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pdfATTACHMENT A
QUESTION BY QUESTION SOURCE LIST AND CROSSWALK
BETWEEN PPA BASELINE AND THE FIRST FOLLOW-UP CONCORDANCE SURVEY
1
1.1
1.1
In what month and year were you born?
MARK (X) ONE MONTH AND ONE YEAR
2
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
PART A: Sections 1 through 3 are the same for both sexually active and non-sexually active respondents.
Implementation Outcome
Question Source(s)
Covariate
First Follow-up Question Text
Tracking
OMB-approved Baseline #
Follow-up Question #
Items for the follow-up survey are listed first, with the corresponding baseline item number noted, when applicable. Modifications to
questions found on both the baseline and the first follow-up surveys are noted in the “Notes” column. Items found only on the first follow-up
survey are indicated with an “N/A” in the “OMB-approved Baseline #” column. The information on how the data will be used (for tracking, as
a covariate, etc.) applies to how the data will be used in the first follow-up analysis.
Notes
What grade are you in?
All About Youth (AAY)
MARK (X) ONE
□
□
□
□
□
□
□
□
1.3
1.3
6th
7th
8th
9th
10th
11th
ade14. The next questions ask you about school.
What grade are you in?
AGRADE
0=6th
1=7th
2=8th
8=Refuse to Answer
12th
Not currently in school
Are you male or female?
MARK (X) ONE
□
□
Male
Female
3
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
OMB-approved Baseline #
1.2
Question Source(s)
Tracking
Follow-up Question #
1.2
First Follow-up Question Text
Notes
Are you Hispanic/Latino?
Add Health, Wave 1
MARK (X) ONE
4. Are you of Hispanic or Latino origin?
Yes
No
□
□
1.5
1.5
Yes
No
What is your race?
YOU MAY MARK (X) MORE THAN ONE ANSWER
□
□
□
□
□
□
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Add Health, Wave 1
6. What is your race?
White
Black or African American
American Indian or Native American
Asian or Pacific Islander
Other
Some other race PRINT OTHER RACE
4
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
OMB-approved Baseline #
1.4
Question Source(s)
Tracking
Follow-up Question #
1.4
First Follow-up Question Text
Notes
Baseline text:
Are you Hispanic or
Latino?
Yes
No
Baseline did not have
an option for “Some
other race”
MARK (X) ONE FOR EACH
Yes/No
a. Relationships, dating, marriage, or
family life
b. Abstinence from sex
c. Methods of birth control
d. Where to get birth control
e. Sexually transmitted diseases, also
known as STDs
f. How to talk to your partner about
whether to have sex or whether to use
birth control
g. How to say no to sex
h. How babies are made
MPR Abstinence (Wave 4 V-3, Female, Section 1):
The following questions are about any classes or special
programs you might have participated in during the last
year that talked about sexual activity and health.
1.7 In the past year, did you take a class or participate in a
special program that talked about any of the following
things? These could be classes that you took in school or
someplace else.
a. The female menstrual cycle—that is, the monthly cycle
or period?
b. Physical development and puberty?
c. Dating?
d. Marriage and family life?
e. The human body/reproduction/how girls get pregnant?
f. Ways people who have sex can prevent making babies?
g. Abstinence—that is, not having sexual intercourse?
h. How to say “no” to sex?
i. Sexually transmitted diseases (STDs)?
5
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Question Source(s)
National Survey of Family Growth (NSFG) combined with
MPR Abstinence:
From NSFG (Female, Cycle 6):
Now I’m interested in knowing about formal sex education
you may have had. (Before you were 18, did you ever have/
Have you ever had) any formal instruction at school,
church, a community center or some other place ...
About how to say no to sex?
About methods of birth control?
Implementation Outcome
First Follow-up Question Text
In the past 12 months, have you received any
information or learned about any of the following?
Covariate
OMB-approved Baseline #
1.9
Tracking
Follow-up Question #
1.6
Notes
Baseline text:
In the last 12 months,
have you received
information or learned
about any of the
following?
- Relationships, dating,
marriage, or family life?
- Abstinence from sex?
- Methods of birth
control?
- Sexually transmitted
diseases, also
known as STDs?
- About refusal skills,
such as how to say no
to sex, or how to resist
peer pressure?
1.6a
N/A
1.7
N/A
Thinking about the past 12 months, how many times
did you get information on relationships, abstinence,
birth control, or sexually transmitted diseases at each
of the following places?
Created b y the PPA Team for the First Follow-up
questionnaire.
Never/1-3 times/4-9 times/10 or more times
c)
d)
e)
f)
g)
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
MARK (X) ONE FOR EACH
a)
b)
Covariate
Question Source(s)
Tracking
OMB-approved Baseline #
Follow-up Question #
First Follow-up Question Text
Did you say “yes” to any item a through h in question
1.6 above?
MARK (X) ONE
□
Yes
□
No (GO TO QUESTION 1.9)
School class
Church, synagogue, mosque, or
religious classes outside of school
Community center, youth organization,
or after-school activity
Doctor, nurse, or clinic
Friends
Parents and other relatives or family
members
Other LIST OTHER SOURCE
6
Notes
Filter question
N/A
National Survey of Reproductive and
Contraceptive Knowledge. Developed by
Guttmacher for The National Campaign for The
Fog Zone study.
YOU MAY MARK (X) MORE THAN ONE
□
□
□
□
□
□
□
□
School class
Church, synagogue, mosque or religious
classes outside of school
Community center, youth organization, or
after-school activity
Doctor, nurse or clinic
Friends
Parents and other relatives or family
members
Internet and media
Other (Please specify)
Q56. Among these sources, from which one
source have you received the most information
in the past 12 months?
Q57. Among all possible sources of information,
which one source would you trust to give you the
most accurate information about contraception and
birth control.
a. Your friends
b. Your partner (current or past)
c. Your mother or father
d. Siblings or other relatives
e. A doctor or nurse
f. A teacher or counselor
g. A minister, priest, or rabbi
h. The internet
j. Books, magazines or pamphlets
k. TV or radio
7
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
Question Source(s)
Tracking
OMB-approved Baseline #
Follow-up Question #
1.8
First Follow-up Question Text
Thinking about the past 12 months, where did you get
information on relationships, abstinence, birth
control, or sexually transmitted diseases that was very
helpful to you?
Notes
In the past 30 days, how often have you felt
that you were unable to control the
important things in your life?
Child Trends’ Research to Results Brief
(Perceived Stress Scale):
MARK (X) ONE
In the last month:
2. How often have you felt that you were unable
to control the important things in your life?
0 = Never
1 = Almost never
2 = Sometimes
3 = Fairly often
4 = Very often
□
□
□
□
□
Never
Almost never
Sometimes
Fairly often
Very often
8
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
OMB-approved Baseline #
N/A
Question Source(s)
Tracking
Follow-up Question #
1.9
First Follow-up Question Text
Notes
In the past 30 days, how often have you felt
difficulties were piling up so high that you
could not overcome them?
Child Trends’ Research to Results Brief
(Perceived Stress Scale):
MARK (X) ONE
In the last month:
10. How often have you felt difficulties were
piling up so high that you could not overcome
them?
□
□
□
□
□
Never
Almost never
Sometimes
Fairly often
Very often
0 = Never
1 = Almost never
2 = Sometimes
3 = Fairly often
4 = Very often
9
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
OMB-approved Baseline #
N/A
Question Source(s)
Tracking
Follow-up Question #
1.10
First Follow-up Question Text
Notes
MARK (X) ONE FOR EACH
Strongly Agree, Agree, Disagree, Strongly
Disagree
a.
b.
c.
d.
You can do things now that will help you to
be healthy when you are an adult
Nothing you do as a teen will affect how
healthy you are as an adult
Taking risks as a teen, like drinking and
drugs, does not really matter for your
health in the long run
The good and bad decisions you make as a
teen will affect your health as an adult
10
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Developed by Kris Moore, Child Trends to
address health promotion orientation.
Implementation Outcome
How strongly do you agree or disagree with
the following statements?
Covariate
OMB-approved Baseline #
N/A
Question Source(s)
Tracking
Follow-up Question #
1.11
First Follow-up Question Text
Notes
How likely is it that you will do each of the
following things?
All About Youth, Baseline
MARK (X) ONE FOR EACH
ade16. How much education do you intend to
get?
Not at all likely, A little bit likely, Somewhat
likely, Very likely
A. Graduate from high school
B. Go to a technical or vocational school after
high school
C. Go to college
D. Graduate from a 2-year or community college
program
E. Graduate from a 4-year college program
0 = Don't plan to finish high school
1 = Plan to finish high school
2 = Attend a technical or vocational school
after high school
3 = Graduate from a 2-year community
college program
4 = Graduate from a 4-year college
5 = Graduate with an advanced degree
(doctor, lawyer, dentist)
8 = Refuse to Answer
11
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
OMB-approved Baseline #
1.11
Question Source(s)
Tracking
Follow-up Question #
1.12
First Follow-up Question Text
Notes
2.1
The next questions are about where you live and
who lives with you.
Which of the following best describes where you
live?
MARK (X) ONE
□ You live in one home GO TO 2.2
□ You live in two or more homes, and go back
and forth
□
GO TO 2.3
You are homeless (living on the
street, in a car or shelter, or staying with
friends/relatives)
GO TO 2.4
MPR Abstinence Wave 1
Who do you live with now?
MARK (X) ALL THAT APPLY
1 My biological mother
2 My biological father
3 My stepmother, adoptive, or foster mother
4 My stepfather, adoptive, or foster father
5 Grandparent(s)
6 Aunt(s), uncle(s)
7 Other adult relative(s) (not brothers and sisters)
8 Other adults I am not related to
9 My older sister(s)
10 My older brother(s)
11 My younger sister(s)
12 My younger brother(s)
13 Cousin(s)
14 Other children I am related to
15 Other children I am not related to
12
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
Question Source(s)
Tracking
OMB-approved Baseline #
Follow-up Question #
2.1
First Follow-up Question Text
Notes
Questions 2.1, 2.2, and 2.3
on the follow-up were
combined as one question
on the baseline:
The next question is about
where you live and who
lives with you.
Do you live in one home,
place, or household all of
the time or do you go back
and forth between two or
more different places?
MARK (X) ONE
1 □ Live in one home FILL OUT ONLY THE FIRST
COLUMN BELOW Mark (X)
all the people who live
with you in your home
2 □ Live in two or more
homes FILL OUT THESE TWO
COLUMNS BELOW
Same Categories as above
listed, two columns for
two homes.
2.1
2. 2. Who lives with you in your home?
MPR Abstinence Wave 1
MARK (X) ALL THAT APPLY
Who do you live with now?
MARK (X) ALL THAT APPLY
1 My biological mother
2 My biological father
3 My stepmother, adoptive, or foster mother
4 My stepfather, adoptive, or foster father
5 Grandparent(s)
6 Aunt(s), uncle(s)
7 Other adult relative(s) (not brothers and sisters)
8 Other adults I am not related to
9 My older sister(s)
10 My older brother(s)
11 My younger sister(s)
12 My younger brother(s)
13 Cousin(s)
14 Other children I am related to
15 Other children I am not related to
□ Your biological mother
□ Your biological father
□ A stepmother or adoptive mother
□ A foster mother
□ A stepfather or adoptive father
□ A foster father
□ Your parent’s partner, boyfriend, or girlfriend
□ Any grandmothers
□ Any grandfathers
□ Any older brothers or sisters
□ Any younger brothers or sisters
□ Any aunts, uncles, or other relatives
□ Any other people you are not related to
□ You live by yourself
AFTER ANSWERING
GO TO 2.4
13
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
Question Source(s)
Tracking
OMB-approved Baseline #
Follow-up Question #
2.2
First Follow-up Question Text
Notes
Questions 2.1, 2.2, and 2.3
on the follow-up were
combined as one question
on the baseline:
The next question is about
where you live and who
lives with you.
Do you live in one home,
place, or household all of
the time or do you go back
and forth between two or
more different places?
MARK (X) ONE
1 □ Live in one home FILL OUT ONLY THE FIRST
COLUMN BELOW Mark (X)
all the people who live
with you in your home
2 □ Live in two or more
homes FILL OUT THESE TWO
COLUMNS BELOW
Same Categories as above
listed, two columns for
two homes.
2.1
Who lives with you in each of your homes?
MARK (X) BOTH COLUMNS
Mark (X) all the people who live with you in your
MAIN home
Mark (X) all the people who live with you in your
OTHER home(s)
□
□
□
□
□
□
□
□
□
□
□
□
□
□
Your biological mother
Your biological father
A stepmother or adoptive mother
A foster mother
A stepfather or adoptive father
A foster father
Your parent’s partner, boyfriend, or girlfriend
Any grandmothers
Any grandfathers
Any older brothers or sisters
Any younger brothers or sisters
Any aunts, uncles, or other relatives
Any other people you are not related to
You live by yourself
MPR Abstinence Wave 1
Who do you live with now?
MARK (X) ALL THAT APPLY
1 My biological mother
2 My biological father
3 My stepmother, adoptive, or foster mother
4 My stepfather, adoptive, or foster father
5 Grandparent(s)
6 Aunt(s), uncle(s)
7 Other adult relative(s) (not brothers and sisters)
8 Other adults I am not related to
9 My older sister(s)
10 My older brother(s)
11 My younger sister(s)
12 My younger brother(s)
13 Cousin(s)
14 Other children I am related to
15 Other children I am not related to
14
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
Question Source(s)
Tracking
OMB-approved Baseline #
Follow-up Question #
2.3
First Follow-up Question Text
Notes
Questions 2.1, 2.2, and 2.3
on the follow-up were
combined as one question
on the baseline:
The next question is about
where you live and who
lives with you.
Do you live in one home,
place, or household all of
the time or do you go back
and forth between two or
more different places?
MARK (X) ONE
1 □ Live in one home FILL OUT ONLY THE FIRST
COLUMN BELOW Mark (X)
all the people who live
with you in your home
2 □ Live in two or more
homes FILL OUT THESE TWO
COLUMNS BELOW
Same Categories as above
listed, two columns for
two homes.
Now we have some questions about your
mother, or the person you think of as your
mother. Is this person…
MPR Abstinence Baseline Survey
1.11 If you live with your mother answer the
next questions about your mother and put a
Your biological mother, that is, the woman check here
MARK (X) ONE
□
who gave birth to you
□ Your stepmother or adoptive mother
□ Your foster mother
□ Your grandmother
□ Your aunt or your older sister
□ Some other adult
□ You don’t have a mother or person you think
of as your mother
GO TO QUESTION 2.9
If you don’t live with your mother but you see
her a lot, answer the next questions about your
mother and put a check here
If you don’t see your mother a lot, is there
someone who lives with you and is like a mother
to you? If yes, then move to this section and tell
us who that person is
Stepmother
Foster Mother
Grandmother
Aunt
Someone else
15
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
OMB-approved Baseline #
2.5
Question Source(s)
Tracking
Follow-up Question #
2.4
First Follow-up Question Text
Notes
2.8
Is she working now?
MPR Abstinence Baseline:
1.13 Is she working now?
MARK (X) ONE
□
□
□
□
□
0 She is not working at a job
1 Yes, working part-time (less than 30 hours a
Yes, she is working part-time or less than 30 week)
hours a week
2 Yes, working full-time (30 hours a week or
Yes, she is working full-time or at more more)
than one job for 30 hours a week or more
-1 Don’t know
She is not working at a paid job
Yes, she works, but I don’t know how many
hours
Don’t know if she is working
16
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
Question Source(s)
Tracking
OMB-approved Baseline #
Follow-up Question #
2.5
First Follow-up Question Text
The following questions are about the person you
marked as your mother or the person you think of as
your mother.
Notes
N/A
How well can you and *CHILD’S NAME+ share
ideas or talk about things that really matter?
Very Well
Somewhat well
Not very well
Not well at all
Now thinking about your biological mother, Child Trends created
that is, the woman who gave birth to you,
how old is she (or would she be if she were
alive)?
NUMBER OF YEARS OLD-your best
guess is fine
□ I do not know about my biological mother
Go To 2.9
17
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
How well can you and she share ideas or talk National Survey of Children’s Health (NSCH)
about things that are important to you?
2007, Section 8:
MARK (X) ONE
□ Not at all well
□ Not very well
□ Somewhat well
□ Very well
2.7
Covariate
OMB-approved Baseline #
N/A
Question Source(s)
Tracking
Follow-up Question #
2.6
First Follow-up Question Text
Notes
Again thinking about your biological mother
and all the children she has ever had- how
old is the oldest one? If the oldest one is not
alive, how old would that child be if still
living?
Child Trends created
NUMBER OF YEARS OLD-your best
guess is fine
□ I do not know about my biological mother
18
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
OMB-approved Baseline #
N/A
Question Source(s)
Tracking
Follow-up Question #
2.8
First Follow-up Question Text
Notes
Next we have some questions about your MPR Abstinence Baseline:
father, or the person you think of as your
father. Is this person…
1.20 If you live with your father answer the next
MARK (X) ONE
questions about your father and put a check
□ Your biological father, that is, the man who here
is genetically related to you
□
□
□
□
□
□
Your stepfather or adoptive father
Your foster father
If you don’t live with your father but you see him
a lot, answer the next questions about your
father and put a check here
Your grandfather
If you don’t see your father a lot, is there
someone who lives with you and is like a father
Some other adult
to you? If yes, then move to this section and tell
You don’t have a father or person you think us who that person is.
of as your father
GO TO 2.12a
Stepfather
Foster Father
Grandfather
Uncle
Someone else
Your uncle or your older brother
19
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
OMB-approved Baseline #
2.13
Question Source(s)
Tracking
Follow-up Question #
2.9
First Follow-up Question Text
Notes
The following questions are about the MPR Abstinence Baseline
person you marked as your father or the
person you think of as your father.
1.22 Is he working now?
Is he working now?
MARK (X) ONE
□
□
□
□
□
He is not working at a paid job
Yes, he is working part-time or less than 30
hours a week
0 He is not working at a job
1 Yes, working part-time (less than 30 hours a
week)
2 Yes, working full-time (30 hours a week or
more)
-1 Don’t know
Yes, he is working full-time or at more than
one job for 30 hours a week or more
Yes, he works, but I don’t know how many
hours
Don’t know if he is working
20
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
OMB-approved Baseline #
2.16
Question Source(s)
Tracking
Follow-up Question #
2.10
First Follow-up Question Text
Notes
How well can you and he share ideas or talk National Survey of Children’s Health (NSCH)
about things that are important to you?
2007, Section 8:
MARK (X) ONE
□ Not at all well
□ Not very well
□ Somewhat well
□ Very well
How well can you and *CHILD’S NAME+ share
ideas or talk about things that really matter?
Very Well
Somewhat well
Not very well
Not well at all
21
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
OMB-approved Baseline #
N/A
Question Source(s)
Tracking
Follow-up Question #
2.11
First Follow-up Question Text
Notes
2.2
Which of the following best describes the
relationship between your biological mother
and biological father? If one or both of your
biological parents have passed away, please
answer about their relationship when both
were alive.
MARK (X) ONE
□ They are married to each other
□ They used to be married to each other, but are
now separated
Original source: MPR Abstinence Wave 1
The next questions are about your family and family
rules.
1.25 My parents . . .
MARK (X) ONE
1 _ are married to each other
2 _ are divorced
3 _ are separated
4 _ have never been married to each other
-1 _ I’m not sure
□ They used to be married to each other, but are
now divorced
□ They have never been married to each other
□ I don’t know
22
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
Question Source(s)
Tracking
OMB-approved Baseline #
Follow-up Question #
2.12a
First Follow-up Question Text
Notes
Follow-up items
2.12a and 2.12 b are
both based on
baseline item 2.2:
Which of the following
best describes your
parents’ living
arrangement?
MARK (X) ONE
□ Both of my parents
live together in one
household and they are
married to each other
□ Both of my parents
live together in one
household and they are
not married to each
other
□ My parents live in
different households
and are married to each
other
□ My parents live in
different households
and are not married to
each other
□ I have only one living
parent
Do your biological mother and biological
father live together now?
MARK (X) ONE
□
□
□
□
Yes
No
One or both of my biological parents have
passed away
Original source: MPR Abstinence Wave 1
The next questions are about your family and family
rules.
1.25 My parents . . .
MARK (X) ONE
1 _ are married to each other
2 _ are divorced
3 _ are separated
4 _ have never been married to each other
-1 _ I’m not sure
I don’t know
23
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
Question Source(s)
Tracking
OMB-approved Baseline #
Follow-up Question #
2.12b 2.2
First Follow-up Question Text
Notes
Follow-up items
2.12a and 2.12 b are
based on baseline item
2.2:
Which of the following
best describes your
parents’ living
arrangement?
MARK (X) ONE
□ Both of my parents
live together in one
household and they are
married to each other
□ Both of my parents
live together in one
household and they are
not married to each
other
□ My parents live in
different households
and are married to each
other
□ My parents live in
different households
and are not married to
each other
□ I have only one living
parent
Thinking about the past month, how often
did your parents know where you were after
school?
MARK (X) ONE
□
□
□
□
□
Always
Usually
Sometimes
Rarely
Never
Never
Rarely
Sometimes
Most of the time
Always
24
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
All About Youth, Baseline
The next questions ask about how much your parent
or parents know about what
you do.
apm1. How much do your parents know about who
your friends really are?
apm2. How much do your parents know about where
you are most afternoons after school?
0 = Don't know
1 = Know a little
2 = Know a moderate amount
3 = Know a lot
8 = Refuse to Answer
AND
From Silverberg and Small's Parental Monitoring
Scale
1. My parents know where I am after school
3. I tell my parent(s) who I am going to be with
before I go out.
Implementation Outcome
The next questions ask what your parents
know about your activities. By parents, we
mean the parents or guardians you live with
most of the time.
Covariate
OMB-approved Baseline #
2.21
Question Source(s)
Tracking
Follow-up Question #
2.13
First Follow-up Question Text
Notes
Thinking about the past month, how often All About Youth, Baseline
did your parents know who you were going The next questions ask about how much your parent
or parents know about what
to be with before you went out?
MARK (X) ONE
□
□
□
□
□
□
Always
Usually
Sometimes
Rarely
Never
I did not go out
you do.
apm1. How much do your parents know about who
your friends really are?
apm2. How much do your parents know about where
you are most afternoons after school?
0 = Don't know
1 = Know a little
2 = Know a moderate amount
3 = Know a lot
8 = Refuse to Answer
AND
From Silverberg and Small's Parental Monitoring
Scale
1. My parents know where I am after school
3. I tell my parent(s) who I am going to be with
before I go out.
Never
Rarely
Sometimes
Most of the time
Always
25
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
OMB-approved Baseline #
2.22
Question Source(s)
Tracking
Follow-up Question #
2.14
First Follow-up Question Text
Notes
The baseline used
the word “last”
and the follow up
uses “past”.
Thinking about the past month, how often
did your parents know where you were
when you went out at night?
MARK (X) ONE
□
□
□
□
□
□
Silverberg and Small’s Parental Monitoring Scale
Li X, Stanton B, Feigelman S. Impact of perceived
parental monitoring on adolescent risk behavior
over 4 years. J Adolescent Health 2000;27:49 –
56
Always
Usually
Sometimes
Rarely
Never
I did not go out at night
1. My parents know where I am after school.
2. If I am going to be home late, I am expected
to call my parents.
3. I tell my parent(s) who I am going to be with
before I go out.
4. When I go out at night, my parent(s) knows
where I am.
5. I talk to my parent(s) about the plans I have
with my friends.
6. When I go out, my parent(s) asks me where I
am going.
Answer categories:
1. Never
2. Rarely
3. Sometimes
4. Most of the time
5. Always
26
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
OMB-approved Baseline #
2.23
Question Source(s)
Tracking
Follow-up Question #
2.15
First Follow-up Question Text
Notes
The baseline used
the word “last”
and the follow up
uses “past”.
If you were going to be home late, would
your parents expect you to call?
MARK (X) ONE
□
□
Yes
No
Silverberg and Small’s Parental Monitoring Scale
Li X, Stanton B, Feigelman S. Impact of perceived
parental monitoring on adolescent risk behavior
over 4 years. J Adolescent Health 2000;27:49 –
56
1. My parents know where I am after school.
2. If I am going to be home late, I am expected
to call my parents.
3. I tell my parent(s) who I am going to be with
before I go out.
4. When I go out at night, my parent(s) knows
where I am.
5. I talk to my parent(s) about the plans I have
with my friends.
6. When I go out, my parent(s) asks me where I
am going.
Answer categories:
1. Never
2. Rarely
3. Sometimes
4. Most of the time
5. Always
27
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
OMB-approved Baseline #
2.24
Question Source(s)
Tracking
Follow-up Question #
2.16
First Follow-up Question Text
Notes
3.1
MARK (X) ONE FOR EACH
Strongly Agree, Agree, Disagree, Strongly Disagree
a.
b.
c.
d.
e.
Having sexual intercourse is a good thing
for you to do at your age
At your age right now, having sexual
intercourse would create problems
At your age right now, not having sexual
intercourse is important for you to be safe
and healthy
At your age right now, it is okay for you to
have sexual intercourse if you use birth
control, like a condom
It is against your values to have sexual
intercourse before marriage
ABT Adolescent Interview
DG13. Now I am going to ask about your
views on sexual intercourse. Again, by sexual
intercourse, we mean “going all the way,” the
act by which babies are made. (Please use the
number buttons on your phone to give me
answers, so no one can overhear you.) For
each of the following statements, (tell me) if
you strongly agree, (press 1; if you) somewhat
agree, (press 2; if you) somewhat disagree,
(press 3); or (if you) strongly disagree, (press
4).
a. Having sexual intercourse is a good thing for
you to do at your age.
b. It is against your values for you to have sexual
intercourse before marriage.
i. At your age right now, having sexual
intercourse would create problems or would
make life difficult.
k. At your age right now, it is okay for you to
have sexual intercourse if you use birth
control.
28
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
Question Source(s)
Tracking
OMB-approved Baseline #
Follow-up Question #
3.1
First Follow-up Question Text
The next series of questions is about your views on
sexual intercourse. In this survey, when we ask about
sexual intercourse, we mean a male putting his penis
into a female’s vagina. How strongly do you agree or
disagree that…?
Notes
Definition on the
baseline was as
follows:
The next series of
questions is about
your views on sexual
intercourse. In this
survey, when we ask
about sexual
intercourse, we mean
vaginal sex - when a
male inserts his penis
into a female’s vagina.
MARK (X) ONE FOR EACH
Strongly Agree, Agree, Disagree, Strongly
Disagree
a. You have goals you want to accomplish
before you have a child
b. It is important for you to finish school before
you have a child
c. It is important for you to have a job and
stable income before you have a child
d. Having a good marriage seems possible for
you
From AAY (All About Youth) Study:
Having a good marriage seems realistic to me
Strongly disagree, Disagree, Agree, Strongly
Agree
From Lina:
1. I have goals I want to accomplish before
having kids/becoming a parent.
2. It is important to me to finish school, before
becoming a parent.
3. It is important to me to have a job and be
financially stable before becoming a parent.
29
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Combination of items from AAY and items
developed by Lina Guzman at Child Trends
through interviews with community college
students for a qualitative study on relationships
and birth control use:
Implementation Outcome
How strongly do you agree or disagree with
the following statements?
Covariate
OMB-approved Baseline #
N/A
Question Source(s)
Tracking
Follow-up Question #
3.2
First Follow-up Question Text
Notes
FOR GIRLS
National Survey of Family Growth (NSFG) –
If you got pregnant now, how would you female, Cycle 6, IH.14:
feel?
If you got pregnant now how would you feel?
MARK (X) ONE
Would you be very upset, a little upset, a little
pleased, or very pleased?
Very happy
Very Upset
A little happy
A little Upset
Neither upset nor happy
A little Pleased
A little upset
Very Pleased
Very upset
IF R INSISTS: She wouldn’t care
30
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
OMB-approved Baseline #
3.2
Question Source(s)
Tracking
Follow-up Question #
3.3
First Follow-up Question Text
Notes
FOR BOYS
National Survey of Family Growth (NSFG) –male,
If you got someone pregnant now, how Cycle 6, JG.14:
would you feel?
If you got a female pregnant now how would
MARK (X) ONE
you feel? Would you be very upset, a little
upset, a little pleased, or very pleased?
Very happy
Probe if R says he wouldn’t care
A little happy
Very Upset
Neither upset nor happy
A little Upset
A little upset
A little Pleased
Very upset
Very Pleased
IF R INSISTS: he wouldn’t care
31
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
OMB-approved Baseline #
3.2
Question Source(s)
Tracking
Follow-up Question #
3.4
First Follow-up Question Text
Notes
Imagine you are alone with someone you All About Youth (AAY):
like very much. How likely is it that you
could . . .
For the next questions, tell us how confident you
MARK (X) ONE FOR EACH
are that you can do what is described.
Not at all Likely, a Little Bit likely, Somewhat Imagine you are alone with someone you like
Likely, Very Likely
very much.
a.
b.
c.
Stop them if they wanted to touch your
chest and you did not want them to do that
(FOR GIRLS)
Stop them if they wanted to touch your
private parts below the waist, meaning the
parts of the body covered by underwear,
and you did not want them to do that
Avoid having sexual intercourse if you
didn’t want to
asr2. Could you stop them if they wanted to
touch your chest or breasts, but you did not
want them to do that?
asr3. Could you stop them if they wanted to
touch your private parts below the waist, but
you did not want them to do that?
asr5. Could you stop them if they wanted to
have vaginal sex with you, but you did not want
them to do that?
1 = I definitely could not
2 = I probably could not
3 = I probably could
4 = I definitely could
8 = Refuse to Answer
32
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
OMB-approved Baseline #
3.3
Question Source(s)
Tracking
Follow-up Question #
3.5
First Follow-up Question Text
Notes
How likely is it that you will get pregnant (or
get someone pregnant) between now and
age 20?
Add Health, Wave 1: (modified)
What do you think are the chances that each of
the following things will happen to you?
MARK (X) ONE
□ Not at all likely
□ A little likely
□ Somewhat likely
□ Very likely
3.6a
N/A
How likely is it that you will get pregnant (or
get someone else pregnant) between now
and when you get married?
MARK (X) ONE
□ Not at all likely
□ A little likely
□ Somewhat likely
□ Very likely
12. You will live to age 35. H1EE12
13. You will be married by age 25. H1EE13
14. You will be killed by age 21. H1EE14
15. You will get HIV or AIDS. H1EE15
Add Health, Wave 1: (modified)
What do you think are the chances that each of
the following things will happen to you?
12. You will live to age 35. H1EE12
13. You will be married by age 25. H1EE13
14. You will be killed by age 21. H1EE14
15. You will get HIV or AIDS. H1EE15
33
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
OMB-approved Baseline #
N/A
Question Source(s)
Tracking
Follow-up Question #
3.6
First Follow-up Question Text
Notes
3.7a
3.5a
The next series of questions is
about condoms, birth control pills,
pregnancy and sexually transmitted
diseases, also known as STDs.
MPR Abstinence (Wave 4-V3, female, Section 3)
If a condom is used correctly, how much can
it decrease the risk of pregnancy?
MARK (X) ONE
□ Not at all
□ A little
□ A lot
□ Don’t know
GO TO QUESTION 3.8
a. If a condom is used correctly, it prevents girls
from getting pregnant.
How confident are you that your answer to
the question above is correct?
Add Health, Wave 1 (asked after a series of
sexual knowledge questions)
Not at all confident
A little confident
How confident are you that your answer is
correct?
Somewhat confident
Very confident
34
Other (see notes)
Sexual Risk Outcome
Implementation Outcome
Intermediate Outcome
3.3 Mark the answer that comes closest to what
you think.
MARK (X) ONE
□
□
□
□
Covariate
OMB-approved Baseline #
3.5
Question Source(s)
Tracking
Follow-up Question #
3.7
First Follow-up Question Text
Notes
MARK (X) ONE
□
□
□
□
3.9
3.7
3.3 Mark the answer that comes closest to what
you think.
Not at all
A little
b. If a condom is used correctly, it prevents HIV
A lot
Don’t know
If a condom is used correctly, how much can MPR Abstinence (Wave 4-V3, female, Section 3)
it decrease the risk of getting Chlamydia and
gonorrhea?
3.3 Mark the answer that comes closest to what
MARK (X) ONE
you think.
□
□
□
□
Not at all
A little
A lot
c. If a condom is used correctly, it prevents
Chlamydia and gonorrhea
Don’t know
35
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
MPR Abstinence (Wave 4-V3, female, Section 3)
Implementation Outcome
If a condom is used correctly, how much can
it decrease the risk of getting HIV, the virus
that causes AIDS?
Covariate
OMB-approved Baseline #
3.6
Question Source(s)
Tracking
Follow-up Question #
3.8
First Follow-up Question Text
Notes
If birth control pills are used correctly, how MPR Abstinence (Wave 4-V3, female, Section 3)
much can they decrease the risk of
pregnancy?
Mark the answer that comes closest to what you
think.
MARK (X) ONE
□
□
□
□
3.10a
3.8a
a. If birth control pills are used correctly, they
prevent girls from getting pregnant
Not at all
A little
A lot
Don’t know
GO TO 3.11
How confident are you that your answer to Add Health, Wave 1 (asked after a series of
the question above is correct?
sexual knowledge questions)
MARK (X) ONE
□
□
□
□
Not at all confident
A little confident
How confident are you that your answer is
correct?
Somewhat confident
Very confident
36
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
OMB-approved Baseline #
3.8
Question Source(s)
Tracking
Follow-up Question #
3.10
First Follow-up Question Text
Notes
If birth control pills are used correctly, how MPR Abstinence (Wave 4-V3, female, Section 3)
much can they decrease the risk of getting
HIV, the virus that causes AIDS?
Mark the answer that comes closest to what you
MARK (X) ONE
think.
□
□
□
□
3.12
3.10
A little
A lot
b. If birth control pills are used correctly, they
prevent HIV
Don’t know
Not at all
A little
A lot
c. If birth control pills are used correctly, they
prevent Chlamydia and gonorrhea
Don’t know
37
Other (see notes)
Sexual Risk Outcome
Implementation Outcome
Intermediate Outcome
Not at all
If birth control pills are used correctly, how MPR Abstinence (Wave 4-V3, female, Section 3)
much can they decrease the risk of getting
Chlamydia and gonorrhea?
Mark the answer that comes closest to what you
MARK (X) ONE
think.
□
□
□
□
Covariate
OMB-approved Baseline #
3.9
Question Source(s)
Tracking
Follow-up Question #
3.11
First Follow-up Question Text
Notes
Can you get a sexually transmitted disease, All About Youth (AAY)
or STD, from having oral sex?
MARK (X) ONE
ahk2. For the next questions, read each
□ Yes
statement carefully and then mark if you think it
is True, False, or if you are Not Sure.
□ No
□
3.13a
3.11a
Don’t know
GO TO 3.14
MARK (X) ONE
Not at all confident
A little confident
How confident are you that your answer is
correct?
Somewhat confident
Very confident
38
Other (see notes)
Sexual Risk Outcome
Implementation Outcome
Intermediate Outcome
You cannot get an STD from having oral sex.
AHK2 STD know: std fr OS 1
0 = False
1 = True
2 = Not sure
8 = Refuse to Answer
How confident are you that your answer to Add Health, Wave 1 (asked after a series of
the question above is correct?
sexual knowledge questions)
□
□
□
□
Covariate
OMB-approved Baseline #
3.11
Question Source(s)
Tracking
Follow-up Question #
3.13
First Follow-up Question Text
Notes
Strongly Agree, Agree, Neither agree nor
disagree, Disagree, Strongly Disagree
a. Condoms should always be used if a person
your age has sexual intercourse
b. Condoms are a hassle to use
c. Condoms are pretty easy to get
d. Condoms are important to make sex safer
e. Using condoms means you don’t trust your
partner
f. Using condoms is morally wrong
g. Condoms decrease sexual pleasure
From Add Health:
How much do you agree or disagree with each of the
following statements:
-In general, birth control is too much of a hassle to
use.
NSAM 1995
o Using condoms to prevent the spread of AIDS is
more trouble than it's worth.
o If I used a condom with a female, she might think
that I am worried about getting AIDS or other
diseases from her.
-Agree a lot
-Agree a little
-Disagree a little
-Disagree a lot
39
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
AAY (All About Youth) Study from file AAY Baseline
v1
I believe condoms should always be used if a person
my age has sex.
0 = Strongly disagree
1 = Disagree
Implementation Outcome
The next series of questions is about
condom use. How strongly do you agree or
disagree that…?
MARK (X) ONE FOR EACH
Covariate
OMB-approved Baseline #
N/A
Question Source(s)
Tracking
Follow-up Question #
3.14
First Follow-up Question Text
Notes
Strongly Agree, Agree, Neither agree nor
disagree, Disagree, Strongly Disagree
a. Birth control should always be used if a
person your age has sexual intercourse
b. Birth control is a hassle to use
c. Birth control is pretty easy to get
d. Birth control is important to make sex safer
e. Birth control has too many negative side
effects
f. Using birth control is morally wrong
I would be embarrassed to buy condoms or ask for them.
40
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Combination items developed by Lina Guzman at
Child Trends through interviews with community
college students for a qualitative study on
relationships and birth control use, and items from
Becoming a Responsible Teen for Assisting in
Rehabilitating Kids (BART for ARK), items from Add
Health, and JAMA scales/SiHLE:
From Lina:
Here are some reasons people don’t use birth
control. Please tell us how much you agree with the
following statements.
It is hard to use birth control when you get caught in
the heat of the moment
I tend to have good luck so I don’t have to worry
about getting (someone) pregnant
If you trust someone it is okay not to use a condom
If you don’t have sex often, chances are you won’t
get pregnant
From PROJECT BART FOR THE ARK:
Even if a sex partner insisted, I would not use a
condom.
From Add Health:
It is easy for you to get birth control
From JAMA/SiHLE:
Implementation Outcome
The next series of questions is about other
methods of birth control, NOT including
condoms. How strongly do you agree or
disagree that…?
MARK (X) ONE FOR EACH
Covariate
OMB-approved Baseline #
N/A
Question Source(s)
Tracking
Follow-up Question #
3.15
First Follow-up Question Text
Notes
N/A
MARK (X) ONE FOR EACH
I am sure it’s true, I think it’s true, I don’t know, I
think it’s false, I am sure it’s false
a.
You can’t get AIDS if you have sex only
once or twice without a condom
b. Condoms are 100% effective in preventing
HIV
c. Once you are infected with HIV, you are
infected for life
d. If a young couple has had unprotected sex
a few times and a pregnancy did not
happen, then they do not have to worry
about her getting pregnant
e. There is a vaccine or shot available to
prevent girls from becoming infected with
certain types of HPV (also known as Human
Papilloma virus).
From the Handbook (CDC)
1. You can’t get AIDS if you have sex only once or twice
without a condom.
2. Condoms are 100% effective in preventing HIV.
4. Once you are infected with HIV, you are infected for life.
I am sure it’s true, I think it’s true, I don’t know, I think it’s
false, I am sure it’s false
From Caitlin Wetzel, Abbigail Tissot, Linda M. Kollar, Paula
A. Hillard, Rachel Stone, , and Jessica A. Kahn, “Development
of an HPV Educational Protocol for Adolescents” J Pediatr
Adolesc Gynecol. 2007 October ; 20(5): 281–287
3. There is a vaccine available to prevent girls from
becoming infected with certain types of HPV infection
From NSAM:
If a young couple has had unprotected sex a few times and a
pregnancy did not happen, then they do not have to worry
about her getting pregnant.
I am sure it’s true, I think it’s true, I don’t know, I think it’s
false, I am sure it’s false
41
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Read each statement below and check the
answer that fits best.
Covariate
Question Source(s)
Combination of items from Handbook for Evaluating HIV
Education, the Division of Adolescent and School Health,
CDC, Wetzel, et al, and National Survey of Adolescent Males
(NSAM)
Tracking
OMB-approved Baseline #
Follow-up Question #
3.16
First Follow-up Question Text
Notes
Thinking about the future, how likely do you Add Health, Wave 1
think it is that you will get HIV/AIDS?
MARK (X) ONE
What do you think your chances are of getting
□ Not at all likely
AIDS?
□ A little likely
□ Somewhat likely
□ Very likely
3.18
N/A
How likely do you think it is that you will get Add Health, Wave 1
an STD other than HIV/AIDS?
MARK (X) ONE
What do you think your chances are of getting
□ Not at all likely
another sexually transmitted disease, such as
gonorrhea or genital herpes?
□ A little likely
□ Somewhat likely
□ Very likely
42
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
OMB-approved Baseline #
N/A
Question Source(s)
Tracking
Follow-up Question #
3.17
First Follow-up Question Text
Notes
Do you intend to have oral sex in the next
year?
All About Youth (AAY):
MARK (X) ONE
ain1. Now thinking about the future, how likely
are the following things to happen?
□
□
□
□
Yes, definitely
Yes, probably
No, probably not
No, definitely not
How likely is it that you will have oral sex in the
next year?
AIN1 Intent: OS next year 1
1 = Not at all likely
2 = Not very likely
3 = Somewhat likely
4 = Probably likely
5 = Definitely likely
8 = Refuse to Answer
43
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
OMB-approved Baseline #
3.13
Question Source(s)
Tracking
Follow-up Question #
3.19
First Follow-up Question Text
Notes
Baseline version:
Think about whether
you will have oral sex
in the next year.
Which statement is
most true for you?
MARK (X) ONE
□ You will not have
oral sex in the next
year
□ You probably will
not have oral sex in
the next year
□ You probably will
have oral sex in the
next year
□ You will have oral
sex in the next year
Do you intend to have sexual intercourse in
the next year?
All About Youth (AAY)
MARK (X) ONE
ain2. How likely is it that you will have vaginal
sex in the next year?
AIN2 Intent: VS next year 1
1 = Not at all likely
2 = Not very likely
3 = Somewhat likely
4 = Probably likely
5 = Definitely likely
8 = Refuse to Answer
□
□
□
□
Yes, definitely
Yes, probably
No, probably not
No, definitely not
GO TO 3.23
44
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
OMB-approved Baseline #
3.12
Question Source(s)
Tracking
Follow-up Question #
3.20
First Follow-up Question Text
Notes
Baseline version:
Think about
whether you will
have sexual
intercourse in the
next year. Which
statement is most
true for you?
MARK (X) ONE
□ You will not have
sexual intercourse
in the next year
□ You probably will
not have sexual in
the next year
intercourse
□ You probably will
have sexual
intercourse in the
next year
□ You will have
sexual intercourse
in the next year
If you have sexual intercourse in the next
year, do you intend to you a condom?
Developed as a performance measure.
MARK (X) ONE
□
□
□
□
Yes, definitely
Yes, probably
No, probably not
No, definitely not
45
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
OMB-approved Baseline #
N/A
Question Source(s)
Tracking
Follow-up Question #
3.21
First Follow-up Question Text
Notes
The next question is about your intention to
use other methods of birth control, NOT
including condoms:
•
•
•
•
•
•
•
Developed as a performance measure.
Birth control pills
The shot (Depo Provera)
The patch
The ring (NuvaRing)
IUD (Mirena or Paragard)
Implants (Implanon)
If you have sexual intercourse in the next
year, do you intend to use any of these
other methods of birth control?
MARK (X) ONE
□
□
□
□
Yes, definitely
Yes, probably
No, probably not
No, definitely not
46
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
OMB-approved Baseline #
N/A
Question Source(s)
Tracking
Follow-up Question #
3.22
First Follow-up Question Text
Notes
3.14
Do you intend to have sexual intercourse
without being married?
All About Youth (AAY)
MARK (X) ONE
ain5. How likely is it that you will remain sexually
abstinent from now until marriage?
AIN5 Intent: abs until marriage 1
1 = Not at all likely
2 = Not very likely
3 = Somewhat likely
4 = Probably likely
5 = Definitely likely
8 = Refuse to Answer
□
□
□
□
Yes, definitely
Yes, probably
No, probably not
No, definitely not
47
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
Question Source(s)
Tracking
OMB-approved Baseline #
Follow-up Question #
3.23
First Follow-up Question Text
Notes
Baseline version:
Think about the future
and whether you will
have sexual intercourse
without being married.
Which statement is
most true for you?
MARK (X) ONE
□ You will not have
sexual intercourse
unless you are
married
□ You probably will not
have sexual
intercourse unless
you are married
□ You probably will
have sexual
intercourse without
being married
□ You will have sexual
intercourse without
being married
Right now, do you have a boyfriend or
girlfriend – someone in particular you are
going out with?
MARK (X) ONE
□
□
Yes
No
Add Health, Wave 3
Which of the following best describes your
relationship at the present time?
Dating exclusively
Dating frequently, but not exclusively
Dating once in a while
Only having sex with person
Not in a relationship
48
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
OMB-approved Baseline #
N/A
Question Source(s)
Tracking
Follow-up Question #
3.24
First Follow-up Question Text
Notes
In the past 3 months, how many TIMES have National Longitudinal Study of Youth, 1997
you gone out on a date?
(NLSY97)
□
Zero or None
GO TO 3.27
| | | NUMBER OF TIMES - Your best guess
is fine
R03494.00
Survey Year: 1997
[YSAQ-296]
# DATES R HAD IN PAST YEAR WITH BOYFRIEND
Thinking back over the past year, how often
have you had a date or gone out with someone
of the opposite sex in an unsupervised social
outing?
1 NEVER THIS YEAR; 2 FEW TIMES (1-3 TIMES); 3
LESS THAN ONCE A MONTH (4-11 TIMES); 4
ONCE OR TWICE A MONTH (12-25 TIMES); 5
ONCE A WEEK OR MORE (MORE THAN 50
TIMES); 6 CURRENTLY MARRIED
49
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Question Source(s)
Covariate
OMB-approved Baseline #
3.15
Tracking
Follow-up Question #
3.25
First Follow-up Question Text
Notes
Thinking about these dates in the past 3
months, how many DIFFERENT PEOPLE did
you go out on a date with?
|
| | NUMBER OF PEOPLE - Your best
guess is fine.
From the National Longitudinal Study of Youth,
1997 (NLSY97)
R03495.00
Survey Year: 1997
[YSAQ-297]
# DIFFERENT BOYS DATED IN LAST YEAR
About how many different persons have you had
a date with or gone out with in the past twelve
months, including any current boyfriend you
might have?
0; 1 TO 4; 5 TO 8; 9 TO 14; 15 TO 19; 20 TO 24;
25 TO 29; 30 TO 34; 35 TO 39; 40 TO 44; 45 TO
49; 50 TO 99999999: 50+
3.27
3.17
Have you ever had sexual intercourse, oral
sex, or anal sex?
Developed for the PPA Baseline Survey
□ YES: GO TO PART B1
□ NO: GO TO PART B2
50
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Question Source(s)
Covariate
OMB-approved Baseline #
3.16
Tracking
Follow-up Question #
3.26
First Follow-up Question Text
Notes
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
Question Source(s)
Tracking
OMB-approved Baseline #
Follow-up Question #
First Follow-up Question Text
Notes
PART B: Sections 4 and 5 of Part B will vary based on whether the respondent is sexually active (Part B1) or non-sexually active (Part B2). Items in
Sections 6 and 7 are the same for sexually active and non-sexually active respondents. Items in Sections 4 and 5 for sexually active respondents are
listed below, followed by the items in Sections 4 and 5 for non-sexually active respondents and items in Sections 6 and 7.
4.1
4.1
The next questions are about your sexual Developed for the PPA Baseline Survey
behaviors and experiences. Please be as
honest as possible. Your answers are
confidential and everything you say will be
kept private.
Just to confirm, have you ever had sexual
intercourse, oral sex, or anal sex?
MARK (X) ONE
□ No
□ Yes
STOP AND GO TO PART B2.
CONTINUE WITH THIS BOOKLET.
51
Confirming that
respondents are in
the correct Part B.
The first questions are about sexual
intercourse. By sexual intercourse, we mean
a male putting his penis into a female’s
vagina.
Add Health, Wave 1
Have you ever had sexual intercourse? When we
say sexual intercourse, we mean when a male
inserts his penis into a female’s vagina.
MARK (X) ONE
4.3
4.3
Yes
No
GO TO QUESTION 4.13
The very first time you had sexual
intercourse, what month and year was it?
MARK (X) ONE MONTH AND ONE YEAR
Add Health, Wave 1
In what month [and year] did you have sexual
intercourse for the very first time?
52
Notes
Baseline version
used a slightly
different definition:
The first questions
are about sexual
intercourse. By
sexual intercourse,
we mean when a
male puts his penis
into a female’s
vagina.
Have you ever had sexual intercourse?
□
□
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
OMB-approved Baseline #
4.2
Question Source(s)
Tracking
Follow-up Question #
4.2
First Follow-up Question Text
The very first time you had sexual
intercourse, how old were you?
| | | NUMBER OF YEARS OLD YOU
WERE - Your best guess is fine.
4.5
4.9
4.10
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Notes
How old were you the first time you had vaginal
intercourse?
Have you had sexual intercourse more than National Longitudinal Study of Youth (NLSY)
one time?
R03501.00 YSAQ-303
MARK (X) ONE
Have you had intercourse more than once?
□
□
4.6
Add Health, Wave 1
Covariate
OMB-approved Baseline #
4.4
Question Source(s)
Tracking
Follow-up Question #
4.4
First Follow-up Question Text
Yes
No
GO TO QUESTION 4.7
How many DIFFERENT PEOPLE have you National Longitudinal Study of Youth, 1997
ever had sexual intercourse with, even if (NLSY97)
only one time?
R03504.00 YSAQ-306
How many partners have you EVER had
|
|
| NUMBER OF PEOPLE - Your best intercourse with? This includes any person you
had intercourse with, even if it was only once, or
guess is fine.
if you did not know him or her well?
53
Baseline version:
How many
DIFFERENT PEOPLE
have you ever had
sexual intercourse
with?
The most recent time you had sexual
intercourse, what month and year was it?
MARK (X) ONE MONTH AND ONE YEAR
4.8
4.8
Add Health, Wave 1
a.
b.
c.
d.
e.
f.
Condoms
Birth control pills or the patch
Depo-Provera or other
injectable birth control
NuvaRing or the ring
Withdrawal or pulling out
Another method PRINT OTHER METHOD
USED
R03499.00 [YSAQ-301]
Survey Year: 1997
R USE BIRTH CONTROL FIRST TIME HAD SEX?
Did you or your sexual partner use any birth
control method, or do anything to avoid
pregnancy such as natural family planning, the
FIRST TIME YOU HAD INTERCOURSE?
54
Other (see notes)
Intermediate Outcome
Implementation Outcome
Sexual Risk Outcome
In what month [and year] did you have sexual
intercourse for the very first time?
The most recent time you had sexual National Longitudinal Study of Youth, 1997
intercourse, did you or your partner use …?
(NLSY97)
MARK (X) ONE FOR EACH
YES OR NO
Covariate
OMB-approved Baseline #
N/A
Question Source(s)
Tracking
Follow-up Question #
4.7
First Follow-up Question Text
Notes
Now please think about the past 3 months. From NLSY97 and AAY:
In the past 3 months, how many TIMES have
you had sexual intercourse?
From NLSY97:
R03506.00 YSAQ-308
About HOW MANY TIMES have you had sexual
□ None
GO TO QUESTION 4.13
|
|
| NUMBER OF TIMES - Your best intercourse in the last 12 months?
guess is fine.
4.10
4.13
In the past 3 months, how many TIMES did
you have sexual intercourse without using a
condom?
From AAY:
avs6. During the last 3 months, how many times
have you had vaginal sex?
All About Youth (AAY):
avs7. During the last 3 months, how many times
have you had vaginal sex without using a
□ None
| | | NUMBER OF TIMES - Your best guess condom?
AVS7 VS: times w/o condom (3 mo) 3
is fine.
0 - 990 = range
998 = Refuse to Answer
55
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
OMB-approved Baseline #
4.11
Question Source(s)
Tracking
Follow-up Question #
4.9
First Follow-up Question Text
Notes
Baseline used
“last” and followup uses “past”.
Baseline version:
In the last 3
months, how many
times did you or
your partner use a
condom when you
had sexual
intercourse?
In the past 3 months, of those times you
used a condom during sexual intercourse,
how many times did the condom break or
slip off during sex?
□
None
|
|
fine.
|
NUMBER OF TIMES-
Your best guess is
All About Youth (AAY):
Of those times you used a condom during
vaginal sex in the last three months, how many
total times did the condom break?
Of those times you used a condom during
vaginal sex in the last three months, how many
total times did the condom slip off during sex or
while the male partner was pulling out?
0 – 990 range
56
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
OMB-approved Baseline #
N/A
Question Source(s)
Tracking
Follow-up Question #
4.11
First Follow-up Question Text
Notes
The next question is about your use of the
following methods of birth control:
Condoms
Birth control pills
The shot (Depo Provera)
The patch
The ring (NuvaRing)
IUD (Mirena or Paragard)
Implants (Implanon)
NLSY97
R03508.00
Survey Year: 1997
Thinking about ALL THE TIMES that you have had
sexual intercourse in the last 12 months, how
many of those times did you or your sexual
partner or partners use a method of birth
In the past 3 months, how many TIMES have you
control?
0 (Go To R03511.00); 1 TO 4; 5 TO 8; 9 TO 14;
15 TO 19; 20 TO 24; 25 TO 29; 30 TO 34; 35 TO
□None
NUMBER OF TIMES – Your best guess is 39; 40 TO 44; 45 TO 49; 50 TO 99999999: 50+
fine.
57
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Notes
Baseline version:
[YSAQ-310]
# TIMES R USED BIRTH CONTROL IN LAST YEAR
had sexual intercourse without using any of
these methods of birth control?
Implementation Outcome
Question Source(s)
Covariate
OMB-approved Baseline #
4.12
Tracking
Follow-up Question #
4.12
First Follow-up Question Text
In the last 3
months, how many
times did you use
any type of birth
control when you
had sexual
intercourse,
including condoms
or any other
method?
□
Zero or None
| | | NUMBER
OF TIMES - Your best
guess is fine
Toledo Adolescent Relationship Study (TARS):
In the past 12 months, how often have you Sometimes people have sex with a person they
had a relationship that was just sexual?
are not actually dating, such as a friend, former
boyfriend or girlfriend, or someone they just
MARK (X) ONE
met. How often have you:
□
□
□
Never
Once
More than once
Had a relationship that was strictly sexual?
(Never, 1-2 times, 3 or 4 times, 5 or more times)
58
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Now please think about the past 12 months.
Implementation Outcome
N/A
Covariate
OMB-approved Baseline #
4.13
Question Source(s)
Tracking
Follow-up Question #
First Follow-up Question Text
Notes
Oral sex is when someone puts
his or her mouth on another person’s
penis or vagina, OR lets someone else
put his or her mouth on their penis or
vagina.
Have you ever had oral sex?
MARK (X) ONE
□
□
4.15
4.15
All About Youth (AAY)
aos1. These next questions are about oral sex.
By oral sex we mean when someone puts his or
her mouth on their partner's penis or vagina, or
lets their partner put his or her mouth on their
penis or vagina. The questions are very personal.
Remember all of your answers are kept private.
Yes
Have you ever had oral sex?
AORAL OS: ever had oral sex 1
0 = No
1 = Yes
8 = Refuse to Answer
The very first time you had oral sex, what Add Health, Wave 1:
month and year was it?
In what [month and] year did you have sexual
MARK (X) ONE MONTH AND ONE YEAR
intercourse for the very first time?
No
GO TO QUESTION 4.19
59
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
OMB-approved Baseline #
4.14
Question Source(s)
Tracking
Follow-up Question #
4.14
First Follow-up Question Text
Notes
How many DIFFERENT PEOPLE have you
ever had oral sex with, even if only one
time?
All About Youth (AAY):
Now please think about the past 3 months.
All About Youth (AAY):
aos3. How many different boys or girls have you
had oral sex with in your life?
|
|
| NUMBER OF PEOPLE - Your best AOS3 OS: # of partners 3
guess is fine.
0 - 990 = range
998 = Refuse to Answer
4.17
4.17
In the past 3 months, how many TIMES have aos4. During the last 3 months, how many times
you had oral sex?
have you had oral sex?
AOS3MO OS: times in past 3 months 3
□ None GO TO QUESTION 4.19
| | | NUMBER OF TIMES - Your best guess 0 - 990 = range
998 = Refuse to Answer
is fine.
60
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
OMB-approved Baseline #
4.16
Question Source(s)
Tracking
Follow-up Question #
4.16
First Follow-up Question Text
Notes
The recall period
may change from
“ever” to the last
12 months, 6
months, or 3
months, depending
on the length of
time between the
baseline and
follow-up.
The recall period
may change to the
last 12 months or 6
months, depending
on the length of
time between the
baseline and
follow-up.
“Last” was used in
the baseline
instead of “past”
In the past 3 months, how many TIMES All About Youth (AAY):
have you had oral sex without using a
avs7. During the last 3 months, how many times
condom?
have you had vaginal sex without using a
condom?
□ None
AVS7 VS: times w/o condom (3 mo) 3
| | | NUMBER OF TIMES – Your 0 - 990 = range
best guess is fine.
998 = Refuse to Answer
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
OMB-approved Baseline #
4.18
Question Source(s)
Tracking
Follow-up Question #
4.18
First Follow-up Question Text
Notes
The recall period
may change to the
last 12 months or 6
months, depending
on the length of
time between the
baseline and
follow-up.
Baseline version:
In the last 3
months, how many
TIMES did you or
your partner use a
condom when you
had oral sex?
□
|
None
| | NUMBER
OF TIMES - Your best
guess is fine.
61
Anal sex is when a male puts his penis in All About Youth (AAY):
someone else’s anus, or their butt, or
someone lets a male put his penis in their aas1. The next questions are about anal sex. By
anus or butt.
anal sex we mean when a boy puts his penis in
his partner's anus (that is, their butt). The
Have you ever had anal sex?
questions are very personal. Remember all of
your answers are kept private.
MARK (X) ONE
□
□
4.20
4.20
Yes
No
GO TO QUESTION 5.1
How many DIFFERENT PEOPLE have you
ever had anal sex with, even if only one
time?
Have you ever had anal sex?
AANAL Anal sex: ever 1
0 = No
1 = Yes
8 = Refuse to Answer
All About Youth (AAY):
aas5. How many different boys or girls have you
had anal sex with in your life?
|
|
| NUMBER OF PEOPLE - Your best AAS5 AS: # of partners 3
guess is fine.
0 - 990 = range
998 = Refuse to Answer
62
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
OMB-approved Baseline #
4.19
Question Source(s)
Tracking
Follow-up Question #
4.19
First Follow-up Question Text
Notes
In the past 3 months, how many TIMES have aas6. During the last 3 months, how many times
you had anal sex?
have you had anal sex?
□
AAS3MO AS: # times past 3 mo 3
GO TO 5.1
0 - 990 = range
| | |
NUMBER OF TIMES – Your
998 = Refuse to Answer
best guess is fine.
None
63
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
4.21
Implementation Outcome
4.22
The very first time you had anal sex, what All About Youth (AAY):
month and year was it?
aas2. How old were you the first time you had
anal sex?
AASAGE AS: age of init 2
MARK (X) ONE MONTH AND ONE YEAR
0 - 17 = range
98 = Refuse to Answer
Now please think about the past 3 months.
All About Youth (AAY):
Covariate
OMB-approved Baseline #
N/A
Question Source(s)
Tracking
Follow-up Question #
4.21
First Follow-up Question Text
Notes
Baseline uses “last”
and follow-up uses
“past”.
In the past 3 months, how many TIMES have
you had anal sex without using a condom?
□
None
|
|
is fine.
All About Youth (AAY) :
aas8. During the last 3 months, how many times
| NUMBER OF TIMES - Your best guess did you have anal sex without using a condom?
AAS8 AS: # times no condom past 3 mo 3
0 - 990 = range
998 = Refuse to Answer
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
OMB-approved Baseline #
4.22
Question Source(s)
Tracking
Follow-up Question #
4.23
First Follow-up Question Text
Notes
Baseline version:
In the last 3
months, how many
times did you or
your partner use a
condom when you
had anal sex?
□
None
| | | NUMBER
OF TIMES - Your best
guess is fine.
5.1
N/A
Have you or your partner ever taken a
pregnancy test?
Developed by the team for the first follow-up
questionnaire.
MARK (X) ONE
□
□
□
Yes
No
Don’t Know
64
To the best of your knowledge, have you Prevention Minimum Evaluation Data Set
ever been pregnant or gotten someone (PMEDS) by Sociometrics 3rd edition, 1999, P.40
pregnant, even if no child was born?
Part B, Section 4
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
OMB-approved Baseline #
4.25b
Question Source(s)
Tracking
Follow-up Question #
5.2a
First Follow-up Question Text
Notes
Item 5.2a was split
for boys and girls
on the baseline:
MARK (X) ONE
□
□
Yes
No
GO TO QUESTION 5.3
Have you ever been pregnant? Be sure to
answer yes if you are currently pregnant or have
had any past pregnancy that ended in a birth, an
abortion, stillbirth, miscarriage, or a live birth
after which the baby died.
Yes
No
National Survey of Family Growth (NSFG) –
male, Cycle 6, KD.1
To the best of your knowledge, have you ever
made someone pregnant?
65
FOR GIRLS ONLY-- To
the best of your
knowledge, have you
ever been pregnant,
even if no child was
born?
FOR BOYS ONLY –
GIRLS
GO
TO
QUESTION 5.3
To the best of your
knowledge, have you
ever gotten someone
pregnant, even if no
child was born?
To the best of your knowledge, how many Prevention Minimum Evaluation Data Set
times have you been pregnant or gotten (PMEDS) by Sociometrics 3rd edition, 1999, P. 41
someone pregnant?
Part B, Section 4
|
5.2c
N/A
|
| NUMBER OF TIMES
|
How old were you when you had your first
pregnancy?
______ years old
66
Other (see notes)
Intermediate Outcome
Implementation Outcome
Sexual Risk Outcome
Altogether, how many times have you been
pregnant?
_____ times
How old were you the first time you got Prevention Minimum Evaluation Data Set
pregnant or got someone pregnant?
(PMEDS) by Sociometrics 3rd edition, 1999, P. 43
Part B, Section 4:
| | NUMBER OF YEARS OLD YOU WERE Your best guess is fine.
Covariate
OMB-approved Baseline #
N/A
Question Source(s)
Tracking
Follow-up Question #
5.2b
First Follow-up Question Text
Notes
Have you ever had a baby or has anyone you Developed by the PPA team.
got pregnant actually had the baby?
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
OMB-approved Baseline #
N/A
Question Source(s)
Tracking
Follow-up Question #
5.2d
First Follow-up Question Text
Notes
MARK (X) ONE
□
□
□
5.3
4.26
B1;
4.19
B2
Yes
No
Don’t Know
In the past 12 months, have you spoken with From NSFG - male , Cycle 6:
a doctor or nurse about sex, birth control or
sexually transmitted diseases, also known as (In the past 12 months, have you...) Received
advice or counseling from a doctor or other
STDs?
MARK (X) ONE
medical care provider about using methods of
birth control, including condoms?
□ Yes
□
No
Yes .............1
No ..............5
67
Baseline uses “last”
and follow-up uses
“past”.
□
□
Yes
No
0 = No
1 = Yes
68
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
4.28
in B1
Implementation Outcome
5.5
In the past 12 months, have you been tested National Survey of Family Growth (NSFG) –
by a doctor or nurse for a sexually female:
transmitted disease (also known as an STD),
like gonorrhea, Chlamydia, syphilis, or HIV?
STDTST12
MARK (X) ONE
JH-4. In the last 12 months, that is, since
□ Yes
(INTERVIEW MONTH, 2001), have you
been tested by a doctor or other medical care
□ No
provider for a sexually
transmitted disease like gonorrhea, chlamydia,
herpes, or syphilis?
Yes ............1
No .............5
In the past 12 months, have you been told AAY (All About Youth) Study Baseline v1
by a doctor or nurse that you had a sexually
transmitted disease (also known as an STD)? Have you ever been told by a doctor or other
MARK (X) ONE
health professional you had an STD?
Covariate
OMB-approved Baseline #
4.27
Question Source(s)
Tracking
Follow-up Question #
5.4
First Follow-up Question Text
Notes
Baseline uses “last”
and follow-up uses
“past”.
Baseline uses “last”
and follow-up uses
“past”.
4.29
in B1
The next series of questions is about the AAY (All About Youth) Study Baseline v1
types of sexually transmitted diseases (STDs)
you have had. In the past 12 months, did st6. What did you have? Please choose all that
you have…
apply.
MARK (X) ONE FOR EACH
0 = No
1 = Yes
Yes, No, Don’t know
a.
b.
c.
d.
e.
f.
g.
Chlamydia
Gonorrhea
Genital herpes
Syphilis
HIV infection or AIDS
Human Papilloma virus, also called HPV
or genital warts
Another sexually transmitted disease
(STD)? PRINT OTHER STD
AST6A STD list: Chlamydia
AST6B STD list: Genital herpes
AST6C STD list: Genital Human Papillomavirus
(HPV) or genital warts
AST6D STD list: Gonorrhea
AST6E STD list: HIV
Part B2: For non-sexually active respondents (Sections 4 and 5).
69
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
Question Source(s)
Tracking
OMB-approved Baseline #
Follow-up Question #
5.6
First Follow-up Question Text
Notes
Baseline used
“last” instead of
“past”
This booklet is for youth who have not had Developed for the PPA Baseline Survey
sex. We want to be sure you are in the
correct booklet. We know we have asked
this before but…
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
OMB-approved Baseline #
4.1
Question Source(s)
Tracking
Follow-up Question #
4.1
First Follow-up Question Text
Notes
Confirming that
respondents are in
the correct Part B.
Main value is to
maintain similarity
in appearance of
the first page of
the sexually active
and non-sexually
active versions.
Just to confirm, have you ever had sexual
intercourse, oral sex, or anal sex?
□ Yes
□ Yes
4.2
4.2
STOP! GO TO PART B1 INSTEAD.
CONTINUE WITH THIS BOOKLET.
The first two questions in this part are about
your schooling.
Developed for the PPA Baseline Survey
Do you expect that you will graduate from
high school?
Mark (X) ONE
□ Yes
□ I already graduated from high school
□ No GO TO QUESTION 4.4
70
In what month and year do you expect to
graduate from high school? If you already
graduated, in what month and year did you
graduate from high school?
Developed for the PPA Baseline Survey
MARK (X) ONE MONTH AND ONE YEAR
Year Range 2007 or earlier to 2018 or later
Month Range January to December
71
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
OMB-approved Baseline #
4.3
Question Source(s)
Tracking
Follow-up Question #
4.3
First Follow-up Question Text
Notes
Main value is to
maintain similarity
in the appearance
of the first page of
the sexually active
and non-sexually
active versions.
4.13
MARK (X) ONE FOR EACH QUESTION
VERY IMPORTANT, SOMEWHAT IMPORTANT, NOT
TOO IMPORTANT, NOT AT ALL IMPORTANT
a. I don’t want to get a sexually transmitted disease,
also known as an STD
b. I don’t want to disappoint my parents
c. I am too young to have sex
d. My boyfriend or girlfriend doesn’t want to have sex
e. I want to wait until I’m married
f. It is against my personal values
g. I haven’t met the right person yet
h. I haven’t had the chance
i. I don’t want to
j. FOR GIRLS I do not want to get pregnant
k. FOR BOYS I do not want to get a girl pregnant
What is the major reason for your decision to wait to
have sex? - Check all that apply
Worried about pregnancy
Worried about HIV/AIDS
Worried about STDs
Worried about what parents might think
Because of what you learned in sex education
You haven’t met the right person
Feel you are too young
Concern for your reputation
Your partner is not ready
You don’t have access to birth control or condoms
You have not had the opportunity
Because of your religion or moral beliefs
None of your friends are doing it
I could get hurt emotionally (Child Tends question)
72
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Kaiser Family Foundation: SexSmarts (a series of
national surveys of teens about sex, virginity, and the
first time) 2000, 2003
Covariate
Question Source(s)
Tracking
OMB-approved Baseline #
Follow-up Question #
4.4
First Follow-up Question Text
Here are some reasons people your age might choose
NOT to have sexual intercourse. How important is
each of these reasons to YOU?
Notes
Baseline version:
There are many reasons a
person your age might not
have had sexual
intercourse. Which of
these reasons, if any, are
reasons why you have not
had sexual intercourse?
Mark (X) ONE FOR EACH
QUESTION
Yes, a reason for me; No,
not a reason for me
f. I do not want to ruin my
reputation
g. I do not have access to
birth control or condoms
h. Because of my religion
or moral values
i. I could get hurt
emotionally
l. FOR BOYS I do not want
to get someone pregnant
4.6
N/A
□
□
Yes
No
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Kaiser Family Foundation: SexSmarts (a series of
national surveys of teens about sex, virginity, and the
first time) 2003
Implementation Outcome
What do you think are the benefits of waiting to
have sexual intercourse?
Strongly Agree, Agree, Disagree, Strongly
Disagree
Mark (X) ONE FOR EACH QUESTION
a. Respect for yourself
b. Respect from parents
c. Keeping true to religious values
d. Respect from friends
e. Not having to worry about pregnancy
f. Not having to worry about sexually transmitted
diseases, also known as STDs
g. Better chance for a good marriage in the
future
h. Fewer distractions so you can focus on school
work
Do people need religion to have good values?
Mark (X) ONE
Covariate
OMB-approved Baseline #
N/A
Question Source(s)
Tracking
Follow-up Question #
4.5
First Follow-up Question Text
Additional
Information on
youth who remain
abstinent
(for possible
descriptive
analysis)
Additional
Information on
youth who remain
abstinent
(for possible
descriptive
analysis)
What do you think are the benefits for waiting to
have sex?
Respect for yourself
Stay in control of your relationship
Respect from parents
Keeping true to religious values
Respect from friends
Don’t have to worry about pregnancy or
STDs
One less thing to worry about
NLSY 97
I don’t need religion to have good values.
Yes
No
73
Notes
Should religious teachings be obeyed in every
situation?
Mark (X) ONE
□
□
4.8
4.9
N/A
N/A
Yes
No
National Survey of Children’s Health (NSCH)
□
□
I pray more than once per day.
Do you think it’s embarrassing for people your
age to admit they are virgins?
Mark (X) ONE
□
Yes
□ No
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Yes
No
National Survey of Children’s Health (NSCH)
No
The Bible/Koran/Torah/religious teachings should be
obeyed in every situation.
Do you pray every day?
Mark (X) ONE
Yes
Covariate
OMB-approved Baseline #
N/A
Question Source(s)
Tracking
Follow-up Question #
4.7
First Follow-up Question Text
Yes
No
National Campaign, Voices Heard 2007
Do you think it’s embarrassing for teens to admit
they are virgins?
Yes
No
74
Notes
Additional
Information on
youth who remain
abstinent
(for possible
descriptive
analysis)
Additional
Information on
youth who remain
abstinent
(for possible
descriptive
analysis)
Additional
Information on
youth who remain
abstinent
(for possible
descriptive
analysis)
MARK (X) ONE
□
Very important
□
Not too important
□
Not important at all
Other (see notes)
In the group you hang out with, how important is
it to have a girlfriend or boyfriend or to be going
out with someone?
Sexual Risk Outcome
N/A
Intermediate Outcome
4.11
Implementation Outcome
Do you think it’s embarrassing for girls your age
to get pregnant?
Mark (X) ONE
□
Yes
□ No
Covariate
OMB-approved Baseline #
N/A
Question Source(s)
Tracking
Follow-up Question #
4.10
First Follow-up Question Text
Kaiser Family Foundation’s National Survey of Teens,
1998
In the group you hang out with, how important is it
to have a (girlfriend or boyfriend/ boyfriend or
girlfriend) or be going out with someone? Is it .
o
o
o
o
o
Very important
Not too important
Not important at all
Don't know
Refused
75
Notes
Additional
Information on
youth who remain
abstinent
(for possible
descriptive
analysis)
Additional
Information on
youth who remain
abstinent
(for possible
descriptive
analysis)
The next few questions are about your Kaiser Family Foundation’s Generation M: Media in
access to and use of TV, cell phones, the Lives of 8–18 Year-Olds study
computers and other forms of technology.
Which of the following items do you, personally,
have? (MARK AS MANY ANSWERS AS YOU NEED)
Do you personally have a phone, computer,
or other device that can connect to the o
internet?
o
Mark (X) ONE
□
□
Yes
No
o
o
o
o
o
o
o
Cell phone
A laptop computer
A handheld videogame player (such as
Nintendo DS or Sony PSP)
iPod or other MP3 player
Discman or Walkman
Pager
A personal digital assistant (such as a Palm Pilot
or Handspring)
Any handheld device that connects to the
Internet (a Blackberry, a cell phone with
Internet connection, etc.)
None of these
76
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
OMB-approved Baseline #
N/A
Question Source(s)
Tracking
Follow-up Question #
4.12
First Follow-up Question Text
Notes
Additional
Information on
youth who remain
abstinent
(for possible
descriptive
analysis)
Do your parents have any rules about…?
Kaiser Family Foundation’s Generation M: Media in
the Lives of 8–18 Year-Olds study
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
OMB-approved Baseline #
N/A
Question Source(s)
Tracking
Follow-up Question #
4.13
First Follow-up Question Text
Additional
Information on
youth who remain
abstinent
(for possible
descriptive
analysis)
Additional
Information on
youth who remain
abstinent
(for possible
descriptive
analysis)
MARK (X) ONE FOR EACH
Do your parents have any rules about...?
Yes, No, Not Applicable
a. The amount of time or when you can text, talk
on the phone, watch TV or be on the computer?
c. Whether or not you can have a profile on a
social networking site like MySpace or Facebook
4.14
N/A
Do your parents have any rules about what
you are allowed to watch on TV?
Mark (X) ONE
□
□
Yes
No
(MARK ONE ANSWER NEXT TO EACH ITEM)
Yes No
o
o
o
How many text messages you can send
How late at night you can talk on a cell phone
Whether or not you can have a profile on a
social networking site like MySpace and
Facebook
Kaiser Family Foundation’s Generation M: Media in
the Lives of 8–18 Year-Olds study
Do your parents have any rules about...?
(MARK ONE ANSWER NEXT TO EACH ITEM)
Yes No
o
Notes
What you’re allowed to watch on TV
77
Do your parents have any rules about what
sites you can access on the internet?
Mark (X) ONE
□
□
Yes
No
Kaiser Family Foundation’s Generation M: Media in
the Lives of 8–18 Year-Olds study
Do your parents have any rules about...?
(MARK ONE ANSWER NEXT TO EACH ITEM)
Yes No
o What you’re allowed to do on the
computer
78
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
OMB-approved Baseline #
N/A
Question Source(s)
Tracking
Follow-up Question #
4.15
First Follow-up Question Text
Notes
Additional
Information on
youth who remain
abstinent
(for possible
descriptive
analysis)
The National Campaign, Sex and Technology Survey,
Some people exchange sexy text messages,
2008
videos, or pictures of themselves or their
friends. How common would you say each of
How common would you say each of the following is
the following is among people your age?
among people your age?
MARK (X) ONE FOR EACH
Not Common at all, Not very Common, Fairly
Common, Very Common
a. Sending or posting sexy text messages
b. Sending or posting sexy pictures or video
Not Common At All, Not Very, Common, Fairly
Common, Very Common
Sending sexy messages to someone else
Sharing sexy messages with people other than
the one(s) they were meant for
Sending of sexy pictures/video of oneself to
someone else
Posting sexy pictures/video of oneself online
Sharing sexy pictures/video with people other
than the one(s) they were meant for
79
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
OMB-approved Baseline #
N/A
Question Source(s)
Tracking
Follow-up Question #
4.16
First Follow-up Question Text
Notes
Additional
Information on
youth who remain
abstinent
(for possible
descriptive
analysis)
□
□
Yes
No
GO TO QUESTION 4.19
What are the reasons that you’ve sent/posted
suggestive messages or nude/semi-nude
pictures/videos (of yourself)?
o
Please think about any/all of those you’ve ever
sent/posted and mark all that apply.
o Get a guy/girl’s attention
Pressured to send it
o As a “sexy” present for a boyfriend/girlfriend
o To feel sexy
o Get a guy/girl to like me
o As a joke
o To get positive feedback To be fun/ flirtatious
o To get noticed
o In response to one that was sent to me
o Other: ___________________________
o Don’t know
80
Other (see notes)
{ASKED IF SENT OR POSTED SEXY MESSAGES OR
PIX/VIDEO TO SOMEONE}
Sexual Risk Outcome
MARK (X) ONE
Intermediate Outcome
The National Campaign, Sex and Technology Survey,
2008
Implementation Outcome
Have you ever sent or posted a sexy message,
picture, or video of yourself by email, IM or text?
Covariate
OMB-approved Baseline #
N/A
Question Source(s)
Tracking
Follow-up Question #
4.17
First Follow-up Question Text
Notes
Additional
Information on
youth who remain
abstinent
(for possible
descriptive
analysis)
Which of the following reasons did you have for
sending or posting a sexy message, picture or
video of yourself?
MARK (X) ONE FOR EACH
Yes, No
a. To get or keep a guy’s or girl’s attention
b. Your boyfriend/girlfriend pressured you to do
it
c. As a “sexy” present for a boyfriend or
girlfriend
d. To get back at someone or cause trouble o
e. Pressure from friends
f. To be fun or to flirt
g. Everybody does it
h. Another reason? PRINT REASON
The National Campaign, Sex and Technology Survey,
2008
{ASKED IF SENT OR POSTED SEXY MESSAGES OR
PIX/VIDEO TO SOMEONE}
What are the reasons that you’ve sent/posted
suggestive messages or nude/semi-nude
pictures/videos (of yourself)?
Please think about any/all of those you’ve ever
sent/posted and mark all that apply.
o Get a guy/girl’s attention
Pressured to send it
o As a “sexy” present for a boyfriend/girlfriend
o To feel sexy
o Get a guy/girl to like me
o As a joke
o To get positive feedback To be fun/ flirtatious
o To get noticed
o In response to one that was sent to me
o Other: ___________________________
o Don’t know
81
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
OMB-approved Baseline #
N/A
Question Source(s)
Tracking
Follow-up Question #
4.18
First Follow-up Question Text
Notes
Additional
Information on
youth who remain
abstinent
(for possible
descriptive
analysis)
Have you ever received a sexy text message, or a
picture or video of someone you know?
The National Campaign, Sex and Technology Survey,
2008
MARK (X) ONE
□
□
Yes
No
GO TO QUESTION 5.1
Which of the following, if any have personally ever
done? Please mark all that apply.
o
o
o
o
o
Sent a sexually suggestive message to
someone (email, IM, text, etc.)
Posted a sexually suggestive message to
someone’s online profile (like on MySpace,
Facebook, etc.)
NET sent/posted sexually suggestive
messages
Received a sexually suggestive message
from someone
Had a sexually suggestive message shared
with me
82
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
OMB-approved Baseline #
N/A
Question Source(s)
Tracking
Follow-up Question #
4.19
First Follow-up Question Text
Notes
Additional
Information on
youth who remain
abstinent
(for possible
descriptive
analysis)
Have you ever shared or forwarded a sexy text
message, or picture or video of someone you
know?
The National Campaign, Sex and Technology Survey,
2008
MARK (X) ONE
Yes
Which of the following, if any have personally ever
done? Please mark all that apply.
No
o
□
□
Shared a sexually suggestive with someone
other than the one it was meant for
83
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
OMB-approved Baseline #
N/A
Question Source(s)
Tracking
Follow-up Question #
4.20
First Follow-up Question Text
Notes
Additional
Information on
youth who remain
abstinent
(for possible
descriptive
analysis)
The next few questions ask about your
community.
How often do you feel that there are teachers or
other adults in your school who really know you
and care about you?
MARK (X) ONE
□
□
□
□
Never
Sometimes
Every Child, Every Promise /America’s Promise:
How often do you feel teachers and other adults in
your school really know you and care about you?
Would you say…
Never
Sometimes
Often
Very often
Often
Very often
84
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
OMB-approved Baseline #
N/A
Question Source(s)
Tracking
Follow-up Question #
5.1
First Follow-up Question Text
Notes
Additional
Information on
youth who remain
abstinent
(for possible
descriptive
analysis)
How often do you feel there are adults in your
neighborhood, or in religious or youth
organizations, who really know you and care
about you?
Every Child, Every Promise /America’s Promise:
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
OMB-approved Baseline #
N/A
Question Source(s)
Tracking
Follow-up Question #
5.2
First Follow-up Question Text
Additional
Information on
youth who remain
abstinent
(for possible
descriptive
analysis)
Additional
Information on
youth who remain
abstinent
(for possible
descriptive
analysis)
How often do you feel the adults from your
neighborhood or religious or youth organizations
really know you and care about you?
MARK (X) ONE
□
□
□
□
5.3
N/A
Never
Sometimes
Often
Never
Sometimes
Often
Very often
Very often
How often do you feel safe in your community or
neighborhood?
MARK (X) ONE
□
□
□
□
Notes
National Survey of Children’s Health (NSCH) 2003
How often do you feel [CHILD] is safe in your
community or neighborhood?
Never
Sometimes
Usually
Always
85
How often do you feel safe at school?
National Survey of Children’s Health (NSCH) 2003
MARK (X) ONE
How often do you feel he/she is safe at school?
□
□
□
□
5.5
N/A
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Notes
Additional
Information on
youth who remain
abstinent
(for possible
descriptive
analysis)
Additional
Information on
youth who remain
abstinent
(for possible
descriptive
analysis)
Never
Sometimes
Usually
Always
How often do you feel safe at home?
National Survey of Children’s Health (NSCH) 2003
MARK (X) ONE
How often do you feel he/she is safe at home?
□
□
□
□
Covariate
OMB-approved Baseline #
N/A
Question Source(s)
Tracking
Follow-up Question #
5.4
First Follow-up Question Text
Never
Sometimes
Usually
Always
86
During the past 12 months, were you on a sports
team or did you take sports lessons after school
or on weekends?
MARK (X) ONE
□
□
5.7
N/A
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
National Survey of Children’s Health (NSCH)
During the past 12 months, was *CHILD’S NAME+ on a
sports team or did he/she take sports lessons after
school or on weekends?
Yes
No
During the past 12 months, did you participate in
any clubs or organizations after school or on
weekends, such as Scouts, a religious group, or
Boy’s/Girl’s Club?
MARK (X) ONE
□
□
Covariate
OMB-approved Baseline #
N/A
Question Source(s)
Tracking
Follow-up Question #
5.6
First Follow-up Question Text
National Survey of Children’s Health (NSCH)
During the past 12 months, did he/she participate in
any clubs or organizations after school or on
weekends, such as Scouts, a religious group, or
Boy/Girl’s Club?
Yes
No
Part B: For sexually active and non-sexually active respondents (Sections 6 and 7).
87
Notes
Additional
Information on
youth who remain
abstinent
(for possible
descriptive
analysis)
Additional
Information on
youth who remain
abstinent
(for possible
descriptive
analysis)
During the past 30 days, not including any R03585.00
[YSAQ-365]
times you just had a sip, on how many days Survey Year: 1997
did you have one or more alcoholic
beverages?
# DAYS R DRINK ALCOHOL LAST 30 DAYS
MARK (X) ONE
□
□
□
□
More than 25 days
5 to 25 days
1 to 4 days
0 (zero) days
GO TO QUESTION 6.4
During the last 30 days, on how many days did
you have one or more drinks of an alcoholic
beverage?
0; 1 TO 4; 5 TO 9; 10 TO 14; 15 TO 19; 20 TO 24;
25 TO 29; 30
88
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
NLSY 1997 combined with National Survey on
Drug Use and Health (NSDUH) - answer choices
are based on NSDUH:
Implementation Outcome
The next questions are about alcohol and
drug use. Please remember, everything you
tell us will be kept private.
Covariate
OMB-approved Baseline #
5.6
Question Source(s)
Tracking
Follow-up Question #
6.1
First Follow-up Question Text
Notes
Baseline uses “last”
and follow-up uses
“past”.
During the past 30 days, on how many days NLSY 1997 combined with National Survey on
did you have 5 or more drinks in a row?
Drug Use and Health (NSDUH) - answer choices
are based on NSDUH:
MARK (X) ONE
□
□
□
□
More than 25 days
5 to 25 days
1 to 4 days
0 (zero) days
R03587.00
Survey Year: 1997
[YSAQ-367]
# DAYS R HAD 5+ DRINKS PER DAY LAST 30 DAYS
On how many days did you have five or more
drinks on the same occasion during the past 30
days? By occasion we mean at the same time or
within hours of each other.
0; 1 TO 4; 5 TO 9; 10 TO 14; 15 TO 19; 20 TO 24;
25 TO 29; 30
89
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Question Source(s)
Covariate
OMB-approved Baseline #
5.7
Tracking
Follow-up Question #
6.2
First Follow-up Question Text
Notes
Baseline uses “last”
and follow-up uses
“past”.
During the past 30 days, on how many days Developed by the PPA team for the First Followdid you get drunk or wasted?
up Survey.
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Question Source(s)
Covariate
OMB-approved Baseline #
N/A
Tracking
Follow-up Question #
6.3
First Follow-up Question Text
Notes
MARK (X) ONE
□
□
□
□
6.4
5.9
More than 25 days
5 to 25 days
1 to 4 days
0 (zero) days
During the past 30 days, on how many days
did you use marijuana, also called weed or
pot?
NLSY 1997 combined with National Survey on
Drug Use and Health (NSDUH) - answer choices
are based on NSDUH:
MARK (X) ONE
R03591.00
Survey Year: 1997
□
□
□
□
More than 25 days
5 to 25 days
1 to 4 days
0 (zero) days
[YSAQ-371]
# DAYS USE MARIJUANA IN LAST 30 DAYS?
On how many days have you used marijuana in
the last 30 days?
0; 1 TO 4; 5 TO 9; 10 TO 14; 15 TO 19; 20 TO 24;
25 TO 29; 30
90
Baseline uses “last”
and follow-up uses
“past”.
7.1
5.10,
5.11,
and
5.12
6.4
Have you ever used any other type of illegal
drug, prescription drugs, or an inhalant that
were not prescribed for you?
Combined from multiple baseline items, based
on NLSY97, Round 2
MARK (X) ONE
YSAQ-372b R21915.00
Have you ever used any drugs like cocaine or
crack or heroin, or any other substance not
prescribed by a doctor, in order to get high or to
achieve an altered state?
1 Yes (Go to YSAQ-372c)
0 No
□
□
Yes
No
In general, how much pressure, if any, do
you feel from your friends to have sexual
intercourse?
MARK (X) ONE
□
□
□
□
MPR Abstinence:
3.45 Is there any pressure from your friends to
have sexual intercourse?
A lot of pressure
Some pressure
A little pressure
No pressure
No pressure at all
A little pressure
Some pressure
A lot of pressure
91
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
Question Source(s)
Tracking
OMB-approved Baseline #
Follow-up Question #
6.5
First Follow-up Question Text
Notes
Baseline version:
Have you ever used
any other type of
illegal drug,
prescription drugs,
or an inhalant that
were not
prescribed for you?
How often is each of the following
statements true for you?
4H Study on Positive Youth Development:
MARK (X) ONE FOR EACH
How true is each of these statements for you?
Never True = 0, Always True =3
Never True, Sometimes True, Often True,
Almost Always True
I can trust my friends
My friends want the best for me in my life
a. I can trust my friends
My friends care about me
b. My friends want the best for me in my My friends are there for me if I need them
life
c. My friends care about me
d. My friends are there for me if I need
them
92
Other (see notes)
Sexual Risk Outcome
Intermediate Outcome
Implementation Outcome
Covariate
OMB-approved Baseline #
N/A
Question Source(s)
Tracking
Follow-up Question #
7.2
First Follow-up Question Text
Notes
| File Type | application/pdf |
| File Title | ATTACHMENT A |
| Author | mthomas |
| File Modified | 2011-07-01 |
| File Created | 2011-07-01 |