“Preventing HIV Risk Behaviors among Hispanic Adolescents”
Attachment 3b: Parent Assessment Battery
(English Language)
Form Approved
OMB No. 0920-XXXX
Expiration Date XX/XX/20XX
“Preventing HIV Risk Behaviors among Hispanic Adolescents”
Parent Assessment Battery
Public reporting burden of this collection of information is estimated to average 45 minutes per response,, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a persons is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; Attn: OMB-PRA (0920-XXXX)
a. Parent Assessment Battery
i. Demographics
ii. Bicultural Investment Questionnaire – Revised
iii. Hispanic Stress Inventory - Revised
iv. Family Relations Scale
v. Parenting Practices Scale
vi. Behavioral Problem Checklist
vii. Parent-Adolescent Communication
viii. Social Provisions Scale
ix. Parent-Adolescent Communication about Sex
x. Parent Relationship with Peer Group
xi. Parent Substance Use Measure
a. Parent Assessment Battery.
Master Parent English - (English)
Master Parent English
PRE1. Enter the Respondent's I.D. Number __ __ __ __ ID
PRE2. Enter the timepoint (PLEASE ENTER TIMEPOINTS BETWEEN 1 AND 5 ONLY PLEASE) __ Time Point
PRE3. What is the Site ID? __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
PRE4. Please enter your interviewer ID. __ __ Interviewer
PRE5. Enter the Respondent's Age __ __
98 Refuse to Answer
PRE6. Enter the Respondent's Gender __ __
DEMOGRAPHICS
HEP1. Are you the primary caregiver (the one who is mostly in charge of taking care of) the child in this program?
1 Yes
0 No Skip to HEP2
8 Refuse to Answer
HEP1a. What is your relation to the adolescent in this program? (Choose one) 1 Mother
2 Father
3 Stepmother
4 Stepfather
5 Grandmother
6 Grandfather
7 Other
8 Refuse to Answer
HEP1c. If other, please specify _________
HEP3. In what country were you born? (Choose one) 00 United States
01 Cuba
02 Nicaragua
03 Honduras
04 Puerto Rico
05 Colombia
06 Mexico
07 Venezuela
08 Dominican Republic
09 Costa Rica
10 El Salvador
11 Panama
12 Peru
13 Guatemala
14 Argentina
15 Ecuador
16 Bolivia
17 Uruguay
18 Paraguay
19 Chile
20 Other Country
98 Refuse to Answer
HEP4. How long have you lived in the United States? (Choose one) 0 Less than 3 Years
1 3 to 10 Years
2 More than 10 Years
8 Refuse to Answer
HEP6. What is your current marital status? (Choose one) 1 married
2 living with someone
3 separated
4 divorced
5 widowed
6 never married and not living with someone
8 Refuse to Answer
HEP7. What is the highest grade in school you have completed? (Choose one)
00 none
01 1 (elementary)
02 2 (elementary)
03 3 (elementary)
04 4 (elementary)
05 5 (elementary)
06 6 (elementary)
07 7 (elementary)
08 8 (elementary)
09 9 (high school)
10 10 (high school)
11 11 (high school)
12 12 (high school)
13 13 (college)
14 14 (college)
15 15 (college)
16 16
(college)
17 17 + (graduate or professional)
08 Refuse to Answer
HEP10. Please tell me which of these statements best describes your present work situation. (Choose one)
1 working full time, that is, 35 hours or more per week
2 working part-time, less than 35 hours per week
3 working occasionally, in temporary jobs
4 unemployed or laid off and looking for work
5 unemployed and not looking for work
6 in school
7 retired
8 homemaker
9 other
98 Refuse to Answer
HEP11. What is your current occupation? What type of work do you do? (Choose one)
01 Higher executive, major professional, owner of large business
02 Business manager of medium sized business, lesser professionals, i.e. nurses, teachers
03 Administrative personnel, manager, minor professionals, owner/proprietor of small business
04 Clerical and sales, technicians, small businesses (bank teller, secretary)
05 Skilled manual-usually having had training (barber, electrician, mechanic, plumber)
06 Semi-skilled (painter, bus driver, cook, waiter, machine operator)
07 Unskilled (attendant, janitor, unspecified labor, include unemployed)
08 Homemaker
09 Student, disabled, no occupation
98 Refuse to Answer
HEP20. For the last year, what was the total household income from all sources? Please tell me the letter that best describes your total household income before taxes. (Choose one) 01 under $5,000
02 $5,000 to 9,999
03 $10,000 to 14,999
04 $15,000 to 19,999
05 $20,000 to 24,999
06 $25,000 to 29,999
07 $30,000 to 34,999
08 $35,000 to 39,999
09 $40,000 to 44,999
10 $45,000 to 49,999
11 $50,000 or more
08 Refuse to Answer
HEP21. During the past year, did anyone in your family receive any income from the following (check all that apply): (Check all that apply)
__ A job, employment
__ Social security
__ Public assistance (AFDC, Welfare)
__ Housing assistance (renter's assistance)
__ Food stamps
__ Unemployment
__ Refuse to Answer
BICULTURAL INVOLVEMENT QUESTIONNAIRE
Next you will be asked some questions regarding aspects of Hispanic culture and American culture. The following questions measure how comfortable you feel. You will be shown a scale from 1 to 5, and you will have to choose 1, 2, 3, 4 or 5. The higher the number that you choose, the more comfortable you feel. The lower the number that you choose, the less comfortable you feel. For example, if you don't feel at all comfortable, Not at all Comfortable, choose number 1. If you feel Very Comfortable, choose number 5. Remember that you can also choose 2, 3 or 4.
BIC1. How comfortable do you feel speaking SPANISH at home? 1 Not at all Comfortable
2 .
3 .
4 .
5 Very Comfortable
8 Refuse to Answer
BIC3. How comfortable do you feel speaking SPANISH at work? 1 Not at all Comfortable
2 .
3 .
4 .
5 Very Comfortable
8 Refuse to Answer
BIC4. How comfortable do you feel speaking SPANISH with friends? 1 Not at all Comfortable
2 .
3 .
4 .
5 Very Comfortable
8 Refuse to Answer
BIC5. How comfortable do you feel speaking SPANISH in general? 1 Not at all Comfortable
2 .
3 .
4 .
5 Very Comfortable
8 Refuse to Answer
BIC6. How comfortable do you feel speaking ENGLISH at home? 1 Not at all Comfortable
2 .
3 .
4 .
5 Very Comfortable
8 Refuse to Answer
BIC8. How comfortable do you feel speaking ENGLISH at work? 1 Not at all Comfortable
2 .
3 .
4 .
5 Very Comfortable
8 Refuse to Answer
BIC9. How comfortable do you feel speaking ENGLISH with friends? 1 Not at all Comfortable
2 .
3 .
4 .
5 Very Comfortable
8 Refuse to Answer
BIC10. How comfortable do you feel speaking ENGLISH in general? 1 Not at all Comfortable
2 .
3 .
4 .
5 Very Comfortable
8 Refuse to Answer
The following questions measure how much you enjoy different things. The higher the number that you choose, the more you enjoy what the question describes. The lower the number that you choose, the less you enjoy it. For example, if you don't enjoy it at all, Not at All, choose number 1. If you enjoy it Very Much, choose number 5. Remember that you can also choose 2, 3 or 4.
BIC11. How much do you enjoy HISPANIC music? 1 Not at All
2 .
3 .
4 .
5 Very Much
8 Refuse to Answer
BIC12. How much do you enjoy HISPANIC dances? 1 Not at All
2 .
3 .
4 .
5 Very Much
8 Refuse to Answer
BIC13. How much do you enjoy HISPANIC-oriented places? 1 Not at All
2 .
3 .
4 .
5 Very Much
8 Refuse to Answer
BIC14. How much do you enjoy HISPANIC-type recreation? 1 Not at All
2 .
3 .
4 .
5 Very Much
8 Refuse to Answer
BIC15. How much do you enjoy HISPANIC TV programs? 1 Not at All
2 .
3 .
4 .
5 Very Much
8 Refuse to Answer
BIC16. How much do you enjoy HISPANIC radio stations? 1 Not at All
2 .
3 .
4 .
5 Very Much
8 Refuse to Answer
BIC17. How much do you enjoy HISPANIC books and magazines? 1 Not at All
2 .
3 .
4 .
5 Very Much
8 Refuse to Answer
BIC18. How much do you enjoy AMERICAN music? 1 Not at All
2 .
3 .
4 .
5 Very Much
8 Refuse to Answer
BIC19. How much do you enjoy AMERICAN dances? 1 Not at All
2 .
3 .
4 .
5 Very Much
8 Refuse to Answer
BIC20. How much do you enjoy AMERICAN-oriented places? 1 Not at All
2 .
3 .
4 .
5 Very Much
8 Refuse to Answer
BIC21. How much do you enjoy AMERICAN-type recreation? 1 Not at All
2 .
3 .
4 .
5 Very Much
8 Refuse to Answer
BIC22. How much do you enjoy AMERICAN TV programs? 1 Not at All
2 .
3 .
4 .
5 Very Much
8 Refuse to Answer
BIC23. How much do you enjoy AMERICAN radio stations? 1 Not at All
2 .
3 .
4 .
5 Very Much
8 Refuse to Answer
BIC24. How much do you enjoy AMERICAN books and magazines? 1 Not at All
2 .
3 .
4 .
5 Very Much
8 Refuse to Answer
HISPANIC STRESS INVENTORY
Please indicate whether the following situations have occurred to you during the last 3 months. Then if it did occur to you, indicate how worried or tense the situation made you feel. If the situation did not happen to you, mark "no" and skip to the next question. Remember there is no right or wrong answer so try and be as honest as you can.
HSI1. I have seen my son/daughter behave delinquently. Has this occurred to you in the past 3 months?
1 Yes
0 No Skip to HSI5
8 Refuse to Answer
HSI2. How worried are you about this? (Choose one) 1 Not at all worried/tense
2 A little worried/tense
3 Moderately worried/tense
4 Very worried/tense
5 Extremely worried/tense
8 Refuse to Answer
HSI5. I have felt unaccepted by others due to my Latino culture. Has this occurred to you in the past 3 months?
1 Yes
0 No Skip to HSI7
8 Refuse to Answer
HSI6. How worried are you about this? (Choose one) 1 Not at all worried/tense
2 A little worried/tense
3 Moderately worried/tense
4 Very worried/tense
5 Extremely worried/tense
8 Refuse to Answer
HSI7. Because I do not know enough English, it has been difficult for me to interact with others. Has this occurred to you in the past 3 months?
1 Yes
0 No Skip to HSI9
8 Refuse to Answer
HSI8. How worried are you about this? (Choose one) 1 Not at all worried/tense
2 A little worried/tense
3 Moderately worried/tense
4 Very worried/tense
5 Extremely worried/tense
8 Refuse to Answer
HSI9. My children have been influenced by bad friends. Has this occurred to you in the past 3 months?
1 Yes
0 No Skip to HSI13
8 Refuse to Answer
HSI10. How worried are you about this? (Choose one) 1 Not at all worried/tense
2 A little worried/tense
3 Moderately worried/tense
4 Very worried/tense
5 Extremely worried/tense
8 Refuse to Answer
HSI13. I have not been able to forget the last few months in my home country. Has this occurred to you in the past 3 months?
1 Yes
0 No Skip to HSI17
8 Refuse to Answer
HSI14. How worried are you about this? (Choose one) 1 Not at all worried/tense
2 A little worried/tense
3 Moderately worried/tense
4 Very worried/tense
5 Extremely worried/tense
8 Refuse to Answer
HSI17. I have thought that my children used illegal drugs. Has this occurred to you in the past 3 months?
1 Yes
0 No Skip to HSI19
8 Refuse to Answer
HSI18. How worried are you about this? (Choose one) 1 Not at all worried/tense
2 A little worried/tense
3 Moderately worried/tense
4 Very worried/tense
5 Extremely worried/tense
8 Refuse to Answer
HSI19. My children have been drinking alcohol. Has this occurred to you in the past 3 months?
1 Yes
0 No Skip to HSI21
8 Refuse to Answer
HSI20. How worried are you about this? (Choose one) 1 Not at all worried/tense
2 A little worried/tense
3 Moderately worried/tense
4 Very worried/tense
5 Extremely worried/tense
8 Refuse to Answer
HSI21. I have been discriminated against. Has this occurred to you in the past 3 months?
1 Yes
0 No Skip to HSI33
8 Refuse to Answer
HSI22. How worried are you about this? (Choose one) 1 Not at all worried/tense
2 A little worried/tense
3 Moderately worried/tense
4 Very worried/tense
5 Extremely worried/tense
8 Refuse to Answer
HSI33. I have thought a lot about the fact that my son (daughter) left home to live independently. Has this occurred to you in the past 3 months?
1 Yes
0 No Skip to HSI35
8 Refuse to Answer
HSI34. How worried are you about this? (Choose one) 1 Not at all worried/tense
2 A little worried/tense
3 Moderately worried/tense
4 Very worried/tense
5 Extremely worried/tense
8 Refuse to Answer
HSI35. Because of American ideas about children it has been difficult for me to decide how strict to be with my children. Has this occurred to you in the past 3 months? 1 Yes
0 No Skip to HSI37
8 Refuse to Answer
HSI36. How worried are you about this? (Choose one) 1 Not at all worried/tense
2 A little worried/tense
3 Moderately worried/tense
4 Very worried/tense
5 Extremely worried/tense
8 Refuse to Answer
HSI37. Because of my poor English people have treated me badly. Has this occurred to you in the past 3 months?
1 Yes
0 No Skip to HSI39
8 Refuse to Answer
HSI38. How worried are you about this? (Choose one) 1 Not at all worried/tense
2 A little worried/tense
3 Moderately worried/tense
4 Very worried/tense
5 Extremely worried/tense
8 Refuse to Answer
HSI39. I have felt that being too close to my family interfered with my own goals. Has this occurred to you in the past 3 months?
1 Yes
0 No Skip to HSI41
8 Refuse to Answer
HSI40. How worried are you about this? (Choose one) 1 Not at all worried/tense
2 A little worried/tense
3 Moderately worried/tense
4 Very worried/tense
5 Extremely worried/tense
8 Refuse to Answer
HSI41. I have thought that my children want their independence before they are ready. Has this occurred to you in the past 3 months?
1 Yes
0 No Skip to HSI43
8 Refuse to Answer
HSI42. How worried are you about this? (Choose one) 1 Not at all worried/tense
2 A little worried/tense
3 Moderately worried/tense
4 Very worried/tense
5 Extremely worried/tense
8 Refuse to Answer
HSI43. I have felt that members of my family are losing their religion. Has this occurred to you in the past 3 months?
1 Yes
0 No Skip to HSI45
8 Refuse to Answer
HSI44. How worried are you about this? (Choose one) 1 Not at all worried/tense
2 A little worried/tense
3 Moderately worried/tense
4 Very worried/tense
5 Extremely worried/tense
8 Refuse to Answer
HSI45. My children have not respected my authority the way they should. Has this occurred to you in the past 3 months?
1 Yes
0 No Skip to HSI47
8 Refuse to Answer
HSI46. How worried are you about this? (Choose one) 1 Not at all worried/tense
2 A little worried/tense
3 Moderately worried/tense
4 Very worried/tense
5 Extremely worried/tense
8 Refuse to Answer
HSI47. Because we have different customs, I have had arguments with other members of my family. Has this occurred to you in the past 3 months?
1 Yes
0 No Skip to HSI49
8 Refuse to Answer
HSI48. How worried are you about this? (Choose one) 1 Not at all worried/tense
2 A little worried/tense
3 Moderately worried/tense
4 Very worried/tense
5 Extremely worried/tense
8 Refuse to Answer
HSI49. Members of my family have considered divorce as a solution to their marital problems. Has this occurred to you in the past 3 months?
1 Yes
0 No Skip to HSI51
8 Refuse to Answer
HSI50. How worried are you about this? (Choose one) 1 Not at all worried/tense
2 A little worried/tense
3 Moderately worried/tense
4 Very worried/tense
5 Extremely worried/tense
8 Refuse to Answer
HSI51. Because of the lack of family unity, I have felt lonely and isolated. Has this occurred to you in the past 3 months?
1 Yes
0 No Skip to HSI59
8 Refuse to Answer
HSI52. How worried are you about this? (Choose one) 1 Not at all worried/tense
2 A little worried/tense
3 Moderately worried/tense
4 Very worried/tense
5 Extremely worried/tense
8 Refuse to Answer
HSI59. Due to problems in understanding English, I have had difficulties in school. Has this occurred to you in the past 3 months?
1 Yes
0 No Skip to HSI65
8 Refuse to Answer
HSI60. How worried are you about this? (Choose one) 1 Not at all worried/tense
2 A little worried/tense
3 Moderately worried/tense
4 Very worried/tense
5 Extremely worried/tense
8 Refuse to Answer
HSI65. I feared the consequences of deportation. Has this occurred to you in the past 3 months?
1 Yes
0 No Skip to HSI67
8 Refuse to Answer
HSI66. How worried are you about this? (Choose one) 1 Not at all worried/tense
2 A little worried/tense
3 Moderately worried/tense
4 Very worried/tense
5 Extremely worried/tense
8 Refuse to Answer
HSI67. I have thought that my children were not receiving a good education. Has this occurred to you in the past 3 months?
1 Yes
0 No Skip to HSI73
8 Refuse to Answer
HSI68. How worried are you about this? (Choose one) 1 Not at all worried/tense
2 A little worried/tense
3 Moderately worried/tense
4 Very worried/tense
5 Extremely worried/tense
8 Refuse to Answer
HSI73. I have felt that my children's ideas about sexuality are too liberal. Has this occurred to you in the past 3 months?
1 Yes
0 No Skip to HSI75
8 Refuse to Answer
HSI74. How worried are you about this? (Choose one) 1 Not at all worried/tense
2 A little worried/tense
3 Moderately worried/tense
4 Very worried/tense
5 Extremely worried/tense
8 Refuse to Answer
HSI75. There has been physical violence among members of my family. Has this occurred to you in the past 3 months?
1 Yes
0 No Skip to HSI79
8 Refuse to Answer
HSI76. How worried are you about this? (Choose one) 1 Not at all worried/tense
2 A little worried/tense
3 Moderately worried/tense
4 Very worried/tense
5 Extremely worried/tense
8 Refuse to Answer
HSI79. Because I am Latino I have had difficulty finding the type of work I want. Has this occurred to you in the past 3 months?
1 Yes
0 No Skip to HSI85
8 Refuse to Answer
HSI80. How worried are you about this? (Choose one) 1 Not at all worried/tense
2 A little worried/tense
3 Moderately worried/tense
4 Very worried/tense
5 Extremely worried/tense
8 Refuse to Answer
HSI85. My children have talked about leaving home. Has this occurred to you in the past 3 months?
1 Yes
0 No Skip to HSI87
8 Refuse to Answer
HSI86. How worried are you about this? (Choose one) 1 Not at all worried/tense
2 A little worried/tense
3 Moderately worried/tense
4 Very worried/tense
5 Extremely worried/tense
8 Refuse to Answer
HSI87. My legal status has limited my contact with family or friends. Has this occurred to you in the past 3 months?
1 Yes
0 No Skip to HSI89
8 Refuse to Answer
HSI88. How worried are you about this? (Choose one) 1 Not at all worried/tense
2 A little worried/tense
3 Moderately worried/tense
4 Very worried/tense
5 Extremely worried/tense
8 Refuse to Answer
HSI89. I have felt that I would never regain the status and respect that I had in my home country. Has this occurred to you in the past 3 months?
1 Yes
0 No Skip to HSI91
8 Refuse to Answer
HSI90. How worried are you about this? (Choose one) 1 Not at all worried/tense
2 A little worried/tense
3 Moderately worried/tense
4 Very worried/tense
5 Extremely worried/tense
8 Refuse to Answer
HSI91. I have felt that family relations are becoming less important for people that I'm close to. Has this occurred to you in the past 3 months?
1 Yes
0 No Skip to HSI93
8 Refuse to Answer
HSI92. How worried are you about this? (Choose one) 1 Not at all worried/tense
2 A little worried/tense
3 Moderately worried/tense
4 Very worried/tense
5 Extremely worried/tense
8 Refuse to Answer
HSI93. My children have received bad school reports (or bad grades). Has this occurred to you in the past 3 months?
1 Yes
0 No Skip to HSI105
8 Refuse to Answer
HSI94. How worried are you about this? (Choose one) 1 Not at all worried/tense
2 A little worried/tense
3 Moderately worried/tense
4 Very worried/tense
5 Extremely worried/tense
8 Refuse to Answer
HSI105. I had serious arguments with family members. Has this occurred to you in the past 3 months?
1 Yes
0 No Skip to HSI107
8 Refuse to Answer
HSI106. How worried are you about this? (Choose one) 1 Not at all worried/tense
2 A little worried/tense
3 Moderately worried/tense
4 Very worried/tense
5 Extremely worried/tense
8 Refuse to Answer
HSI107. I have been around too much violence. Has this occurred to you in the past 3 months?
1 Yes
0 No Skip to HSI109
8 Refuse to Answer
HSI108. How worried are you about this? (Choose one) 1 Not at all worried/tense
2 A little worried/tense
3 Moderately worried/tense
4 Very worried/tense
5 Extremely worried/tense
8 Refuse to Answer
HSI109. I have avoided immigration officials. Has this occurred to you in the past 3 months?
1 Yes
0 No Skip to HSI111
8 Refuse to Answer
HSI110. How worried are you about this? (Choose one) 1 Not at all worried/tense
2 A little worried/tense
3 Moderately worried/tense
4 Very worried/tense
5 Extremely worried/tense
8 Refuse to Answer
HSI111. I have thought that if I went to a social or government agency I would be deported. Has this occurred to you in the past 3 months?
1 Yes
0 No Skip to HSI113
8 Refuse to Answer
HSI112. How worried are you about this? (Choose one) 1 Not at all worried/tense
2 A little worried/tense
3 Moderately worried/tense
4 Very worried/tense
5 Extremely worried/tense
8 Refuse to Answer
HSI113. My personal goals have been in conflict with family goals. Has this occurred to you in the past 3 months?
1 Yes
0 No Skip to HSI117
8 Refuse to Answer
HSI114. How worried are you about this? (Choose one) 1 Not at all worried/tense
2 A little worried/tense
3 Moderately worried/tense
4 Very worried/tense
5 Extremely worried/tense
8 Refuse to Answer
HSI117. Because I do not know enough English, it has been difficult to deal with day to day situations. Has this occurred to you in the past 3 months?
1 Yes
0 No Skip to HSI119
8 Refuse to Answer
HSI118. How worried are you about this? (Choose one) 1 Not at all worried/tense
2 A little worried/tense
3 Moderately worried/tense
4 Very worried/tense
5 Extremely worried/tense
8 Refuse to Answer
HSI119. I have not been able to forget about the war related deaths which happened to friends or family members.Has this occurred to you in the past 3 months? 1 Yes
0 No Skip to HSI123
8 Refuse to Answer
HSI120. How worried are you about this? (Choose one) 1 Not at all worried/tense
2 A little worried/tense
3 Moderately worried/tense
4 Very worried/tense
5 Extremely worried/tense
8 Refuse to Answer
HSI123. My children have seen too much sex on television or at the movies. Has this occurred to you in the past 3 months?
1 Yes
0 No Skip to HSI125
8 Refuse to Answer
HSI124. How worried are you about this? (Choose one) 1 Not at all worried/tense
2 A little worried/tense
3 Moderately worried/tense
4 Very worried/tense
5 Extremely worried/tense
8 Refuse to Answer
HSI125. I have noticed that religion is less important to me now than before. Has this occurred to you in the past 3 months?
1 Yes
0 No Skip to HSI127
8 Refuse to Answer
HSI126. How worried are you about this? (Choose one) 1 Not at all worried/tense
2 A little worried/tense
3 Moderately worried/tense
4 Very worried/tense
5 Extremely worried/tense
8 Refuse to Answer
HSI127. I have felt guilty about leaving family and friends in my home country. Has this occurred to you in the past 3 months?
1 Yes
0 No Skip to HSI133
8 Refuse to Answer
HSI128. How worried are you about this? (Choose one) 1 Not at all worried/tense
2 A little worried/tense
3 Moderately worried/tense
4 Very worried/tense
5 Extremely worried/tense
8 Refuse to Answer
HSI133. There have been conflicts among members of my family. Has this occurred to you in the past 3 months?
1 Yes
0 No Skip to HSI135
8 Refuse to Answer
HSI134. How worried are you about this? (Choose one) 1 Not at all worried/tense
2 A little worried/tense
3 Moderately worried/tense
4 Very worried/tense
5 Extremely worried/tense
8 Refuse to Answer
HSI135. I have been questioned about my legal status. Has this occurred to you in the past 3 months?
1 Yes
0 No Skip to HSI137
8 Refuse to Answer
HSI136. How worried are you about this? (Choose one) 1 Not at all worried/tense
2 A little worried/tense
3 Moderately worried/tense
4 Very worried/tense
5 Extremely worried/tense
8 Refuse to Answer
HSI137. I have had difficulty finding legal services. Has this occurred to you in the past 3 months?
1 Yes
0 No Skip to HSI141
8 Refuse to Answer
HSI138. How worried are you about this? (Choose one) 1 Not at all worried/tense
2 A little worried/tense
3 Moderately worried/tense
4 Very worried/tense
5 Extremely worried/tense
8 Refuse to Answer
HSI141. I have felt pressured to learn English. Has this occurred to you in the past 3 months?
1 Yes
0 No Skip to HSI143
8 Refuse to Answer
HSI142. How worried are you about this? (Choose one) 1 Not at all worried/tense
2 A little worried/tense
3 Moderately worried/tense
4 Very worried/tense
5 Extremely worried/tense
8 Refuse to Answer
HSI143. Some members of my family have become too individualistic. Has this occurred to you in the past 3 months?
1 Yes
0 No Skip to instructions before FAM1
8 Refuse to Answer
HSI144. How worried are you about this? (Choose one) 1 Not at all worried/tense
2 A little worried/tense
3 Moderately worried/tense
4 Very worried/tense
5 Extremely worried/tense
8 Refuse to Answer
FAMILY RELATIONS SCALE
The following questions have to do with families. We want to know how much each one is true about your family. Click on the item that indicates how true each one is about your family in your opinion.
FAM1. Family members feel very close to each other. (Choose one) 1 Not at all true
2 Hardly ever true
3 True a lot
4 Almost always or always true
8 Refuse to Answer
FAM2. My family expects too much of me. (Choose one) 1 Not at all true
2 Hardly ever true
3 True a lot
4 Almost always or always true
8 Refuse to Answer
FAM3. We can easily think of things to do together as a family. (Choose one)
1 Not at all true
2 Hardly ever true
3 True a lot
4 Almost always or always true
8 Refuse to Answer
FAM4. I have trouble accepting someone else's answer to a family problem. (Choose one)
1 Not at all true
2 Hardly ever true
3 True a lot
4 Almost always or always true
8 Refuse to Answer
FAM5. My family and I have the same views about what is right and wrong. (Choose one)
1 Not at all true
2 Hardly ever true
3 True a lot
4 Almost always or always true
8 Refuse to Answer
FAM6. My family doesn't let me be myself. (Choose one) 1 Not at all true
2 Hardly ever true
3 True a lot
4 Almost always or always true
8 Refuse to Answer
FAM7. Family members ask each other for help. (Choose one) 1 Not at all true
2 Hardly ever true
3 True a lot
4 Almost always or always true
8 Refuse to Answer
FAM8. I often don't understand what other family members are saying. (Choose one)
1 Not at all true
2 Hardly ever true
3 True a lot
4 Almost always or always true
8 Refuse to Answer
FAM10. I listen to what other family members have to say, even when I disagree. (Choose one)
1 Not at all true
2 Hardly ever true
3 True a lot
4 Almost always or always true
8 Refuse to Answer
FAM11. Family members like to spend free time with each other. (Choose one)
1 Not at all true
2 Hardly ever true
3 True a lot
4 Almost always or always true
8 Refuse to Answer
FAM12. I am tired of being blamed for family problems. (Choose one) 1 Not at all true
2 Hardly ever true
3 True a lot
4 Almost always or always true
8 Refuse to Answer
FAM14. If someone in the family has upset me, I keep it to myself. (Choose one)
1 Not at all true
2 Hardly ever true
3 True a lot
4 Almost always or always true
8 Refuse to Answer
FAM15. I am available when others in the family want to talk to me. (Choose one)
1 Not at all true
2 Hardly ever true
3 True a lot
4 Almost always or always true
8 Refuse to Answer
FAM16. Family togetherness is important. (Choose one) 1 Strongly Disagree
2 Disagree
3 Agree
4 Strongly Agree
8 Refuse to Answer
FAM17. Kids should value a close relationship with their family and not have to be asked to spend time at home. (Choose one)
1 Strongly Disagree
2 Disagree
3 Agree
4 Strongly Agree
8 Refuse to Answer
FAM18. No matter what, family members should stick together. (Choose one) 1 Strongly Disagree
2 Disagree
3 Agree
4 Strongly Agree
8 Refuse to Answer
FAM19. Family members should be able to speak their minds with one another. (Choose one)
1 Strongly Disagree
2 Disagree
3 Agree
4 Strongly Agree
8 Refuse to Answer
FAM20. Parents should teach their children what they need to know to make it in the world. (Choose one)
1 Strongly Disagree
2 Disagree
3 Agree
4 Strongly Agree
8 Refuse to Answer
FAM21. Children should always talk to their parents with respect. (Choose one) 1 Strongly Disagree
2 Disagree
3 Agree
4 Strongly Agree
8 Refuse to Answer
FAM22. Kids should obey their parents even when they don't agree with them. (Choose one)
1 Strongly Disagree
2 Disagree
3 Agree
4 Strongly Agree
8 Refuse to Answer
FAM23. Parents should expect kids my child's age to do some work around the house. (Choose one)
1 Strongly Disagree
2 Disagree
3 Agree
4 Strongly Agree
8 Refuse to Answer
FAM24. Kids my child's age should call home if they think they might be late. (Choose one)
1 Strongly Disagree
2 Disagree
3 Agree
4 Strongly Agree
8 Refuse to Answer
FAM25. Kids my child's age should clean up for themselves without having to be told. (Choose one)
1 Strongly Disagree
2 Disagree
3 Agree
4 Strongly Agree
8 Refuse to Answer
PARENTING PRACTICES SCALE
These questions refer specifically to your relationship with the child that is in this program with you. The following questions have to do with the kinds of things that you and your child may have talked about or have done together in the past six (6) months.
PPR1. When was the last time that you discussed with your child his/her plans for the coming day? (Choose one)
1 More than 1 month ago
2 Within last month
3 Within last week
4 Yesterday/today
5 Don't Know
8 Refuse to Answer
PPR2. In the past six months, about how often have you discussed with your child his/her plans for the coming day? (Choose one)
1 Less than once a month
2 At least once a month
3 At least once a week
4 Almost every day
5 Don't know
8 Refuse to Answer
PPR3. When was the last time you talked with your child about what he/she had actually done during the day? (Choose one)
1 More than 1 month ago
2 Within last month
3 Within last week
4 Yesterday/today
5 Don't Know
8 Refuse to Answer
PPR4. In the past six months, about how often have you talked with your child about what he/she had actually done during the day? (Choose one)
1 Less than once a month
2 At least once a month
3 At least once a week
4 Almost every day
5 Don't know
8 Refuse to Answer
PPR5. Does your child have a set time to be home on school nights? (Choose one)
1 He/she is not allowed out
2 Before 8:00 pm
3 8:00-8:59 pm
4 9:00-9:59 pm
5 10:00-10:59 pm
6 11:00 pm or later
7 As late as he/she wants
8 Refuse to Answer
PPR6. Does your child have a set time to be home on weekend nights? (Choose one)
1 He/she is not allowed out
2 Before 9:00 pm
3 9:00-9:59 pm
4 10:00-10:59 pm
5 11:00-11:59 pm
6 12:00-12:59 am
7 1:00- 1:59 am
8 After 2:00 am
9 As late as he/she wants
98 Refuse to Answer
PPR7. If your child did not come home by the time that was set, would you know? (Choose one)
0 No
1 Probably
2 Certainly
8 Refuse to Answer
PPR8. If you or another adult are not at home, does your child leave you a note or call you to let you know where he/she is going? (Choose one)
1 Almost never
2 Sometimes
3 Almost always
8 Refuse to Answer
PPR9. Do you know who your child's companions are when he/she is not at home? (Choose one)
1 Almost never
2 Sometimes
3 Almost always
8 Refuse to Answer
PPR10. When you are not home, does your child know how to get in touch with you? (Choose one)
1 Almost never
2 Sometimes
3 Almost always
8 Refuse to Answer
PPR11. When your child is out, do you know what time he/she will be home? (Choose one)
1 Almost never
2 Sometimes
3 Almost always
8 Refuse to Answer
PPR12. Is it important to you to know what your child is doing when he/she is outside of the home? (Choose one)
1 No, not important
2 Yes, somewhat important
3 Yes, very important
8 Refuse to Answer
PPR13. Where does your child usually go after school? More than one response may be selected. (Check all that apply)
__ Home, supervised (adult or responsible minor present)
__ Home, unsupervised
__ Somewhere else, supervised (adult or responsible minor present)
__ Somewhere else, unsupervised
__ Somewhere else, don't know if supervised
__ Other
__ Don't know
__ Refuse to Answer
PPR14. Where is your child usually in the evening? More than one response may be selected. (Check all that apply)
__ Home, supervised (adult or responsible minor present)
__ Home, unsupervised
__ Somewhere else, supervised (adult or responsible minor present)
__ Somewhere else, unsupervised
__ Somewhere else, don't know if supervised
__ Other
__ Don't know
__ Refuse to Answer
PPR15. Where is your child usually on weekends? More than one response may be selected. (Check all that apply)
__ Home, supervised (adult or responsible minor present)
__ Home, unsupervised
__ Somewhere else, supervised (adult or responsible minor present)
__ Somewhere else, unsupervised
__ Somewhere else, don't know if supervised
__ Other
__ Don't know
__ Refuse to Answer
PPR16. How many of your child's friends do you know? (Choose one) 0 None
1 Some
2 Most
3 All
8 Refuse to Answer
PPR17. When you and your child are both at home, do you know what he/she is doing? (Choose one)
1 Hardly ever
2 Sometimes
3 Often
8 Refuse to Answer
PPR18. Does your child help to plan family activities? (Choose one) 1 Hardly ever
2 Sometimes
3 Often
8 Refuse to Answer
PPR19. Does your child like to get involved in family activities? (Choose one) 1 Hardly ever
2 Sometimes
3 Often
8 Refuse to Answer
PPR20. Do you find time to listen to your child when he/she wants to talk to you? (Choose one)
1 Hardly ever
2 Sometimes
3 Often
8 Refuse to Answer
PPR21. Do you and your child do things together at home? (Choose one) 1 Hardly ever
2 Sometimes
3 Often
8 Refuse to Answer
PPR22. Does your child go with members of the family to movies, sports events or other outings? (Choose one)
1 Hardly ever
2 Sometimes
3 Often
8 Refuse to Answer
PPR23. Does your child go with members of the family to Church, Synagogue, or Sunday school? (Choose one)
1 Hardly ever
2 Sometimes
3 Often
8 Refuse to Answer
PPR24. How often do you have a friendly chat with your child? (Choose one) 1 Hardly ever
2 Sometimes
3 Often
8 Refuse to Answer
PPR25. Does your child help you? (Choose one) 1 Hardly ever
2 Sometimes
3 Often
8 Refuse to Answer
PPR26. Does your child prefer to be with his/her friends rather than with the family? (Choose one)
1 Hardly ever
2 Sometimes
3 Often
8 Refuse to Answer
PPR27. Do you talk with your child about how he/she is doing at school? (Choose one)
1 Hardly ever
2 Sometimes
3 Often
8 Refuse to Answer
PPR28. On the average, how much time each day are you together with your child on weekdays, that is, when you and your child are both awake? (Choose one) 1 Less than 30 minutes
2 30 minutes to 1 hour
3 More than 1 hour, less than 3 hours
4 3 to 6 hours
5 More than 6 hours
8 Refuse to Answer
PPR29. And on weekends? (Choose one) 1 Less than 30 minutes
2 30 minutes to 1 hour
3 More than 1 hour, less than 3 hours
4 3 to 6 hours
5 More than 6 hours
8 Refuse to Answer
PPR30. On weekdays, how much of that time are you doing something together, like making something, playing a game, talking, or going out together? (Choose one) 1 Less than 30 minutes
2 30 minutes to 1 hour
3 More than 1 hour, less than 3 hours
4 3 to 6 hours
5 More than 6 hours
8 Refuse to Answer
PPR31. And on weekend days? (Choose one) 1 Less than 30 minutes
2 30 minutes to 1 hour
3 More than 1 hour, less than 3 hours
4 3 to 6 hours
5 More than 6 hours
8 Refuse to Answer
PPR32. In general, are these activities enjoyable? (Choose one) 1 Not really enjoyable
2 Sometimes enjoyable
3 Almost always enjoyable
8 Refuse to Answer
PPR33. When your child has done something that you like or approve of, do you not say anything about it, or ignore it? (Choose one)
1 Almost never
2 Sometimes
3 Often
8 Refuse to Answer
PPR34. When your child has done something that you like or approve of, do you give him a wink or a smile? (Choose one)
1 Almost never
2 Sometimes
3 Often
8 Refuse to Answer
PPR35. When your child has done something that you like or approve of, do you say something nice about it; praise or give approval? (Choose one)
1 Almost never
2 Sometimes
3 Often
8 Refuse to Answer
PPR36. When your child has done something that you like or approve of, do you give him a hug, pat on the back, or a kiss for it? (Choose one)
1 Almost never
2 Sometimes
3 Often
8 Refuse to Answer
PPR37. When your child has done something that you like or approve of, do you give him some reward for it, like a present, extra money, or something special to eat? (Choose one) 1 Almost never
2 Sometimes
3 Often
8 Refuse to Answer
PPR38. When your child has done something that you like or approve of, do you give him a special privilege such as staying up late, or doing some special activity? (Choose one) 1 Almost never
2 Sometimes
3 Often
8 Refuse to Answer
PPR39. When your child has done something that you like or approve of, do you do something special together such as going to the movies, to a game, playing a game, or going somewhere? (Choose one) 1 Almost never
2 Sometimes
3 Often
8 Refuse to Answer
PPR40. When your child has done something that you like or approve of, do you mention it to someone else? (Choose one)
1 Almost never
2 Sometimes
3 Often
8 Refuse to Answer
PPR41. When your child has done something that you like or approve of, do you ask him why he is not always good like this? (Choose one)
1 Almost never
2 Sometimes
3 Often
8 Refuse to Answer
PPR42. Is there anything else that you do when he has been good? 1 Yes
0 No
8 Refuse to Answer
Consider the past six (6) months in answering the following questions.
PPR43. If you punish your child, does his/her behavior get worse? (Choose one) 1 Almost never
2 Sometimes
3 Often
8 Refuse to Answer
PPR44. Are you worried that your way of disciplining your child is making him/her stubborn? (Choose one)
1 Almost never
2 Sometimes
3 Often
8 Refuse to Answer
PPR45. Do you hesitate to enforce the rules with your child because you fear he/she might then harm someone in your household? (Choose one)
1 Almost never
2 Sometimes
3 Often
8 Refuse to Answer
PPR46. Do you feel that you must be careful not to upset your child? (Choose one) 1 Almost never
2 Sometimes
3 Often
8 Refuse to Answer
PPR47. Do you feel that other family members must be careful not to upset your child? (Choose one)
1 Almost never
2 Sometimes
3 Often
8 Refuse to Answer
PPR48. Do you feel that it is more trouble than it is worth to ask your child to help you? (Choose one)
1 Almost never
2 Sometimes
3 Often
8 Refuse to Answer
PPR49. Do you think that your child will take it out on other children if you try to make him obey you? (Choose one)
1 Almost never
2 Sometimes
3 Often
8 Refuse to Answer
PPR50. When you are by yourself, do you have much difficulty controlling your child? (Choose one)
1 Almost never
2 Sometimes
3 Often
8 Refuse to Answer
PPR51. When other adults are present, do you have much difficulty controlling your child? (Choose one)
1 Almost never
2 Sometimes
3 Often
8 Refuse to Answer
PPR52. Do you leave your child alone because of his/her moodiness? (Choose one)
1 Almost never
2 Sometimes
3 Often
8 Refuse to Answer
PPR53. Do you think that your child will try to get back at you if you try to make him/her obey you? (Choose one)
1 Almost never
2 Sometimes
3 Often
8 Refuse to Answer
The following questions have to do with child rearing. Please indicate how often they apply - Almost Never, Sometimes or Almost Always. If the question does not apply to your family, choose Not Applicable.
PPR54. If you ask your child to do something and he/she does not do it, do you give up trying to get him/her to do it? (Choose one)
1 Almost never
2 Sometimes
3 Almost always
8 Refuse to Answer
9 Not Applicable
PPR55. If you warn your child that he/she will be punished if he/she does not stop doing something, do you actually punish him/her if he/she does not stop? (Choose one) 1 Almost never
2 Sometimes
3 Almost always
8 Refuse to Answer
9 Not Applicable
PPR56. If you have told your child that he/she is grounded for a period of time as a punishment, would he/she be let off (released, forgiven) before the time is up? (Choose one) 1 Almost never
2 Sometimes
3 Almost always
8 Refuse to Answer
9 Not Applicable
PPR57. Do you let your child get away with things? (Choose one) 1 Almost never
2 Sometimes
3 Almost always
8 Refuse to Answer
9 Not Applicable
PPR58. Does your child usually know how you will react or punish him/her when he/she has done something wrong? (Choose one)
1 Almost never
2 Sometimes
3 Almost always
8 Refuse to Answer
9 Not Applicable
PPR59. If your child is punished, does the punishment work? (Choose one) 1 Almost never
2 Sometimes
3 Almost always
8 Refuse to Answer
9 Not Applicable
PPR60. If a punishment has been decided upon, can your child change it by explanations, arguments or excuses? (Choose one)
1 Almost never
2 Sometimes
3 Almost always
8 Refuse to Answer
9 Not Applicable
PPR61. Do you and your partner agree with one another about how to bring up your child? (Choose one)
1 Almost never
2 Sometimes
3 Almost always
8 Refuse to Answer
9 Not Applicable
PPR62. Do you disagree openly with your partner about how to discipline your child when he/she is present? (Choose one)
1 Almost never
2 Sometimes
3 Almost always
8 Refuse to Answer
9 Not Applicable
PPR63. Who really has the
final say about disciplining your child?
Mark Not
Applicable if you don't have a partner. (Choose one)
1 Your partner only
2 Mostly your partner
3 Yourself and your partner about equally
4 Mostly yourself
5 Yourself only
6 Yourself, your partner and your child about equally
7 Mostly your child
98 Refuse to Answer
99 Not Applicable
PPR63a. Who really has the
final say about disciplining your child?
Mark Not
Applicable if you have a partner.
(Choose one) 04 Mostly
yourself
07 Mostly your child
10 You and your child about equally
98 Refuse to Answer
99 Not Applicable
PPR64. Does the kind of punishment you give your child depend on if you are in a good or a bad mood? (Choose one)
1 No difference
2 Some difference
3 Big difference
8 Refuse to Answer
PPR65. Is the discipline you use effective for your child? (Choose one) 1 Not really
2 Half of the time
3 Usually
8 Refuse to Answer
PPR66. Do you feel you have found the right kind of discipline to deal with your child? (Choose one)
0 Never
1 In some situations
2 Half of the time
3 In most situations
4 In all situations
8 Refuse to Answer
PPR67. If your child does something that he/she is not allowed to do or that you don't like, do you take away a privilege or pocket money? (Choose one)
1 Almost never
2 Sometimes
3 Often
8 Refuse to Answer
PPR68. If your child does something that he is not allowed to do or that you don't like, do you send him out of the room? (Choose one)
1 Almost never
2 Sometimes
3 Often
8 Refuse to Answer
PPR69. If your child does something that he is not allowed to do or that you don't like, do you yell or scold? (Choose one)
1 Almost never
2 Sometimes
3 Often
8 Refuse to Answer
PPR70. If your child does something that he is not allowed to do or that you don't like, do you calmly discuss what happened? (Choose one)
1 Almost never
2 Sometimes
3 Often
8 Refuse to Answer
PPR71. If your child does something that he is not allowed to do or that you don't like, do you ignore it or not pay attention to it? (Choose one)
1 Almost never
2 Sometimes
3 Often
8 Refuse to Answer
PPR72. If your child does something that he/she is not allowed to do or that you don't like, do you slap or spank him/her or hit him/her with something? (Choose one) 1 Almost never
2 Sometimes
3 Often
8 Refuse to Answer
PPR73. If your child does something that he/she is not allowed to do or that you don't like, do you tell him/her to get out or temporarily lock him/her out of the house? (Choose one) 1 Almost never
2 Sometimes
3 Often
8 Refuse to Answer
PPR74. Is there anything else you do when your child does something you do not like?
1 Yes
0 No
8 Refuse to Answer
BEHAVIORAL PROBLEM CHECKLIST
Please indicate which of the following are problems, as far as your child in this program is concerned. If an item does not constitute a problem, or if you have had no opportunity to observe, or have no knowledge about the item, click on No Problem. If an item constitutes a Mild Problem or Severe Problem, click on the corresponding response.
BPC1. Restless; unable to sit still. (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC2. Seeks attention; "shows off" (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC3. Stays out late at night (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC4. Self conscious; easily embarrassed (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC5. Disruptive; annoys and bothers others (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC6. Feels inferior (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC7. Steals in company with others (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC8. Preoccupied; "in a world of his own;" stares into space (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC9. Shy, bashful (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC10. Withdraws; prefers solitary activities (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC11. Belongs to a gang (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC12. Repetitive speech; says the same thing over and over (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC13. Short attention span; poor concentration (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC14. Lacks self-confidence (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC15. Inattentive to what others say (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC16. Incoherent speech, what is said doesn't make sense (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC17. Fights (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC18. Loyal to delinquent friends (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC19. Has temper tantrums (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC20. Truant from school, usually in company with others (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC21. Hypersensitive; feelings are easily hurt (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC22. Generally fearful; anxious (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC23. Irresponsible, undependable (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC24. Has "bad" companions, ones who are always in some kind of trouble (Choose one)
0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC25. Tense; unable to relax (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC26. Disobedient; difficult to control (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC27. Depressed; always sad (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC28. Uncooperative in group situations (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC29. Passive, suggestible; easily led by others (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC30. Hyperactive; "always on the go" (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC31. Distractible; easily diverted from the task at hand (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC32. Destructive in regard to own and/or other's property (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC33. Negative; tends to do the opposite of what is requested (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC34. Impertinent, talks back (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC35. Sluggish, slow moving, lethargic (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC36. Drowsy, not "wide awake" (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC37. Nervous, jittery, jumpy, easily startled (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC38. Irritable, hot-tempered, easily angered (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC39. Expresses strange, far-fetched ideas (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC40. Argues; quarrels (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC41. Sulks and pouts (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC42. Persists and nags, can't take "no" for an answer (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC43. Avoids looking others in the eye (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC44. Answers without stopping to think (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC45. Unable to work independently; needs constant help and attention (Choose one)
0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC46. Uses drugs in company with others (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC47. Impulsive; starts before understanding what to do; doesn't stop and think (Choose one)
0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC48. Chews on inedible things (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC49. Tries to dominate others; bullies; threatens (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC50. Picks at other children as a way of getting their attention; seems to want to relate but doesn't know how (Choose one)
0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC51. Steals from people outside the home (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC52. Expresses beliefs that are clearly untrue (delusions) (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC53. Says nobody loves him or her (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC54. Freely admits disrespect for moral values and laws (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC55. Brags and boasts (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC56. Slow and not accurate in doing things (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC57. Shows little interest in things around him or her (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC58. Does not finish things; gives up easily; lacks perseverance (Choose one)
0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC59. Is part of a group that rejects school activities such as team sports, clubs, projects to help others (Choose one)
0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC60. Cheats (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC61. Seeks company of older, "more experienced" companions (Choose one)
0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC62. Knows what's going on but is listless and uninterested (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC63. Resists leaving mother's (or other caretaker's) side (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC64. Difficulty in making choices; can't make up mind (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC65. Teases others (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC66. Absentminded; forgets simple things easily (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC67. Acts like he or she were much younger; immature, "childish" (Choose one)
0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC68. Has trouble following directions (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC69. Will lie to protect his/her friends (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC70. Afraid to try new things for fear of failure (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC71. Selfish; won't share; always takes the biggest piece (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC72. Uses alcohol in company with others (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC73. School work is messy, sloppy (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC74. Does not respond to praise from adults (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC75. Not liked by others; is a "loner" because of aggressive behavior (Choose one)
0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC76. Does not use language to communicate (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC77. Cannot stand to wait; wants everything right now (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC78. Refuses to take directions, won't do as told (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC79. Blames others; denies own mistakes (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC80. Admires and seeks to associate with "rougher" peers (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC81. Punishment doesn't affect his or her behavior (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC82. Squirms, fidgets (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC83. Deliberately cruel to others (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC84. Feels he or she can't succeed (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC85. Tells imaginary things as though true; unable to tell real from imagined (Choose one)
0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC86. Does not hug and kiss members of the family; affectionless (Choose one)
0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC87. Runs away; is truant from home (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC88. Openly admires people who operate outside the law (Choose one) 0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
BPC89. Repeats what is said to him or her; "parrots" others' speech (Choose one)
0 No Problem/Don't Know
1 Mild Problem
2 Severe Problem
8 Refuse to Answer
Parent-Adolescent Communication Scale
The following questions refer specifically to your relationship with the child that is in this program with you. Please think of him/her when answering the following questions.
PAC1. I can discuss my beliefs with my child without feeling restrained or embarrassed. (Choose one)
1 Strongly disagree
2 Moderately disagree
3 Neither agree nor disagree
4 Moderately agree
5 Strongly agree
8 Refuse to Answer
PAC2. Sometimes I have trouble believing everything my child tells me. (Choose one)
1 Strongly disagree
2 Moderately disagree
3 Neither agree nor disagree
4 Moderately agree
5 Strongly agree
8 Refuse to Answer
PAC3. My child is always a good listener. (Choose one) 1 Strongly disagree
2 Moderately disagree
3 Neither agree nor disagree
4 Moderately agree
5 Strongly agree
8 Refuse to Answer
PAC4. I am sometimes afraid to ask my child for what I want. (Choose one) 1 Strongly disagree
2 Moderately disagree
3 Neither agree nor disagree
4 Moderately agree
5 Strongly agree
8 Refuse to Answer
PAC5. My child has a tendency to say things to me which would be better left unsaid. (Choose one)
1 Strongly disagree
2 Moderately disagree
3 Neither agree nor disagree
4 Moderately agree
5 Strongly agree
8 Refuse to Answer
PAC6. My child can tell how I'm feeling without asking. (Choose one) 1 Strongly disagree
2 Moderately disagree
3 Neither agree nor disagree
4 Moderately agree
5 Strongly agree
8 Refuse to Answer
PAC7. I am very satisfied with how my child and I talk together. (Choose one) 1 Strongly disagree
2 Moderately disagree
3 Neither agree nor disagree
4 Moderately agree
5 Strongly agree
8 Refuse to Answer
PAC8. If I were in trouble, I could tell my child. (Choose one) 1 Strongly disagree
2 Moderately disagree
3 Neither agree nor disagree
4 Moderately agree
5 Strongly agree
8 Refuse to Answer
PAC9. I openly show affection to my child. (Choose one) 1 Strongly disagree
2 Moderately disagree
3 Neither agree nor disagree
4 Moderately agree
5 Strongly agree
8 Refuse to Answer
PAC10. When we are having a problem, I often give my child the silent treatment. (Choose one)
1 Strongly disagree
2 Moderately disagree
3 Neither agree nor disagree
4 Moderately agree
5 Strongly agree
8 Refuse to Answer
PAC11. I am careful about what I say to my child. (Choose one) 1 Strongly disagree
2 Moderately disagree
3 Neither agree nor disagree
4 Moderately agree
5 Strongly agree
8 Refuse to Answer
PAC12. When talking with my child, I have a tendency to say things that would be better left unsaid. (Choose one)
1 Strongly disagree
2 Moderately disagree
3 Neither agree nor disagree
4 Moderately agree
5 Strongly agree
8 Refuse to Answer
PAC13. When I ask questions, I get honest answers from my child. (Choose one)
1 Strongly disagree
2 Moderately disagree
3 Neither agree nor disagree
4 Moderately agree
5 Strongly agree
8 Refuse to Answer
PAC14. My child tries to understand my point of view. (Choose one) 1 Strongly disagree
2 Moderately disagree
3 Neither agree nor disagree
4 Moderately agree
5 Strongly agree
8 Refuse to Answer
PAC15. There are topics I avoid discussing with my child. (Choose one) 1 Strongly disagree
2 Moderately disagree
3 Neither agree nor disagree
4 Moderately agree
5 Strongly agree
8 Refuse to Answer
PAC16. I find it easy to discuss problems with my child. (Choose one) 1 Strongly disagree
2 Moderately disagree
3 Neither agree nor disagree
4 Moderately agree
5 Strongly agree
8 Refuse to Answer
PAC17. It is very easy for me to express all my true feelings to my child. (Choose one)
1 Strongly disagree
2 Moderately disagree
3 Neither agree nor disagree
4 Moderately agree
5 Strongly agree
8 Refuse to Answer
PAC18. My child nags/bothers me. (Choose one) 1 Strongly disagree
2 Moderately disagree
3 Neither agree nor disagree
4 Moderately agree
5 Strongly agree
8 Refuse to Answer
PAC19. My child insults me when s/he is angry with me. (Choose one) 1 Strongly disagree
2 Moderately disagree
3 Neither agree nor disagree
4 Moderately agree
5 Strongly agree
8 Refuse to Answer
PAC20. I don't think I can tell my child how I really feel about some things. (Choose one)
1 Strongly disagree
2 Moderately disagree
3 Neither agree nor disagree
4 Moderately agree
5 Strongly agree
8 Refuse to Answer
SPS Social Provisions Scale
In answering the following questions, think about your current relationships with friends, family members, co-workers, community members, and so on. Please indicate to what extent each statement describes your current relationships with other people.
SPS1. There are people I can depend on to help me if I really need it. (Choose one)
1 Strongly Disagree
2 Disagree
3 Agree
4 Strongly Agree
8 Refuse to Answer
SPS2. I feel that I do not have close personal relationships with other people. (Choose one)
1 Strongly Disagree
2 Disagree
3 Agree
4 Strongly Agree
8 Refuse to Answer
SPS3. There is no one I can turn to for guidance in times of stress. (Choose one) 1 Strongly Disagree
2 Disagree
3 Agree
4 Strongly Agree
8 Refuse to Answer
SPS4. There are people who enjoy the same social activities I do. (Choose one) 1 Strongly Disagree
2 Disagree
3 Agree
4 Strongly Agree
8 Refuse to Answer
SPS5. Other people do not view me as competent. (Choose one) 1 Strongly Disagree
2 Disagree
3 Agree
4 Strongly Agree
8 Refuse to Answer
SPS6. I feel part of a group of people who share my attitudes and beliefs. (Choose one)
1 Strongly Disagree
2 Disagree
3 Agree
4 Strongly Agree
8 Refuse to Answer
SPS7. I do not think other people respect my skills and abilities. (Choose one) 1 Strongly Disagree
2 Disagree
3 Agree
4 Strongly Agree
8 Refuse to Answer
SPS8. If something went wrong, no one would come to my assistance. (Choose one)
1 Strongly Disagree
2 Disagree
3 Agree
4 Strongly Agree
8 Refuse to Answer
SPS9. I have close relationships that provide me with a sense of emotional security and well-being. (Choose one)
1 Strongly Disagree
2 Disagree
3 Agree
4 Strongly Disagree
8 Refuse to Answer
SPS10. There is someone I could talk to about important decisions in my life. (Choose one)
1 Strongly Disagree
2 Disagree
3 Agree
4 Strongly Agree
8 Refuse to Answer
SPS11. I have relationships where my competence and skill are recognized. (Choose one)
1 Strongly Disagree
2 Disagree
3 Agree
4 Strongly Agree
8 Refuse to Answer
SPS12. There is no one who shares my interests and concerns. (Choose one) 1 Strongly Disagree
2 Disagree
3 Agree
4 Strongly Agree
8 Refuse to Answer
SPS13. There is a trustworthy person I could turn to for advice if I were having problems. (Choose one)
1 Strongly Disagree
2 Disagree
3 Agree
4 Strongly Agree
8 Refuse to Answer
SPS14. I feel a strong emotional bond with at least one other person. (Choose one) 1 Strongly Disagree
2 Disagree
3 Agree
4 Strongly Agree
8 Refuse to Answer
SPS15. There is no one I can depend on for aid if I really need it. (Choose one) 1 Strongly Disagree
2 Disagree
3 Agree
4 Strongly Agree
8 Refuse to Answer
SPS16. There is no one I feel comfortable talking about problems with. (Choose one)
1 Strongly Disagree
2 Disagree
3 Agree
4 Strongly Agree
8 Refuse to Answer
SPS17. There are people who admire my talents and abilities. (Choose one) 1 Strongly Disagree
2 Disagree
3 Agree
4 Strongly Agree
8 Refuse to Answer
SPS18. I lack a feeling of intimacy with another person. (Choose one) 1 Strongly Disagree
2 Disagree
3 Agree
4 Strongly Agree
8 Refuse to Answer
SPS19. There is no one who likes to do the things I do. (Choose one) 1 Strongly Disagree
2 Disagree
3 Agree
4 Strongly Agree
8 Refuse to Answer
SPS20. There are people who I can count on in an emergency. (Choose one) 1 Strongly Disagree
2 Disagree
3 Agree
4 Strongly Agree
8 Refuse to Answer
SPS21. I know someone who would loan me $100 to help me. (Choose one) 1 Strongly Disagree
2 Disagree
3 Agree
4 Strongly Agree
8 Refuse to Answer
SPS22. There are people I regularly spend time with. (Choose one) 1 Strongly Disagree
2 Disagree
3 Agree
4 Strongly Agree
8 Refuse to Answer
SPS23. I know someone who would bring my meals to my room or apartment if I were sick. (Choose one)
1 Strongly Disagree
2 Disagree
3 Agree
4 Strongly Agree
8 Refuse to Answer
SPS24. If I decided to go to a movie today or tomorrow, I could easily find someone to go with me. (Choose one)
1 Strongly Disagree
2 Disagree
3 Agree
4 Agree Strongly
8 Refuse to Answer
SPS25. If I needed it, my family or someone else would help me with financial support on a continuing basis. (Choose one)
1 Strongly Disagree
2 Disagree
3 Agree
4 Strongly Agree
8 Refuse to Answer
SPS26. There are people who depend on me for help. (Choose one) 1 Strongly Disagree
2 Disagree
3 Agree
4 Strongly Agree
8 Refuse to Answer
SPS27. I feel personally responsible for the well-being of another person. (Choose one)
1 Strongly Disagree
2 Disagree
3 Agree
4 Strongly Agree
8 Refuse to Answer
SPS28. There is no one who really relies on me for their well-being. (Choose one) 1 Strongly Disagree
2 Disagree
3 Agree
4 Strongly Agree
8 Refuse to Answer
SPS29. No one needs me to care for them. (Choose one) 1 Strongly Disagree
2 Disagree
3 Agree
4 Strongly Agree
8 Refuse to Answer
PARENT-ADOLESCENT SEX COMMUNICATION SCALE
PSC1. I have talked to my child about sex. (Choose one) 1 Strongly Disagree
2 Moderately Disagree
3 Moderately Agree
4 Strongly Agree
8 Refuse to Answer
PSC2. I can discuss sex with my child without feeling embarrassed. (Choose one) 1 Strongly Disagree
2 Moderately Disagree
3 Moderately Agree
4 Strongly Agree
8 Refuse to Answer
PSC3f. If my daughter were
pregnant, she would tell me.
If the child in the
program with you is male, mark Not Applicable. (Choose
one) 1 Strongly Disagree
2 Moderately Disagree
3 Moderately Agree
4 Strongly Agree
8 Refuse to Answer
9 Not Applicable
PSC3m. If my son got a girl
pregnant, he would tell me.
If the child in the program
with you is female, mark Not Applicable. (Choose one)
1 Strongly Disagree
2 Moderately Disagree
3 Moderately Agree
4 Strongly Agree
8 Refuse to Answer
9 Not Applicable
PSC4. When my child asks questions about sex, I give him/her honest answers. (Choose one)
1 Strongly Disagree
2 Moderately Disagree
3 Moderately Agree
4 Strongly Agree
8 Refuse to Answer
PSC5. My child is afraid to ask me about sex. (Choose one) 1 Strongly Disagree
2 Moderately Disagree
3 Moderately Agree
4 Strongly Agree
8 Refuse to Answer
PSC6. Sex is a topic my child avoids talking about to me. (Choose one) 1 Strongly Disagree
2 Moderately Disagree
3 Moderately Agree
4 Strongly Agree
8 Refuse to Answer
PSC7. I find it easy to discuss sex with my child. (Choose one) 1 Strongly Disagree
2 Moderately Disagree
3 Moderately Agree
4 Strongly Agree
8 Refuse to Answer
PSC8. If my child had a sexually transmitted disease, she/he would tell me. (Choose one)
1 Strongly Disagree
2 Moderately Disagree
3 Moderately Agree
4 Strongly Agree
8 Refuse to Answer
PSC9f. I worry a lot about my
daughter getting pregnant.
If the child in the program
with you is male, mark Not Applicable. (Choose one) 1 Strongly
Disagree
2 Moderately Disagree
3 Moderately Agree
4 Strongly Agree
8 Refuse to Answer
9 Not Applicable
PSC9m. I worry a lot about my
son getting a girl pregnant.
If the child in the
program with you is female, mark Not Applicable. (Choose one)
1 Strongly Disagree
2 Moderately Disagree
3 Moderately Agree
4 Strongly Agree
8 Refuse to Answer
9 Not Applicable
PSC10. I do not trust that my child can make good decisions about sex. (Choose one)
1 Strongly Disagree
2 Moderately Disagree
3 Moderately Agree
4 Strongly Agree
8 Refuse to Answer
PSC11. I am always accusing my child of having sex. (Choose one) 1 Strongly Disagree
2 Moderately Disagree
3 Moderately Agree
4 Strongly Agree
8 Refuse to Answer
PSC12. I have talked to my child about HIV/AIDS. (Choose one) 1 Strongly Disagree
2 Moderately Disagree
3 Moderately Agree
4 Strongly Agree
8 Refuse to Answer
PSC13. I have talked to my child about safe sex. (Choose one) 1 Strongly Disagree
2 Moderately Disagree
3 Moderately Agree
4 Strongly Agree
8 Refuse to Answer
PSC14. I have talked to my child about birth control. (Choose one) 1 Strongly Disagree
2 Moderately Disagree
3 Moderately Agree
4 Strongly Agree
8 Refuse to Answer
Parent Relationship With Peer Group
PER1. Do you know any of your son's /daughter's friends? 1 Yes
0 No
8 Refuse to Answer
PER2. How well do you personally know your child's best friends? (Choose one) 1 Not at all
2 A little bit
3 Somewhat well
4 Pretty well
5 Extremely well
8 Refuse to Answer
PER3. How often during a typical week do you supervise your child and his/her best friends spending time together? (Choose one)
1 Not at all
2 A little bit
3 Somewhat often
4 Pretty often
5 Extremely often
8 Refuse to Answer
PER4. How often during a typical week do you spend time talking with your child about his/her friends? (Choose one)
1 Not at all
2 A little bit
3 Somewhat often
4 Pretty often
5 Extremely often
8 Refuse to Answer
PER5. How well do you personally know the PARENTS of your child's best friends? (Choose one)
1 Not at all
2 A little bit
3 Somewhat well
4 Pretty well
5 Extremely well
8 Refuse to Answer
PER6. How often during a typical week do you see or talk to the PARENTS of your child's best friends? (Choose one)
1 Not at all
2 A little bit
3 Somewhat often
4 Pretty often
5 Extremely often
8 Refuse to Answer
Parent Substance Use Measure
The following questions have to do with the parents or primary caregivers of the adolescent in this study.
PSU1. Have the parents or primary caregivers of the adolescent in this study ever smoked cigarettes?
1 Yes
0 No Skip to PSU4
8 Refuse to Answer
PSU2. Have the parents or primary caregivers of the adolescent in this study smoked cigarettes in the past three months?
1 Yes
0 No Skip to PSU4
8 Refuse to Answer
PSU3. Have the parents or primary caregivers of the adolescent in this study smoked cigarettes in the past 30 days?
1 Yes
0 No
8 Refuse to Answer
PSU4. Have the parents or primary caregivers of the adolescent in this study been drunk or very high from drinking alcoholic beverages in their lifetime?
1 Yes
0 No Skip to PSU7
8 Refuse to Answer
PSU5. Have the parents or primary caregivers of the adolescent in this study been drunk or very high from drinking alcoholic beverages in the past 3 months?
1 Yes
0 No Skip to PSU7
8 Refuse to Answer
PSU6. Have the parents or primary caregivers of the adolescent in this study been drunk or very high from drinking alcoholic beverages in the past 30 days?
1 Yes
0 No
8 Refuse to Answer
PSU7. Have the parents or primary caregivers of the adolescent in this study ever used drugs?
1 Yes
0 No End
8 Refuse to Answer
PSU8. Have the parents or primary caregivers of the adolescent in this study used drugs in the past 3 months?
1 Yes
0 No End
8 Refuse to Answer
PSU9. Have the parents or primary caregivers of the adolescent in this study used drugs in the past 30 days?
1 Yes
0 No
8 Refuse to Answer
| File Type | application/msword |
| Author | ibi0 |
| Last Modified By | ziy6 |
| File Modified | 2010-07-13 |
| File Created | 2010-07-13 |