Form 3 Youth baseline survey

Evaluation of Pregnancy Prevention Program Replications for High Risk and Hard to Reach Youth

Appendix D_MITRE Pregnancy Prevention Youth Survey Baseline Instrument_clean

Youth Baseline Form and Assent

OMB: 0990-0472

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MITRE Pregnancy Prevention in Adolescents

Youth Baseline Survey

April 2020


  • This document presents the items MITRE will use to evaluate contracted programs’ impact on youth knowledge, attitude, beliefs, intentions, and behavior.


  • The list of items is organized by category and does not necessarily reflect the ordering of items in the final survey instrument.


  • Skip and display patterns are noted in square brackets. MITRE plans to administer the survey electronically to automate skip and display patterns.


  • MITRE will facilitate translation services for contracted programs that serve a population literate in a language other than English.


DEMOGRAPHIC INFORMATION/FAMILY/ENVIRONMENT/BACKGROUND


Item #

Item

Source

Classification/Notes


D1

What is your date of birth?

MARK (X) ONE MONTH AND ONE YEAR

Evaluation of Adolescent Pregnancy Prevention Approaches (OMB No.: 0970-0360) Baseline Item #1.1 Part A

Age


D2

What grade are you currently in, or if you aren’t in school right now, what grade did you last complete?

MARK (X) ONE

4th

5th

6th

7th

8th

9th

10th

11th

12th

Evaluation of Adolescent Pregnancy Prevention Approaches (OMB No.: 0970-0360) Baseline Item #1.2 Part A


Modifications made- Changed from “What grade are you in?”; added lower grade levels

Education


D3

Are you a…?

MARK (X) ONE

Male

Female



Evaluation of Adolescent Pregnancy Prevention Approaches (OMB No.: 0970-0360) Baseline Item #1.3 Part A



Biological sex


D4

Are you Hispanic or Latino?

MARK (X) ONE

Yes

No

Evaluation of Adolescent Pregnancy Prevention Approaches (OMB No.: 0970-0360) Baseline Item #1.4 Part A

Ethnicity


D5

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

Evaluation of Adolescent Pregnancy Prevention Approaches (OMB No.: 0970-0360) Baseline Item #1.5 Part A

Race


D6

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

Other PRINT OTHER LANGUAGES

Evaluation of Adolescent Pregnancy Prevention Approaches (OMB No.: 0970-0360) Baseline Item #1.6 Part A

Language spoken with family


D7

Which of the following best describes where you live?

You live in one home

You live in two or more homes, and go back and forth

You are homeless (living on the street, in a car or shelter, or staying with friends/relatives)

Other (You live in a residential facility, detention center, or another type of facility)

Evaluation of Adolescent Pregnancy Prevention Approaches (OMB No.: 0970-0360) Concordance Item #2.1a Part A


Modifications made: Added “other” category

Living arrangement


D8

Do you currently live in a group home?

Yes

No

Evaluation of Adolescent Pregnancy Prevention Approaches (OMB No.: 0990-0382) OICA Follow-Up Survey Item #1.4

Living arrangement


D9

[Display if response to D7 was live in one home or live in two or more homes and response to D8 was no.]

Who lives in your home with you? Check all that apply.

  1. Your biological mother

  2. A stepmother or adoptive mother

  3. A foster mother

  4. Your biological father

  5. A stepfather or adoptive father

  6. A foster father

  7. Your parent’s partner, boyfriend or girlfriend

  8. Grandparents

  9. Older brothers or sisters

  10. Younger brothers or sisters

  11. Aunts, uncles, other relatives

  12. Other adults not related to you

  13. Other kids not related to you

  14. You live by yourself

[If two or more homes, repeat question for other homes: “Now think about the other home you live in. Who lives there with you?”]

Evaluation of Adolescent Pregnancy Prevention Approaches (OMB No.: 0970-0360) Concordance Item #2.2 Part A


Modifications made: separated people not related to you into children and adults, changed ordering of response options for mother and father items

Living arrangement


D10

Are you now, or have you ever been, in foster care?

Yes

No

Added by MITRE

Living arrangement


D11

[Display if response was Yes to D10]

How old were you when you entered the foster care system?

Less than 1 year old

1 year old

2 years old

16 years old

Evaluation of Adolescent Pregnancy Prevention Approaches (OMB No.: 0990-0382) OICA Follow-Up Survey Item #1.3

Living arrangement


D12

[Display if response to D7 was live in one home or live in two or more homes and response to D8 was no.]

The following questions are about the food situation in your home during the last month. Please circle the answer that best describes you.

  1. Did you worry that food at home would run out before your family got money to buy more?

  2. Did the food that your family bought run out, and you didn’t have money to get more?

  3. Did your meals only include a few kinds of cheap foods because your family was running out of money to buy food?

  4. How often were you not able to eat a balanced meal because your family didn’t have enough money?

  5. Did you have to eat less because your family didn’t have enough money to buy food?

  6. Has the size of your meals been cut because your family didn’t have enough money for food?

  7. Did you have to skip a meal because your family didn’t have enough money for food?

  8. Were you hungry but didn’t eat because your family didn’t have enough food?

  9. Did you not eat for a whole day because your family didn’t have enough money for food?

[Response options: A lot, Sometimes, Never]

USDA Economic Research Service’s Self-Administered Food Security Survey Module for Children Ages 12 Years and Older (Connell et al., 2004)

Family income/socio-economic status


D13

In the last 12 months, how often did you attend religious services or activities?

MARK (X) ONE

More than once a week

Once a week

1-3 times per month

Less than once a month

Never

Evaluation of Adolescent Pregnancy Prevention Approaches (OMB No.: 0970-0360) Baseline Item #1.7 Part A

Religion


D14

How important is religion in your life?

MARK (X) ONE

Not at all important

Somewhat important

Very important

Evaluation of Adolescent Pregnancy Prevention Approaches (OMB No.: 0970-0360) Baseline Item #1.8 Part A

Religion


D15

The following questions are about your mother or the person you think of as your mother. Do you have a mother or a person you think of as a mother, even if she’s not alive now?

Yes

No



Evaluation of Adolescent Pregnancy Prevention Approaches (OMB No.: 0970-0360) Concordance Item #2.6 Part A (Introductory Text)


Modifications made- changed introduction from “the person you marked as your mother” to remove “you marked”. Added question to ask whether they had/have such a person in their lives.


Mother


D16

[Display only if the response to D15 is Yes]

How far did she go in school?

MARK (X) ONE

She finished some high school but didn’t graduate

She graduate from high school

She finished some college but didn’t graduate

She graduated from college

Don’t know

Evaluation of Adolescent Pregnancy Prevention Approaches (OMB No.: 0970-0360) Concordance Items #2.6 and #2.7 Part A


Mother


D17

[Display only if the response to D15 is Yes]

Is she alive?

Yes

No

Added by MITRE

Mother


D18

[Display only if the response to D17 is Yes]

How close do you feel to your mother or the person you think of as a mother?

MARK (X) ONE

Not at all close

A little close

Somewhat close

Very close

Evaluation of Adolescent Pregnancy Prevention Approaches (OMB No.: 0970-0360) Concordance Item #2.10 Part A


Mother


D19

[Display only if the response to D17 is Yes]

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

Evaluation of Adolescent Pregnancy Prevention Approaches (OMB No.: 0970-0360) Concordance Item #2.11 Part A


Mother


D20

The following questions are about your father or the person you think of as a father. Do you have a father or a person you think of as a father, even if she’s not alive now?

Yes

No



Evaluation of Adolescent Pregnancy Prevention Approaches (OMB No.: 0970-0360) Concordance Item #2.15 Part A (Introductory Text)


Modifications made- changed introduction from “the person you marked as your father” to remove “you marked”. Added question to ask whether they had/have such a person in their lives.

Father


D21

[Display only if the response to D20 is Yes]

How far did he go school?

MARK (X) ONE

He finished some high school but didn’t graduate

He graduated from high school

He finished some college but didn’t graduate

He graduated from college

Don’t know

Evaluation of Adolescent Pregnancy Prevention Approaches (OMB No.: 0970-0360) Concordance Item #2.15 and #2.16 Part A


Father


D22

[Display only if the response to D20 is Yes]

Is he alive?

Yes

No

Added by MITRE

Father


D23

[Display only if the response to D22 is Yes]

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

Evaluation of Adolescent Pregnancy Prevention Approaches (OMB No.: 0970-0360) Concordance Item #2.18 Part A


Father


D24

[Display only if the response to D22 is Yes]

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 _

Evaluation of Adolescent Pregnancy Prevention Approaches (OMB No.: 0970-0360) Concordance Item #2.19 Part A


Father


D25

Transition: The next questions are about relationships, abstinence, birth control, and sexually transmitted diseases.


In the past 12 months, have you received information or learned about any of the following?

MARK (X) ONE FOR EACH QUESTION

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

Evaluation of Adolescent Pregnancy Prevention Approaches (OMB No.: 0990-0382) Engender Health Survey Item #1.7 Part A

Previous exposure to sexual health information


D26

How much would you be interested in attending a program that gives you information on relationships, abstinence, birth control, and sexually transmitted diseases?

  1. Very interested

  2. A little interested

  3. Not at all interested

Added by MITRE

Matching variable for comparison youth who do not participate in a program





BEHAVIOR (B)


Item #

Item/Scale

Source

Classification/Notes

B1

In the past year, how much have you talked to your parent(s) or guardian(s) about the following topics?

  1. Using condoms

  2. Using other forms of birth control, like birth control pills

  3. Sexually transmitted diseases (STDs)

  4. HIV/AIDS

  5. Getting pregnant/getting someone else pregnant

  6. Waiting to have sex until you’re older or sexual abstinence


In the past year, how much have you talked to your best friend about the following topics?

  1. Using condoms

  2. Using other forms of birth control, like birth control pills

  3. Sexually transmitted diseases (STDs)

  4. HIV/AIDS

  5. Getting pregnant/getting someone else pregnant

  6. Waiting to have sex until you’re older or sexual abstinence


In the past year, have you had a boyfriend/girlfriend or someone you liked “more than friends” who you have talked to or hung out with?

Yes

No (Skip to end of survey)

In the past year, how much have you talked to your boyfriend/girlfriend about the following topics?

  1. Using condoms

  2. Using other forms of birth control, like birth control pills

  3. Sexually transmitted diseases (STDs)

  4. HIV/AIDS

  5. Getting pregnant/getting someone else pregnant

  6. Waiting to have sex until you’re older or sexual abstinence


[Response options for all sub-scales: Never talked about this, Talked about this 1 time, Talked about this 2 or 3 times, Talked about this 4 to 6 times, Talked about this 7+ times]

Adolescent Sexual Communication Scale (Widman & Stewart, 2020)


Modifications made: Added mention of guardian(s) to the parent sub-scale

Protective behaviors- communication with parents

B2

How many times in the last 6 months has a boyfriend or girlfriend done these things to you?

  • 22b Said things to hurt your feelings on purpose

  • 22c Insulted you in front of others

  • 22e Would not let you do things with other people

  • 22f Threatened to start dating someone else

  • 22i Did something just to make you jealous

  • 22j Blamed you for bad things they did

  • 22k Threatened to hurt you

  • 22l Made you describe where you were every minute of the day

  • 22n Put down your looks

  • Pushed, grabbed, shoved, or kicked you


  • 23a Called you names, put you down, or said really mean things to you on Snapchat, Instagram, Facebook or other social media and messaging apps

  • 23b Called your cellphone or sent you messages when you didn’t want them to, just to make you mad

  • 23c Sent you messages that asked you to engage in sexual acts when you didn’t want to

  • 23d Spread rumors about you on Snapchat, Instagram, Facebook or other social media and messaging apps

  • 23e Used your posts or messages on Snapchat, Instagram, Facebook or other social media and messaging apps to harass you or put you down

  • 23g Shared private or embarrassing pictures or videos of you on Snapchat, Instagram, Facebook or other social media and messaging apps

  • 23h Used Snapchat, Instagram, Facebook or other social media and messaging apps to threaten to hurt you physically


How many times in the last 6 months have you done these things to a boyfriend or girlfriend?

  • 24b Said things to hurt their feelings on purpose

  • 24c Insulted them in front of others

  • 24e Would not let them do things with other people

  • 24f Threatened to start dating someone else

  • 24i Did something just to make them jealous

  • 24j Blamed them for bad things you did

  • 24k Threatened to hurt them

  • 24l Made them describe where they were every minute of the day

  • 24n Put down their looks

  • Pushed, grabbed, shoved, or kicked them


  • 25a Called them names, put them down, or said really mean things to them on Snapchat, Instagram, Facebook or other social media and messaging apps

  • 25b Called their cellphone or sent them messages when they didn’t want you to, just to make them mad

  • 25c Sent them messages that asked them to engage in sexual acts when they didn’t want to

  • 25d Spread rumors about them on Snapchat, Instagram, Facebook or other social media and messaging apps

  • 25e Used their posts or messages on Snapchat, Instagram, Facebook or other social media and messaging apps to harass them or put them down

  • 25g Shared private or embarrassing pictures or videos of them on Snapchat, Instagram, Facebook or other social media and messaging apps

25h Used Snapchat, Instagram, Facebook or other social media and messaging apps to threaten to hurt them physically


[Response options for all sub-scales: Never, 1-3 times, 4-9 times, 10 or more times]

Evaluation of the Safe Dates Project (OMB No.: 0920-0783) Youth Dating Survey Items 22, 23, 24, 25


Item stem wording taken from Miller et al. (2015) Teen Dating Violence Measures- Perpetration and Victimization


Modifications made: Changed personal pronouns from first to second person to be consistent with other items in this survey. Deleted 22 & 24 a, d, g, h, m, o. Added “Pushed, grabbed, shoved, or kicked you/them.” Deleted 23 & 25 f.

Re-worded references to social media and messaging apps to reference current popular apps.

Risk behaviors- dating violence

B3

The next question asks about cigarette smoking.

During the past 30 days, have you smoked cigarettes, even once?

  1. Yes

  2. No


Added by MITRE

Risk behaviors- drug and alcohol use

B4

The next question asks about electronic vapor products, such as JUUL, Vuse, MarkTen, blu, KandyPens, PaxEraPro, and APX Vape. Electronic vapor products include e-cigarettes, e-cigars, e-hookahs, marijuana vape pens, hookah pens, and mods.

During the past 30 days, have you used an electronic vapor product, even once?

  1. Yes

  2. No

Introductory text is from Item #34 2019 National YRBS (OMB No.: 0920-0493)


Question added by MITRE

Risk behaviors- drug and alcohol use

B5

The next question asks about drinking alcohol. This includes drinking beer, wine, wine coolers, and liquor such as rum, gin, vodka, or whiskey. For this question, drinking alcohol does not include drinking a few sips of wine for religious purposes.

During the past 30 days, have you drank alcohol, even once?

  1. Yes

  2. No

Introductory text is from Item #41.

2019 National YRBS (OMB No.: 0920-0493)


Question added by MITRE

Risk behaviors- drug and alcohol use

B6

The next question asks about marijuana use. Marijuana also is called pot, weed, or cannabis.

During your life, have you ever used marijuana?

  1. Yes

  2. No


Introductory text is from Item #45.

2019 National YRBS (OMB No.: 0920-0493)


Question added by MITRE

Risk behaviors- drug and alcohol use

B7

The next question asks about synthetic marijuana use. Synthetic marijuana also is called Spice, fake weed, K2, King Kong, Yucatan Fire, or Skunk.

During your life, have you ever used synthetic marijuana?

  1. Yes

  2. No

Introductory text from item Item #48, 2019 National YRBS (OMB No.: 0920-0493)



Question added by MITRE

Risk behaviors- drug and alcohol use

B8

The next question asks about the use of prescription pain medicine without a doctor’s prescription or differently than how a doctor told you to use it. For this question, count drugs such as codeine, Vicodin, OxyContin, Hydrocodone, and Percocet.

During your life, have you ever you taken prescription pain medicine without a doctor’s prescription or differently than how a doctor told you to use it?

  1. Yes

  2. No


Introductory text from item #49, 2019 National YRBS (OMB No.: 0920-0493)


Question added by MITRE

Risk behaviors- drug and alcohol use

B9

The next question asks about other drugs.


During your life, have you ever you used cocaine, heroin, methamphetamines, ecstasy, or hallucinogenic drugs like LSD, acid, or mushrooms?

  1. Yes

  2. No


Question added by MITRE

Risk behaviors- drug and alcohol use

B10

The next set of questions are about your sexual history. By sex, we mean vaginal, oral, or anal sex. Please remember that your answers are strictly confidential.

Have you ever had any kind of sex?

MARK (X) ONE

Yes

No

2019-2020 NHANES (OMB No.: 0920-095) Item # SXQ.615



Sexual behavior

B11

[Display only if response was Yes for B10]


During your life, with whom have you had sexual contact?

MARK (X) ONE

A. Females

B. Males

C. Females and males

2019 National YRBS (OMB No.: 0920-0493) Item #65

Sexual Behavior

B12

[Display only if response was Yes for B10]

Have you ever had vaginal sex, also called sexual intercourse? This is when a man puts his penis into a woman’s vagina.

MARK (X) ONE

Yes

No

2019 National YRBS (OMB No.: 0920-0493) Item #58


Modifications made: defined sexual intercourse as “when a pan puts his penis into a woman’s vagina”

Sexual Behavior

B13

[Display only if response was Yes for B12]

The very first time you had sexual intercourse, how old were you?

| | | NUMBER OF YEARS OLD YOU WERE — Your best guess is fine.

Evaluation of Adolescent Pregnancy Prevention Approaches (OMB No.: 0970-0360) Baseline Item #4.4 Part B1

Sexual behavior

B14

[Display only if response was Yes for B10]

Now please think about the last 3 months. In the last 3 months, did you had sexual intercourse?

  1. Yes

  2. No

Evaluation of Adolescent Pregnancy Prevention Approaches (OMB No.: 0970-0360) Baseline Item #4.11 Part B1


Modifications: changed response set from number of times to yes/no

Sexual behavior

B15

[Display only if response was Yes for B14]

In the past 3 months, did you have sexual intercourse without using a condom?

  1. Yes

  2. No

Evaluation of Adolescent Pregnancy Prevention Approaches (OMB No.: 0970-0360) Concordance Item #4.12 Part B1


Modicifation: Changed “how many times” to “did you” have sexual intercourse

Sexual behavior

B16

[Display only for females, and only if response was Yes for B14]

The next question is about your use of the following methods of birth control:

Birth control pills

The shot (like, Depo Provera)

The patch

The ring (like, NuvaRing)

IUD (like, Mirena or Paragard)

Implants (like, Implanaon)


In the past 3 months, did you have sexual intercourse without using any of these methods of birth control?

  1. Yes

  2. No

Evaluation of Adolescent Pregnancy Prevention Approaches (OMB No.: 0970-0360) Concordance Item #4.13 Part B1


Modifications made: Deleted “condoms” from the list and will add display logic so this question is only for girls who have previously had sex. Made response choice yes/no.

Sexual behavior

B17

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

Evaluation of Adolescent Pregnancy Prevention Approaches (OMB No.: 0970-0360) Baseline Item #4.14 Part B1

Sexual behavior

B18

[Display only if response was Yes for B17]

Now please think about the last 3 months. In the last 3 months, did you have oral sex?

  1. Yes

  2. No

Evaluation of Adolescent Pregnancy Prevention Approaches (OMB No.: 0970-0360) Baseline Item #4.17 Part B1

Sexual behavior

B19

[Display only if response was Yes for B17]

In the past 3 months, did you have you oral sex without using a condom or dental dam?

  1. Yes

  2. No

Evaluation of Adolescent Pregnancy Prevention Approaches (OMB No.: 0970-0360) Concordance Item #4.18 Part B1


Modifications made: changed time responses to yes/no and added “and dental dam”.

Sexual behavior

B20

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

Yes

No

Evaluation of Adolescent Pregnancy Prevention Approaches (OMB No.: 0970-0360) Baseline Item #4.19 Part B1

Sexual behavior

B21

[Display only if response was Yes for B20]

Now please think about the last 3 months. In the last 3 months, did you have anal sex?

  1. Yes

  2. No


Evaluation of Adolescent Pregnancy Prevention Approaches (OMB No.: 0970-0360) Baseline Item #4.21 Part B1


Modifications made: changed time responses to yes/no

Sexual behavior

B22

[Display only if response was Yes for B20]

In the past 3 months, did you have you anal sex without using a condom?

  1. Yes

  2. No




Evaluation of Adolescent Pregnancy Prevention Approaches (OMB No.: 0970-0360) Concordance Item #4.22 Part B1


Modifications made: changed time responses to yes/no

Sexual behavior

B23

FOR GIRLS ONLY—To the best of your knowledge, have you ever been pregnant, even if no child was born?

MARK (X) ONE

Yes

No

FOR BOYS ONLY – To the best of your knowledge, have you ever gotten someone pregnant, even if no child was born?

MARK (X) ONE

Yes

No

Evaluation of Adolescent Pregnancy Prevention Approaches (OMB No.: 0970-0360) Baseline Item #4.24c Part B1 and Item #4.25b Part B1

Pregnancy outcome

B24

In the last 12 months, have you been tested by a doctor or nurse for a sexually transmitted disease, or STD, like gonorrhea, Chlamydia, syphilis, or HIV?

MARK (X) ONE

Yes

No

Evaluation of Adolescent Pregnancy Prevention Approaches (OMB No.: 0970-0360) Baseline Item #4.27 Part B1

Sexual health behavior

B25

In the last 12 months, have you been told by a doctor or other health professional that you had a sexually transmitted disease, or STD?

MARK (X) ONE

Yes

No

Don’t know

Evaluation of Adolescent Pregnancy Prevention Approaches (OMB No.: 0970-0360) Baseline Item #4.28 Part B1

STD outcome




INTENTIONS (I)


Item #

Item

Source

Justification/Notes

I1

Do you intend to have oral sex in the next year?

MARK (X) ONE

Yes, definitely

Yes, probably

No, probably not

No, definitely not

Evaluation of Adolescent Pregnancy Prevention Approaches (OMB No.: 0970-0360) Concordance Item #3.15 Part A

Sexual behavior intentions

I2

Do you intend to have sexual intercourse in the next year?

MARK (X) ONE

Yes, definitely

Yes, probably

No, probably not

No, definitely not

Evaluation of Adolescent Pregnancy Prevention Approaches (OMB No.: 0970-0360) Concordance Item #3.16 Part A

Sexual behavior intentions

I3

[Not displayed if “No, definitely not” is response for I2]

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

Evaluation of Adolescent Pregnancy Prevention Approaches (OMB No.: 0970-0360) Concordance Item #3.17 Part A

Sexual behavior intentions

I4

[Only display for females; Not displayed if “No, definitely not” is response for I2]

The next question is about your intention to use other methods of birth control, NOT including condoms:

Birth control pills

The shot (like, Depo Provera)

The patch

The ring (like, NuvaRing)

IUD (like, Mirena or Paragard)

Implants (like, Implanaon)


If you have sexual intercourse in the next year, do you intend to use any of these other methods of birth control?

Yes, definitely

Yes, probably

No, probably not

No, definitely not

Evaluation of Adolescent Pregnancy Prevention Approaches (OMB No.: 0970-0360) Concordance Item #3.18 Part A

Sexual behavior intentions

I5

How likely is it that you will do each of the following things?

MARK (X) ONE

Not at all likely, A little 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?

Evaluation of Adolescent Pregnancy Prevention Approaches (OMB No.: 0970-0360) Baseline Item #1.11 Part A

Educational intentions




KNOWLEDGE (K)


Item #

Item

Source

Classification/Notes

K1

The next series of questions is about condoms, birth control pills, pregnancy and sexually transmitted diseases, also called STDs.

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

Evaluation of Adolescent Pregnancy Prevention Approaches (OMB No.: 0970-0360) Baseline Item #3.5 Part A


Modifications made- Removed “don’t know” as a response option because of follow-up certainty question.

Knowledge- condoms

K2

How confident are you that your answer is correct?

MARK (X) ONE

Not at all confident

A little confident

Somewhat confident

Very confident

Evaluation of Adolescent Pregnancy Prevention Approaches (OMB No.: 0970-0360) Baseline Item #3.5a Part A

Change in certainty

K3

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

Evaluation of Adolescent Pregnancy Prevention Approaches (OMB No.: 0970-0360) Baseline Item #3.6 Part A

Knowledge- condoms

K4

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

Evaluation of Adolescent Pregnancy Prevention Approaches (OMB No.: 0970-0360) Baseline Item #3.7 Part A

Knowledge- condoms

K5

A condom can be used more than once.

True

False

Evaluation of Adolescent Pregnancy Prevention Approaches (OMB No.: 0990-0382) OICA Follow-Up Survey Item #2.5c

Knowledge- condoms

K6

A sexually active girl can become pregnant if she forgets to take her birth control pills for several days in a row.

True

False

Evaluation of Adolescent Pregnancy Prevention Approaches (OMB No.: 0990-0382) OICA Follow-Up Survey Item #2.5a

Knowledge- birth control

K7

A person who has Genital Herpes must have open sores to give the infection to his or her sexual partner.

True

False

Sexually Transmitted Disease- Knowledge Questionnaire (STD-KQ; Jaworski & Carey, 2007) Item #21

Knowledge- STD/HIV transmission

K8

If a person had Gonorrhea in the past he or she is immune (protected) from getting it again.

True

False

Sexually Transmitted Disease Knowledge Questionnaire (STD-KQ; Jaworski & Carey, 2007) Item #24

Knowledge- STD/HIV transmission

K9

Showering, or washing one’s genitals/private parts, after sex keeps a person from getting HIV.

True

False

Brief HIV Knowledge Questionnaire (HIV-KQ-18; Carey & Schroder, 2002) Item #5

Knowledge- STD/HIV transmission

K10

A person can get HIV from oral sex.

True

False

Brief HIV Knowledge Questionnaire (HIV-KQ-18; Carey & Schroder, 2002) Item #17

Knowledge- STD/HIV transmission



ATTITUDES AND BELIEFS (A)


Item #

Item/Scale

Source

Classification/Notes

A1

In your opinion, how likely or unlikely is it that each of the following things would happen to you personally if you were to have sexual intercourse? (If you’ve never had sexual intercourse, please try to imagine and make your best guess.)

[Items will be displayed in randomized order]

  1. Get pregnant or get someone pregnant

  2. Enjoy it

  3. Get a sexually transmitted disease

  4. Feel guilty

  5. Be more popular

  6. Have fun

  7. Nothing about my life would change

  8. Get into trouble with your parents

  9. Get a bad reputation

  10. Feel more loved and wanted

  11. Lose your self-respect

  12. Feel more attractive

  13. Keep your boyfriend or girlfriend from breaking up with you

  14. Feel pleasure

  15. Feel closer to your partner

  16. Disappoint people who are important to you

  17. Feel satisfied

  18. Get HIV/AIDS

  19. Feel excited

  20. Feel more grown up

[Response options: very unlikely, somewhat unlikely, somewhat likely, very likely]

Adolescent Sexual Expectancies Scale (ASEXS; Bourdeau et al., 2011)


Expectancy beliefs about the consequences of sexual behavior

A2

Please fill in the answer for each question that best describes how you feel.

  1. I believe people my age should wait until they are older before they have sex.

  2. I believe it’s OK for people my age to have sex with a steady boyfriend or girlfriend.

  3. I believe condoms (rubbers) should always be used if a person my age has sexual intercourse.

  4. I believe condoms (rubbers) should always be used if a person my age has sexual intercourse, even if the girl uses hormonal birth control.

  5. I believe condoms (rubbers) should always be used if a person my age has sexual intercourse, even if the two people know each other very well.

  6. I believe condoms (rubbers) should always be used if a person my age has anal sex.

  7. I believe condoms (rubbers) or dental dams should always be used if a person my age has oral sex.

[Response options: Definitely Yes, Probably Yes, Probably No, Definitely No]


The following questions ask you about your friends and what they think. Even if you’re not sure, mark the answer that you think best describes what they think.

  1. Most of my friends believe people my age should wait until they are older before they have sex.

  2. Most of my friends believe it’s OK for people my age to have sex with a steady boyfriend or girlfriend.

  3. Most of my friends believe condoms (rubbers) should always be used if a person my age has sexual intercourse.

  4. Most of my friends believe condoms (rubbers) should always be used if a person my age has sexual intercourse, even if the girl uses hormonal birth control.

  5. Most of my friends believe condoms (rubbers) should always be used if a person my age has sexual intercourse, even if the two people know each other very well.

  6. Most of my friends believe condoms (rubbers) should always be used if a person my age has anal sex.

  7. Most of my friends believe condoms (rubbers) or dental dams should always be used if a person my age has oral sex.

[Response options: Definitely Yes, Probably Yes, Probably No, Definitely No]


What do you think about condoms? Please tell us how much you agree or disagree with the following statements.

  1. It would be embarrassing to buy condoms (rubbers) in a store.

  2. I would feel uncomfortable carrying condoms (rubbers) with me.

  3. It would be wrong to carry a condom (rubber) with me because it would mean that I’m planning to have sex.

[Response options: I strongly agree, I kind of agree, I kind of disagree, I strongly disagree]

Sexual Risk Behavior Beliefs and Self-Efficacy Scales (Basen-Engquist et al., 2020)


Modifications made to Your Beliefs scale: changed sex to sexual intercourse in items 3, 4, and 5. Added items 6 and 7. Changed original ordering of items.


Modifications made to What do your friends believe? scale: Same changes that were made to Your Beliefs scale.



Addresses:

  • Attitudes about sexual intercourse

  • Norms about sexual intercourse

  • Attitudes about condom use

  • Norms about condom use

  • Barriers to condom use




References


Basen-Engquist, K., Masse, L. C., Coyle, K., Kirby, D., Parcel, D., Banspach, S., Nodora, J. (2020). Sexual risk behavior beliefs and self-

efficacy scales. In R. R. Milhausen, J. K. Sakaluk, T. D. Fisher, C. M. Davis, W. L. Yarber (Eds.), Handbook of Sexuality-Related Measures (4th ed., pp. 381-384). New York, NY: Routledge.

Bourdeau, B., Grube, J. W., Bersamin, M. M., Fisher, D. A. (2011). The role of beliefs in sexual behavior of adolescents: Development

and validation of an Adolescent Sexual Expectancies Scale (ASEXS). Journal of Research on Adolescence, 21(3), 639-648.

Carey, M. P. & Schroder, K. E. E. (2002). Development and psychometric evaluation of the brief HIV knowledge questionnaire. AIDS

Education and Prevention, 14(2), 172-182.

Connell, C. L, Nord, M., Lofton, K. L., Yadrick, K. (2004). Food security of older children can be assessed using a standardized survey

instrument. Journal of Nutrition, 134(10), 2566-2572.

Jaworski, B. C. & Carey, M. P. (2007). Development and psychometric evaluation of a self-administered questionnaire to measure

knowledge of sexually transmitted diseases. AIDS and Behavior, 11(4), 557-574.

Widman & Stewart. (2020). Adolescent Sexual Communication Scale. In R. R. Milhausen, J. K. Sakaluk, T. D. Fisher, C. M. Davis, W. L.

Yarber (Eds.), Handbook of Sexuality-Related Measures (4th ed., pp. 251-253). New York, NY: Routledge.




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