Youth Survey

Evaluation of the Parents Speak Up National Campaign: Youth Survey

0990-0325-Youth Survey

Youth Survey

OMB: 0990-0325

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Self-Administered Web Survey

Parents Speak Up National Campaign

Children’s Survey


Web screen:


[NOTE: Assent form will precede the questions below, and contains introductory text about purpose of the survey, as well as providing information for informed assent.]


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Q1. Let’s begin the survey now. Once again, your answers will be kept private, and your name will be replaced with an ID number to protect your privacy. If anyone comes into the room while you are taking the survey, press the save button and then the log off button on the screen. This will save your answers and allow you to log on again when you are alone.



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 {CHILD} TO CONTINUE ANOTHER TIME)

99. SKIPPED


We will be asking you questions about you and one of your parents, and how you communicate. In the rest of this survey, we will be referring only to your {PARENT}, PARENT NAME, when we ask you these questions.

  1. MEDIA EXPOSURE


The first questions are about TV and other media you may use.


Q2. Which of the following do you have in your 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)_____


Q3. 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 _______________?


Q4. Have you ever visited the website www.4parents.gov?

  1. Yes (CONTINUE WITH Q5)

  2. No (SKIP TO Q6)

8. Don’t know (SKIP TO Q6)

99. SKIPPED


Q5. Please indicate which of the following actions you took when you visited the www.4parents.gov website (Check all that apply)

[NOTE: WEBSITE IS CURRENTLY BEING REVISED BY OFFICE OF POPULATION AFFAIRS. CATEGORIES BELOW WILL BE REVISED TO MATCH TEEN-ORIENTED PAGES ON THE SITE WHEN IT IS COMPLETED.]


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


B. RELIGIOSITY


These questions are about the role that religious beliefs may play in your life. For questions 6 and 7, please indicate whether you strongly disagree, disagree, agree, or strongly agree.


Q6. Your religious beliefs are a very important part of your life.


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

    1. SKIPPED


Q7. Your religious beliefs influence how you make decisions in your life.


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

    1. SKIPPED

Q8. In the past 12 months, how often have you attended a worship service like a church or synagogue service, or a service at a mosque?


1.  Never


2.  Once or twice


3.  Less than once a month


4.  About once a month


5.  About twice a month


6.  About once a week


7.  Several times a week


8.  Everyday






C. RELATIONSHIP WITH YOUR PARENT


The next questions are about your relationship with {PARENT}.


Q9. In the past 30 days, how many times have you done the following things with {PARENT}? If you're not sure, choose an answer that comes closest to what you think might be true for each activity.


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


Q10. For the following list of activities, indicate whether this is something you and {PARENT} 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


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


Always Often Sometimes Seldom Never SKIPPED

  1. You get along well

with him/her 1 2 3 4 5 99

  1. {PARENT} and you

make decisions

about your 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 {PARENT} communicate with each other?


    1. When you ask {PARENT} questions, you get honest answers from {him/her}.


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

99 SKIPPED


    1. {PARENT} helps you to understand yourself 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 {PARENT}?


  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



  1. FRIENDS AND OTHERS YOUR AGE


Q14. Do you think young people your age that are sexually active have more friends?


  1. Definitely not

  2. Probably not

  3. Probably yes

  4. Definitely yes

  1. SKIPPED


Q15. How many of your four closest friends are sexually active?


  1. None (SKIP TO Q17)

  2. 1

  3. 2

  4. 3

  5. 4

  1. SKIPPED


Q16. How many of your four closest friends are sexually involved with more than one person?


1. None of them

2. 1

3. 2

4. 3

5. 4

99. SKIPPED



E. EXPOSURE TO OTHER PREVENTION EFFORTS


Q17. In the past 12 months, have you seen or heard about any programs or activities in your school aimed at helping children delay sexual activity?


  1. Yes

  2. No

98. DON’T KNOW

99. REFUSED


Q18. 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? (NOTE: Community means the neighborhood and nearby areas in which you live)


  1. Yes

  2. No

98. DON’T KNOW

99. REFUSED



F. ATTITUDES, BELIEFS AND PERCEPTIONS


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:


Q19. Sexual activity is likely to have harmful psychological effects for teens.


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly Disagree

99. SKIPPED


Q20. Sexual activity is likely to have harmful physical effects for teens.


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly Disagree

    1. SKIPPED


Q21. When it comes to your decisions about sex, who is most influential?


  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 sexually transmitted diseases (STDs)

99. SKIPPED


Q22. Waiting to have sex is the most effective way to prevent health risks like unwanted pregnancy or HIV/sexually transmitted diseases (STDs). Do you. . .


1. Strongly agree

2. Agree

  1. Disagree

  2. Strongly disagree

    1. SKIPPED


Q23. 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


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


Q24. What are your expectations about talking with {PARENT}? If you talk early and often with {PARENT} about sexual topics (such as waiting to be sexually active until you are older). . . .


  1. . . .you 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. . . . you will not listen to what {PARENT} says.


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

99 SKIPPED


c. . . . you will not think {PARENT} is judgmental.


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

99 SKIPPED


d. . . . {PARENT} will be a hypocrite.


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

99 SKIPPED


e. . . . you would understand the benefits of waiting to become sexually active.


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

99 SKIPPED


f. . . . you would rebel and want to engage in sexual activity even more. Do you. . .


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

99 SKIPPED


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


Q25. It is easy for you to find time to talk with {PARENT} about sexual activity and waiting to have sex.


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

99 SKIPPED


Q26. It would be difficult for you to explain your feelings if you talked with {PARENT} about sexual activity or waiting to have sex.


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

99. SKIPPED


Q27. How often has {PARENT} initiated conversations with you about sexual activity or waiting to have sex?


  1. Often

  2. Sometimes

  3. Seldom

  4. Never

  1. SKIPPED


Q28. {PARENT} disapproves of you being sexually active as a teenager. Do you…


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

99 SKIPPED


Q29. How often do you and {PARENT} 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



G. YOUR SELF IMAGE AND BEHAVIOR


Now there are a few questions about you. How much do you agree or disagree with the following statements?


Q30. I like to take risks.


Would you say you…


  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

  5. No opinion

9. Refused


Q31. I would like to explore strange places.


Would you say you…

  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

  5. No opinion

9. Refused


Q32. I like to do frightening things.


Would you say you…

  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

  5. No opinion

9. Refused


Q33. I like new and exciting experiences, even if I have to break the rules.


Would you say you…

  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

  5. No opinion

9. Refused


Q34. I prefer friends who are exciting and unpredictable.


Would you say you…

  1. Strongly agree

  2. Agree

  3. Disagree

  4. Strongly disagree

  5. No opinion

9. Refused


Q35. How advanced is your physical development compared with other boys/girls your age?


  1. I look younger than most

  2. I look younger than some

  3. I look about average

  4. I look older than some

  5. I look older than most

99. SKIPPED


Q36. How much do you agree or disagree with this statement?


You show physical signs of puberty, such as changing voice [for boys]/beginning of menstrual cycle [for girls].


1. Strongly agree

2. Agree

3. Disagree

4. Strongly disagree

99. Skipped



H. PARENTAL AND FAMILY INFLUENCES


Q37. How much has {PARENT} talked to you about being sexually active?

  1. A great deal

  2. A moderate amount

  3. Somewhat

  4. Not at all (SKIP TO Q39)

99 SKIPPED


Q38. How much have you and {PARENT} talked about your being sexually active and. . .

A great A moderate Somewhat Not at all SKIPPED

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


Q39. Has {PARENT} asked (recommended) that you wait to have sex?


  1. Yes

  2. No

99 SKIPPED



I. SOCIAL NETWORKING


Q40. Do you have a profile on any of the following Web sites?


        1. MySpace – broadest across all ages

        2. Facebook – college

        3. Friendster – adult

        4. Xanga – younger teens (supposed to be 13 or older to open an account)

        5. Bebo – not sure

        6. Other, please specify: _____________

        7. No (SKIP to Q45)

99. SKIPPED


Q41. Have you made your profile private using options on the Web site(s) so that only other people you approve as "friends" can see your profile and leave comments?


              1. Yes

              2. No

              3. Don’t Know

99. SKIPPED


Q42. How often have you visited this (these) Web site(s) in the past 30 days?


  1. Every day

  2. A few times per week

  3. Once per week

  4. Less than once per week

  5. Haven’t visited in past 30 days (SKIP to Q45)

99. SKIPPED


Q43. When you visited this (these) site(s) in the past 30 days, how often did you talk about sex with your friends?


  1. Always

  2. Often

  3. Sometimes

  4. Rarely

  5. Never (SKIP TO Q45)

99. SKIPPED


Q44. When you talked about sex on this (these) site(s), what topics did you talk about? Please respond in a just few words here: _____________________________



J. MODERATOR VARIABLES


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


Q45. Are you Hispanic or Latino?

  1. Yes

  2. No (SKIP TO Q47)

99 SKIPPED


Q46. 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


Q47. 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


Q48. (ASK ONLY IF MORE THAN ONE ANSWER SELECTED FOR Q47): Which one of these groups best describes you? Choose only one of the following.

(PRESENT ONLY OPTIONS MENTIONED IN Q47)

  1. American Indian or Alaska Native

  2. Asian

  3. Black or African American

  4. Native Hawaiian or Other Pacific Islander

  5. White

  1. Other, specify

99. SKIPPED


Q49. [IF Q45=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








Thank you for completing this survey!


File Typeapplication/msword
File TitleSelf-Administered Web Survey
AuthorDHHS
Last Modified ByDHHS
File Modified2009-07-08
File Created2009-07-08
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