New items for Followup_response to comments_to OMB_051412

LIST OF NEW QUESTIONS ON PPA SITE-SPECIFIC FOLLOW-UP INSTRUMENTS

The questions listed below are new items that were not included on previously approved data collection instruments. The “notes” column lists a source, where applicable. If no source is noted, the item was developed by the PPA team.

Note: The wording of the questions often reflects or refers to the wording of preceding questions that have already been approved. Additional clarification is provided in the “notes” column.

Question #	Question Text	Notes
Children’s Hospital Los Angeles (CHLA) – many of the questions on the CHLA instrument will be asked only where the skip logic makes them relevant. This is noted in the table.
1.3	What type of schooling did you complete after high school? MARK (X) ONE □ Some adult education classes □ Some technical or vocation school □ Some classes at a 2-year college □ Some classes at a 4-year college or university	Please use measures that are consistent with those used by the National Center for Education Statistics information collections. R: Response categories will be adjusted accordingly.
1.4	Did you go back to school or a GED program after having your first baby? MARK (X) ONE □ Yes – I went back to my old high school □ Yes – I went back to a different school □ Yes – I went back to a GED program □ I never stopped school - GO TO 1.6 □ No – I did not go back - GO TO 1.6
1.5	How old was your baby when you returned to school or your GED program? | | | NUMBER OF MONTHS OLD
1.9	Do you make enough money in this job to support yourself? MARK (X) ONE □ Yes □ No	Asked only if respondent indicated in a previous question that they are currently employed.
1.10	Do you plan on staying in this job for the next two years? MARK (X) ONE □ Yes □ No	Asked only if respondent indicated in a previous question that they are currently employed.
1.12	Is this person the father of your first child? MARK (X) ONE □ Yes □ No	Asked only if respondent indicated in a previous question that they are currently in a relationship or dating someone.
3.1	In the past 12 months, have you received any information about the following: MARK (X) ONE FOR EACH Yes, No a. Methods of birth control b. Where to get birth control
3.2	In the past 12 months, did you receive information about… MARK (X) ONE FOR EACH Yes, No a. Condoms c. Birth control pills d. The shot (Depo-Provera) e. The patch f. The ring (NuvaRing) g. IUD (Mirena or Paragard) h. Implant (Implanon)	Asked only of those who received any information about methods of birth control and/or where to get birth control.
3.3	Where did you receive information about birth control? MARK (X) ALL THAT APPLY At a hospital At a clinic from a doctor, nurse or other health professional At home from a nurse, social worker, or other health care professional At school in a class In an after-school program/activity From a friend Other (please specify)	Asked only of those who received any information about methods of birth control and/or where to get birth control.
3.4	What services have you received or what programs have you been involved in over the past 12 months? MARK (X) ALL THAT APPLY School or community-based program for pregnant or parenting teens Parenting education Case Management WIC CalLearn AFLP Other (Please specify)	Could a valid response category be “none?” R: This change has been made to the survey.
4.8	Thinking about the past 12 months, in which months were you sexually active (had sexual intercourse)? MARK (X) ONE FOR EACH Yes, No January – December (Note: Relevant months will appear based on baseline date.)	Could a valid response category be “none?” R: There is a previous question that asks whether they’ve had sexual intercourse in the past 12 months (4.6). If they say “no”, they skip out of this question. We have left this question as-is for now.
4.9	Have you used any of the following birth control methods in the past 12 months? MARK (X) ONE FOR EACH Yes, No Condom Emergency contraception, also known as “Plan B” or “Preven”, or “morning after pills” Birth control pills The shot (Depo-Provera) The patch The ring (Nuva Ring) IUD (Mirena or Paragard) Implant (Implanon) Foam Sponge Female condom Withdrawal Other (Please specify)	Subsequent questions on each method of contraception will only be asked of those who indicate using that specific method of contraception.
4.10	FOR CONDOM USE In which months did you use condoms? MARK (X) ALL THAT APPLY January – December (Note: Relevant months will appear based on baseline date.)	This question is the first in a series that repeats for the specific forms of birth control the respondent indicated using in question 4.9 (the pill, the shot/Depo-Provera, the patch/Ortho-Evra, IUD, vaginal ring, implant).
4.11	In the months you used a condom, would you say you used a condom with your partner for sexual intercourse…? MARK (X) ONE Every time Most of the time About half of the time Some of the time None of the time
4.12	FOR EMERGENCY CONTRACEPTION USE How many different times have you used emergency contraception (Plan B) in the past 12 months? | | | NUMBER OF TIMES - Your best guess is fine.
4.14	FOR BIRTH CONTROL PILL USE In general over this time, would you say you took your birth control pills consistently…? Taking your birth control pills consistently means taking your pills every day. Some types of pills have a set of 7 different colored pills that do not contain any hormones. Women may opt not to take these 7 pills only. MARK (X) ONE All of the time Most of the time Some of the time None of the time	This consistency question is part of a series of questions asked for each of the user-dependent forms of birth control (the pill, the patch, the ring) the respondent reports using in 4.9. For each method, a description of consistent use is provided: 4.21 Using the patch consistently means applying a new patch the same day each week for 3 weeks. You would not use a patch in week 4 then would resume using the patch on the same day in week 5. 4.31 Using the ring consistently means removing the ring on the same day 3 weeks after it was inserted and inserting a new one on the same day one week after it was removed (even if your period has not stopped).
4.15	During the last month you used birth control pills, how many pills that you were supposed to take did you miss…? MARK (X) ONE One - GO TO 4.17 None - GO TO 4.17 Two or more
4.16	Did you miss two or more pills in a row? MARK (X) ONE □ Yes □ No
4.17	Some people try a method and then don’t use it again, or stop using it. What was the reason or reasons why you stopped using birth control pills? MARK (X) ALL THAT APPLY Too expensive Too difficult to use Too messy Your partner did not like it You had side effects You were worried you might have side effects You worried the method would not work The method failed, you became pregnant The method did not protect against disease Because of other health problem, a doctor told you that you should not use the method again The method decreased your sexual pleasure Too difficult to obtain the method Did not like the changes to your menstrual cycle You got pregnant You were trying to get pregnant	This question is part of a series that repeats for each form of birth control the respondent reported using in question 4.9 (the shot/Depo-Provera, the patch/Ortho-Evra, IUD, vaginal ring, implant).
4.22	FOR THE PATCH (ORTHO-EVRA) USE During the last month you used the patch, were you one or more days late in changing the patch? MARK (X) ONE Yes No - GO TO 4.24
4.23	Please indicate all the weeks that you were late in changing the patch. MARK (X) ONE First week Second week Third week
4.26	FOR IUD (MIRENA OR PARAGARD) USE Have you had the IUD removed since then? MARK (X) ONE Yes No - GO TO 4.29	This question is asked after the respondent indicates in which month the IUD was inserted.
4.27	In which months did you have the IUD removed? MARK (X) ALL THAT APPLY January – December (Note: Relevant months will appear based on baseline date.)
4.28	Did you have the IUD inserted a second time? MARK (X) ONE □ Yes □ No
4.34	FOR IMPLANT (IMPLANON USE) Have you had it removed since then? MARK (X) ONE □ Yes □ No - GO TO 4.36	This question is asked after the respondent indicates in which month the implant was inserted.
4.35	In which months did you have the implant removed? MARK (X) ALL THAT APPLY January – December (Note: Relevant months will appear based on baseline date.)
5.1	The next questions ask about your pregnancy and your relationship with your baby’s father. Are you currently pregnant? MARK (X) ONE □ Yes □ No - GO TO 5.6
5.2	When is your baby due? Month | | | Year | | || | |
5.3	When you got pregnant this time, were you trying to get pregnant? MARK (X) ONE □ Yes □ No
5.5	To the best of your knowledge, were you pregnant any other time since the birth of your first child? MARK (X) ONE □ Yes - GO TO 5.7 □ No - GO TO 5.13	Only asked if respondent is currently pregnant.
5.6	To the best of your knowledge, have you been pregnant since the birth of your first child? MARK (X) ONE □ Yes □ No - GO TO 5.13	Only asked if respondent is currently pregnant.
5.7	How many times have you been pregnant since the birth of your first child? | | | NUMBER OF TIMES – Your best guess is fine
5.8	Have you given birth since your first child was born? MARK (X) ONE □ Yes □ No - GO TO 5.13
5.9	Please list the birth date for each child you have given birth to since your first child. Month | | | Day | | | Year | | || | |
5.12	Do all of your children have the same biological father? MARK (X) ONE □ Yes □ No	Perhaps add “don’t know,” or “refused.” R: Added “don’t know”.
5.13	How much is your first child’s father involved in raising that child? MARK (X) ONE □ A lot □ A little Not very much Not at all
6.3a	Was your first or second goal about a job or an occupation? MARK (X) ONE □ Yes □ No - GO TO 6.4	Asked after respondent lists their goals for the future (6.3).
6.3b	Thinking of your first occupational goal listed, how much do you hope for the kind of work that occurs with this occupational goal? MARK (X) ONE □ Barely □ Not much Somewhat Very much	Asked after respondent lists their goals for the future (6.3). We think this item would benefit from cognitive testing with 9 or fewer persons, with the revision (if any) to be submitted with the instrument as non-substantive change before this survey is administered. The question does not seem clear. R: We will rephrase and cognitively test this item with 9 or fewer respondents and report back to OMB with any revisions.
6.3c	Thinking of your first occupational goal, please indicate how likely it will be that you obtain this possible self, using the numbers 1 through 7, with 1 being very unlikely and 7 being very likely. (Scale: 1 = Vey unlikely to 9 =Very likely)	Asked after respondent lists their goals for the future (6.3). We think this item would benefit from cognitive testing with 9 or fewer persons, with the revision (if any) to be submitted with the instrument as non-substantive change before this survey is administered. The question does not seem clear. R: We will rephrase and cognitively test this item with 9 or fewer respondents and report back to OMB with any revisions.
*	Do you know anyone who has participated in the AIM4Teen Moms program? Yes No	*Question was inadvertently omitted from the instrument, but will be included in the instrument to be submitted with the revised package. Will only be asked of the control group.
*	Who do you know that has participated in AIM 4 Teen Moms? Your sister Another relative Close friend Acquaintance	*Question was inadvertently omitted from the instrument, but will be included in the instrument to be submitted with the revised package. Will only be asked of the control group.
*	Have you discussed any of the following with the women who participated in AIM 4 Teen Moms? AIM 4 TeenMoms Portfolio (worksheets, resume, and certificate) What they learned about long term contraceptive use Job aspirations	* Question was inadvertently omitted from the instrument, but will be included in the instrument to be submitted with the revised package. Will be asked only of the control group. Add yes/no format R: Revised to yes/no format.
Ohio Health
1.4	What is your current marital status? MARK ONE □ Never married □ Married □ Divorced □ Separated □ Widowed
1.11	In the past 6 months, how many different times, if any, did you receive birth control from a doctor or nurse at a place such as a hospital, clinic, or trailer, or during a visit to your home? □ None ______ Number of times
3.10	Now please think about your friends and the people you hang out with who have sexual intercourse. How often do you think they use ANY method of birth control, such as condoms or birth control pills? MARK ONE Never Sometimes Half of the time Most of the time Always
3.11	How many of your friends or people you hang out with had a baby before they were 20 years old? MARK ONE None One or two Three or more	We think this item would benefit from cognitive testing with 9 or fewer persons, with the revision (if any) to be submitted with the instrument as non-substantive change before this survey is administered. The question does not seem clear. (friends or people—does this refer to peer group, family, older persons who may influence the participant, or? Does this refer to women/girls or both women/girls and men/boys? If all, please state. Also, add “don’t know”) R: We have dropped the phrase “or people you hang out with” and the question now reflects one used previously: Raneri, Leslie G. and Constance M. Wiemann. Social Ecological Predictors of Adolescent Pregnancy. Perspectives on Sexual and Reproductive Health, 2007, 39(1):39–47, doi: 10.1363/3903907
3.12	How many of your friends or people you hang out with had more than one baby before they were 20 years old? MARK ONE None One or two Three or more	We think this item would benefit from cognitive testing with 9 or fewer persons, with the revision (if any) to be submitted with the instrument as non-substantive change before this survey is administered. The question does not seem clear. (friends or people—does this refer to peer group, family, older persons who may influence the participant, or? Does this refer to women/girls or both women/girls and men/boys? If all, please state. Also, add “don’t know”) R: We have dropped the phrase “or people you hang out with” and the question now reflects one used previously: Raneri, Leslie G. and Constance M. Wiemann. Social Ecological Predictors of Adolescent Pregnancy. Perspectives on Sexual and Reproductive Health, 2007, 39(1):39–47, doi: 10.1363/3903907
4.28	Did you breastfeed your baby at all? □ Yes □ No – GO TO 4.30
4.29	How many months did you breastfeed your baby or are you still breastfeeding him or her? □ Still breastfeeding ____ NUMBER OF MONTHS
4.30	Have you been pregnant again since that pregnancy ended? □ Yes □ No – GO TO 4.34
4.33	How many weeks along in your current pregnancy are you? | | | NUMBER OF WEEKS □ Don’t know
Engender Health
2.6	How comfortable are you sharing ideas or talking with her about things that are important to you? MARK (X) ONE Not at all comfortable Somewhat comfortable Comfortable Very comfortable	This refers to the person the respondent indicated as their mother/mother figure in a previous question.
2.11	How comfortable are you sharing ideas or talking with him about things that are important to you? MARK (X) ONE Not at all comfortable Somewhat comfortable Comfortable Very comfortable	This refers to the person the respondent indicated as their father/father figure in a previous question.
3.18	In the past 6 months, have you had a boyfriend or girlfriend? MARK (X) ONE □ Yes □ No
3.19	In the past 6 months, how many different boyfriends or girlfriends have you had? | | | NUMBER OF PEOPLE - Your best guess is fine.
	How many other people do you know of at your high school who participated in Gen.M this past summer? □ None | | | NUMBER OF PEOPLE – Your best guess is fine.	Asked only of youth in the treatment group
	How often do you hang out with any of those kids? MARK (X) ONE □ A lot □ Sometimes □ Rarely □ Never	Asked only of youth in the treatment group
	Did you attend an event sponsored by Gen.M after you completed your summer Gen.M group? MARK (X) ONE □ Yes □ No	Asked only of youth in the treatment group
	If a friend asked, how likely would you be to recommend Gen.M to them? MARK (X) ONE □ Not at all likely □ A little likely □ Somewhat likely □ Very likely	Asked only of youth in the treatment group
	How many times have you done the following things in the past six months? MARK (X) ONE FOR EACH QUESTION 0, 1-2, 3-5, 6-10 a. Gotten together with members of your Gen.M group b. Texted members of your Gen.M group c. Spoken to a member of your group on the phone d. Friended somebody from your group on Facebook e. Been in touch with members of your group in any other way	Asked only of youth in the treatment group
Princeton Center for Leadership Training (PCLT)
1.9	For the next question, please indicate how often you do the item listed. How often have you talked about each of the topics listed below with your partner in the last month? I didn’t have a partner in the last month MARK (X) ONE FOR EACH Often, Sometimes, Never Expectations in the relationship Pregnancy Birth control Sexually Transmitted Infections (STIs) What you feel comfortable doing sexually What you do not feel comfortable doing sexually	Source: Teen Sexual Health Research Study, Page 11, questions 1 (a) through 1 (f).

Question #	Question Text	Notes
1.10	For the next question, please answer how often you do each of the statements below. When you have to make a decision about your sexual behavior, how often do you… MARK (X) ONE FOR EACH Very Often, Often, Not often, Never Think of the consequences of each possible choice First get as much information as you can Make it on the spot without worrying about the consequences	Source: Teen Sexual Health Research Study, page 13 (questions 22, 23, 24)
1.12	How strongly do you agree or disagree with the following statements? MARK (X) ONE FOR EACH Strongly agree, Agree, Disagree, Strongly disagree If my partner refused to use condoms, I could refuse to have sex I would have sex now if someone I cared about pressured me to have sex I believe I could go to a clinic if I needed to get tested for HIV/AIDS or another sexually transmitted infection (STI)	Source: Teen Sexual Health Research Study, Page 7, questions 20 through 25.
2.6	How well can you and your mother or the person you think of as your mother share ideas or talk about things that are important to you? MARK (X) ONE Not at all well Not very well Somewhat well Very well	Source: Adapted from National Survey of Children’s Health (NSCH) 2007, Section 8.
2.11	How well can you and your father or the person you think of as your father share ideas or talk about things that are important to you? MARK (X) ONE Not at all well Not very well Somewhat well Very well	Source: Adapted from National Survey of Children’s Health (NSCH) 2007, Section 8.
Live the Life
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? (Not at all like me, Somewhat like me, Like me, Very much like me) My decision to NOT have sex is good for me I am comfortable with my decision to NOT have sex My decision to NOT have sex makes me feel good about myself At this stage in my life, sex is NOT important to me

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