Live the Life Ministries/WAIT Training

Evaluation of Pregnancy Prevention Approaches - First Follow-up

0990-0382Attachment F_LTL

Live the Life Ministries/WAIT Training

OMB: 0990-0382

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0990-0382 can be found here:

2015-04-15 - Extension without change of a currently approved collection

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ATTACHMENT F
EVALUATION OF ADOLESCENT PREGNANCY PREVENTION APPROACHES
FOLLOW- UP INSTRUMENT: 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

Form approved
OMB No. 0990-0382
Exp. Date: xx/xx/20xx

FOLLOW-UP QUESTIONNAIRE
PART A
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.

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

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it
displays a valid OMB control number. The valid OMB control number for this information collection is 0990-0382. The time
required to complete this information collection is estimated to average 42 minutes per response, including the time to review
instructions and complete and review the information collection. If you have comments concerning the accuracy of the time
estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA,
200 Independence Ave., S.W., Suite 336-E, Washington D.C. 20201, Attention: PRA Reports Clearance Officer

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
Green

If the color of your eyes is brown, you would mark (X)
the first box as shown.

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

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

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 – FU 1 Part A Wait Training – 1/24/12

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
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

3. Did you do any of the following last week?
YOU MAY MARK (X) MORE THAN ONE ANSWER
X

Went to a play

Went to a movie
Attended a sporting event

EXAMPLE 5: FILL IN THE NUMBER
In the past seven (7) days, how many chocolate bars have you eaten?
0

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.

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 – FU 1 Part A Wait Training – 1/24/12

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

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.

PPA Study – FU 1 Part A Wait Training – 1/24/12

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 – FU 1 Part A Wait Training – 1/24/12

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

1.6. What is the main language you speak at home?
MARK (X) ONE

English
Spanish
Some other language PRINT OTHER LANGUAGE

PPA Study – FU 1 Part A Wait Training – 1/24/12

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 a 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. Did you say “yes” to any item a through h in question 1.9 above?
MARK (X) ONE

Yes
No

GO TO QUESTION 1.13

PPA Study – FU 1 Part A Wait Training – 1/24/12

1.11. Thinking about the past 12 months, how many times did you get information on relationships,
abstinence, birth control, or sexually transmitted diseases at each of the following places?
MARK (X) ONE FOR EACH

Never

1-3
times

4-9 times

10 or
more times

a. School class ..............................................................................................................................................
b. Church, synagogue, mosque, or religious classes
outside of school........................................................................................................................................
c. Community center, youth organization, or
after-school activity ....................................................................................................................................
d. Doctor, nurse, or clinic ...............................................................................................................................
e. Friends .......................................................................................................................................................
f. Parents or other relatives or family members ...........................................................................................
g. Internet or media .......................................................................................................................................
h. Other

LIST OTHER SOURCE

......................................................................................................

1.12. Thinking about the past 12 months, where did you get information on relationships, abstinence,
birth control, or sexually transmitted diseases that was very helpful to you?
YOU MAY MARK (X) MORE THAN ONE

School class
Church, synagogue, mosque or religious classes outside of school
Community center, youth organization, or after-school activity
Doctor, nurse, or clinic
Friends
Parents or other relatives or family members
Internet or media
Other LIST OTHER SOURCE

1.13. 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 – FU 1 Part A Wait Training – 1/24/12

SECTION 2: FAMILY
2.1. The next questions are about where you live and who lives with you.
Which of the following best describes where you live?
MARK (X) ONE

You live in one home

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 – FU 1 Part A Wait Training – 1/24/12

GO TO 2.4

2.3. Who lives with you in each of your homes?
MARK (X) BOTH COLUMNS
Mark (X) all the people who live with you in your MAIN home

Mark (X) all the people who live with you in your OTHER home(s)

Your biological mother

Your biological father

A stepmother or adoptive mother

A foster mother

A stepfather or adoptive father

A foster father

Your parent’s partner, boyfriend, or girlfriend

Any grandmothers

Any grandfathers

Any older brothers or sisters

Any younger brothers or sisters

Any aunts, uncles, or other relatives

Any other people you are not related to

You live by yourself

PPA Study – FU 1 Part A Wait Training – 1/24/12

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
You don’t have a mother or person you think of as you mother

GO TO 2.6

2.5. Is the person you marked as your mother or the person you think of as your mother 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 – FU 1 Part A Wait Training – 1/24/12

FATHER
2.6. 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
You don’t have a father or person you think of as your father

GO TO 2.8

2.7. Is the person you marked as your father or the person you think of as your father 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 you don’t know how many hours
Don’t know if he is working

PPA Study – FU 1 Part A Wait Training – 1/24/12

PARENTS
2.8. 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

2.9. Do your biological mother and father live together now?
MARK (X) ONE

Yes
No
One or both of your biological parents have passed away
Don’t know

PPA Study – FU 1 Part A Wait Training – 1/24/12

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. This question is about your views on sexual intercourse before marriage. How strongly do you
agree or disagree with each of the following statements?
MARK (X) ONE FOR EACH

STRONGLY
AGREE

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. You are confident that you can wait until marriage to
have sexual intercourse .................................................................................................................................
e. It is against your values to have sexual intercourse
before marriage .............................................................................................................................................
f.

Waiting until marriage to have sexual intercourse
is the safest and healthiest choice .................................................................................................................

g. Most people who are important to you think that you
should wait until marriage to have sexual intercourse ...................................................................................

PPA Study – FU 1 Part A Wait Training – 1/24/12

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 do each
of these things?
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 – FU 1 Part A Wait Training – 1/24/12

3.5. The next series of questions is about condom use. How strongly do you agree or disagree with
each of the following statements?
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 condoms are used correctly and consistently, how much can they decrease the risk of
pregnancy?
MARK (X) ONE

Not at all
A little
A lot
Completely
Don’t know

GO TO 3.7

3.6a. How confident are you that your answer to the question above is correct?
MARK (X) ONE

Not at all confident
A little confident
Somewhat confident
Very confident

PPA Study – FU 1 Part A Wait Training – 1/24/12

3.7. If condoms are used correctly and consistently, 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
Completely
Don’t know

3.8. If condoms are used correctly and consistently, how much can they decrease the risk of getting
gonorrhea?
MARK (X) ONE

Not at all
A little
A lot
Completely
Don’t know

3.9. The next series of questions is about birth control pills.
If birth control pills are used correctly and consistently, how much can they decrease the risk of
pregnancy?
MARK (X) ONE

Not at all
A little
A lot
Completely
Don’t know

GO TO 3.10

3.9a. How confident are you that your answer to the question above is correct?
MARK (X) ONE

Not at all confident
A little confident
Somewhat confident
Very confident

PPA Study – FU 1 Part A Wait Training – 1/24/12

3.10. If birth control pills are used correctly and consistently, 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
Completely
Don’t know

3.11. If birth control pills are used correctly and consistently, how much can they decrease the risk of
getting gonorrhea?
MARK (X) ONE

Not at all
A little
A lot
Completely
Don’t know

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 to the question above is correct?
MARK (X) ONE

Not at all confident
A little confident
Somewhat confident
Very confident

PPA Study – FU 1 Part A Wait Training – 1/24/12

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, if you have the chance?
MARK (X) ONE

Yes, definitely
Yes, probably
No, probably not
No, definitely not

GO TO 3.19

3.17. If you were to have sexual intercourse in the next year, do you intend to use (or have your partner
use) a condom?
MARK (X) ONE

Yes, definitely
Yes, probably
No, probably not
No, definitely not

PPA Study – FU 1 Part A Wait Training – 1/24/12

3.18. The next question is about your intention to use any of these methods of birth control:
•
•
•
•
•
•
•

Condoms
Birth control pills
The shot (Depo-Provera)
The patch
The ring (NuvaRing)
IUD (Mirena or Paragard)
Implants (Implanon)

If you were to have sexual intercourse in the next year, do you intend to use (or have your partner
use) any of these methods of birth control?
MARK (X) ONE

Yes, definitely
Yes, probably
No, probably not
No, definitely not

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

GO TO PART B2 AND PUT THIS BOOKLET BACK IN THE ENVELOPE

Complete the correct Part B.

PPA Study – FU 1 Part A Wait Training – 1/24/12

Put this booklet back in
the envelope and

Go to the correct Part B.

PPA Study – FU 1 Part A Wait Training – 1/24/12

Form approved
OMB No. 0990-0382
Exp. Date: xx/xx/20xx

FOLLOW-UP QUESTIONNAIRE
PART B1
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

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

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
GO TO 4.13

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 – FU 1 Part B1 Wait Training – 1/24/12

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, would you say that it was voluntary or not
voluntary?
MARK (X) ONE

Voluntary
Not voluntary

4.6. 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 4.8

4.7. The first time you had sexual intercourse, did you or your partner use any of these methods?
MARK (X) ONE FOR EACH

YES

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 – FU 1 Part B1 Wait Training – 1/24/12

.....................................................................................

4.8. Have you had sexual intercourse more than one time?
MARK (X) ONE

Yes
GO TO 4.13

4.9. How many DIFFERENT PEOPLE have you ever had sexual intercourse with, even if only one
time?
NUMBER OF PEOPLE – Your best guess is fine.

4.10. Now please think about the past 3 months. In the past 3 months, how many TIMES have you had
sexual intercourse?
None

GO TO 4.13

NUMBER OF TIMES – Your best guess is fine.

4.11. 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.

4.12. 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 – FU 1 Part B1 Wait Training – 1/24/12

4.13. 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
GO TO 4.17

4.14. 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

4.15. How many DIFFERENT PEOPLE have you ever had oral sex with, even if only one time?
NUMBER OF PEOPLE – Your best guess is fine.

4.16. Now please think about the past 3 months.
In the past 3 months, how many TIMES have you had oral sex?
None
NUMBER OF TIMES – Your best guess is fine.

PPA Study – FU 1 Part B1 Wait Training – 1/24/12

4.17. 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

4.18. To the best of your knowledge, how many times have you been pregnant or gotten someone
pregnant?
NUMBER OF TIMES

4.19. Have you ever had a baby or has anyone you got pregnant actually had the baby?
MARK (X) ONE

Yes
No
Don’t know

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 – FU 1 Part B1 Wait Training – 1/24/12

SECTION 5: ALCOHOL AND DRUG USE
5.1. The next questions are about alcohol and drugs. Please 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 – FU 1 Part B1 Wait Training – 1/24/12

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, prescription drugs, or an inhalant that were not
prescribed for you?
MARK (X) ONE

Yes
No

PPA Study – FU 1 Part B1 Wait Training – 1/24/12

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 wait to have
sexual intercourse until marriage .....................................................................................................................

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 – FU 1 Part B1 Wait Training – 1/24/12

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 survey materials in the
envelope and give it to the moderator.
Thank you!

PPA Study – FU 1 Part B1 Wait Training – 1/24/12

Thank you for
completing this survey!

PPA Study – FU 1 Part B1 Wait Training – 1/24/12

Form approved
OMB No. 0990-0382
Exp. Date: xx/xx/20xx

FOLLOW-UP QUESTIONNAIRE
PART B2

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

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.

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
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 – FU1 Part B Wait Training – 1/24/12

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 consistent,
regular place to live?
MARK (X) ONE

GO TO 4.8

Yes
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 – FU1 Part B Wait Training – 1/24/12

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 – FU1 Part B Wait Training – 1/24/12

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

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’m 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..............................................................................................................................

I don’t want to ..............................................................................................................................................

k. Waiting for sex is the safest, healthiest choice for me ................................................................................
l.

FOR GIRLS I don’t want to get pregnant ....................................................................................................

m. FOR BOYS I don’t want to get a girl pregnant ............................................................................................

PPA Study – FU1 Part B Wait Training – 1/24/12

4.17. Have you ever kissed someone on the lips?
MARK (X) ONE

Yes
No

GO TO 4.19

4.18. Have you ever French kissed, that is put your tongue in someone’s mouth while kissing?
MARK (X) ONE

Yes
No

4.19. Have you ever touched another person’s private parts?
MARK (X) ONE

Yes
No

4.20. Have you ever let someone touch your private parts?
MARK (X) ONE

Yes
No

4.21. 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

4.22. 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 – FU1 Part B Wait Training – 1/24/12

4.23. Have you made a decision not to have sexual intercourse until you get married?
MARK (X) ONE

Yes
No

GO TO 5.1

4.24. Here are some statements about how you might feel about your decision NOT to have sexual
intercourse until you get married. How much does each statement reflect how you feel?
MARK (X) ONE FOR EACH

NOT AT ALL
LIKE ME

SOMEWHAT
LIKE ME

LIKE
ME

VERY MUCH
LIKE ME

a. My decision to NOT have sex is good for me ................................................................................................
b. I am comfortable with my decision to NOT have sex ....................................................................................
c. My decision to NOT have sex makes me feel
good about myself..........................................................................................................................................
d. At this stage in my life, sex is NOT important to me ......................................................................................

PPA Study – FU1 Part B Wait Training – 1/24/12

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 – FU1 Part B Wait Training – 1/24/12

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, prescription drugs or an inhalant that were not
prescribed for you?
MARK (X) ONE

Yes
No

PPA Study – FU1 Part B Wait Training – 1/24/12

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 – FU1 Part B Wait Training – 1/24/12

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 survey materials in the
envelope and give it to the moderator.
Thank you!

PPA Study – FU1 Part B Wait Training – 1/24/12

Thank you for
completing this survey!

PPA Study – FU1 Part B Wait Training – 1/24/12

File Type	application/pdf
Author	MThomas
File Modified	2012-03-27
File Created	2012-03-27