually active as a young teen. Do you. . . .


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

99 SKIPPED


b. . . .{CHILD NAME} will not listen to what you say.


1 Strongly agree

2 Agree

3 Disagree

4 Strongly disagree

99 SKIPPED


c. . . . {CHILD NAME} will not think you are judgmental.


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

99 SKIPPED


d. . . .you will be a hypocrite.


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

99 SKIPPED


e. . . . {CHILD NAME} would understand the benefits of waiting to become sexually active.


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

99 SKIPPED


f. . . .{CHILD NAME} would rebel and want to engage in sexual activity even more. Do you. . . .


1. Strongly agree

2. Agree

  1. Disagree

  2. Strongly disagree

99 SKIPPED


How much do you agree or disagree with each of the following statements?


Q26. By effectively talking with {CHILD NAME] about delaying sexual activity, you will be able to positively impact {CHILD NAME}’s future success and happiness.


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

99 SKIPPED



Q27. If you can convince {CHILD NAME} to wait to have sex, he/she will have a better chance to succeed as an adult.


    1. Strongly agree

    2. Agree

    3. Disagree

    4. Strongly disagree

  1. SKIPPED


Q28. You have heard that you should talk early and often to {CHILD NAME} about waiting to have sex.


    1. Strongly agree

    2. Agree

    3. Disagree

    4. Strongly disagree

    1. SKIPPED


Q29. You really don't know enough about sexual activity or waiting to have sex to talk about them with {CHILD NAME}.


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

99 SKIPPED


Q30. It is not too late for you to start talking with {CHILD NAME} about sexual activity or waiting to have sex.


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

99 SKIPPED


Q31. You are sure this is the right developmental time to talk with {CHILD NAME} about sexual activity and waiting to have sex.


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

99 SKIPPED


Q32. Education about sexual activity and waiting to have sex is best handled by the schools or medical professionals, not parents.


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

99 SKIPPED


Q33. It is easy for you to find time to talk with {CHILD NAME} about sexual activity and waiting to have sex.


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

99 SKIPPED


Q34. It would be difficult for you to explain things if you talked with {CHILD NAME} about sexual activity or waiting to have sex.


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

99 SKIPPED


Q35. You disapprove of {CHILD NAME}’s being sexually active as a teenager. Do you…


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

99 SKIPPED


Q36. You feel trapped by your responsibilities as a parent. Do you. . .

1 Strongly agree

2 Somewhat agree

3 Somewhat disagree

4 Strongly disagree

99 SKIPPED


Q37. You find that taking care of your child(ren) is much more work than pleasure. Do you. . .


1 Strongly agree

2 Somewhat agree

3 Somewhat disagree

5 Strongly disagree

99 SKIPPED


C. CHILD CHARACTERISTICS


Now there are a few questions about {CHILD NAME}.


Q38. How advanced is {CHILD NAME}’s physical development compared with other boys/girls his/her age?


  1. He/she looks younger than most

  2. He/she looks younger than some

  3. He/she looks about average

  4. He/she looks older than some

  5. He/she looks older than most

99. SKIPPED


Q39. Your child shows physical signs of puberty, such as changing voice for boys or beginning of menstrual cycle for girls.

 1. Strongly agree

 2. Agree

 3. Disagree

 4. Strongly disagree

 99. Skipped


Q40 Has {CHILD NAME} completed or is he/she currently participating in a sex education course at school?


  1. Yes

  2. No

99 SKIPPED


Q41. Do you think that {CHILD NAME} has ever been sexually active? By sexually active, we mean not as a result of abuse or coercion.


  1. Yes

  2. No (SKIP TO Q42)

    1. SKIPPED


Q41a. How old do you think {CHILD NAME} was when (he/she) first became sexually active?


  1. Younger than 8 years old

  2. 8 years old

  3. 9 years old

  4. 10 years old

  5. 11 years old

  6. 12 years old

  7. 13 years old

  8. 14 years old (DO NOT ALLOW ANSWERS OLDER THAN CHILD’S CURRENT AGE)

99 SKIPPED


D. PARENTAL BEHAVIOR


Q42. How often have you initiated conversations with {CHILD NAME} about sexual activity or waiting to have sex?


  1. Often

  2. Sometimes

  3. Seldom

  4. Never

  1. SKIPPED


Q43. How much have you talked to {CHILD NAME} about being sexually active?

  1. A great deal

  2. A moderate amount

  3. Somewhat

  4. Not at all (SKIP TO Q44)

99 SKIPPED


Q43a. (ONLY ASK IF Q41=YES AND Q43<4): When did you talk with {CHILD NAME} about being sexually active? Was it. . .

1. Before you found out he/she was sexually active

2. After you found out he/she was sexually active

3. Both before and after you found out he/she was sexually active

99. SKIPPED


Q44. How much have you and {CHILD NAME} talked about (his/her) being sexually active and. . .

A A Somewhat Not at all SKIPPED great moderate

Deal amount

a. The biology of sex

and pregnancy 1 2 3 4 99


  1. Issues about dating

and relationships 1 2 3 4 99


  1. Whether to wait to

be sexually active

until you are married 1 2 3 4 99


  1. The negative or bad

things that would

happen if (he got

someone/she got)

pregnant? 1 2 3 4 99


e. The dangers of getting

a sexually transmitted

disease? 1 2 3 4 99


f. The negative or bad

impact on (his/her)

social life because

(he/she) would lose

the respect of others? 1 2 3 4 99


g. The moral issues of

not having sexual

intercourse? 1 2 3 4 99


Q45. Have you asked (recommended) that {CHILD NAME} wait to have sex?


  1. Yes

  2. No

99 SKIPPED


Q46. How often do you and {CHILD NAME} talk about media messages and images that promote or glamorize teen sexual activity?


  1. Every Day

  2. Weekly

  3. Monthly

  4. Every few months

  5. Never

  1. SKIPPED

E. RELIGIOSITY AND EXPOSURE TO OTHER PREVENTION


The next few questions ask about you!


Q47. These questions are about the role that religious beliefs may play in your life. For each statement, please indicate whether you strongly disagree, disagree, agree, or strongly agree.


a. Your religious beliefs are a very important part of your life.


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

    1. SKIPPED


b. Your religious beliefs influence how you make decisions in your life.


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

    1. SKIPPED




Q48. In the past 12 months, have you seen or heard about any programs or activities in your community aimed at helping children delay sexual activity?


  1. Yes

  2. No (SKIP TO Q50)

98. DON’T KNOW (SKIP TO Q50)

99. REFUSED (SKIP TO Q50)


Q49. Which of the following best describes the kinds of programs or activities in your community aimed at helping children delay sexual activity?


  1. Educational program during school time at{CHILD NAME}’s school

  2. After-school program at a community center

  3. Youth-organized group

  4. Program at a local church or other place of worship

  5. Other (specify): ______________

98. DON’T KNOW (CONTINUE WITH Q50)

99. REFUSED (SKIP TO Q50)


G. MODERATOR VARIABLES


There are just a few more questions. They are about your media use and background.


Q50. Please answer the following questions about the “www.4parents.gov” website:

a. Have you ever visited the website “www.4parents.gov”?

  1. Yes (CONTINUE WITH Q50b)

  2. No (SKIP TO Q51)

8. Don’t know (SKIP TO Q51)

99 SKIPPED


    1. Please indicate which of the following actions you took when you visited the “4parents.gov” website (Check all that apply)

YES NO SKIPPED

  1. Read the overview information on the home page of the site

  2. Visited the “The Basic Facts” section that provide information about puberty, reproductive health and pregnancy, and risky

  3. Visited the “Talking with Your Pre-Teen or Teen about Waiting” section that discuss how to have a good relationship with your child and why and how to talk with your teen about waiting to have sex

  4. Visited the “What Every Parent Needs to Know” section that provide information and conversation starters on what parents should know when communicating with their child about sex

  5. Visited the “WISE way to Raise Kids” page that discuss how to initiate conversations with your child

  6. Visited the “Power of Parents” page that discusses the influence of parents in the decisions of their children

  7. Looked at or downloaded the Parents Speak Up or Teen Chat booklets



Q51. During the past 7 days, on average, how many hours a day did you:


ENTER TIME TO NEAREST HALF-HOUR


1. Watch TV _______________?

2. Listen to the radio _______________?

3. Browse or surf the Internet _______________?

4. Read magazines _______________?


Q52. How far did you go in school?

  1. 8th grade or less

  2. More than 8th grade, but did not graduate from high school

  3. Went to a business, trade, or vocational school instead of high school

  4. High school graduate

  5. Completed a GED

  6. Went to a business, trade, or vocational school after high school

  7. Went to college, but did not graduate

  8. Graduated from a college or university

  9. Professional training beyond a 4-year college or university

  10. Never went to school

99 SKIPPED


Q53. What is your current marital status?


  1. Currently married

  2. Widowed

  3. Divorced

  4. Separated

  5. Never been married

8. Don’t know

99 SKIPPED


Q54. What is your relationship with {CHILD NAME}?


  1. Biological mother/father

  2. Stepmother/father

  3. Adoptive mother/father

  4. Foster mother/father

  5. Other: ___________

99 SKIPPED


Q55. Does {CHILD NAME}’s father/mother or a person like a father/mother to {CHILD NAME} live in the home?


  1. Yes

  2. No (SKIP TO Q57)

99 SKIPPED (SKIP TO Q57)


Q56. What is his/her relationship to {CHILD NAME}?


  1. Biological father/mother

  2. Stepfather/mother

  3. Adoptive father/mother

  4. Foster father/mother

  5. Other: ___________

99 SKIPPED


Q57. Are you currently employed full-time, part-time, or not employed?


  1. Full-time

  2. Part-time

  3. Not employed

8. DON’T KNOW

99 SKIPPED


Q58. The next question is about the total family income from all sources during 2006. We would like you to combine everyone’s income. Before taxes and other deductions, was the total combined family income during 2006 . . . .


  1. Less than $25,000

  2. $25,000-$49,999

  3. $50,000-$74,999

  4. $75,000-$99,999

  5. $100,000-$124,999

  6. $125,000-$149,999

  7. $150,000 or more

  8. DON’T KNOW

99 SKIPPED


Q59. Are you Hispanic or Latino

  1. Yes

  2. No (SKIP TO Q61)

99 SKIPPED


Q60. How would you describe your Hispanic origin or descent?

  1. Mexican

  2. Puerto Rican

  3. Cuban

  4. Central American

  5. South American

  6. Other [specify]

99. SKIPPED


Q61. How do you describe yourself? You can choose more than one of the following categories.

  1. American Indian or Alaska Native

  2. Asian

  3. Black or African American

  4. Native Hawaiian or Other Pacific Islander

  5. White

  6. Other (specify):___________________________

  1. SKIPPED


Q62. (ASK ONLY IF MORE THAN ONE ANSWER SELECTED FOR Q61): Which one of these groups best describes you? Choose only one of the following.

(PRESENT ONLY OPTIONS MENTIONED IN Q61)

  1. American Indian or Alaska Native

  2. Asian

  3. Black or African American

  4. Native Hawaiian or Other Pacific Islander

  5. White

  6. Other, specify

99. SKIPPED


Q63. [IF Q59=1 (HISPANIC):] How much do you watch Spanish and English television? Would you say…

  1. Only Spanish

  2. Spanish more than English

  3. Spanish and English equally

  4. English more than Spanish

  5. English only

99 SKIPPED

Q64. In what country were you born?

  1. U.S.

  2. Other, specify___________________________

99 SKIPPED

Parents Speak Up National Campaign

Parent Follow-Up Survey


Web screen:


[NOTE: Consent form will precede the questions below, and contains introductory text about purpose of the survey, as well as providing information for informed consent. Consent form is included in the OMB supporting statement appendices.]


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 0990-0311. The time required to complete this information collection is estimated to average 24 minutes per response, including the time to review instructions and complete the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to:

U.S. Department of Health & Human Services; OS/OCIO/PRA;

OMB NO.: 0990-0311 200 Independence Ave., S.W., Suite 531-H; Washington D.C. 20201;

EXPIRATION DATE: Attention: PRA Reports Clearance Officer



Q1. Let’s begin the interview now. Once again, your answers will be kept private, and your name will be replaced with an ID number to protect your privacy.


We are interested in your opinion about parent-child communication and teen sexual activity. If you're not sure, choose an answer that comes closest to what you think might be true for each activity.


Before we start, are you the only one who can see the questions and your answers?


  1. Yes

  2. No (GO TO EXIT SCREEN TO ALLOW PARENT TO CONTINUE ANOTHER TIME)

99 SKIPPED


Q2. Is {CHILD NAME} a boy or girl? [Already asked in screening, Knowledge Networks will confirm whether this info can be delivered from screening or needs to be asked again. Same with age of child]


1. Boy

2. Girl

99 SKIPPED


A. PARENT-CHILD RELATIONSHIP


The first questions are about your relationship with {CHILD NAME}.


Q3. In the past 30 days, how many times have you done the following things with {CHILD NAME}?


At least At least

Once once Less

a week a month Often Never SKIPPED

  1. Gone shopping

  2. Gone to a movie,

sport event,

concert, play,

or museum

  1. Watched an

entire television

show together


Q4. For the following list of activities, indicate whether this is something you and {CHILD NAME} do together at least once a week, at least once a month, less often, or never. How often do you. . .

At least At least

Once once Less

a week a month Often Never SKIPPED

a. Go to religious services or

other religious

activities together 1 2 3 4 99


b. Do homework or school

projects when school

is in session 1 2 3 4 99


c. Attend a party or a family

gathering together 1 2 3 4 99


d. Do volunteer work together

to help other people or

improve your

neighborhood 1 2 3 4 99


e. Play a game or sport

together 1 2 3 4 99


Q5. How often do you feel you miss events or activities that are important to {CHILD NAME}? Is it a lot, sometimes, or almost never?


  1. A lot

  2. Sometimes

  3. Almost never

99. SKIPPED


Q6. About how many close friends does {CHILD NAME} have? By close friends, I mean friends that he/she spends a lot of his/her free time with.


  1. None (SKIP TO Q7)

  2. One

  3. Two to four

  4. Five to eight

  5. Nine to fifteen

  6. Sixteen to twenty-five

  7. Twenty-six or more

99. SKIPPED


Q6a. Do you know (this friend/all of these friends) by sight and by first and last name?


  1. Yes (SKIP TO Q7)

  2. No

99. SKIPPED


Q6b. About how many of these close friends do you know by sight and by first and last name? Is it. . .


  1. All of them

  2. Most of them

  3. Some of them

  4. None of them

99. SKIPPED


Q7. About how often do you know who {CHILD NAME} is with when (he/she) is not at home or in school? Would you say you know who {CHILD NAME} is with. . . .


  1. All the time

  2. Most of the time

  3. Some of the time

  4. Only rarely

99. SKIPPED


Q8. About how often do you know what {CHILD NAME} is doing when (he/she) is not at home or in school? Would you say you know what he/she is doing. . . .


  1. All the time

  2. Most of the time

  3. Some of the time

  4. Only rarely

99. SKIPPED


Q9. How often do you monitor what {CHILD NAME} watches on TV?


  1. Often

  2. Sometimes

  3. Rarely

  4. Never

  5. SKIPPED


Q10. How often do you put restrictions on the music, CDs, or videogames {CHILD NAME} can play?


  1. Often

  2. Sometimes

  3. Rarely

  4. Never

  1. SKIPPED


Q11. Which of the following does {CHILD NAME} have in his/her bedroom?


Yes No SKIPPED

  1. Television

  2. Cable TV connection

  3. Computer

  4. Internet connection

  5. CD player/stereo

  6. iPod

  7. Video games

  8. Other media (specify)_____


Q11. How often would it be true for you to make each of the following statements about {CHILD NAME}?


Always Often Sometimes Seldom Never SKIPPED

  1. You get along well

with him/her 1 2 3 4 5 99

  1. {CHILD NAME} and you

make decisions

about his/her life

together 1 2 3 4 5 99

  1. You just do not

understand him/her 1 2 3 4 5 99

  1. You feel you can

really trust him/her

  1. He/she interferes

with your activities 1 2 3 4 5 99


Q12. How do you think you and {CHILD NAME} communicate with each other?


    1. When {CHILD NAME} asks questions, he/she gets honest answers from you.


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

99 SKIPPED


    1. You help {CHILD NAME} to understand himself/herself better.


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

99 SKIPPED


Q13. During the past 12 months, how many times have you argued or had a fight with {CHILD NAME}?


  1. 0 times

  2. 1 or 2 times

  3. 3 to 5 times

  4. 6 to 9 times

  5. 10 or more times

  1. SKIPPED

B. PARENT ATTITUDES, BELIEFS AND PERCEPTIONS OF TEEN NORMS & OUTCOME EFFICACY


The next questions ask about your opinions about sexual activity and teens. For each of the following, please indicate how much you agree or disagree with the statement:


Q14a. Sexual activity is likely to have harmful psychological effects for teens.


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly Disagree

99 SKIPPED


Q14b. Sexual activity is likely to have harmful physical effects for teens.


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly Disagree

    1. SKIPPED


Q15. When it comes to teens’ decisions about sexual activity, which of the following influences them the most?


  1. Parents

  2. Morals, values, and/or religious beliefs

  3. Friends

  4. The media

  5. Teachers and sex educators

  6. Worries about pregnancy

  7. Worries about STDs

99. SKIPPED


Q16. Waiting to have sex is the most effective way to prevent health risks like unwanted pregnancy or HIV/STDs. Do you. . .


1. Strongly agree

2. Agree

  1. Disagree

  2. Strongly disagree

    1. SKIPPED


Q17. It would be much easier for teens to postpone sexual activity and avoid teen pregnancy if they were able to have more open, honest conversations about these topics with their parents.


1. Strongly agree

  1. Agree

  2. Disagree

  3. Strongly disagree

99 SKIPPED


Q18. Earlier you answered a question about waiting to have sex as the most effective way to prevent health risks like unwanted pregnancy or HIV/STDs. How were you defining sex? Do you include:

Yes No SKIPPED

1. Vaginal sex (sexual intercourse) 1 2 99

2. Oral sex 1 2 99

3. Anal sex 1 2 99

4. Intimate touching (skin-to-skin contact) 1 2 99


Q19. To what age do you think boys should wait before being sexually active—until they are 12, 14, 16, 18, 21, or until they are married?


  1. Until they are 12

  2. Until they are 14

  3. Until they are 16

  4. Until they are 18

  5. Until they are 21

  6. Until they are married

99. SKIPPED


Q20. Do you think most boys will actually wait that long or will most be sexually active earlier?


  1. Will wait

  2. Will have intercourse earlier

99. SKIPPED


Q21. To what age do you think girls should wait before being sexually active—until they are 12, 14, 16, 18, 21, or until they are married?


  1. Until they are 12

  2. Until they are 14

  3. Until they are 16

  4. Until they are 18

  5. Until they are 21

  6. Until they are married

99 SKIPPED


Q22. Do you think most girls will actually wait that long or will most be sexually active earlier?


  1. Will wait

  2. Will have intercourse earlier

99 SKIPPED.


The next questions are about certain topics you may discuss with {CHILD NAME}. Please indicate how sure or unsure you are about this statement.


Q23. How sure are you that you can always explain to {CHILD NAME}. . .


a. . . .why he/she should wait until he/she is older to be sexually active?


  1. Completely sure

  2. Very sure

  3. Somewhat sure

  4. Neither sure nor unsure

  5. Somewhat unsure

  6. Very unsure

  7. Not sure at all

  1. SKIPPED


b. . . .how to make a boy/girl (OPPOSITE SEX OF CHILD) wait until he/she (CHILD’S SEX) is ready to be sexually active?


  1. Completely sure

  2. Very sure

  3. Somewhat sure

  4. Neither sure nor unsure

  5. Somewhat unsure

  6. Very unsure

  7. Not sure at all

  1. SKIPPED


c. . . .how to tell a boy/girl no if he/she does not want to be sexually active?


  1. Completely sure

  2. Very sure

  3. Somewhat sure

  4. Neither sure nor unsure

  5. Somewhat unsure

  6. Very unsure

  7. Not sure at all

    1. SKIPPED


d. . . .ways to have fun with a boy/girl without being sexually active?


1 Completely sure

2 Very sure

3 Somewhat sure

4 Neither sure nor unsure

5 Somewhat unsure

6 Very unsure

7 Not sure at all

99 SKIPPED


Q24. How likely do you think {CHILD NAME} would be to be sexually active if asked by someone he/she was dating as a young teen? Would you say. . . .


  1. Very likely

  2. Somewhat likely

  3. Not very likely

  4. Not at all likely

99 SKIPPED


Q25. What are your expectations about talking with {CHILD NAME}? If you talk early and often with {CHILD NAME} about sexual topics (such as waiting to be sexually active until he/she is older). . . .


  1. . . .{CHIlD NAME} will be less likely to be sexually active as a young teen. Do you. . . .


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

99 SKIPPED


b. . . .{CHILD NAME} will not listen to what you say.


1 Strongly agree

2 Agree

3 Disagree

4 Strongly disagree

99 SKIPPED


c. . . . {CHILD NAME} will not think you are judgmental.


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

99 SKIPPED


d. . . .you will be a hypocrite.


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

99 SKIPPED


e. . . . {CHILD NAME} would understand the benefits of waiting to become sexually active.


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

99 SKIPPED


f. . . .{CHILD NAME} would rebel and want to engage in sexual activity even more. Do you. . . .


1. Strongly agree

2. Agree

  1. Disagree

  2. Strongly disagree

99 SKIPPED


How much do you agree or disagree with each of the following statements?


Q26. By effectively talking with {CHILD NAME] about delaying sexual activity, you will be able to positively impact {CHILD NAME}’s future success and happiness.


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

99 SKIPPED



Q27. If you can convince {CHILD NAME} to wait to have sex, he/she will have a better chance to succeed as an adult.


    1. Strongly agree

    2. Agree

    3. Disagree

    4. Strongly disagree

  1. SKIPPED


Q28. You have heard that you should talk early and often to {CHILD NAME} about waiting to have sex.


    1. Strongly agree

    2. Agree

    3. Disagree

    4. Strongly disagree

    1. SKIPPED


Q29. You really don't know enough about sexual activity or waiting to have sex to talk about them with {CHILD NAME}.


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

99 SKIPPED


Q30. It is not too late for you to start talking with {CHILD NAME} about sexual activity or waiting to have sex.


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

99 SKIPPED


Q31. You are sure this is the right developmental time to talk with {CHILD NAME} about sexual activity and waiting to have sex.


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

99 SKIPPED


Q32. Education about sexual activity and waiting to have sex is best handled by the schools or medical professionals, not parents.


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

99 SKIPPED


Q33. It is easy for you to find time to talk with {CHILD NAME} about sexual activity and waiting to have sex.


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

99 SKIPPED


Q34. It would be difficult for you to explain things if you talked with {CHILD NAME} about sexual activity or waiting to have sex.


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

99 SKIPPED


Q35. You disapprove of {CHILD NAME}’s being sexually active as a teenager. Do you…


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

99 SKIPPED


Q36. You feel trapped by your responsibilities as a parent. Do you. . .

1 Strongly agree

2 Somewhat agree

3 Somewhat disagree

4 Strongly disagree

99 SKIPPED


Q37. You find that taking care of your child(ren) is much more work than pleasure. Do you. . .

1 Strongly agree

2 Somewhat agree

3 Somewhat disagree

5 Strongly disagree

99 SKIPPED


C. CHILD CHARACTERISTICS


Now there are a few questions about {CHILD NAME}.


Q38. How advanced is {CHILD NAME}’s physical development compared with other boys/girls his/her age?


  1. He/she looks younger than most

  2. He/she looks younger than some

  3. He/she looks about average

  4. He/she looks older than some

  5. He/she looks older than most

99. SKIPPED


Q39. Your child shows physical signs of puberty, such as changing voice or hair growth for boys, or beginning of menstrual cycle or breast growth for girls.


 1. Strongly agree

 2. Agree

 3. Disagree

 4. Strongly disagree

 99. Skipped


Q40. Has {CHILD NAME} completed or is he/she currently participating in a sex education course at school?


  1. Yes

  2. No

99 SKIPPED


Q41. Do you think that {CHILD NAME} has ever been sexually active? By sexually active, we mean not as a result of abuse or coercion.


  1. Yes

  2. No (SKIP TO Q42)

99 SKIPPED

Q41a. How old do you think {CHILD NAME} was when (he/she) first became sexually active?


1. Younger than 8 years old

2. 8 years old

3. 9 years old

4. 10 years old

5. 11 years old

  1. 12 years old

  2. 13 years old

  3. 14 years old

  4. 15 years old

  5. 16 years old (DO NOT ALLOW ANSWERS OLDER THAN CHILD’S CURRENT AGE)

99 SKIPPED


D. PARENTAL BEHAVIOR


Q42. How often have you initiated conversations with {CHILD NAME} about sexual activity or waiting to have sex?


  1. Often

  2. Sometimes

  3. Seldom

  4. Never

  1. SKIPPED


Q43. How much have you talked to {CHILD NAME} about being sexually active?

  1. A great deal

  2. A moderate amount

  3. Somewhat

  4. Not at all (SKIP TO Q44)

99 SKIPPED


Q43a. (ONLY ASK IF Q41=YES AND Q43<4): When did you talk with {CHILD NAME} about being sexually active? Was it. . .

1. Before you found out he/she was sexually active

2. After you found out he/she was sexually active

3. Both before and after you found out he/she was sexually active

99. SKIPPED


Q44. How much have you and {CHILD NAME} talked about (his/her) being sexually active and. . .

A A Somewhat Not at all SKIPPED great moderate

Deal amount

a. The biology of sex

and pregnancy 1 2 3 4 99


  1. Issues about dating

and relationships 1 2 3 4 99


  1. Whether to wait to

be sexually active

until you are married 1 2 3 4 99


  1. The negative or bad

things that would

happen if (he got

someone/she got)

pregnant? 1 2 3 4 99


e. The dangers of getting

a sexually transmitted

disease? 1 2 3 4 99


f. The negative or bad

impact on (his/her)

social life because

(he/she) would lose

the respect of others? 1 2 3 4 99


g. The moral issues of

not having sexual

intercourse? 1 2 3 4 99


Q45. Have you asked (recommended) that {CHILD NAME} wait to have sex?


  1. Yes

  2. No

99 SKIPPED


Q46. How often do you and {CHILD NAME} talk about media messages and images that promote or glamorize teen sexual activity?


  1. Every Day

  2. Weekly

  3. Monthly

  4. Every few months

  5. Never

  1. SKIPPED

E. RELIGIOSITY AND EXPOSURE TO OTHER PREVENTION


The next few questions ask about you!


Q47. These questions are about the role that religious beliefs may play in your life. For each statement, please indicate whether you strongly disagree, disagree, agree, or strongly agree.


a. Your religious beliefs are a very important part of your life.


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

    1. SKIPPED


b. Your religious beliefs influence how you make decisions in your life.


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

    1. SKIPPED


Q48. In the past 12 months, have you seen or heard about any programs or activities in your community aimed at helping children delay sexual activity?

  1. Yes

  2. No (SKIP TO Q50)

98. DON’T KNOW (SKIP TO Q50)

99. REFUSED (SKIP TO Q50)


Q49. Which of the following best describes the kinds of programs or activities in your community aimed at helping children delay sexual activity?


  1. Educational program during school time at{CHILD NAME}’s school

  2. After-school program at a community center

  3. Youth-organized group

  4. Program at a local church or other place of worship

  5. Other (specify): ______________

98. DON’T KNOW (CONTINUE WITH Q50)

99. REFUSED (SKIP TO Q50)

[TREATMENT CONDITION RESPONDENTS ON POST-BASELINE SURVEYS WILL COMPLETE SECTION F. FOR THOSE SURVEYS ONLY, SECTION F BELOW WILL BE INCLUDED. ALL OTHER RESPONDENTS/CONDITIONS WILL PROCEED DIRECTLY TO SECTION G.]


F. TREATMENT CONDITION (HIGH AND LOW) MODULE: PSUNC CAMPAIGN EXPOSURE, PARENT AWARENESS, AND PARENT REACTIONS


Q50. Overall Campaign Theme Awareness

a. What is the primary theme/slogan of the ads you just viewed or heard?

  1. Children should wait before engaging in sexual activity

  2. Children should wait until marriage before engaging in sexual activity

  3. Abstinence

  4. Abstinence until marriage

  5. Talk to your children about waiting to engage in sexual activity

  6. Talk early and often to your children about waiting to engage in sexual activity

  7. Other (specify): _________________

98. DON’T KNOW (CONTINUE WITH Q51)

99. REFUSED (CONTINUE WITH Q51)



The following questions are about the ad you viewed earlier, entitled “_________.” [FILL IN NAME OF AD.] This was the ad that showed parents talking to their kids about waiting, and then showed the kids when they were grown up.


Q51. Parent message reactions/receptivity (cognitive and affective – likeability, believability)

a. Indicate how much you agree or disagree with the following statement: This ad is convincing.

Would you say you:

  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

  5. Have no opinion

  6. 99 SKIPPED


b. Would you say the ad grabbed your attention?

  1. Yes

  2. No

8. Don’t know

99 SKIPPED


c. Would you say the ad gave you good reasons to talk to your kids about sexual activity?

  1. Yes

  2. No

8. Don’t know

99 SKIPPED


d. Did you talk to your friends or other adult family members (not your child[ren]) about this ad?

  1. Yes

  2. No

8. Don’t Know

99 SKIPPED


e. Did you talk to your child(ren) about the ad?


  1. Yes

  2. No

8. Don’t Know

99 SKIPPED


Q52. Would you say this ad said something important to you?


  1. Yes

  2. No

8. Don’t Know

  1. SKIPPED


[REPEAT PRECEDING INSTRUCTION AND Q51-52 FOR EACH AD SHOWN IN THE TREATMENT CONDITIONS, FOLLOWED BY THE FOLLOWING 4 QUESTIONS.]


The following questions ask about the messages, logos, and other material in these ads overall


Q53. When you think of these ads you think…

Strongly agree; agree; disagree; strongly disagree; no opinion; SKIPPED

a.) I can successfully talk to{CHILD NAME} about waiting before becoming sexually active

b.) {CHILD NAME} wants me to talk to him/her about waiting before becoming sexual active

c.) Talking to {CHILD NAME} about sexual activity will help him/her be successful in life

d.) Talking to {CHILD NAME} about sexual activity can reduce negative effects of the media and other influences in society


Q54. Please indicate your agreement with each of the following statements:


a. The parents in the PSUNC ads are just like me. Would you say you:


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

  5. No opinion

99 SKIPPED

b. The kids in these ads are just like my kids. Would you say you:

  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

  5. No opinion

99 SKIPPED

c. If I had a chance, I would tell other parents with teen or pre-teen children to watch these ads.

  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

  5. No opinion

  1. SKIPPED

d. These ads would be helpful to other parents like myself.

  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

  5. No opinion

  1. SKIPPED


G. MODERATOR VARIABLES


There are just a few more questions. They are about your media use and background.


Q55. Please answer the following questions about the “www.4parents.gov” website:

a. Have you ever visited the website “www.4parents.gov”?

  1. Yes (CONTINUE WITH Q55b)

  2. No (SKIP TO Q56)

8. Don’t know (SKIP TO Q56)

99 SKIPPED


    1. Please indicate which of the following actions you took when you visited the “www.4parents.gov” website (Check all that apply)

YES NO SKIPPED

        1. Read the overview information on the home page of the site

        2. Visited the “The Basic Facts” section that provide information about puberty, reproductive health and pregnancy, and risky

        3. Visited the “Talking with Your Pre-Teen or Teen about Waiting” section that discuss how to have a good relationship with your child and why and how to talk with your teen about waiting to have sex

        4. Visited the “What Every Parent Needs to Know” section that provide information and conversation starters on what parents should know when communicating with their child about sex

        5. Visited the “WISE way to Raise Kids” page that discuss how to initiate conversations with your child

        6. Visited the “Power of Parents” page that discusses the influence of parents in the decisions of their children

        7. Looked at or downloaded the Parents Speak Up or Teen Chat booklets


Q56. During the past 7 days, on average, how many hours a day did you:


ENTER TIME TO NEAREST HALF-HOUR


1. Watch TV _______________?

2. Listen to the radio _______________?

3. Browse or surf the Internet _______________?

4. Read magazines _______________?


Q57. What is your current marital status?


  1. Currently married

  2. Widowed

  3. Divorced

  4. Separated

  5. Never been married

8. Don’t know

99 SKIPPED


Q58. Does {CHILD NAME}’s father/mother or a person like a father/mother to {CHILD NAME} live in the home?


  1. Yes

  2. No (SKIP TO Q60)

99 SKIPPED (SKIP TO Q60)


Q59. What is his/her relationship to {CHILD NAME}?


  1. Biological father/mother

  2. Stepfather/mother

  3. Adoptive father/mother

  4. Foster father/mother

  5. Other: ___________

99 SKIPPED


Q60. Are you currently employed full-time, part-time, or not employed?


  1. Full-time

  2. Part-time

  3. Not employed

8. DON’T KNOW

99 SKIPPED






File Typeapplication/msword
File TitleJanuary 2004
AuthorOlivia Silber Ashley
Last Modified ByDHHS
File Modified2008-03-13
File Created2008-03-13
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