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pdfEVALUATION OF ADOLESCENT PREGNANCY PREVENTION APPROACHES
SUMMARY TABLE, SITE- SPECIFIC BASELINE SURVEY, AND CONSENT AND
ASSENT FORMS: LIVE THE LIFE (LTL)
The LTL survey instrument is divided into three sections:
PART A – FOR ALL YOUTH (this section ends with a question on whether the adolescent has had sex, in
which case the adolescent chooses to continue to either PART B1 or B2)
PART B1 – FOR SEXUALLY-ACTIVE YOUTH
PART B2 – FOR NON-SEXUALLY-ACTIVE YOUTH
SUMMARY OF DIFFERENCES BETWEEN THE BASELINE CONCORDANCE INSTRUMENT AND THE LIVE THE LIFE SURVEY
Concordance #
Live the Life #
Items are listed in the order in which they appear on the Live the Life baseline instrument. The number for the corresponding baseline concordance
item is listed in the “Concordance #” column. Items in Part A are listed first, followed by items in Section 4, Part B1 (for sexually active
respondents), items in Section 4, Part B2 (for non-sexually active respondents) and items in Sections 5 and 6, Parts B1 and B2 (these sections are
the same for sexually active and non-sexually active respondents). Items found on the concordance instrument that are not on the Live the Life
instrument are listed at the bottom of the table.
• Modifications to an existing baseline concordance item are listed in the “Modifications” column; otherwise, the question text on the Live
the Life instrument is the same as that on the baseline concordance instrument.
• If an item is specific to the Live the Life instrument, it is indicated by an “N/A” in the “Concordance #” column and the question text is noted
in the “Modifications” column.
Baseline Concordance Question text
Modified for Live the Life
PART A (Sections 1 – 3): All items in Part A are the same for sexually active and non-sexually active respondents.
1.1
1.1
In what month and year were you born?
MARK (X) ONE MONTH AND ONE YEAR
1
Live the Life #
Concordance #
1.2
1.2
1.3
1.4
Baseline Concordance Question text
Modified for Live the Life
What grade are you in?
MARK (X) ONE
1.3
□
6th
□
7th
□
8th
□
9th
□
10th
□
11th
□
12th
□
Not currently in school
Are you male or female?
1.4
MARK (X) ONE
□
Male
□
Female
Are you Hispanic/Latino?
MARK (X) ONE
□
Yes
□
No
2
Live the Life #
Concordance #
Baseline Concordance Question text
1.5
1.5
What is your race?
Modified for Live the Life
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
□
Some other race PRINT OTHER RACE
1.6
1.6a
What is the main language you speak at home?
□
□
□
□
1.7
1.7
English
Spanish
Chinese language such as Mandarin or Cantonese
Some other language PRINT OTHER LANGUAGE ____________________________
In the past 12 months, how often did you attend religious services or activities?
MARK (X) ONE
□
□
□
□
□
Never
Less than once a month
1-3 times per month
Once a week
More than once a week
3
What is the main language you speak at
home?
□
□
□
English
Spanish
Some other language PRINT OTHER
LANGUAGE
Live the Life #
Concordance #
1.8
1.8
Baseline Concordance Question text
How important is religion in your life?
MARK (X) ONE
□
□
□
1.9
1.9
Modified for Live the Life
Not at all important
Somewhat important
Very important
In the past 12 months, have you received any information or learned about any of the following?
MARK (X) ONE FOR EACH QUESTION
Yes, No
a.
b.
c.
d.
e.
f.
g.
h.
Relationships, dating, marriage, or family life
Abstinence from sex
Methods of birth control
Where to get birth control
Sexually transmitted diseases, also known as STDs
How to talk to your partner about whether to have sex or whether to use birth control
How to say no to sex
How babies are made
4
Live the Life #
Concordance #
1.10
1.11
Baseline Concordance Question text
Modified for Live the Life
How likely is it that you will do each of the following things?
MARK (X) ONE
Not at all likely, A little bit likely, Somewhat likely, Very likely
a.
b.
c.
d.
e.
Graduate from high school
Go to a technical or vocational school after high school
Go to college
Graduate from a 2-year or community college program
Graduate from a 4-year college program
5
Live the Life #
Concordance #
Baseline Concordance Question text
2.1
2.1
The next question is about where you live and who lives with you.
Modified for Live the Life
Which of the following best describes where you live?
□ 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, staying with friends/relatives) – GO
TO 2.4
2.2
2.2
Who lives with you in your home?
MARK ALL THAT APPLY
□
□
□
□
□
□
□
□
□
□
□
□
□
□
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
6
Live the Life #
Concordance #
Baseline Concordance Question text
2.3
2.3
Who lives with you in each of your homes?
Modified for Live the Life
Mark all of the people who live with you in your MAIN home, and then mark all of the people
who live with you in your OTHER homes.
MARK ALL THAT APPLY (List appears for both the MAIN home and the 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
7
Live the Life #
Concordance #
2.4
2.6
Baseline Concordance Question text
Modified for Live the Life
Now we have some questions about your mother, or the person you think of as your mother. Is
this person…
MARK (X) ONE
□
□
□
□
□
□
□
2.5
2.7
Your biological mother, that is, the woman who gave birth to you
Your stepmother or adoptive mother
Your foster mother
Your grandmother
Your aunt or your older sister
Some other adult
Don’t have a mother or person I think of as a mother
GO TO 2.12
The following questions are about the person you marked as your mother or the person you
think of as your mother.
Did she graduate from high school?
MARK (X) ONE
□
□
□
2.6
2.8
Yes
No
Don’t know
Did she graduate from a 4-year college?
MARK (X) ONE
□
□
□
Yes
No
Don’t know
8
Live the Life #
Concordance #
2.7
2.9
2.8
2.10
Baseline Concordance Question text
Modified for Live the Life
Is she working now?
MARK (X) ONE
□
She is not working at a paid job
□
Yes, she is working part-time or less than 30 hours a week
□
Yes, she is working full-time or at more than one job for 30
hours a week or more
□
Yes, she works, but I don’t know how many hours
□
Don’t know if she is working
How close do you feel to your mother or the person you think of as your mother?
MARK (X) ONE
□
□
□
□
2.9
2.11
Not at all close
A little close
Somewhat close
Very close
In general, how much do you think she cares about you?
MARK (X) ONE
□
□
□
□
Does not care at all
Cares a little bit
Cares somewhat
Cares very much
9
Live the Life #
Concordance #
2.10
2.12
Baseline Concordance Question text
Modified for Live the Life
Whether you have done this or not, how would she feel about you having sex at this time in your
life?
MARK (X) ONE
□
□
□
□
□
2.11
2.13
Strongly approve
Approve
Neither approve nor disapprove
Disapprove
Strongly disapprove
How would she feel about you having a baby at this time in your life?
MARK (X) ONE
□
□
□
□
□
Strongly approve
Approve
Neither approve nor disapprove
Disapprove
Strongly disapprove
10
Live the Life #
Concordance #
2.12
2.14
Baseline Concordance Question text
Modified for Live the Life
Next we have some questions about your father, or the person you think of as your father. Is this
person…
MARK (X) ONE
□
2.13
2.15
Your biological father, that is, the man who is genetically
related to you
□
Your stepfather or adoptive father
□
Your foster father
□
Your grandfather
□
Your uncle or your older brother
□
Some other adult
□
Don’t have a father or person I think of as a father GO TO 2.20
The following questions are about the person you marked as your father or the person you think
of as your father.
Did he graduate from high school?
MARK (X) ONE
□
□
□
2.14
2.16
Yes
No
Don’t know
Did he graduate from a 4-year college?
MARK (X) ONE
□
□
□
Yes
No
Don’t know
11
Live the Life #
Concordance #
Baseline Concordance Question text
2.15
2.17
Is he working now?
2.18
MARK (X) ONE
□
He is not working at a paid job
□
Yes, he is working part-time or less than 30 hours a week
□
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
How close do you feel to your father or the person you think of as your father?
2.16
Modified for Live the Life
MARK (X) ONE
□ Not at all close
□ A little close
□ Somewhat close
□ Very close
2.17
2.19
In general, how much do you think he cares about you?
MARK (X) ONE
□
□
□
□
Does not care at all
Cares a little bit
Cares somewhat
Cares very much
12
Live the Life #
Concordance #
2.18
2.20
Baseline Concordance Question text
Modified for Live the Life
Whether you have done this or not, how would he feel about you having sex at this time in your
life?
MARK (X) ONE
□
□
□
□
□
2.19
2.21
Strongly approve
Approve
Neither approve nor disapprove
Disapprove
Strongly disapprove
How would he feel about you having a baby at this time in your life?
MARK (X) ONE
□
□
□
□
□
2.20
2.22a
Strongly approve
Approve
Neither approve nor disapprove
Disapprove
Strongly disapprove
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
o
o
o
o
o
They are married to each other
They used to be married to each other, but are now separated
They used to be married to each other, but are now divorced
They have never been married to each other
I don’t know
13
Live the Life #
Concordance #
Baseline Concordance Question text
2.21
2.22b
Do your biological mother and biological father live together now?
Modified for Live the Life
MARK (X) ONE
o
o
o
o
2.22
2.23
Yes
No
One or both of my biological parents have passed away
I don’t know
The next questions are about the parents or guardians you live with most of the time. Thinking
about the past month, how often did your parents know where you were after school?
MARK (X) ONE
□
Always
□
Usually
□
Sometimes
□
Rarely
□
Never
2.23
2.24
Thinking about the past month, how often did your parents know who you were going to be with
before you went out?
MARK (X) ONE
□
Always
□
Usually
□
Sometimes
□
Rarely
□
Never
□
I did not go out
14
Live the Life #
Concordance #
2.24
2.27
Baseline Concordance Question text
Modified for Live the Life
In the past 12 months, how many times have you talked with at least one of your parents or
guardians about . . .
MARK (X) ONE FOR EACH QUESTION
Never, 1-2 Times, 3-9 Times, 10 or more times
a.
b.
c.
d.
e.
f.
g.
h.
How things are going with school work or with your grades
A personal problem you were having
How to have good romantic relationships
Strategies for safe dating
How to resist pressures to have sex
Avoiding drugs and alcohol
Pregnancy or birth
Sexually transmitted diseases (also called STDs), HIV, or AIDS
15
Live the Life #
Concordance #
3.1
3.1
Baseline Concordance Question text
Modified for Live the Life
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 . . .
MARK (X) ONE FOR EACH QUESTION
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 . . .
Strongly Agree, Agree, Disagree, Strongly Disagree
MARK (X) ONE FOR EACH
a.
b.
c.
Strongly Agree, Agree, Disagree, Strongly
Disagree
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
a.
b.
c.
d.
e.
f.
g.
h.
16
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
If you have sexual intercourse as a teen, it
will not do any harm
You would feel guilty having sexual
intercourse as a teen
You would feel embarrassed to say no to a
boyfriend or girlfriend who wanted to
have sexual intercourse with you
You would not want to disappoint a
boyfriend or girlfriend who wanted to
have sexual intercourse with you
Live the Life #
Concordance #
3.2
N/A
Baseline Concordance Question text
Modified for Live the Life
The next series of questions is about your views
on sexual intercourse before marriage. How
strongly do you agree or disagree that…
MARK (X) ONE FOR EACH
Strongly Agree, Agree, Disagree, Strongly
Disagree
a.
b.
c.
d.
e.
f.
g.
h.
17
You intend to wait until marriage to
have sexual intercourse
It would be good for you to wait until
marriage to have sexual intercourse
Whether or not you wait until
marriage to have sexual intercourse is
completely up to you
It would be difficult for you to wait
until marriage to have sexual
intercourse
It is against your values to have sexual
intercourse before marriage
You think people who wait until
marriage to have sexual intercourse
are being safe and responsible
It would be unpleasant for you to wait
until marriage to have sexual
intercourse
Most people who are important to
you think that you should wait until
marriage to have sexual intercourse
Live the Life #
Concordance #
3.3
3.2
Baseline Concordance Question text
Modified for Live the Life
FOR GIRLS
If you got pregnant now, how would you feel?
MARK (X) ONE
□
□
□
□
□
3.3
3.2
Very happy
A little happy
Neither happy nor upset
A little upset
Very upset
FOR BOYS
If you got someone pregnant now, how would you feel?
MARK (X) ONE
□
□
□
□
□
Very happy
A little happy
Neither happy nor upset
A little upset
Very upset
18
Live the Life #
Concordance #
Baseline Concordance Question text
3.4
3.3
Imagine you are alone with someone you like very much. How likely is it that you could . . .
Modified for Live the Life
MARK (X) ONE FOR EACH
Not at all Likely, A Little Bit Likely, Somewhat Likely, Very Likely
a.
3.5
3.4
Stop them if they wanted to touch your chest and you did not want them to do that (FOR
GIRLS)
b. 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
c. Avoid having sexual intercourse if you didn’t want to
The next series of questions is about condom use. How strongly do you agree or disagree that …
MARK (X) ONE FOR EACH
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
19
a. Condoms should always be used if a person
your age has sexual intercourse
b. Condoms are a hassle to use
c. Condoms don ont protect from the
emotional impact of sexual intercourse
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
Live the Life #
Concordance #
Baseline Concordance Question text
3.6
3.5
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
3.6a
3.7
3.8
3.5a
3.6
3.7
Modified for Live the Life
GO TO 3.7
How confident are you that your answer is correct?
MARK (X) ONE
□
Not at all confident
□
A little confident
□
Somewhat confident
□
Very confident
If a condom is used correctly, how much can it decrease the risk of getting HIV, the virus that
causes AIDS?
MARK (X) ONE
□
Not at all
□
A little
□
A lot
□
Don’t know
If a condom is used correctly, how much can it decrease the risk of getting Chlamydia and
gonorrhea?
MARK (X) ONE
□
Not at all
□
A little
□
A lot
□
Don’t know
20
Live the Life #
Concordance #
Baseline Concordance Question text
3.9
3.9
If birth control pills are used correctly, how much can they decrease the risk of pregnancy?
MARK (X) ONE
□
Not at all
□
A little
□
A lot
□
Don’t know
3.9a
3.10
3.9a
3.10
GO TO 3.10
How confident are you that your answer is correct?
MARK (X) ONE
□
Not at all confident
□
A little confident
□
Somewhat confident
□
Very confident
If birth control pills are used correctly, how much can they decrease the risk of getting HIV, the
virus that causes AIDS?
MARK (X) ONE
□
Not at all
□
A little
□
A lot
□
Don’t know
21
Modified for Live the Life
The next series of questions is about birth
control pills.
If birth control pills are used correctly,
how much can they decrease the risk of
pregnancy?
MARK (X) ONE
Not at all
A little
A lot
Don’t know
GO TO 3.10
Live the Life #
Concordance #
3.11
3.11
3.12
3.12
Baseline Concordance Question text
If birth control pills are used correctly, how much can they decrease the risk of getting
Chlamydia and gonorrhea?
MARK (X) ONE
□
Not at all
□
A little
□
A lot
□
Don’t know
Can you get a sexually transmitted disease, or STD, from having oral sex?
MARK (X) ONE
□
□
□
3.12
a
3.12a
3.13
3.13
Modified for Live the Life
Yes
No
Don’t know
GO TO 3.13
How confident are you that your answer is correct?
MARK (X) ONE
□
Not at all confident
□
A little confident
□
Somewhat confident
□
Very confident
In the past 3 months, how many TIMES have you gone out on a date?
□ Zero or None
GO TO 3.15
| | | NUMBER OF TIMES - Your best guess is fine
3.14
3.14
Thinking about these dates in the past 3 months, how many DIFFERENT PEOPLE did you go out
on a date with?
□
Zero or None
| | | NUMBER OF PEOPLE - Your best guess is fine.
22
Live the Life #
Concordance #
Baseline Concordance Question text
3.15
3.15
Do you intend to have oral sex in the next year?
o
o
o
o
3.16
3.16
3.17
Yes, definitely
Yes, probably
No, probably not
No, definitely not
Do you intend to have sexual intercourse in the next year?
o
o
o
o
3.17
Modified for Live the Life
Yes, definitely
Yes, probably
No, probably not
No, definitely not
If you have sexual intercourse in the next year, do you intend to use a condom?
o
o
o
o
Yes, definitely
Yes, probably
No, probably not
No, definitely not
23
Live the Life #
Concordance #
3.18
3.18
Baseline Concordance Question text
Modified for Live the Life
The next question is about your intention to use other methods of birth control, NOT including
condoms:
• Birth control pills
• The shot (Depo Provera)
• The patch
• The ring (NuvaRing)
• IUD (Mirena or Paragard)
• Implants (Implanaon)
If you have sexual intercourse in the next year, do you intend to use any of these other methods
of birth control?
o Yes, definitely
o Yes, probably
o No, probably not
o No, definitely not
3.19
3.19
Do you intend to have sexual intercourse without being married?
o
o
o
o
3.20
3.20
Yes, definitely
Yes, probably
No, probably not
No, definitely not
Have you ever had sexual intercourse, oral sex, or anal sex?
Have you ever had sexual intercourse or oral
sex?
□ YES: GO TO PART B1 AND PUT THIS BOOKLET BACK IN THE
ENVELOPE
□ NO: GO TO PART B2 AND PUT THIS BOOKLET BACK IN THE
ENVELOPE
PART B1: The items in Section 4, Part B1 are specifically for sexually active respondents. Items in Sections 5 and 6, Part B1 are the same as the items in Sections 5
and 6, Part B2 (for non-sexually active respondents).
24
Live the Life #
Concordance #
4.1
Part
B1
4.1
Part
B1
4.2
Part
B1
4.2
Part
B1
4.3
Part
B1
4.3
Part
B1
4.4
Part
B1
4.4
Part
B1
Baseline Concordance Question text
Modified for Live the Life
The next questions are about your sexual 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?
The next questions are about your sexual
behaviors and experiences. Please be as honest
as possible. Your answers are confidential and
everything you say will be kept private.
□ No STOP AND GO TO PART B2
□ Yes CONTINUE WITH THIS BOOKLET.
Just to confirm, have you ever had sexual
intercourse or oral sex?
The first questions are about sexual intercourse. By sexual intercourse, we mean a male putting
his penis into a female’s vagina.
Have you ever had sexual intercourse?
MARK (X) ONE
□
Yes
□
No
GO TO 4.14
The very first time you had sexual intercourse, what month and year was it?
MARK (X) ONE MONTH AND ONE YEAR
The very first time you had sexual intercourse, how old were you?
|
|
| NUMBER OF YEARS OLD YOU WERE - Your best guess is fine.
25
□ No STOP AND GO TO PART B2
□ Yes CONTINUE WITH THIS BOOKLET.
Live the Life #
Concordance #
4.5
Part
B1
4.5
Part
B1
The very first time you had sexual intercourse, how old was your partner?
4.6
Part
B1
4.6
Part
B1
The very first time you had sexual intercourse, would you say that it was voluntary or not
voluntary?
Baseline Concordance Question text
MARK (X) ONE
□
□
□
□
□
4.7
Part
B1
A year or two younger than you
Three or more years younger than you
The same age as you
A year or two older than you
Three or more years older than you
MARK (X) ONE
□
□
4.7
Part
B1
Modified for Live the Life
Voluntary
Not voluntary
Birth control methods are something used to reduce the risk of pregnancy, and some can reduce
the risk of sexually transmitted diseases, also called STDs.
The first time you had sexual intercourse, did you or your partner use any type of birth control,
including condoms or any other method?
MARK (X) ONE
□
□
Yes
No
GO TO 4.9
26
Live the Life #
Concordance #
4.8
Part
B1
4.8
Part
B1
Baseline Concordance Question text
Modified for Live the Life
The first time you had sexual intercourse, did you or your partner use …
MARK (X) ONE FOR EACH
MARK (X) ONE FOR EACH ITEM
YES, NO
a.
b.
c.
d.
e.
f.
4.9
Part
B1
4.10
Part
B1
4.11
Part
B1
4.9
Part
B1
4.10
Part
B1
4.11
Part
B1
Condoms
Birth control pills or the patch
Depo-Provera, the shot, or other injectable birth control
Nuva ring or the ring
Withdrawal or pulling out
Another method PRINT OTHER METHOD USED
Have you had sexual intercourse more than one time?
MARK (X) ONE
□ Yes
□ No
GO TO 4.14
How many DIFFERENT PEOPLE have you ever had sexual intercourse with, even if only one time?
| | | NUMBER OF PEOPLE - Your best guess is fine.
Now please think about the past 3 months. In the past 3 months, how many TIMES have you had
sexual intercourse?
□
None
GO TO 4.14
| | | NUMBER OF TIMES - Your best guess is fine.
27
Live the Life #
Concordance #
4.12
Part
B1
4.12
Part
B1
In the past 3 months, how many TIMES did have sexual intercourse without using a condom?
4.13
Part
B1
4.13
Part
B1
The next question is about your use of the following methods of birth control:
Baseline Concordance Question text
Modified for Live the Life
□
None
| | | NUMBER OF TIMES - Your best guess is fine.
•
•
•
•
•
•
•
Condoms
Birth control pills
The shot (Depo Provera)
The patch
The ring (NuvaRing)
IUD (Mirena or Paragard)
Implants (Implanaon)
In the past 3 months, how many TIMES have you had sexual intercourse without using any of
these methods of birth control?
□
None
| | | NUMBER OF TIMES - Your best guess is fine.
4.14
Part
B1
4.14
Part
B1
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
□
□
Yes
No
GO TO 4.18
28
Live the Life #
Concordance #
4.15
Part
B1
4.15
Part
B1
The very first time you had oral sex, what month and year was it?
4.16
Part
B1
4.16
Part
B1
How many DIFFERENT PEOPLE have you ever had oral sex with, even if only one time?
4.17
Part
B1
4.17
Part
B1
Now please think about the past 3 months. In the past 3 months, how many TIMES have you had
oral sex?
4.18
a
Part
B1
4.24a
Part
B1
FOR GIRLS
a. Have you ever had your period, that is, your menstrual period?
4.18
b
Part
B1
4.24b
Part
B1
Baseline Concordance Question text
Modified for Live the Life
MARK (X) ONE MONTH AND ONE YEAR
|
|
| NUMBER OF PEOPLE - Your best guess is fine.
□
None
| | | NUMBER OF TIMES - Your best guess is fine.
□
MARK (X) ONE
□ Yes
□ No GO TO 4.27
How old were you when you had your first period, that is, your first menstrual period?
|
|
| NUMBER OF YEARS OLD YOU WERE - Your best guess is fine.
29
No GO TO 4.19
Live the Life #
Concordance #
4.18
a
Part
B1
4.25a
Part
B1
Baseline Concordance Question text
Modified for Live the Life
FOR BOYS
□ These changes have not yet started GO TO
4.19
People reach puberty at different ages. Signs of puberty for males include physical changes such
as developing pubic or facial hair, or the voice cracking or lowering. Which of the following best
describes these changes for you?
MARK (X) ONE
□ These changes have not yet started GO TO 4.27
□ These changes have barely started
□ These changes are definitely underway
□ These changes seem complete
4.18
b
Part
B1
4.19
a
Part
B1
4.25b
Part
B1
How old were you when these changes started?
4.26a
FOR BOYS AND GIRLS
|
|
| NUMBER OF YEARS OLD YOU WERE - Your best guess is fine.
□
No GO TO 4.20
a. To the best of your knowledge, have you ever been pregnant or gotten someone pregnant,
even if no child was born?
MARK (X) ONE
□ Yes
□
No GO TO 4.26
4.19
b
Part
B1
4.26b
To the best of your knowledge, how many times have you been pregnant or gotten someone
pregnant?
□
None
| | | NUMBER OF TIMES
To the best of your knowledge, how many times
have you been pregnant or gotten someone
pregnant?
|
30
|
| NUMBER OF TIMES
Live the Life #
Concordance #
Baseline Concordance Question text
4.19
c
Part
B1
4.26c
Have you ever had a baby or has anyone you got pregnant actually had the baby?
4.20
Part
B1
4.27
Part
B1
MARK (X) ONE
□
Yes
□
No
□
Don’t know
In the past 12 months, have you spoken with a doctor or nurse about sex, birth control or
sexually transmitted diseases, also known as STDs?
MARK (X) ONE
□
□
4.21
Part
B1
Modified for Live the Life
4.28
Part
B1
Yes
No
In the past 12 months, have you been tested by a doctor or nurse for a sexually transmitted
disease (STD), like gonorrhea, Chlamydia, syphilis, or HIV?
MARK (X) ONE
□
□
Yes
No
31
Live the Life #
Concordance #
4.22
Part
B1
4.29
Part
B1
Baseline Concordance Question text
In the past 12 months, have you been told by a doctor or nurse that you had a sexually
transmitted disease (STD)?
MARK (X) ONE
□
□
□
4.23
Part
B1
4.31
Part
B1
Modified for Live the Life
Yes
No
Don’t know
Have you ever been in a situation where someone touched you in a sexual way that you did not
want, or someone forced you to touch him or her in a sexual way that you did not want to?
MARK (X) ONE
□
□
Yes
No
PART B2: The items in Section 4, Part B2 are specifically for non-sexually active respondents. Items in Sections 5 and 6, Part B1 are the
same as the items in Sections 5 and 6, Part B2 (for non-sexually active respondents).
4.1
Part
B2
4.1
Part
B2
This booklet is for youth who have not had sex. We want to be sure you are in the correct
booklet. We know we asked this before but…
Just to confirm, have you ever had sexual intercourse, oral sex, or anal sex?
MARK (X) ONE
□ Yes STOP AND GO TO PART B1
□ No CONTINUE WITH THIS BOOKLET
This booklet is for youth who have not had sex.
We want to be sure you are in the correct
booklet. We know we asked this before but…
Just to confirm, have you ever had sexual
intercourse or oral sex?
MARK (X) ONE
□ Yes STOP AND GO TO PART B1
□ No CONTINUE WITH THIS BOOKLET
32
Live the Life #
Concordance #
4.2
Part
B2
4.2
Part
B2
Baseline Concordance Question text
Modified for Live the Life
The first two questions in this booklet are about your schooling.
Do you expect that you will graduate from high school?
MARK (X) ONE
□
□
□
Yes
I already graduated from high school
No
GO TO 4.4
4.3
Part
B2
4.3
Part
B2
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?)
4.4
Part
B2
4.4
Part
B2
The next questions are about where you live.
MARK (X) ONE MONTH AND ONE YEAR
In the last 7 days, did you spend any nights somewhere like a shelter, someone else’s home, in a
car, on the street or in any other temporary housing because you did not have a regular place to
stay?
MARK (X) ONE
□
□
4.5
Part
B2
4.5
Part
B2
Yes GO TO 4.8
No
In how many homes, places, or households do you live: one, two, or three or more?
MARK (X) ONE
□ 1 home GO TO 4.8
□ 2 homes
□ 3 or more homes
33
Live the Life #
Concordance #
4.6
Part
B2
4.6
Part
B2
Do you consider one of these homes to be your main home?
4.7
Part
B2
4.7
Part
B2
Thinking about the past 30 days, how many nights did you spend in each home?
4.8
Part
B2
4.11a
Part
B2
Baseline Concordance Question text
Modified for Live the Life
MARK (X) ONE
□ Yes
□ No
FILL IN TWO OR THREE NUMBERS
|
|
| Number of nights at home #1 – Your best guess is fine.
|
|
| Number of nights at home #2 – Your best guess is fine.
|
|
| Number of nights at another home or other homes – Your best guess is fine.
These next few questions are about you and your friends. How strongly do you agree
or disagree that . . .
These next few questions are about you and
your friends.
How strongly do you agree or disagree that you
have friends who will give you good advice?
MARK (X) ONE FOR EACH QUESTION
Strongly agree, Agree, Disagree, Strongly disagree
MARK (X) ONE
a.
b.
c.
d.
You have friends who will give you good advice
You have a friend who cares about you
You have a friend you can talk to when you need to
You have someone who you can call your best friend
□ Strongly Agree
□ Agree
□ Disagree
□ Strongly disagree
34
Live the Life #
Concordance #
4.9
Part
B2
4.11b
Part
B2
4.10
Part
B2
4.11
Part
B2
4.11c
Part
B2
4.11d
Part
B2
Baseline Concordance Question text
Modified for Live the Life
These next few questions are about you and your friends. How strongly do you agree
or disagree that . . .
MARK (X) ONE FOR EACH QUESTION
Strongly agree, Agree, Disagree, Strongly disagree
MARK (X) ONE
a.
You have friends who will give you good advice
b.
You have a friend who cares about you
c.
You have a friend you can talk to when you need to
d.
You have someone who you can call your best friend
These next few questions are about you and your friends. How strongly do you agree
or disagree that . . .
MARK (X) ONE FOR EACH QUESTION
Strongly agree, Agree, Disagree, Strongly disagree
□ Strongly Agree
□ Agree
□ Disagree
□ Strongly disagree
How strongly do you agree or disagree that you
have a friend you can talk to when you need to?
MARK (X) ONE
a.
You have friends who will give you good advice
b.
You have a friend who cares about you
c.
You have a friend you can talk to when you need to
d.
You have someone who you can call your best friend
These next few questions are about you and your friends. How strongly do you agree
or disagree that . . .
MARK (X) ONE FOR EACH QUESTION
Strongly agree, Agree, Disagree, Strongly disagree
a.
b.
c.
d.
How strongly do you agree or disagree that you
have a friend who cares about you?
□ Strongly Agree
□ Agree
□ Disagree
□ Strongly disagree
How strongly do you agree or disagree that you
have someone who you can call your best
friend?
MARK (X) ONE
□ Strongly Agree
□ Agree
□ Disagree
□ Strongly disagree
You have friends who will give you good advice
You have a friend who cares about you
You have a friend you can talk to when you need to
You have someone who you can call your best friend
35
Live the Life #
Concordance #
4.12
Part
B2
4.12a
Part
B2
Baseline Concordance Question text
Modified for Live the Life
The next series of questions is about effort. How strongly do you agree or disagree that . . .
These next few questions are about you.
How strongly do you agree or disagree that
when you start a project, you finish it?
MARK (X) ONE FOR EACH QUESTION
Strongly agree, Agree, Disagree, Strongly disagree
MARK (X) ONE
a.
b.
c.
d.
4.13
Part
B2
4.12b
Part
B2
4.12c
Part
B2
□ Strongly Agree
□ Agree
□ Disagree
□ Strongly disagree
The next series of questions is about effort. How strongly do you agree or disagree that . . .
MARK (X) ONE FOR EACH QUESTION
Strongly agree, Agree, Disagree, Strongly disagree
a.
b.
c.
d.
4.14
Part
B2
When you start a project, you finish it
You only work as hard as you have to
You are someone people can count on
When you work, you do a good job
MARK (X) ONE
□ Strongly Agree
□ Agree
□ Disagree
□ Strongly disagree
When you start a project, you finish it
You only work as hard as you have to
You are someone people can count on
When you work, you do a good job
The next series of questions is about effort. How strongly do you agree or disagree that . . .
How strongly do you agree or disagree that you
are someone people can count on?
MARK (X) ONE
MARK (X) ONE FOR EACH QUESTION
Strongly agree, Agree, Disagree, Strongly disagree
a.
b.
c.
d.
How strongly do you agree or disagree that that
you only work as hard as you have to?
□ Strongly Agree
□ Agree
□ Disagree
□ Strongly disagree
When you start a project, you finish it
You only work as hard as you have to
You are someone people can count on
When you work, you do a good job
36
Live the Life #
Concordance #
4.15
Part
B2
4.12d
Part
B2
4.16
Part
B2
4.13
Part
B2
Baseline Concordance Question text
Modified for Live the Life
The next series of questions is about effort. How strongly do you agree or disagree that . . .
How strongly do you agree or disagree that
when you do work, you do a good job?
MARK (X) ONE FOR EACH QUESTION
Strongly agree, Agree, Disagree, Strongly disagree
MARK (X) ONE
a. When you start a project, you finish it
b. You only work as hard as you have to
c. You are someone people can count on
d. When you work, you do a good job
Here are some reasons people your age might choose NOT to have sexual intercourse. How
important is each of these reasons to YOU?
MARK (X) ONE FOR EACH QUESTION
Very Important, Somewhat Important, Not Too Important, Not At All Important
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
I don’t want to get a sexually transmitted disease, also known as an STD
I don’t want to disappoint my parents
I am too young to have sex
My boyfriend or girlfriend doesn’t want to have sex
I want to wait until I’m married
It is against my personal values
I haven’t met the right person yet
I haven’t had the chance
I don’t want to
FOR GIRLS: I do not want to get pregnant
FOR BOYS: I do not want to get a girl pregnant
□ Strongly Agree
□ Agree
□ Disagree
□ Strongly disagree
a.
b.
c.
d.
e.
f.
g.
h.
i.
j.
k.
l.
37
I believe it is better for my longterm health and well-being
I don’t want to get a sexually
transmitted disease, also known as
an STD
I don’t want to disappoint my
parents
I am too young to have sex
My boyfriend or girlfriend doesn’t
want to have sex
I want to wait until I’m married
It is against my personal values
I haven’t met the right person yet
I haven’t had the chance
I don’t want to
FOR GIRLS: I do not want to get
pregnant
FOR BOYS: I do not want to get a
girl pregnant
Live the Life #
Concordance #
4.17
a
Part
B2
4.14 a
Part
B2
4.17
b
Part
B2
4.14b
Part
B2
4.18
a
Part
B2
4.15a
Part
B2
Baseline Concordance Question text
Modified for Live the Life
FOR GIRLS ONLY- Have you ever had your period, that is, your menstrual period?
MARK (X) ONE
□ Yes
□ No GO TO 4.19
FOR GIRLS ONLY- How old were you when you had your first period, that is, your first menstrual
period?
|
|
| NUMBER OF YEARS OLD YOU WERE - Your best guess is fine.
FOR BOYS ONLY
People reach puberty at different ages. Signs of puberty for males include physical changes such
as developing pubic or facial hair, or the voice cracking or lowering. Which of the following best
describes these changes for you?
MARK (X) ONE
□
□
□
□
4.18
b
Part
B2
4.15b
Part
B2
These changes have not yet started
These changes have barely started
These changes are definitely underway
These changes seem complete
GO TO 4.19
FOR BOYS: How old were you when these changes started?
|
|
| NUMBER OF YEARS OLD YOU WERE
38
Live the Life #
Concordance #
4.19
Part
B2
4.16a
Part
B2
4.20
Part
B2
4.16b
Part
B2
Baseline Concordance Question text
Modified for Live the Life
Have you ever done any of the following?
Have you ever kissed someone on the lips?
Yes, No
MARK (X) ONE
a. Kissed someone on the lips
b. French kissed, that is put your tongue in someone’s mouth while kissing
c. Touched another person’s private parts
d. Let someone touch your private parts
Have you ever done any of the following?
Yes, No
□ Yes
□ No GO TO 4.21
Have you ever French kissed, that is put your
tongue in someone’s mouth while kissing?
MARK (X) ONE
4.21
Part
B2
4.16c
Part
B2
a. Kissed someone on the lips
b. French kissed, that is put your tongue in someone’s mouth while kissing
c. Touched another person’s private parts
d. Let someone touch your private parts
Have you ever done any of the following?
Yes, No
□ Yes
□ No
Have you ever touched another person’s
private parts?
MARK (X) ONE
4.22
Part
B2
4.16d
Part
B2
a. Kissed someone on the lips
b. French kissed, that is put your tongue in someone’s mouth while kissing
c. Touched another person’s private parts
d. Let someone touch your private parts
Have you ever done any of the following?
Yes, No
□ Yes
□ No
Have you ever let someone touch your private
parts?
MARK (X) ONE
a. Kissed someone on the lips
b. French kissed, that is put your tongue in someone’s mouth while kissing
c. Touched another person’s private parts
d. Let someone touch your private parts
39
□ Yes
□ No
Live the Life #
Concordance #
4.23
Part
B2
4.17
Part
B2
4.24
Part
B2
4.20
Part
B2
Baseline Concordance Question text
Modified for Live the Life
Have you ever been in a situation where someone touched you in a sexual way that you did not
want, or someone forced you to touch him or her in a sexual way that you did not want to?
MARK (X) ONE
□ Yes
□ No
If you decided to have sexual intercourse outside of marriage, how likely is it you would use a
condom or other contraceptive method?
MARK (X) ONE
□ Not at all likely
□ A little bit likely
□ Somewhat likely
□ Very likely
□ Don’t plan to have sexual intercourse outside of marriage
If you decided to have sexual intercourse
outside of marriage, how likely is it you would
use a condom or other contraceptive method?
MARK (X) ONE
□
Don’t plan to have sexual intercourse
outside of marriage
□
Not at all likely
□
A little bit likely
□
Somewhat likely
□
Very likely
Sections 5 and 6 (Parts B1 and B2) – these items are the same for sexually active and non-sexually active respondents.
5.1
5.4
The next questions are about alcohol and drugs. Please be as honest as possible, and remember
that everything you tell us will be kept private.
Have you ever had an alcoholic drink, such as beer, wine or other liquor, NOT counting any times
you just had a sip?
MARK (X) ONE
□
□
Yes
No GO TO 5.8
40
Live the Life #
Concordance #
Baseline Concordance Question text
5.2
5.5
The very first time you had an alcoholic drink, how old were you?
|
5.3
5.6
|
Modified for Live the Life
| NUMBER OF YEARS OLD YOU WERE - Your best guess is fine.
During the past 30 days, on how many days did you have one or more alcoholic drink, such as
beer, wine or other liquor, NOT counting any times you just had a sip?
MARK (X) ONE
□
□
□
□
5.4
5.5
More than 25 days
5 to 25 days
1 to 4 days
0 (zero) days
5.7
During the past 30 days, on how many days did you have 5 or more drinks in a row?
5.8
MARK (X) ONE
□
More than 25 days
□
5 to 25 days
□
1 to 4 days
□
0 (zero) days
Have you ever used marijuana, also called weed or pot?
MARK (X) ONE
□
□
Yes
No GO TO 5.10
41
Live the Life #
Concordance #
Baseline Concordance Question text
5.6
5.9
During the past 30 days, on how many days did you use marijuana?
5.7
5.10
Modified for Live the Life
MARK (X) ONE
□
More than 25 days
□
5 to 25 days
□
1 to 4 days
□
0 (zero) days
Have you ever used any other type of illegal drug, for example Methamphetamine, speed, PCP,
ecstasy, or any form of cocaine, such as crack?
MARK (X) ONE
□
Yes
□
No
42
Live the Life #
Concordance #
Baseline Concordance Question text
6.1
6.1
How many of your friends who are your age think the following things? Your best guess is fine
MARK (X) ONE FOR EACH QUESTION
None, Some, Half, Most, All, Don’t Know
a.
b.
c.
d.
e.
6.2
6.2
How many of your friends who are your age
think the following things? Your best guess is
fine
MARK (X) ONE FOR EACH QUESTION
None, Some, Half, Most, All, Don’t Know
Having sexual intercourse is a good thing for them to do at
their age.
It would be okay for them to have sexual intercourse as long
as they used birth control, like a condom.
It would be okay for them to have sexual intercourse if they
were dating the same person for a long time
They should wait until they are older to have sexual
intercourse.
They should wait until marriage to have sexual intercourse.
a.
How many of your friends who are your age have done the following things?
MARK (X) ONE FOR EACH QUESTION
None, Some, Half, Most, All, Don’t Know
a.
b.
Modified for Live the Life
Having sexual intercourse is a good thing
for them to do at their age.
b. It would be okay for them to have sexual
intercourse as long as they used birth
control, like a condom.
c. It would be okay for them to have sexual
intercourse if they were dating the same
person for a long time
d. They should wait until they are older to
have sexual intercourse.
e. They should wait until marriage to have
sexual intercourse.
f.
It is more important to finish high school
than to have sexual intercourse
How many of your friends who are your age
have done the following things?
MARK (X) ONE FOR EACH QUESTION
None, Some, Half, Most, All, Don’t Know
Had sexual intercourse.
Had oral sex.
a.
b.
c.
43
Had sexual intercourse.
Had oral sex.
Have decided to delay having sexual
intercourse until later in life
Live the Life #
Concordance #
Baseline Concordance Question text
6.3
6.3
In general, how much pressure, if any, do you feel from your friends to have sexual intercourse?
Modified for Live the Life
MARK (X) ONE
□
□
□
□
6.4
6.5
A lot of pressure
Some pressure
A little pressure
No pressure
How much do you feel that your friends care about you?
MARK (X) ONE
□
Do not care at all
□
Care a little bit
□
Care somewhat
□
Care very much
DROPPED: The questions listed below are part of the baseline concordance instrument, but are not part of this site-specific baseline
instrument.
N/A
1.6
When you are at home or with your family, what language or languages do you usually speak?
YOU MAY MARK (X) MORE THAN ONE ANSWER
□
English
□
Spanish
□
Chinese language such as Mandarin or Cantonese
□
Some other language PRINT OTHER LANGUAGE(S) ____________________________
44
Live the Life #
Concordance #
N/A
1.10
Baseline Concordance Question text
Modified for Live the Life
In an average week last month, including weekends, about how many hours did you spend
participating in each of the following?
MARK (X) ONE FOR EACH QUESTION
Zero Hours Per Week, More Than Zero but Less Than 2 Hours Per Week, 2-5 Hours Per Week,
More Than 5 Hours Per Week
a.
b.
c.
N/A
2.4
Sports-related clubs, teams, or organizations
Lessons, clubs, or performances for art, music, or drama
Other clubs, teams, and organizations, such as academic
clubs, Scouts, chess clubs, or debating teams
d. Services or programs at a church, temple, synagogue,
mosque, or other place of worship
e. Working at a paid job
f.
Volunteering
On how many days last week did all the family members who live in your household sit down
together for a meal?
MARK (X) ONE
□0
□1
□2
□3
□4
□5
□6
□7
45
Live the Life #
Concordance #
N/A
2.5
N/A
N/A
2.25
2.26
Baseline Concordance Question text
Modified for Live the Life
On how many days last week did you do something with at least one adult in your family like
play a game, watch a movie, go to a sporting event, or work on something you enjoy doing
together?
MARK (X) ONE
□0
□1
□2
□3
□4
□5
□6
□7
Thinking about the past month, how often did your parents know where you were when you
went out at night?
MARK (X) ONE
□
Always
□
Usually
□
Sometimes
□
Rarely
□
Never
□
I did not go out at night
If you were going to be home late, would your parents expect you to call?
MARK (X) ONE
□
Yes
□
No
46
Live the Life #
Concordance #
N/A
3.8
Baseline Concordance Question text
Modified for Live the Life
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
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
N/A
N/A
4.18
Part
B1
4.19
Part
B1
In the past 3 months, how many TIMES have you had oral sex without using a condom?
□
None
| | | NUMBER OF TIMES - Your best guess is fine.
Anal sex is when a male puts his penis in someone else’s anus, or their butt, or someone lets a
male put his penis in their anus or butt. Have you ever had anal sex?
MARK (X) ONE
□
□
N/A
4.20
Part
B1
Yes
No
GO TO 4.22
How many DIFFERENT PEOPLE have you ever had anal sex with, even if only one time?
|
|
| NUMBER OF PEOPLE - Your best guess is fine.
47
Live the Life #
Concordance #
N/A
4.21
Part
B1
Now please think about the past 3 months. In the past 3 months, how many TIMES have you had
anal sex?
4.22
Part
B1
In the past 3 months, how many TIMES have you had anal sex without using a condom?
N/A
N/A
N/A
4.32
Part
B1
4.30
Part
B1
Baseline Concordance Question text
Modified for Live the Life
□
None
GO TO 4.22
| | | NUMBER OF TIMES - Your best guess is fine.
□
None
| | | NUMBER OF TIMES - Your best guess is fine.
Have you ever been fearful that someone you were dating or having sex with might physically
hurt you?
MARK (X) ONE
□ Yes
□ No
The next series of questions is about the types of sexually transmitted diseases or STDs you had.
In the past 12 months, did you have…
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:
48
Live the Life #
Concordance #
N/A
4.8
Part
B2
Is there anyone who moves with you from home to home?
4.9
Part
B2
Is your home or any of your homes a group home or halfway house?
N/A
N/A
4.10
Part
B2
Baseline Concordance Question text
MARK (X) ONE
□
□
4.18
Part
B2
Yes
No
□ Yes
□ No
This question is about who lives with you in your home. If you have more than one home, please
think about your main home.
How many people usually live in your home, including all children and anyone who normally lives
there even if they are not there now, like someone who is away traveling or in a hospital?
|
N/A
Modified for Live the Life
|
| NUMBER OF PEOPLE
Have you ever been fearful that someone you were dating or having sex with might physically
hurt you?
MARK (X) ONE
□
□
Yes
No
49
Live the Life #
Concordance #
N/A
4.19
Part
B2
N/A
N/A
4.23
Part
B1
5.2
Baseline Concordance Question text
In the past 12 months, have you spoken with a doctor or nurse about sex, birth control or
sexually transmitted diseases, also known as STDs?
MARK (X) ONE
□
Yes
□
No
Have you ever had oral sex or anal sex with a person the same sex as you?
MARK (X) ONE
□ Yes
□ No
The very first time you smoked a cigarette, how old were you?
|
N/A
5.3
Modified for Live the Life
|
| NUMBER OF YEARS OLD YOU WERE - Your best guess is fine.
During the past 30 days, on how many days did you smoke one or more cigarettes?
MARK (X) ONE
□
□
□
□
More than 25 days
5 to 25 days
1 to 4 days
0 (zero) days
50
Live the Life #
Concordance #
N/A
5.11
Baseline Concordance Question text
Modified for Live the Life
Have you ever used any prescription pills or other prescription drugs that were not prescribed
for you?
MARK (X) ONE
□
Yes
□
No
N/A
N/A
5.12
6.4
Have you ever used an inhalant, such as sniffed glue, breathed the contents of spray cans, or
inhaled any paints or solvents to get high?
MARK (X) ONE
□
Yes
□
No
People are different in their sexual attraction to other people. Which of the following best
describes you?
MARK (X) ONE
□
□
□
□
□
I am only attracted to males
I am attracted to both males and females
I am only attracted to females
I am not attracted to either males or females
I am not sure
51
OMB Control No:
Expiration Date:
BASELINE QUESTIONNAIRE
PART A
LIVE THE LIFE
CONFIDENTIALITY
Thank you for your help with this important study. It will help us understand what things are like
for people your age today. Your answers are confidential and everything you say will be kept
private. Your name will not be on the questionnaire. Please answer all questions as well as you
can.
We want you to know that:
1.
We hope that you will answer all the questions, but you may skip any questions you do not
wish to answer.
2.
The answers you give will never be identified as yours. Your responses will be combined
with those of other people your age.
Mathematica Policy Research
THE PAPERWORK REDUCTION ACT OF 1995
Public reporting burden for this collection of information is estimated to average 30 minutes per response, including the time for
reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not
conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid
OMB control number.
GENERAL INSTRUCTIONS
1.
PLEASE MARK ALL ANSWERS WITHIN THE WHITE BOXES PROVIDED! USE A PEN OR PENCIL.
PLEASE READ EACH QUESTION CAREFULLY. There are different ways to answer the questions in this
survey. It is important that you follow the instructions when answering each kind of question. Here are
some examples.
EXAMPLE 1: MARK (X) ONE ANSWER
What is the color of your eyes?
MARK (X) ONE
X
Brown
Blue
If the color of your eyes is brown, you would mark (X)
the first box as shown.
Green
Another color
2.
EXAMPLE 2: MARK (X) ONE ANSWER and FILL IN THE BLANK
What is the color of your hair?
MARK (X) ONE
Brown
Black
If the color of your hair is purple, you would mark (X)
the last box and write the word “purple” in the blank as
shown. BE SURE TO WRITE CLEARLY.
Blond
Red
X
3.
Some other color PRINT OTHER COLOR
purple
EXAMPLE 3: YOU MAY MARK (X) MORE THAN ONE ANSWER
Do you plan to do any of the following next week?
YOU MAY MARK (X) MORE THAN ONE ANSWER
X
Rent a movie
X
Go to a baseball game
If you plan to rent a movie and go to a baseball game
next week, you would mark (X) both boxes.
Study at a friend’s house
PPA Study – Part A – Wait Training 6/28/11
1
4.
EXAMPLE 4: QUESTION WITH A SKIP
1. Do you ever eat chocolate?
Because you answered “Yes” to question 1, you would
continue to question 2 and then question 3.
MARK (X) ONE
X
Yes
No
GO TO QUESTION 3
If you answered “No” to question 1, you would skip
question 2 and go right to question 3.
2. Do you always brush your teeth after eating chocolate?
MARK (X) ONE
Yes
X
No
3. Did you do any of the following last week?
YOU MAY MARK (X) MORE THAN ONE ANSWER
X
Went to a play
X
Went to a movie
Attended a sporting event
5.
EXAMPLE 5: FILL IN THE NUMBER
In the past seven (7) days, how many chocolate bars have you eaten?
0
2
NUMBER OF CHOCOLATE BARS – Your best guess is fine.
Fill in the boxes with the correct number. For any number less than 10, put a
zero (0) in the first box. For example, if you had eaten 2 chocolate bars in the
past 7 days, you would write “0” in the first box and “2” in the second box. If
you had eaten 15 chocolate bars, you would write “1” in the first box and “5”
in the second box.
6.
EXAMPLE 6: MARK (X) ONE ANSWER FOR EACH QUESTION
In the past 12 months, have you done any of the following?
MARK (X) ONE FOR EACH QUESTION
a.
b.
c.
d.
e.
f.
YES
NO
Walked a dog on a leash? .......................................................................................................................... X
Played Frisbee? .......................................................................................................................................... X
X
Weeded a garden? .....................................................................................................................................
Eaten a piece of fresh fruit?........................................................................................................................ X
X
Played a piano? ..........................................................................................................................................
X
Watched a movie? ......................................................................................................................................
Mark (x) either “yes” or “no” for each of the six (6) questions
(a–f) by marking (x) one of the of two boxes in each row.
PPA Study – Part A – Wait Training 6/28/11
2
7.
EXAMPLE 7: MARK (X) ONE MONTH AND ONE YEAR
In what month and year did you finish elementary school?
MARK (X) ONE MONTH AND ONE YEAR
Month finished
Year finished
January
2010
X
February
X
8.
2009
March
2008
April
2007
May
2006
June
2005
July
2004
August
2003
September
2002
October
2001
November
2000
December
1999
If you finished elementary school in
June of 2009, you would mark (X) the
box next to June and mark (X) the box
next to 2009.
EXAMPLE 8: FOR GIRLS or FOR BOYS
1a. FOR GIRLS Do you want to be a mother someday?
MARK (X) ONE
Yes
No
GO TO 2
1b. FOR BOYS Do you want to be a father someday?
MARK (X) ONE
Yes
No
2.
Do you have any brothers or sisters?
MARK (X) ONE
Yes
Some questions are just for girls and some
questions are just for boys. These
questions are marked with FOR GIRLS or
FOR BOYS. If a question is not marked
specifically FOR GIRLS or FOR BOYS, then
it is a question for everyone to answer.
In the example, if you are a girl, you would
answer 1a (FOR GIRLS), skip 1b (FOR
BOYS), and then answer question 2, for
everyone. If you are a boy, you would skip
1a (FOR GIRLS), answer 1b (FOR BOYS),
and answer question 2, for everyone.
No
PPA Study – Part A – Wait Training 6/28/11
3
SECTION 1: YOU AND YOUR BACKGROUND
1.1. In what month and year were you born?
MARK (X) ONE MONTH AND ONE YEAR
Month born
Year born
January
2002
February
2001
March
2000
April
1999
May
1998
June
1997
July
1996
August
1995
September
1994
October
1993
November
1992
December
1991
1.2. What grade are you in?
MARK (X) ONE
6th
7th
8th
9th
10th
11th
12th
Not currently in school
PPA Study – Part A – Wait Training 6/28/11
4
1.3. Are you male or female?
MARK (X) ONE
Male
Female
1.4. Are you Hispanic/Latino?
MARK (X) ONE
Yes
No
1.5. 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
Some other race PRINT OTHER RACE(S)
1.6. What is the main language you speak at home?
MARK (X) ONE
English
Spanish
Some other language PRINT OTHER LANGUAGE
PPA Study – Part A – Wait Training 6/28/11
5
1.7. In the past 12 months, how often did you attend religious services or activities?
MARK (X) ONE
Never
Less than once a month
1-3 times per month
Once a week
More than once a week
1.8. How important is religion in your life?
MARK (X) ONE
Not at all important
Somewhat important
Very important
1.9. In the past 12 months, have you received any information or learned about any of the following?
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 ....................................................................................................................................
1.10. How likely is it that you will do each of the following things?
MARK (X) ONE FOR EACH
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.......................................................................................................
PPA Study – Part A – Wait Training 6/28/11
6
SECTION 2: FAMILY
The next questions are about where you live and who lives with you.
2.1. Which of the following best describes where you live?
MARK (X) ONE
You live in one home
2.2.
GO TO 2.2
You live in two or more homes and go back and forth
GO TO 2.3
You are homeless, for example, living on the street,
in a car or shelter, or staying with friends or relatives
GO TO 2.4
Who lives with you in your home?
MARK (X) ALL THAT APPLY
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
PPA Study – Part A – Wait Training 6/28/11
GO TO 2.4
7
2.3.
Who lives with you in each of your homes?
MARK (X) BOTH COLUMNS
Mark (X) everyone you live with in your MAIN home
Mark (X) everyone you live with in your OTHER home(s)
Your biological mother
Your biological mother
Your biological father
Your biological father
A stepmother or adoptive mother
A stepmother or adoptive mother
A foster mother
A foster mother
A stepfather or adoptive father
A stepfather or adoptive father
A foster father
A foster father
Your parent’s partner, boyfriend, or girlfriend
Your parent’s partner, boyfriend, or girlfriend
Any grandmothers
Any grandmothers
Any grandfathers
Any grandfathers
Any older brothers or sisters
Any older brothers or sisters
Any younger brothers or sisters
Any younger brothers or sisters
Any aunts, uncles, or other relatives
Any aunts, uncles, or other relatives
Any other people you are not related to
Any other people you are not related to
You live by yourself
You live by yourself
PPA Study – Part A – Wait Training 6/28/11
8
MOTHER
2.4. Now we have some questions about your mother, or the person you think of as your mother.
Is this person…
MARK (X) ONE
Your biological mother, that is, the woman who gave birth to you
Your stepmother or adoptive mother
Your foster mother
Your grandmother
Your aunt or your older sister
Some other adult
Don’t have a mother or person I think of as my mother
GO TO 2.12
2.5. The following questions are about the person you marked as your mother or the person you think
of as your mother.
Did she graduate from high school?
MARK (X) ONE
Yes
No
Don’t know
2.6. Did she graduate from a 4-year college?
MARK (X) ONE
Yes
No
Don’t know
2.7. Is she working now?
MARK (X) ONE
She is not working at a paid job
Yes, she is working part-time or less than 30 hours a week
Yes, she is working full-time or at more than one job for 30 hours a week or more
Yes, she works, but I don’t know how many hours
Don’t know if she is working
PPA Study – Part A – Wait Training 6/28/11
9
2.8. How close do you feel to your mother or the person you think of as your mother?
MARK (X) ONE
Not at all close
A little close
Somewhat close
Very close
2.9. In general, how much do you think she cares about you?
MARK (X) ONE
Does not care at all
Cares a little bit
Cares somewhat
Cares very much
2.10. Whether you have done this or not, how would she feel about you having sex at this time in your
life?
MARK (X) ONE
Strongly approve
Approve
Neither approve nor disapprove
Disapprove
Strongly disapprove
2.11. How would she feel about you having a baby at this time in your life?
MARK (X) ONE
Strongly approve
Approve
Neither approve nor disapprove
Disapprove
Strongly disapprove
PPA Study – Part A – Wait Training 6/28/11
10
FATHER
2.12. Next we have some questions about your father, or the person you think of as your father. Is this
person…
MARK (X) ONE
Your biological father, that is, the man who is genetically related to you
Your stepfather or adoptive father
Your foster father
Your grandfather
Your uncle or your older brother
Some other adult
Don’t have a father or person I think of as my father
GO TO 2.20
2.13. The following questions are about the person you marked as your father or the person you think
of as your father.
Did he graduate from high school?
MARK (X) ONE
Yes
No
Don’t know
2.14. Did he graduate from a 4-year college?
MARK (X) ONE
Yes
No
Don’t know
2.15. 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
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
PPA Study – Part A – Wait Training 6/28/11
11
2.16. How close do you feel to your father or the person you think of as your father?
MARK (X) ONE
Not at all close
A little close
Somewhat close
Very close
2.17. In general, how much do you think he cares about you?
MARK (X) ONE
Does not care at all
Cares a little bit
Cares somewhat
Cares very much
2.18. Whether you have done this or not, how would he feel about you having sex at this time in your
life?
MARK (X) ONE
Strongly approve
Approve
Neither approve nor disapprove
Disapprove
Strongly disapprove
2.19. How would he feel about you having a baby at this time in your life?
MARK (X) ONE
Strongly approve
Approve
Neither approve nor disapprove
Disapprove
Strongly disapprove
PPA Study – Part A – Wait Training 6/28/11
12
PARENTS
2.20. The next two questions are about your biological parents.
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
They used to be married to each other, but are now divorced
They have never been married to each other
Don’t know
2.21. 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
Don’t know
2.22. The next questions are about the parents or guardians you live with most of the time.
Thinking about the past month, how often did your parents know where you were after school?
MARK (X) ONE
Always
Usually
Sometimes
Rarely
Never
PPA Study – Part A – Wait Training 6/28/11
13
2.23. Thinking about the past month, how often did your parents know who you were going to be with
before you went out?
MARK (X) ONE
Always
Usually
Sometimes
Rarely
Never
I did not go out
2.24. In the past 12 months, how many times have you talked with at least one of your parents or
guardians about…
MARK (X) ONE FOR EACH
NEVER
1-2
TIMES
3-9
TIMES
10 OR MORE
TIMES
a. How things are going with school work or
with your grades? .......................................................................................................................................
b. A personal problem you were having? .......................................................................................................
c. How to have good romantic relationships?.................................................................................................
d. Strategies for safe dating? ..........................................................................................................................
e. How to resist pressures to have sex? .........................................................................................................
f.
Avoiding drugs and alcohol?.......................................................................................................................
g. Pregnancy or birth? ....................................................................................................................................
h. Sexually transmitted diseases
(also known as STDs), HIV, or AIDS? ........................................................................................................
PPA Study – Part A – Wait Training 6/28/11
14
SECTION 3: VIEWS AND PERCEPTIONS
3.1. 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…
MARK (X) ONE FOR EACH
STRONGLY
AGREE
AGREE
DISAGREE
STRONGLY
DISAGREE
a. Having sexual intercourse is a good thing for you to
do at your age? ..............................................................................................................................................
b. At your age right now, having sexual intercourse would
create problems? ...........................................................................................................................................
c. At your age right now, not having sexual intercourse is
important for you to be safe and healthy? .....................................................................................................
d. At your age right now, it is okay for you to have sexual
intercourse if you use birth control, like a condom? ......................................................................................
e. If you have sexual intercourse as a teen, it will not do
any harm? ......................................................................................................................................................
f.
You would feel guilty having sexual intercourse as
a teen? ...........................................................................................................................................................
g. You would feel embarrassed to say no to a boyfriend
or girlfriend who wanted to have sexual intercourse
with you? ........................................................................................................................................................
h. You would not want to disappoint a boyfriend or
girlfriend who wanted to have sexual intercourse with you? .........................................................................
3.2. The next series of questions is about your views on sexual intercourse before marriage. How
strongly do you agree or disagree that…
MARK (X) ONE FOR EACH
STRONGLY
AGREE
a.
AGREE
DISAGREE
STRONGLY
DISAGREE
You intend to wait until marriage to have sexual
intercourse? ...................................................................................................................................................
b. It would be good for you to wait until marriage to
have sexual intercourse? ...............................................................................................................................
c. Whether or not you wait until marriage to have sexual
intercourse is completely up to you? .............................................................................................................
d. It would be difficult for you to wait until marriage to
have sexual intercourse? ...............................................................................................................................
e. It is against your values to have sexual intercourse
before marriage? ...........................................................................................................................................
f.
You think people who wait until marriage to have sexual
intercourse are being safe and responsible?.................................................................................................
g. It would be unpleasant for you to wait until marriage
to have sexual intercourse? ...........................................................................................................................
h. Most people who are important to you think that you
should wait until marriage to have sexual intercourse? .................................................................................
PPA Study – Part A – Wait Training 6/28/11
15
3.3. FOR GIRLS
If you got pregnant now, how would you feel?
MARK (X) ONE
Very happy
A little happy
Neither happy nor upset
A little upset
Very upset
3.3. FOR BOYS
If you got someone pregnant now, how would you feel?
MARK (X) ONE
Very happy
A little happy
Neither happy nor upset
A little upset
Very upset
3.4. Imagine you are alone with someone you like very much. How likely is it that you could…
MARK (X) ONE FOR EACH
NOT AT ALL
LIKELY
A LITTLE
BIT LIKELY
SOMEWHAT
LIKELY
VERY
LIKELY
a. Stop them if they wanted to touch your chest and
you did not want them to do that (FOR GIRLS)? ............................................................................................
b. 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? ....................................................................................
c. Avoid having sexual intercourse if you didn’t want to? ....................................................................................
PPA Study – Part A – Wait Training 6/28/11
16
3.5. The next series of questions is about condom use. How strongly do you agree or disagree that…
MARK (X) ONE FOR EACH
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 do not protect from the emotional
impact of sexual intercourse? ........................................................................................................................
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? ...........................................................................................................
3.6. 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 3.7
3.6a. How confident are you that your answer is correct?
MARK (X) ONE
Not at all confident
A little confident
Somewhat confident
Very confident
3.7. If a condom is used correctly, how much can it decrease the risk of getting HIV, the virus that
causes AIDS?
MARK (X) ONE
Not at all
A little
A lot
Don’t know
PPA Study – Part A – Wait Training 6/28/11
17
3.8. If a condom is used correctly, how much can it decrease the risk of getting Chlamydia and
gonorrhea?
MARK (X) ONE
Not at all
A little
A lot
Don’t know
3.9. The next series of questions is about birth control pills.
If birth control pills are used correctly, how much can they decrease the risk of pregnancy?
MARK (X) ONE
Not at all
A little
A lot
Don’t know
GO TO 3.10
3.9a. How confident are you that your answer is correct?
MARK (X) ONE
Not at all confident
A little confident
Somewhat confident
Very confident
3.10. If birth control pills are used correctly, how much can they decrease the risk of getting HIV, the
virus that causes AIDS?
MARK (X) ONE
Not at all
A little
A lot
Don’t know
3.11. If birth control pills are used correctly, how much can they decrease the risk of getting Chlamydia
and gonorrhea?
MARK (X) ONE
Not at all
A little
A lot
Don’t know
PPA Study – Part A – Wait Training 6/28/11
18
3.12. Can you get a sexually transmitted disease, or STD, from having oral sex?
MARK (X) ONE
Yes
No
Don’t know
GO TO 3.13
3.12a. How confident are you that your answer is correct?
MARK (X) ONE
Not at all confident
A little confident
Somewhat confident
Very confident
3.13. In the past 3 months, how many TIMES have you gone out on a date?
Zero or None
GO TO 3.15
NUMBER OF TIMES – Your best guess is fine.
3.14. 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.
3.15. Do you intend to have oral sex in the next year?
MARK (X) ONE
Yes, definitely
Yes, probably
No, probably not
No, definitely not
3.16. Do you intend to have sexual intercourse in the next year?
MARK (X) ONE
Yes, definitely
Yes, probably
No, probably not
No, definitely not
GO TO 3.19
PPA Study – Part A – Wait Training 6/28/11
19
3.17. If you have sexual intercourse in the next year, do you intend to use a condom?
MARK (X) ONE
Yes, definitely
Yes, probably
No, probably not
No, definitely not
3.18. The next question is about your intention to use other methods of birth control, NOT including
condoms:
• 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
PPA Study – Part A – Wait Training 6/28/11
20
3.19. Do you intend to have sexual intercourse without being married?
MARK (X) ONE
Yes, definitely
Yes, probably
No, probably not
No, definitely not
3.20. Have you ever had sexual intercourse or oral sex?
Yes
GO TO PART B1 AND PUT THIS BOOKLET BACK IN THE ENVELOPE
No
GO TO PART B2 AND PUT THIS BOOKLET BACK IN THE ENVELOPE
Complete the correct Part B
B1 or B2,
but not both.
PPA Study – Part A – Wait Training 6/28/11
21
Put this booklet back in
the envelope and
go to the correct Part B.
PPA Study – Part A – Wait Training 6/28/11
22
OMB Control No:
Expiration Date:
BASELINE QUESTIONNAIRE
PART B1
LIVE THE LIFE
Please be sure that you have the correct Part B.
If you answered “Yes” to the last question of Part A, you have the correct version of
Part B. If you answered “No,” please put this version back in your envelope and fill out
Part B2 instead.
Thank you.
Mathematica Policy Research
THE PAPERWORK REDUCTION ACT OF 1995
Public reporting burden for this collection of information is estimated to average 30 minutes per response, including the time for
reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not
conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid
OMB control number.
PART B
4.1. The next questions are about your sexual 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 or oral sex?
MARK (X) ONE
No
STOP AND GO TO PART B2.
Yes
CONTINUE WITH THIS BOOKLET.
4.2. The first questions are about sexual intercourse. By sexual intercourse, we mean a male putting
his penis into a female’s vagina.
Have you ever had sexual intercourse?
MARK (X) ONE
Yes
No
GO TO 4.14
4.3. The very first time you had sexual intercourse, what month and year was it?
MARK (X) ONE MONTH AND ONE YEAR
Month of First Sexual
Intercourse
Year of First Sexual
Intercourse
January
2011
February
2010
March
2009
April
2008
May
2007
June
2006
July
2005
August
2004
September
2003
October
2002
November
2001
December
2000 or earlier
PPA Study – Part B – Wait Training 6/28/11
1
4.4. 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. The very first time you had sexual intercourse, how old was your partner?
MARK (X) ONE
Three or more years younger than you
A year or two younger than you
The same age as you
A year or two older than you
Three or more years older than you
4.6. The very first time you had sexual intercourse, would you say that it was voluntary or not
voluntary?
MARK (X) ONE
Voluntary
Not voluntary
4.7. Birth control methods are something used to reduce the risk of pregnancy, and some can reduce
the risk of sexually transmitted diseases, also known as STDs.
The first time you had sexual intercourse, did you or your partner use any type of birth control—
including condoms or any other method?
MARK (X) ONE
Yes
No
GO TO 4.9
4.8. The first time you had sexual intercourse, did you or your partner use…
MARK (X) ONE FOR EACH
YES
NO
a. Condoms?......................................................................................................................................................
b. Birth control pills or the patch? ......................................................................................................................
c. Depo-Provera or other injectable birth control? .............................................................................................
d. NuvaRing or the ring? ....................................................................................................................................
e. Withdrawal or pulling out? .............................................................................................................................
f.
Another method? PRINT OTHER METHOD USED
PPA Study – Part B1 – Wait Training 6/28/11
...................................................................................
2
4.9. Have you had sexual intercourse more than one time?
MARK (X) ONE
Yes
No
GO TO 4.14
4.10. How many DIFFERENT PEOPLE have you ever had sexual intercourse with, even if only one
time?
NUMBER OF PEOPLE – Your best guess is fine.
4.11. Now please think about the past 3 months. In the past 3 months, how many TIMES have you had
sexual intercourse?
None
GO TO 4.14
NUMBER OF TIMES – Your best guess is fine.
4.12. In the past 3 months, how many TIMES have you had sexual intercourse without using a
condom?
None
NUMBER OF TIMES – Your best guess is fine.
4.13. 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)
In the past 3 months, how many TIMES have you had sexual intercourse without using any of
these methods of birth control?
None
NUMBER OF TIMES – Your best guess is fine.
PPA Study – Part B1 – Wait Training 6/28/11
3
4.14. 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
Yes
No
GO TO 4.18
4.15. The very first time you had oral sex, what month and year was it?
MARK (X) ONE MONTH AND MARK (X) ONE YEAR
Month of First Oral Sex
Year of First Oral Sex
January
2011
February
2010
March
2009
April
2008
May
2007
June
2006
July
2005
August
2004
September
2003
October
2002
November
2001
December
2000 or earlier
4.16. How many DIFFERENT PEOPLE have you ever had oral sex with, even if only one time?
NUMBER OF PEOPLE – Your best guess is fine.
4.17. Now please think about the past 3 months.
In the past 3 months, how many TIMES have you had oral sex?
None
GO TO 4.18
NUMBER OF TIMES – Your best guess is fine.
PPA Study – Part B1 – Wait Training 6/28/11
4
4.18. FOR GIRLS
a. Have you ever had your period, that is, your menstrual period?
MARK (X) ONE
Yes
No
GO TO 4.19
b. How old were you when you had your first period, that is, your first menstrual period?
NUMBER OF YEARS OLD YOU WERE – Your best guess is fine.
4.18. FOR BOYS
a. People reach puberty at different ages. Signs of puberty for males include physical changes
such as developing pubic or facial hair, or their voices cracking or lowering. Which of the
following best describes these changes for you?
MARK (X) ONE
These changes have not yet started
GO TO 4.19
These changes have barely started
These changes are definitely underway
These changes seem complete
b. How old were you when these changes started?
NUMBER OF YEARS OLD YOU WERE – Your best guess is fine.
4.19. FOR BOYS AND GIRLS
a.
To the best of your knowledge, have you ever been pregnant or gotten someone pregnant,
even if no child was born?
MARK (X) ONE
Yes
No
GO TO 4.20
b. To the best of your knowledge, how many times have you been pregnant or gotten someone
pregnant?
NUMBER OF TIMES
c.
Have you ever had a baby or has anyone you got pregnant actually had the baby?
MARK (X) ONE
Yes
No
Don’t know
PPA Study – Part B1 – Wait Training 6/28/11
5
4.20. In the past 12 months, have you spoken with a doctor or nurse about having sex, birth control or
sexually transmitted diseases, also known as STDs?
MARK (X) ONE
Yes
No
4.21. In the past 12 months, have you been tested by a doctor or nurse for a sexually transmitted
disease (STD), like gonorrhea, Chlamydia, syphilis, or HIV?
MARK (X) ONE
Yes
No
4.22. In the past 12 months, have you been told by a doctor or nurse that you had a sexually
transmitted disease (STD)?
MARK (X) ONE
Yes
No
4.23. Have you ever been in a situation where someone touched you in a sexual way that you did not
want, or someone forced you to touch him or her in a sexual way that you did not want to?
MARK (X) ONE
Yes
No
PPA Study – Part B1 – Wait Training 6/28/11
6
SECTION 5: ALCOHOL AND DRUG USE
5.1. The next questions are about alcohol and drugs. Please be as honest as possible, and remember
that everything you tell us will be kept private.
Have you ever had an alcoholic drink, such as beer, wine or other liquor, NOT counting any times
you just had a sip?
MARK (X) ONE
Yes
No
GO TO 5.5
5.2. The very first time you had an alcoholic drink, how old were you?
NUMBER OF YEARS OLD YOU WERE – Your best guess is fine.
5.3. During the past 30 days, not including any times you just had a sip, on how many days did you
have one or more alcoholic beverages?
MARK (X) ONE
More than 25 days
5 to 25 days
1 to 4 days
0 (zero) days
5.4. During the past 30 days, on how many days did you have 5 or more drinks in a row?
MARK (X) ONE
More than 25 days
5 to 25 days
1 to 4 days
0 (zero) days
PPA Study – Part B1 – Wait Training 6/28/11
7
5.5. Have you ever used marijuana, also called weed or pot?
MARK (X) ONE
Yes
No
GO TO 5.7
5.6. During the past 30 days, on how many days did you use marijuana?
MARK (X) ONE
More than 25 days
5 to 25 days
1 to 4 days
0 (zero) days
5.7. Have you ever used any other type of illegal drug, for example, Methamphetamine, speed, PCP,
ecstasy or any form of cocaine, such as crack?
MARK (X) ONE
Yes
No
PPA Study – Part B1 – Wait Training 6/28/11
8
SECTION 6: FRIENDS AND RELATIONSHIPS
6.1. How many of your friends who are your age think the following things? Your best guess is fine.
MARK (X) ONE FOR EACH
NONE
SOME
HALF
MOST
ALL
DON’T
KNOW
a. Having sexual intercourse is a
good thing for them to do at their age ..............................................................................................................
b. It would be okay for them to have
sexual intercourse as long as they
used birth control, like a condom .....................................................................................................................
c. It would be okay for them to have
sexual intercourse if they were
dating the same person for a long time ...........................................................................................................
d. They should wait until they are older
to have sexual intercourse ...............................................................................................................................
e. They should wait until marriage to
have sexual intercourse ...................................................................................................................................
f.
It is more important to finish high school
than to have sexual intercourse .......................................................................................................................
6.2. How many of your friends who are your age have done the following things?
MARK (X) ONE FOR EACH
NONE
SOME
HALF
MOST
ALL
DON’T
KNOW
a. Had sexual intercourse ....................................................................................................................................
b. Had oral sex .....................................................................................................................................................
c. Have decided to delay having
sexual intercourse until later in
life.....................................................................................................................................................................
6.3. In general, how much pressure, if any, do you feel from your friends to have sexual intercourse?
MARK (X) ONE
A lot of pressure
Some pressure
A little pressure
No pressure
PPA Study – Part B1 – Wait Training 6/28/11
9
6.4. How much do you feel that your friends care about you?
MARK (X) ONE
Do not care at all
Care a little bit
Care somewhat
Care very much
Please put all three parts of the survey back
into the envelope and give the envelope back
to the moderator.
Thank you!
PPA Study – Part B1 – Wait Training 6/28/11
10
We thank you for
completing this survey!
PPA Study – Part B1 – Wait Training 6/28/11
11
OMB Control No:
Expiration Date:
BASELINE QUESTIONNAIRE
PART B2
LIVE THE LIFE
Please be sure that you have the correct Part B.
If you answered “No” to the last question of Part A, you have the correct version of
Part B. If you answered “Yes,” please put this version back in your envelope and fill
out Part B1 instead.
Thank you.
Mathematica Policy Research
THE PAPERWORK REDUCTION ACT OF 1995
Public reporting burden for this collection of information is estimated to average 30 minutes per response, including the time for
reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not
conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid
OMB control number.
PART B
4.1. This booklet is for youth who have not had sex. We want to be sure you are in the correct
booklet. We know we asked this before but…
Just to confirm, have you ever had sexual intercourse or oral sex?
MARK (X) ONE
Yes
STOP AND GO TO PART B1.
No
CONTINUE WITH THIS BOOKLET.
4.2. The first two questions in this booklet are about your schooling.
Do you expect that you will graduate from high school?
MARK (X) ONE
Yes
I already graduated from high school
No
GO TO 4.4
4.3. 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?)
MARK (X) ONE MONTH AND ONE YEAR
Month of Graduation
Year of Graduation
January
2018 or later
February
2017
March
2016
April
2015
May
2014
June
2013
July
2012
August
2011
September
2010
October
2009
November
2008
December
2007 or earlier
PPA Study – Part B – Wait Training 6/28/11
1
4.4. The next questions are about where you live.
In the past 7 days, did you spend any nights somewhere like a shelter, someone else’s home, in a
car, on the street or in any other temporary housing because you did not have a regular place to
stay?
MARK (X) ONE
Yes
GO TO 4.8
No
4.5. In how many homes, places, or households do you live: one, two, or three or more?
MARK (X) ONE
1 home
GO TO 4.8
2 homes
3 or more homes
4.6. Do you consider one of these homes to be your main home?
MARK (X) ONE
Yes
No
4.7. Thinking about the past 30 days, how many nights did you spend in each home?
FILL IN TWO OR THREE NUMBERS
Number of nights at home #1 – Your best guess is fine.
Number of nights at home #2 – Your best guess is fine.
Number of nights at another home or other homes – Your best guess is fine.
4.8. These next few questions are about you and your friends.
How strongly do you agree or disagree that you have friends who will give you good advice?
MARK (X) ONE
Strongly Agree
Agree
Disagree
Strongly disagree
PPA Study – Part B – Wait Training 6/28/11
2
4.9. How strongly do you agree or disagree that you have a friend who cares about you?
MARK (X) ONE
Strongly Agree
Agree
Disagree
Strongly disagree
4.10. How strongly do you agree or disagree that you have a friend you can talk to when you need to?
MARK (X) ONE
Strongly Agree
Agree
Disagree
Strongly disagree
4.11. How strongly do you agree or disagree that you have someone who you can call your best
friend?
MARK (X) ONE
Strongly Agree
Agree
Disagree
Strongly disagree
4.12. These next few questions are about you.
How strongly do you agree or disagree that when you start a project, you finish it?
MARK (X) ONE
Strongly Agree
Agree
Disagree
Strongly disagree
4.13. How strongly do you agree or disagree that you only work as hard as you have to?
MARK (X) ONE
Strongly Agree
Agree
Disagree
Strongly disagree
PPA Study – Part B1 – Wait Training 6/28/11
3
4.14. How strongly do you agree or disagree that you are someone people can count on?
MARK (X) ONE
Strongly Agree
Agree
Disagree
Strongly disagree
4.15. How strongly do you agree or disagree that when you do work, you do a good job?
MARK (X) ONE
Strongly Agree
Agree
Disagree
Strongly disagree
4.16. Here are some reasons people your age might choose NOT to have sexual intercourse. How
important is each of these reasons to you?
MARK (X) ONE FOR EACH QUESTION
VERY
IMPORTANT
SOMEWHAT
IMPORTANT
NOT TOO
IMPORTANT
NOT AT ALL
IMPORTANT
a. I believe it is better for my long-term health
and well-being ..............................................................................................................................................
b. I don’t want to get a sexually transmitted
disease, also known as an STD ..................................................................................................................
c. I don’t want to disappoint my parents ..........................................................................................................
d. I am too young to have sex..........................................................................................................................
e. My boyfriend or girlfriend doesn’t want
to have sex...................................................................................................................................................
f.
I want to wait until I’m married .....................................................................................................................
g. It is against my personal values ..................................................................................................................
h. I haven’t met the right person yet ................................................................................................................
i.
I haven’t had the chance..............................................................................................................................
j.
I don’t want to ..............................................................................................................................................
k. FOR GIRLS I do not want to get pregnant ..................................................................................................
l.
FOR BOYS I do not want to get a girl pregnant ..........................................................................................
PPA Study – Part B1 – Wait Training 6/28/11
4
4.17. FOR GIRLS
a. Have you ever had your period, that is, a menstrual period?
MARK (X) ONE
Yes
No
GO TO 4.19
b. How old were you when you had your first period, that is, your first menstrual period?
NUMBER OF YEARS OLD YOU WERE – Your best guess is fine.
GO TO 4.19
4.18. FOR BOYS
a. People reach puberty at different ages. Signs of puberty for males include physical changes
such as developing pubic or facial hair, or their voices cracking or lowering. Which of the
following best describes these changes for you?
MARK (X) ONE
These changes have not yet started
GO TO 4.19
These changes have barely started
These changes are definitely underway
These changes seem complete
b. How old were you when these changes started?
NUMBER OF YEARS OLD YOU WERE – Your best guess is fine.
4.19. Have you ever kissed someone on the lips?
MARK (X) ONE
Yes
No
GO TO 4.21
4.20. Have you ever French kissed, that is put your tongue in someone’s mouth while kissing?
MARK (X) ONE
Yes
No
PPA Study – Part B1 – Wait Training 6/28/11
5
4.21. Have you ever touched another person’s private parts?
MARK (X) ONE
Yes
No
4.22. Have you ever let someone touch your private parts?
MARK (X) ONE
Yes
No
4.23. Have you ever been in a situation where someone touched you in a sexual way that you did not
want, or someone forced you to touch him or her in a sexual way that you did not want to?
MARK (X) ONE
Yes
No
4.24. If you decided to have sexual intercourse outside of marriage, how likely is it that you would use
a condom or other method of birth control?
MARK (X) ONE
Don’t plan to have sexual intercourse outside of marriage
Not at all likely
A little bit likely
Somewhat likely
Very likely
PPA Study – Part B1 – Wait Training 6/28/11
6
SECTION 5: ALCOHOL AND DRUG USE
5.1. The next questions are about alcohol and drugs. Please be as honest as possible, and remember
that everything you tell us will be kept private.
Have you ever had an alcoholic drink, such as beer, wine or other liquor, NOT counting any times
you just had a sip?
MARK (X) ONE
Yes
No
GO TO 5.5
5.2. The very first time you had an alcoholic drink, how old were you?
NUMBER OF YEARS OLD YOU WERE - Your best guess is fine.
5.3. During the past 30 days, not including any times you just had a sip, on how many days did you
have one or more alcoholic beverages?
MARK (X) ONE
More than 25 days
5 to 25 days
1 to 4 days
0 (zero) days
5.4. During the past 30 days, on how many days did you have 5 or more drinks in a row?
MARK (X) ONE
More than 25 days
5 to 25 days
1 to 4 days
0 (zero) days
PPA Study – Part B1 – Wait Training 6/28/11
7
5.5. Have you ever used marijuana, also called weed or pot?
MARK (X) ONE
Yes
No
GO TO 5.7
5.6. During the past 30 days, on how many days did you use marijuana?
MARK (X) ONE
More than 25 days
5 to 25 days
1 to 4 days
0 (zero) days
5.7. Have you ever used any other type of illegal drug, for example, Methamphetamine, speed, PCP,
ecstasy or any form of cocaine, such as crack?
MARK (X) ONE
Yes
No
PPA Study – Part B1 – Wait Training 6/28/11
8
SECTION 6: FRIENDS AND RELATIONSHIPS
6.1. How many of your friends who are your age think the following things? Your best guess is fine.
MARK (X) ONE FOR EACH
NONE
SOME
HALF
MOST
ALL
DON’T
KNOW
a. Having sexual intercourse is a good
thing for them to do at their age ......................................................................................................................
b. It would be okay for them to have
sexual intercourse as long as they
used birth control, like a condom ....................................................................................................................
c. It would be okay for them to have
sexual intercourse if they were
dating the same person for a long
time .................................................................................................................................................................
d. They should wait until they are
older to have sexual intercourse .....................................................................................................................
e. They should wait until marriage
to have sexual intercourse ..............................................................................................................................
f.
It is more important to finish high school
than to have sexual intercourse ......................................................................................................................
6.2. How many of your friends who are your age have done the following things?
MARK (X) ONE FOR EACH
NONE
SOME
HALF
MOST
ALL
DON’T
KNOW
a. Had sexual intercourse ...................................................................................................................................
b. Had oral sex ....................................................................................................................................................
c. Have decided to delay having
sexual intercourse until later in
life.....................................................................................................................................................................
6.3. In general, how much pressure, if any, do you feel from your friends to have sexual intercourse?
MARK (X) ONE
A lot of pressure
Some pressure
A little pressure
No pressure
PPA Study – Part B1 – Wait Training 6/28/11
9
6.4. How much do you feel that your friends care about you?
MARK (X) ONE
Do not care at all
Care a little bit
Care somewhat
Care very much
Please put all three parts of the survey back
into the envelope and give the envelope back
to the moderator.
Thank you!
PPA Study – Part B1 – Wait Training 6/28/11
10
We thank you for
completing this survey!
PPA Study – Part B1 – Wait Training 6/28/11
11
| File Type | application/pdf |
| Author | MThomas |
| File Modified | 2011-06-29 |
| File Created | 2011-06-29 |