Adolescent Survey of Health 2021

Form Approved

OMB No. 0920-new

Expiration Date: ##/##/20##

Client	NORC Public Health/CDC DASH
Project Name	National Adolescent Health Survey – Teen MAIN
Project Number	8644
Survey length (median)	20 minute survey
Population	Age 15-19
Pretest	N=9 (2020 pilot to be conducted with OMB waiver)
Main	N=900 (dyad with parent interview)
MODE	Web/Phone
Language	English
Sample Source	AmeriSpeak Teen + AmeriSpeak (nomination)
Incentive	20,000
Survey description	Teen Survey of Health 2021
Eligibility Rate	100%

Public reporting burden of this collection of information is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a current valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-new).

Standard demographic preloads:

Var Name	Include on Preload Testing-page?	Var Type	Var length	Variable Label
S_AGE	Y	Numeric	5	Age
S_GENDER	Y	String	8	Gender
S_RACETH	Y	Numeric	8	Race/ethnicity
S_EDUC	N	Numeric	6	Education
S_EDUC5	Y	Numeric	4	5-level education
S_MARITAL	Y	Numeric	9	Marital Status
S_EMPLOY	Y	Numeric	8	Current employment status
S_INCOME	N	Numeric	8	Household income
S_HHINC_4	N	Numeric	4	4-level income
S_HHINC_9	N	Numeric	4	9-level income
S_STATE	Y	String	7	State
S_METRO	N	Numeric	7	Metropolitan area flag
S_INTERNET	N	Numeric	10	Household internet access
S_HOUSING	N	Numeric	9	Home ownership
S_HOME_TYPE	N	Numeric	11	Building type of panelist’s residence
S_PHONESERVC	N	Numeric	11	Telephone service for the household
S_HHSIZE	N	Numeric	8	Household size (including children)
S_HH01	N	Numeric	6	Number of HH members age 0-1
S_HH25	N	Numeric	6	Number of HH members age 2-5
S_HH612	N	Numeric	7	Number of HH members age 6-12
S_HH1317	N	Numeric	8	Number of HH members age 13-17
S_HH18OV	N	Numeric	8	Number of HH members age 18+
S_file_date	N	Date	11
S_GENFRACE	N	Numeric	8	GenF custom race

These populated as a pre-load when the panelists get sampled into the survey

Standard sample preloads

Variable Name	Include on Preload Testing-only page?	Variable Type	Variable Label
Username	N	Numeric	Analogous to Member_PIN
P_Batch	N	Numeric	Batch Number (if only one assignment, then everyone will be 1)
Dialmode	N	Numeric	CATI Dialmode (predictive, preview, etc)
P_LCS	N	Numeric	Life cycle stage, 0=released but not touched
Y_FCELLP	N	String
Surveylength	N	Numeric	Estimated length of survey
Incentwcomma	N	String	Study specific
P_Hold01	N	Numeric	Prevents dialing cases without phone numbers
PANEL_TYPE	Y	Numeric	1 AmeriSpeak 2 Next Generation 3 GenF Extended (not in use) 4 AmeriSpeak Teen Panel 11 UTUS Converted 20 Lucid 21 SSI 50 Household 13-17 51 Household < 13 52 Household Adult

Custom survey-specific

Variable Name	Program in VCC?	Include on Preload Testing-only page?	Variable Type	Variable Label
R_CASE_NAME	NO	YES	STRING	Requestor name (preload, not spawn)

This survey will use the following RND_xx variables: none

PHONE SCRIPTS

[CATI - OUTBOUND]

INTRO

Hello, my name is $I. I'm calling from AmeriSpeak by NORC. May I please speak with [FIRSTNAME]?

[IF RESPONDENT IS AVAILABLE]

Thank you for your continued participation in AmeriSpeak. I am calling to let you know that your next survey is available. The survey takes approximately [SURVEYLENGTH] minutes to complete. If you complete the survey, you will receive [INCENTWCOMMA] AmeriPoints for your time. We will keep all of your answers confidential. Shall we proceed?

Great. As always, for quality assurance purposes, this call may be recorded or monitored.

[CATI-INBOUND]

INTRO

Thank you for calling AmeriSpeak by NORC.  My name is $I.  How are you today?

And are you calling to take your next survey?

I just need to confirm that I'm speaking with [FIRSTNAME] [LASTNAME]. Is that you?

Great. This survey takes approximately [SURVEYLENGTH] minutes to complete over the phone and you will receive [INCENTWCOMMA] AmeriPoints for your time.  We will keep all of your answers confidential. 

As always, for quality assurance purposes, this call may be recorded or monitored.

Shall we proceed?

[CATI-CALLBACK]

CBINTRO

Hello, my name is $I. I'm calling from AmeriSpeak by NORC. We previously spoke with [FIRSTNAME] about completing an AmeriSpeak survey. Is [FIRSTNAME] available?

[IF RESPONDENT IS AVAILABLE]

Hello, my name is $I, calling from AmeriSpeak by NORC. We previously spoke with you about completing an AmeriSpeak survey. Are you available now to continue?

As always, for quality assurance purposes, this call may be recorded or monitored.

[DISPLAY THIS AM LANGUAGE IF SurveyAccessEnd-CALLDATE>1 DAY]

[CATI-MISSED OUTBOUND, ANSWERING MACHINE]

AM1

Hello, this message is [FIRSTNAME] [LASTNAME]. I'm calling from AmeriSpeak from NORC to let you know that you have a survey waiting for you. The survey will take approximately [SURVEYLENGTH] minutes and you will receive [INCENTWCOMMA] AmeriPoints for your time. Call us toll-free at 888-326-9424 and enter your PIN number, [MEMBER_PIN], to complete your survey and receive rewards. Thank you.

[DISPLAY THIS AM LANGUAGE IF SurveyAccessEnd-CALLDATE>1 DAY]

[CATI-ANSWERING MACHINE MISSED APPOINTMENT CALLBACK]

AMHARD

Hello, this message is for [FIRSTNAME] and I'm calling from AmeriSpeak from NORC. When we spoke previously, you requested that we call you back <at this time>. I'm sorry that we've missed you. We'll try to contact you again soon but please feel free to return our call any time at 888-326-9424 and enter your PIN number, [MEMBER_PIN], to complete your survey and receive rewards. Thank you.

[DISPLAY THIS AM LANGUAGE IF SurveyAccessEnd-CALLDATE>1 DAY]

[CATI-ANSWERING MACHINE MISSED CALLBACK]

AMSOFT

Hello, this message is for [FIRSTNAME]. I am calling from AmeriSpeak from NORC. We are calling you back to complete your AmeriSpeak survey. Remember, you will receive rewards for completing this survey. I'm sorry that we've missed you. We'll try to contact you again soon but please feel free to return our call any time at 888-326-9424 and enter your PIN number, [MEMBER_PIN], to complete this survey. Thank you.

[DISPLAY THIS AM LANGUAGE IF SurveyAccessEnd-CALLDATE=1 DAY]

[CATI-NEARING END OF FIELD, ANSWERING MACHINE]

AMEND

Hello, this message is for [FIRSTNAME]. I'm calling from AmeriSpeak from NORC to let you know that a survey will be ending tomorrow. We’d love to hear from you so please call us toll-free at 888-326-9424 and enter your PIN number, [MEMBER_PIN], to complete your survey and receive rewards. Thank you.

Please include the following options for all questions in CATI:

77 DON’T KNOW

99 REFUSED

Please code refusals in CAWI:

98 IMPLICIT REFUSAL, WEB SKIP

Do not code 77 Don’t Know/99 Refused options in CAWI unless written in item response options

Text shown in green includes researcher notes and should not be included in the programming.

[START OF SURVEY]

CREATE DATA-ONLY VARIABLE: QUAL

1=Qualified Complete

2=Not Qualified

3=In progress

AT START OF SURVEY COMPUTE QUAL=3 “IN PROGRESS”

CREATE MODE_START

1=CATI

2=CAWI

[DISPLAY-WINTRO_1]

Welcome to today’s Amerispeak survey! You are invited to participate in a survey about your mental health, sexual and reproductive health, social support systems, and school environment!

A few things...

This survey is voluntary. We're excited to hear what you think and hope you will answer as many questions as you can, but it is OK to leave a question blank if you choose not to answer it.

Your answers will be kept private. Your answers will be combined with answers from teens across the country. <u><i>NO ONE</i></u> will be told how you answered any of your questions.

There are NO wrong answers. We want you to answer truthfully and as best you can, but this is a chance for you to have a voice: tell us what YOU think!

[SP; double prompt]

CONSENT.

We are asking you to take part in this survey on how teens like you feel about your mental health, sexual and reproductive health, social support systems, and school environment. This will take about 20 minutes to finish, depending on your answers.

Important things you should know are:

• The Teen and Parent Surveys of Health are being conducted by NORC on behalf of the U.S. Centers for Disease Control and Prevention’s (CDC) Division of Adolescent and School Health.

• The survey is voluntary; you can choose whether or not to take it, and you can stop taking the survey at any time.

• We would encourage you to take the survey at any time when you will have privacy.

• You will be compensated for your time with a reward of [INCENTWCOMMA] AmeriPoints for completing the survey.

If you have any questions or concerns about your participation in this study, you can contact AmeriSpeak Support at [email protected] or call (888) 326-9424.

Are you willing to complete this survey?

CAWI RESPONSE OPTIONS:

1. Yes

2. No

CATI RESPONSE OPTIONS:

1. YES

2. NO

IF CONSENT=2, 77, 98, 99 TERMINATE

 SET QUAL=2, CO_DATE

 GO TO TERMSORRY

 No back (disable browser back button)

 auto redirect to member portal after 10 seconds

[NO PIMS TRANSACTION]

[SHOW IF TERMINATED]

TERMSORRY. 

Thank you for your time today. Unfortunately you are not eligible for this study. We value your opinion and hope that you will participate in future AmeriSpeak surveys.

We will redirect you to the AmeriSpeak Member Portal in [n] seconds.

[SET QUAL=2 “Not Qualified” and END INTERVIEW, no incentive given]

[REMOVE “PREVIOUS” BUTTON FROM PAGE]

[CAWI NO BACK – disable web browser back button]

CAWI auto-redirect to MEMBER PORTAL in 10 seconds, display remaining number of seconds in [n]

[DISPLAY – INTRO2]

Thank you for your help with this important survey. We will ask questions on a series of topics, including: your communication with your parent(s)/caregiver(s); social support systems; school environment; mental health; and sexual and reproductive health. We will start by asking you a few questions about yourself.

[CAWI: Please use the "Continue" and "Previous" buttons to navigate between the questions within the questionnaire. Do not use your browser buttons.]

Section A. Background

[SP]

Q1.

During the past 30 days, where did you usually sleep?

1. In [CAWI: my; CATI: your] parent's or primary caregiver's home

2. In the home of a friend, family member, or other person because [CAWI: I; CATI: you] had to leave [CAWI: my; CATI: your] home or [CAWI: my; CATI: your] parent or primary caregiver cannot afford housing

3. Your own house or apartment

4. A shelter or emergency housing

5. In a motel or hotel

6. In a car, park, campground, or other public place

7. [CAWI: I; CATI: You] do not have a usual place to sleep

8. Somewhere else

[MP]

Q2.

Who do you live with currently?

[CAWI - REMOVE BOLD] <i> Please select all that apply. </i>

[CATI] SELECT ALL THAT APPLY

1. Mother

2. Father

3. Stepmother

4. Stepfather

5. Parent's/caregiver’s boyfriend/girlfriend

6. Grandmother

7. Grandfather

8. Foster mother

9. Foster father

10. Aunt

11. Uncle

12. Boyfriend/girlfriend

13. Brother (including step-, half-, and foster brother) ([CAWI: If yes, enter number: [numbox 1-5]; CATI: IF YES, ASK: “How many brothers are you currently living with?” AND ENTER A NUMBER BETWEEN 1 AND 5 [SPACE] CATI: AFTER TYPING THE ANSWER IN THE NUMBOX, PLEASE PLACE THE CURSOR ON THE CONTINUE BUTTON TO PROCEED: [numbox 1-5]])

14. Sister (including step-, half-, and foster sister) [CAWI: If yes, enter number: [numbox 1-5]; CATI: IF YES, ASK: “How many sisters are you currently living with?” AND ENTER A NUMBER BETWEEN 1 AND 5 [SPACE] CATI: AFTER TYPING THE ANSWER IN THE NUMBOX, PLEASE PLACE THE CURSOR ON THE CONTINUE BUTTON TO PROCEED: [numbox 1-5]])

15. [CAWI: I; CATI: You] live by [CAWI: myself; CATI: yourself] [SP]

16. Other, please specify: __[SMALL TEXTBOX]____

[SHOW IF S_AGE=15-17]

[SP]

Q3a.

Is [R_CASE_NAME] the adult that is most responsible for you? That is, is [R_CASE_NAME] your parent or primary caregiver?

CAWI RESPONSE OPTIONS:

1. Yes

2. No

CATI RESPONSE OPTIONS:

1. YES

2. NO

[SHOW IF Q3A=2, 77, 98, 99 or S_AGE>=18]

[SP]

Q3b.

[IF S_AGE=15-17]Who is the adult that is most responsible for you? That is, who is your primary parent or caregiver?

[IF S_AGE>=18]Who is the adult that is most responsible for you? That is, who is your parent or primary caregiver? If you have more than one parent who is responsible, please <u>choose only one</u>. We will be asking you some questions later about your relationship with this one person.

1. No parent or caregiver is responsible for [CAWI: me; CATI: you] [IF S_AGE>=18: .][IF S_AGE=15-17: / [CAWI: I’m; CATI: You’re] an emancipated minor. ]

2. Mother

3. Father

4. Stepmother

5. Stepfather

6. Parent’s/caregiver’s boyfriend/girlfriend

7. Grandmother

8. Grandfather

9. Foster mother

10. Foster father

11. Aunt

12. Uncle

13. Other, please specify: __[SMALL TEXTBOX]____

[SHOW ON SAME PAGE AS Q3B]

[SHOW IF Q3B=2-13]

[SMALL TEXTBOX]

Q3c.

What do you call that person?

[SPACE]

CATI: AFTER TYPING THE ANSWER IN THE TEXTBOX, PLEASE PLACE THE CURSOR ON THE CONTINUE BUTTON TO PROCEED

________[SMALL TEXTBOX]__________

COMPUTE DOV_CARENAME [STRING]

IF Q3A=1 DOV_CARENAME=R_CASE_NAME

IF Q3C<>SKIP DOV_CARENAME=Q3C

IF Q3C=SKIP DOV_CARENAME='your parent/caregiver'

[SP]

Q4.

[IF MONTH=MAY-AUGUST] What grade will you be enrolled in this Fall?

[IF MONTH=SEPTEMBER-APRIL]What grade are you in?

1. Not enrolled in school

2. 8^th grade

3. 9^th grade

4. 10^th grade

5. 11^th grade

6. 12^th grade

7. College first-year or freshman

8. College second-year or sophomore

9. College third-year or junior

10. College fourth-year or senior

11. Other, please specify: __[SMALL TEXTBOX]____

[SHOW IF Q4=2-11]

Q4_A

In the past 12 months, which of the following ways did you attend school a MAJORITY of the time? By majority we mean most of the time or more than half.

RESPONSE OPTIONS:

1. In-person full time

2. Virtual/online full-time

3. Hybrid format-- In-person PART-TIME and virtual PART-TIME (meaning a combination of in-person attendance and virtual learning that follows a consistent schedule)

4. Homeschool (meaning enrolled in an official or formal homeschool program)

5. Other, please specify: [TEXTBOX]

[SHOW IF Q4=2-11]

[SP]

Q4_B

In the past 14 days, how have you attended school?

1. In-person full time

2. Virtual/online full-time

3. Hybrid format-- In-person PART-TIME and virtual PART-TIME (meaning a combination of in-person attendance and virtual learning that follows a consistent schedule)

4. Homeschool (meaning enrolled in an official or formal homeschool program)

5. Other, please specify: [TEXTBOX]

[SP]

Q5.

What sex were you assigned at birth, on your original birth certificate?

1. Male

2. Female

77. [CAWI: I; CATI: You] don’t know

99. Prefer not to answer

[SP]

Q5b.

Do you currently describe yourself as male, female, or transgender?

1. Male

2. Female

3. Transgender

4. None of these

[SHOW IF (Q5=1 and Q5b=2) or (Q5=2 and Q5b=1)]

[CUSTOM PROMPT ONCE IF Q5C=2:

CAWI: "You can go back to change your answer to the last questions by clicking the 'Back' button"

CATI: IF R CHOOSES 2, ASK: “Would you like to change your answer to the last two questions?”]

[SP]

Q5c.

Just to confirm, you were assigned [Q5 RESPONSE, sentence case] at birth and now you describe yourself as [Q5b RESPONSE, sentence case], is that correct?

1. Yes

2. No

77. [CAWI: I; CATI: You] don’t know

99. Prefer not to answer

[MP]

Q6.

Which best describes your sexual attraction to other people?

Are you…

[CAWI - REMOVE BOLD] <i> Please select all that apply. </i>

[CATI] SELECT ALL THAT APPLY

1. Attracted to females

2. Attracted to males

3. Attracted to other genders/non-binary/transgender persons

4. Not sexually attracted to anyone [SP]

5. Other, please specify: __[SMALL TEXTBOX]____

[SP]

Q7.

Which of the following best represents how you think of yourself?

1. [If Q5b=2: Lesbian or gay] [If Q5b=1,3,4, 77, 98, 99: Gay]

2. Straight, that is, not [If Q5b=2: lesbian or gay] [If Q5b=1,3,4, 77, 98, 99: gay]

3. Bisexual

4. Something else

77. [CAWI: I; CATI: You] don’t know the answer

Section B. Individual Protective Factors (self-regulation, problem-solving, school-related self-efficacy, future orientation)

[GRID, SP]

Q8. (self-regulation)

How true do you feel these statements are about you personally?

	Very much true	Pretty much true	A little true	Not true at all
a. [CAWI: I; CATI: You] know how to relax when [CAWI: I; CATI: you] feel tense
b. [CAWI: I am; CATI: You are] always able to keep [CAWI: my; CATI: your] feelings under control
c. [CAWI: I; CATI: You] know how to calm down when [CAWI: I am; CATI: you are] feeling nervous
d. [CAWI: I; CATI: You] control [CAWI: my; CATI: your] temper

[GRID, SP]

Q9. (problem-solving)

How true do you feel these statements are about you personally?

	Very much true	Pretty much true	A little true	Not true at all
a. [CAWI: I; CATI: You] can think of many ways to get out of a difficult situation
b. [CAWI: I; CATI: You] can find lots of ways around any problem
c. [CAWI: I; CATI: You] can think of many ways to get the things in life that are important to [CAWI: me; CATI: you]
d. Even when others get discouraged, [CAWI: I; CATI: you] know [CAWI: I; CATI: you] can find a way to solve the problem

[SHOW IF Q4=2-11]

[GRID, SP]

Q10. (self-efficacy)

How true do you feel these statements are about you personally?

	Very much true	Pretty much true	A little true	Not true at all
a. [CAWI: I’m; CATI: You’re] certain [CAWI: I; CATI: you] can master the skills taught in school
b. [CAWI: I’m; CATI: You’re] certain [CAWI: I; CATI: you] can figure out how to do the most difficult school work
c. [CAWI: I; CATI: You] can do almost all the work in school if [CAWI: I; CATI: you] don't give up
d. Even if the work is hard, [CAWI: I; CATI: you] can learn it
e. [CAWI: I; CATI: You] can do even the hardest school work if [CAWI: I; CATI: you] try

[GRID, SP; 2, 3]

Q11. (future orientation)

The next questions ask about your future goals. Think about yourself and what is going on in your life right now. Then, please state how much you agree or disagree with the following statements.

	Strongly agree	Agree	Neither agree nor disagree	Disagree	Strongly disagree
a. [CAWI: I; CATI: You] have plans for [CAWI: my; CATI: your] educational future (obtaining a high school diploma, GED, college degree, or other course work)
b. [CAWI: I; CATI: You] have plans for [CAWI: my; CATI: your] financial future (getting a job, saving money, etc.)
c. [CAWI: I; CATI: You] have plans for [CAWI: my; CATI: your] future that are not related to education or financial goals
d. [CAWI: I; CATI: You] can think of many ways to reach the goals [CAWI: I; CATI: you] have right now
e. [CAWI: I; CATI: You] have plans for things [CAWI: I’ll; CATI: you’ll] be doing a year from now

Section C. Family Protective Factors (family/parent connectedness, parental expectations, parental monitoring, parent-adolescent communication)

[DISPLAY – SECTC_INTRO]

The next set of questions asks about your family.

[GRID, SP]

Q12.

How much do you feel that…

	Very much	Quite a bit	Somewhat	Very little	Not at all
a. [SHOW IF Q3A=1 or Q3B=2-13] Your parent(s)/caregiver(s) care about you
b. People in your family understand you
c. You and your family have lots of fun together
d. Your family pays a lot of attention to you
e. [SHOW IF Q3A=1 or Q3B=2-13] You feel close to [DOV_CARENAME]
f. [SHOW IF Q3A=1 or Q3B=2-13] [IF Q3C<>SKIP, pipe in DOV_CARENAME; IF Q3C = SKIP, pipe in “Your parent/caregiver”] cares about you

[SHOW IF Q3A=1 or Q3B=2-13]

[SP]

Q13.

How much do you agree or disagree with the following?

[SPACE]

"Overall, [CAWI: I am; CATI: you are] satisfied with the relationship [CAWI: I; CATI: you] have with [IF CAWI and Q3C<>SKIP, pipe in DOV_CARENAME; IF CAWI and Q3C = SKIP, pipe in “my parent/caregiver”; IF CATI, pipe in DOV_CARENAME]."

1. Strongly agree

2. Agree

3. Neither agree nor disagree

4. Disagree

5. Strongly disagree

[SHOW IF Q3A=1 or Q3B=2-13]

[DISPLAY – SECTC_1]

The next questions will ask about [DOV_CARENAME]’s opinions and expectations.

[SHOW IF Q3A=1 or Q3B=2-13]

[GRID, SP; 4, 4]

Q14.

How much would [DOV_CARENAME] approve or disapprove if you…

	Strongly Approve	Approve	Neither Approve nor Disapprove	Disapprove	Strongly Disapprove
Had sex while you are a teenager
[SHOW IF Q5=2] Used an IUD, implant, birth control pills, shot (“Depo-Provera”), skin patch, or vaginal ring at this time in your life
Used alcohol, tobacco, or vaping or e-cigarette device
Used marijuana (pot, weed, or cannabis)
Used prescription opioids (e.g., codeine, Vicodin, OxyContin, Hydrocodone, Percocet) without a doctor’s prescription or in a way other than prescribed
Used illicit drugs (e.g., cocaine/crack, ecstasy, heroin, methamphetamine (speed, meth), hallucinogens (LSD), or inhalants)
Did not graduate from high school
Did not graduate from college

[SHOW IF Q3A=1 or Q3B=2-13]

[DISPLAY – SECTC_2]

The next questions will ask about [DOV_CARENAME]’s monitoring of your day-to-day activities.

[SHOW IF Q3A=1 or Q3B=2-13]

[GRID, SP]

Q15.

When you’re living at home, how much does [DOV_CARENAME] know about…

	They know a lot	They know a moderate amount	They know a little	They don’t know anything
a. Who your friends are
b. How you spend your money
c. Where you are after school
d. Where you are when you go out
e. What you do with your free time
f. What you do online
g. Who you text with

[SHOW IF Q3A=1 or Q3B=2-13]

[GRID, SP]

Q16.

During the past <i>30 days</i>, how often has [DOV_CARENAME]…

	More than a few times	A few times	Once or twice	Never
a. Restricted or blocked certain websites that you might use
b. Restricted the amount of time you spend online
c. Monitored or tracked what you are doing online, such as reading your texts, installing an app on your phone, or checking your Instagram or Snapchat account or search history

[SHOW IF Q3A=1 or Q3B=2-13]

Q17.

Does [DOV_CARENAME] follow you on social media accounts that you regularly use?

1. Yes

2. No

77. [CAWI: I; CATI: You] don’t know

[SHOW IF Q3A=1 or Q3B=2-13]

[SP]

Q18.

How much do you agree or disagree with the following?

[SPACE]

"[IF CAWI and Q3C<>SKIP, pipe in DOV_CARENAME; IF CAWI and Q3C = SKIP, pipe in “My parent/caregiver”; IF CATI and Q3C<>SKIP, pipe in DOV_CARENAME; IF CATI and Q3C=SKIP, pipe in “Your parent/caregiver”] has rules and consequences for [CAWI: my; CATI: your] behavior (e.g., curfews, punishments for breaking rules)."

1. Strongly agree

2. Agree

3. Neither agree nor disagree

4. Disagree

5. Strongly disagree

[SHOW IF Q3A=1 or Q3B=2-13]

[DISPLAY – SECTC_3]

The next set of questions asks about how you communicate with [DOV_CARENAME].

[SHOW IF Q3A=1 or Q3B=2-13]

[GRID, SP; 4, 4, 4, 4]

Q19.

During the past <i>12 months</i>, how often have you talked with [DOV_CARENAME] about each of the following…

	More than a few times	A few times	Once or twice	Never
Treating people you date respectfully or being treated respectfully
Sexting (sending, receiving, or forwarding sexually suggestive messages, images, or videos via cell phones, emails, instant messages (IM), or online social networks)
Your decisions about whether to have sex
The importance of giving and receiving consent for sex
How to say no to sex
How to prevent pregnancy
How to prevent sexually transmitted infections (STIs), including HIV
Where to get healthcare services for sexual and reproductive health, like birth control or STI testing
Where to get help for stress, anxiety, and depression
Dangers of smoking cigarettes, using e-cigarettes or vaping devices, drinking alcohol, and using marijuana or other drugs
How to avoid online risks like chatting with strangers
How to keep information private while using the internet
Your relationships with your friends
Treating people of different races or ethnicities with respect
How you are doing in school
The range of sexual orientations (such as gay, lesbian, bisexual, heterosexual) and gender identities (such as cisgender, non-binary/conforming, transgender)

[SHOW IF Q3A=1 or Q3B=2-13]

[GRID, SP]

Q20.

Have you ever talked with [DOV_CARENAME] about the following?

	[CAWI: Yes; CATI: YES]	[CAWI: No; CATI: NO]
a. Where you can go to receive health care
b. What to expect during an appointment with a healthcare provider (such as a doctor or nurse)
c. Preparing for time alone with a healthcare provider

[SHOW IF Q3A=1 or Q3B=2-13]

[SP]

Q21.

How comfortable or uncomfortable are you talking to [DOV_CARENAME] about how you are feeling (for instance, stressed, anxious, or depressed)?

1. Very comfortable

2. Comfortable

3. Neither comfortable nor uncomfortable

4. Uncomfortable

5. Very uncomfortable

[SHOW IF Q3A=1 or Q3B=2-13]

[SP]

Q22.

How much do you agree or disagree with the following?

[SPACE]

"[CAWI: I am; CATI: You are] satisfied with the way [IF CAWI: IF Q3C<>SKIP, pipe in DOV_CARENAME; IF CAWI and Q3C = SKIP, pipe in “my parent/caregiver”; IF CATI, pipe in DOV_CARENAME] and [CAWI: I; CATI: you] communicate."

1. Strongly agree

2. Agree

3. Neither agree nor disagree

4. Disagree

5. Strongly disagree

Section D. Peer and School Protective Factors (social support, school connectedness)

[DISPLAY – SECTD_INTRO]

There may be some people in your life other than your parents/primary caregivers who provide you with emotional support, such as comforting you when you are upset or encouraging you when you are frustrated.

[SP]

Q23.

How helpful are other adults in your life with providing you with emotional support?

1. Very helpful

2. Somewhat helpful

3. Not too helpful

4. Not at all helpful

5. [CAWI: I; CATI: You] do not have other adults in [CAWI: my; CATI: your] life

[SP]

Q24.

How helpful are your friends your own age in providing you with emotional support?

1. Very helpful

2. Somewhat helpful

3. Not too helpful

4. Not at all helpful

5. [CAWI: I; CATI: You] do not have friends [CAWI: my; CATI: your] own age

[SHOW IF Q4_B = 1,2,3,5]

[DISPLAY – SECTD_1]

Now we will ask about your experiences at school. For these questions, please answer about your current school year. If you are not enrolled in school, please think about the most recent year you were enrolled.

[GRID, SP]

[SHOW IF Q4_B = 1,2,3,5]

Q25.

How much do you agree or disagree with the following statements about your school?

	Strongly agree	Agree	Neither agree nor disagree	Disagree	Strongly disagree
a. [CAWI: I; CATI: You] feel close to people at school
b. Teachers care about [CAWI: me; CATI: you]
c. [CAWI: I; CATI: You] feel happy at school
d. [CAWI: I; CATI: You] feel like [CAWI: I am; CATI: you are] part of [CAWI: my; CATI: your] school
e. [CAWI: I; CATI: You] feel teachers treat students fairly
f. [CAWI: I; CATI: You] feel safe in [CAWI: my; CATI: your] school

[SP]

[SHOW IF Q4_B = 1,2,3,5]

Q26.

Does your school have a club/student group that supports lesbian, gay, bisexual, transgender, and queer students and their allies?

[REMOVE BOLD]<i>These clubs are sometimes called Gay/Straight Alliances or Genders and Sexualities Alliances (GSAs).</i>

CAWI RESPONSE OPTIONS:

1. Yes

2. No

77. Don’t know

CATI RESPONSE OPTIONS:

1. YES

2. NO

77. DON'T KNOW

[SHOW IF Q26=1]

[SP]

Q27.

Are you a member of this club/student group?

CAWI RESPONSE OPTIONS:

1. Yes

2. No

CATI RESPONSE OPTIONS:

1. YES

2. NO

Section E. Neighborhood/Community Protective Factors

[DISPLAY – SECTE_INTRO]

IF Q4=2-11: The next questions ask about your feelings about your school and neighborhood.

IF Q4=1,77,98,99: The next questions ask about your feelings about your neighborhood.

[SHOW IF Q4=2-11]

[SP]

Q28.

In the most recent school year, how often did you feel safe getting to and from school?

1. Always

2. Most of the time

3. Sometimes

4. Rarely

5. Never

[GRID, SP]

[SHOW SP "N/A" BELOW GRID; IF SELECTED HIDE GRID]

Q29.

How much do you agree or disagree with the following statements about your neighborhood?

	Strongly agree	Agree	Neither agree nor disagree	Disagree	Strongly disagree
[CAWI: I; CATI: You] see people being friendly with each other in [CAWI: my; CATI: your] neighborhood
People in [CAWI: my; CATI: your] neighborhood are willing to help their neighbors
People in [CAWI: my; CATI: your] neighborhood generally get along with each other

-[SP] Not applicable (e.g., [CAWI: I; CATI: you] don’t know/[CAWI: I; CATI: you] do not live in a neighborhood)

Section F: Mental Health

[DISPLAY – SECTF_INTRO]

This section contains questions about your <u>mental health</u>. Mental health includes things like stress, anxiety, and depression.

INSERT FOOTER <center> These questions may be difficult to answer. Please click here for a list of mental health and suicide prevention resources. </center>

Link behind “here”: 8644 CDC DASH NAHS CAWI Help Button.pdf

[SP]

Q30.

Have you ever been diagnosed with a behavioral, developmental, emotional, or mental health condition for which treatment, therapy, or counseling may be needed?

Examples may include anxiety, depression, attention deficit disorder or ADHD, autism spectrum disorder, learning or intellectual disability, speech or other language disorder.

INSERT FOOTER <center> These questions may be difficult to answer. Please click here for a list of mental health and suicide prevention resources. </center>

Link behind “here”: 8644 CDC DASH NAHS CAWI Help Button.pdf

1. Yes

2. No

99. Prefer not to answer

[GRID, SP]

Q31.

The next question asks you to rate how much stress you feel in different areas of your life.

During the past <i>6 months</i>, how much stress have you had related to…

	Very high stress	High stress	Moderate stress	Low stress	None	N/A
A. School
B. Home
C. Work
D. Friends

INSERT FOOTER <center> These questions may be difficult to answer. Please click here for a list of mental health and suicide prevention resources. </center>

Link behind “here”: 8644 CDC DASH NAHS CAWI Help Button.pdf

[GRID, SP; 5, 4]

Q32.

How often have you been bothered by each of the following symptoms during the past <u>2 weeks</u>?

	Nearly every day	More than half the days	A few days	Not at all
Feeling down, depressed, irritable or hopeless
Little interest or pleasure in doing things
Trouble falling or staying asleep, or sleeping too much
Poor appetite, weight loss, or overeating
Feeling tired, or having little energy
Feeling bad about yourself or that you are a failure or have let yourself or your family down
Trouble concentrating on things like school work, reading, or watching TV
Moving or speaking so slowly that other people could have noticed. Or the opposite - being so fidgety or restless that you have been moving around a lot more than usual
Thoughts that you would be better off dead, or of hurting yourself

INSERT FOOTER <center> These questions may be difficult to answer. Please click here for a list of mental health and suicide prevention resources. </center>

Link behind “here”: 8644 CDC DASH NAHS CAWI Help Button.pdf

[SP]

Q33.

During the past <i>12 months</i>, how often has your mental health interfered with your ability to do things other young people your age do?

1. Always

2. Usually

3. Sometimes

4. Rarely

5. Never

INSERT FOOTER <center> These questions may be difficult to answer. Please click here for a list of mental health and suicide prevention resources. </center>

Link behind “here”: 8644 CDC DASH NAHS CAWI Help Button.pdf

[SP]

Q34.

During the past <i>30 days</i>, how often was your mental health not good? (Mental health includes stress, anxiety, and depression.)

1. Always

2. Most of the time

3. Sometimes

4. Rarely

5. Never

INSERT FOOTER <center> These questions may be difficult to answer. Please click here for a list of mental health and suicide prevention resources. </center>

Link behind “here”: 8644 CDC DASH NAHS CAWI Help Button.pdf

[DISPLAY – SECTF_1]

The next questions ask about sad feelings and attempted suicide. Sometimes people feel so depressed about the future that they may consider attempting suicide, that is, taking some action to end their own life.

INSERT FOOTER <center> These questions may be difficult to answer. Please click here for a list of mental health and suicide prevention resources. </center>

Link behind “here”: 8644 CDC DASH NAHS CAWI Help Button.pdf

[SP]

Q35.

During the past <i>12 months</i>, did you ever feel so sad or hopeless almost every day for <i>2 weeks or more in a row</i> that you stopped doing some usual activities?

CAWI RESPONSE OPTIONS:

1. Yes

2. No

CATI RESPONSE OPTIONS:

1. YES

2. NO

INSERT FOOTER <center> These questions may be difficult to answer. Please click here for a list of mental health and suicide prevention resources. </center>

Link behind “here”: 8644 CDC DASH NAHS CAWI Help Button.pdf

[SP]

Q36.

During the past <i>2 weeks</i>, did you ever feel so sad or hopeless that you stopped doing some usual activities?

CAWI RESPONSE OPTIONS:

1. Yes

2. No

CATI RESPONSE OPTIONS:

1. YES

2. NO

INSERT FOOTER <center> These questions may be difficult to answer. Please click here for a list of mental health and suicide prevention resources. </center>

Link behind “here”: 8644 CDC DASH NAHS CAWI Help Button.pdf

[SP]

Q37.

During the past <i>12 months</i>, did you ever <u>seriously</u> consider attempting suicide?

CAWI RESPONSE OPTIONS:

1. Yes

2. No

CATI RESPONSE OPTIONS:

1. YES

2. NO

INSERT FOOTER <center> These questions may be difficult to answer. Please click here for a list of mental health and suicide prevention resources. </center>

Link behind “here”: 8644 CDC DASH NAHS CAWI Help Button.pdf

[SHOW IF Q37=1, 77, 98, 99]

[SP]

Q38.

During the past <i>12 months</i>, how many times did you actually attempt suicide?

1. 0 times

2. 1 time

3. 2 or 3 times

4. 4 or 5 times

5. 6 or more times

INSERT FOOTER <center> These questions may be difficult to answer. Please click here for a list of mental health and suicide prevention resources. </center>

Link behind “here”: 8644 CDC DASH NAHS CAWI Help Button.pdf

[DISPLAY – SECTF_2]

The previous questions about mental health, including stress, anxiety, depression, and suicide, may have been difficult to answer. Please click here for a list of mental health and suicide prevention resources.

Please click 'Continue' to proceed with your survey.

INSERT FOOTER <center> These questions may be difficult to answer. Please click here for a list of mental health and suicide prevention resources. </center>

Section G. Adverse Childhood Events

[GRID, SP; 4, 4, 5, 3, 3] [DO NOT SHOW NUMERIC LABELS]

Q39.

Many young people experience stressful life events. Please read the statements below and mark all that you experienced at any point since you were born. You may skip questions you do not want to answer.

	[CAWI: Yes; CATI: YES]	[CAWI: No; CATI: NO]
Your parents or primary caregivers were separated or divorced
You lived with a household member who served time in jail or prison
You lived with a household member who was depressed, mentally ill or attempted suicide
You saw or heard household members hurt or threaten to hurt each other
A household member swore at, insulted, humiliated, or put you down in a way that scared you OR a household member acted in a way that made you afraid that you might be physically hurt
Someone touched your private parts or asked you to touch their private parts in a sexual way that was unwanted, against your will, or made you feel uncomfortable
More than once, you went without food, clothing, a place to live, or had no one to protect you
Someone pushed, grabbed, slapped or threw something at you OR you were hit so hard that you were injured or had marks
You lived with someone who had a problem with drinking or using drugs
You often felt unsupported, unloved and/or unprotected
You have been in foster care
You have experienced harassment or bullying at school
You have lived with a parent or primary caregiver who died
You have been separated from your primary caregiver through deportation or immigration
You have had a serious medical procedure or life-threatening illness
You have often seen or heard violence in the neighborhood or in your school neighborhood
You have been detained, arrested or incarcerated
You have often been treated badly because of race, ethnicity, gender, sexual orientation, place of birth, disability or religion
You have experienced verbal or physical abuse or threats from a romantic partner (i.e., boyfriend or girlfriend)

INSERT FOOTER <center> These questions may be difficult to answer. Please click here for a list of mental health and suicide prevention resources. </center>

Link behind “here”: 8644 CDC DASH NAHS CAWI Help Button.pdf

[GRID, SP; 2, 4]

Q40.

Sometimes, scary or upsetting events affect how people think, feel, and act. The next question asks how you have been feeling and thinking recently.

How often did each of these happen in the <i>last 30 days</i>?

	3+ times per week	1-2 times per week	1-2 times during the entire month	Never
You had strong feelings in your body when you remembered something that happened (sweating, heart beats fast, feel sick)
You tried to stay away from people, places, or things that reminded you about something that happened
You had trouble feeling happy
You had trouble sleeping
You found it hard to concentrate or pay attention
You felt alone and not close to people around you

INSERT FOOTER <center> These questions may be difficult to answer. Please click here for a list of mental health and suicide prevention resources. </center>

Link behind “here”: 8644 CDC DASH NAHS CAWI Help Button.pdf

Section H. Experience with Racism

[DISPLAY – SECTH_INTRO]

The next question will ask about discrimination you may have experienced in your life.

[GRID, SP; 4, 3]

Q41.

During your life, how often have you …

	Always	Most of the time	Sometimes	Rarely	Never
a. Felt that you were treated badly or unfairly in school because of your race or ethnicity
b. Felt that you were watched closely or followed around by security guards or store clerks because of your race or ethnicity
c. Felt that people assumed you were less intelligent because of your race or ethnicity
d. Felt that you got poor or slow service at a restaurant or store because of your race or ethnicity
e. Seen your parents or other family members treated badly or unfairly because of their race or ethnicity
f. Felt you were treated badly or less well than others during a visit to the doctor or healthcare clinic because of your race or ethnicity
g. Felt you were treated badly or unfairly by police because of your race or ethnicity

Section I. Experiences with Violence

­­

[DISPLAY – SECTI_INTRO]

The next questions ask about experiences you may have had with violence.

[SP]

[SHOW IF Q4 = 2-11]

Q42_1.

During the past 30 days, on how many days did you not go to school because you felt you would be unsafe at school or on your way to or from school?

1. 0 days

2. 1 day

3. 2 or 3 days

4. 4 or 5 days

5. 6 or more days

[SP]

Q42_2.

During the past 12 months, how many times did someone you were dating or going out with force you to do sexual things that you did not want to do? (Count such things as kissing, touching, or being physically forced to have sexual intercourse.)

1. [CAWI: I; CATI: You] did not date or go out with anyone during the past 12 months

2. 0 times

3. 1 time

4. 2 or 3 times

5. 4 or 5 times

6. 6 or more times

[SHOW IF Q42_2=2-6, 77, 98, 99]

[SP]

Q43.

During the past 12 months, how many times did someone you were dating or going out with physically hurt you on purpose? (Count such things as being hit, slammed into something, or injured with an object or weapon.)

1. [SHOW IF Q42_2=77, 98, 99] [CAWI: I; CATI: You] did not date or go out with anyone during the past 12 months

2. 0 times

3. 1 time

4. 2 or 3 times

5. 4 or 5 times

6. 6 or more times

[SHOW IF Q43 = 2-6, 77, 98, 99]

[SP]

Q44.

During the past 12 months, did you ever force someone you were dating or going out with to do sexual things that they did not want to do? (Count such things as kissing, touching, or physically forcing them to have sexual intercourse.)

CAWI RESPONSE OPTIONS:

1. [SHOW IF Q42_2=77, 98, 99 AND Q43 = 77,98,99] I did not date or go out with anyone during the past 12 months

2. Yes

3. No

CATI RESPONSE OPTIONS:

1. [SHOW IF Q42_2=77, 98, 99 AND Q43 = 77,98,99] YOU DID NOT DATE OR GO OUT WITH ANYONE DURING THE PAST 12 MONTHS

2. YES

3. NO

[SP]

Q45.

Have you ever used physical force to make someone have sexual intercourse with you when you knew they did not want to?

CAWI RESPONSE OPTIONS:

1. Yes

2. No

CATI RESPONSE OPTIONS:

1. YES

2. NO

[SP]

Q46.

During the past 12 months, how many times were you in a physical fight?

1. 0 times

2. 1 time

3. 2 or 3 times

4. 4 or 5 times

5. 6 or 7 times

6. 8 or 9 times

7. 10 or 11 times

8. 12 or more times

[SP]

Q47.

In the past 2 weeks, have kids your age called you hurtful names, spread rumors about you or made sexual jokes or comments to you, either in person or online?

CAWI RESPONSE OPTIONS:

1. Yes

2. No

CATI RESPONSE OPTIONS:

1. YES

2. NO

[SP]

Q48.

In the past 2 weeks, have you called other kids hurtful names, spread rumors about them, or made sexual jokes or comments to them, either in person or online?

CAWI RESPONSE OPTIONS:

1. Yes

2. No

CATI RESPONSE OPTIONS:

1. YES

2. NO

Section J. Health Education

[DISPLAY – SECTJ_INTRO]

People get information about health from many different sources. The next questions are about where you get information about <u>mental health</u>. As mentioned earlier, mental health includes things like stress, anxiety, and depression.

[GRID, SP; 4, 4, 5]

Q49.

Have you ever received mental health information from the following sources?

	[CAWI: Yes; CATI: YES]	[CAWI: No; CATI: NO]
Health classes in school
A healthcare provider (outside of your school)
School nurse or other healthcare provider in your school
Another adult at your school like a teacher, coach, or counselor
An Internet search (such as a Google search)
A website specifically for teens
A medical website
Social media (such as Twitter, Instagram, or YouTube)
Your parent(s)/caregiver(s)
Your friends
Your siblings
A person you are in a romantic relationship with (like a boyfriend or girlfriend)
Other, please specify: __[IF Q49m=1 SHOW SMALL TEXTBOX]____

[SHOW IF ANY Q49a-m=1]

[GRID, SP; SHOW NUMERIC LABELS]

Q50.

Please rate how useful the mental health information was you’ve gotten from the following source(s), 5 being very useful and 1 being not at all useful:

	(Very useful)5	4	3	2	(Not at all useful) 1
[SHOW IF Q49A=1] Health classes in school
[SHOW IF Q49B=1] Your healthcare provider (outside of your school)
[SHOW IF Q49C=1] School nurse or other healthcare provider in your school
[SHOW IF Q49D=1] Another adult at your school like a teacher, coach, or counselor
[SHOW IF Q49E=1] An Internet search (such as a Google search)
[SHOW IF Q49F=1] A website specifically for teens
[SHOW IF Q49G=1] A medical website
[SHOW IF Q49H=1] Social media (such as Twitter, Instagram, or YouTube)
[SHOW IF Q49I=1] Your parent(s)/caregiver(s)
[SHOW IF Q49J=1] Your friends
[SHOW IF Q49K=1] Your siblings
[SHOW IF Q49L=1] A person you are in a romantic relationship with (like a boyfriend or girlfriend)
[SHOW IF Q49M=1] [INSERT Q49M TEXT RESPONSE]

[GRID, SP]

Q51

How much do you agree or disagree with the following statements?

	Strongly agree	Agree	Neither agree nor disagree	Disagree	Strongly disagree
a. [CAWI: I am; CATI: You are] confident that [CAWI: I; CATI: you] know where to seek information about mental health
b. [CAWI: I am; CATI: You are] confident using the internet or telephone to find information about mental health
c. [CAWI: I am; CATI: You are] confident talking in person with a healthcare provider, like a doctor or nurse, to get information about mental health
d. [CAWI: I am; CATI: You are] confident [CAWI: I; CATI: you] have access to resources (e.g., provider, internet, friends) about mental health
e. [CAWI: I am; CATI: You are] confident sharing information about mental health with a healthcare provider through virtual platforms (e.g., a video call)

[DISPLAY – SECTJ_1]

The next questions are similar to ones you just answered about finding information about mental health. This time, we want you to think about where you find information about <u>sexual and reproductive health</u>. Sexual and reproductive health refers to topics like sex, sexuality, relationships, or other issues like how to prevent sexually transmitted infections (STIs) or unintended pregnancies.

[GRID, SP; 4, 4, 5]

Q52.

Have you ever received sexual and reproductive health information from the following sources?

	[CAWI: Yes; CATI: YES]	[CAWI: No; CATI: NO]
Your healthcare provider (outside of your school)
Health classes in school
School nurse or other healthcare provider in your school
Another adult at your school like a teacher, coach, or counselor
An Internet search (such as a Google search)
A website specifically for teens
A medical website
Social media (such as Twitter, Instagram, or YouTube)
Your parent(s)/caregiver(s)
Your friends
Your siblings
A person you are in a romantic relationship with (like a boyfriend or girlfriend)
Other, please specify: [IF Q52M=1, SHOW SMALL TEXTBOX]

[SHOW IF ANY Q52A-M=1]

[GRID, SP; SHOW NUMERIC LABELS]

Q53.

Please rate how useful the sexual and reproductive health information was you’ve gotten from the following sources, 5 being very useful and 1 being not at all useful:

	5 (Very useful)	4	3	2	1 (Not at all useful)
[SHOW IF Q52A=1] Your healthcare provider (outside of your school)
[SHOW IF Q52B=1] Health classes in school
[SHOW IF Q52C=1] School nurse or other healthcare provider in your school
[SHOW IF Q52D=1] Another adult at your school like a teacher, coach, or counselor
[SHOW IF Q52E=1] An Internet search (such as a Google search)
[SHOW IF Q52F=1] A website specifically for teens
[SHOW IF Q52G=1] A medical website
[SHOW IF Q52H=1] Social media (such as Twitter, Instagram, or YouTube)
[SHOW IF Q52I=1] Your parent(s)/caregiver(s)
[SHOW IF Q52J=1] Your friends
[SHOW IF Q52K=1] Your siblings
[SHOW IF Q52L=1] A person you are in a romantic relationship with (like a boyfriend or girlfriend)
[SHOW IF Q52M=1] [INSERT Q44M TEXT RESPONSE]

[GRID, SP]

Q54

How much do you agree or disagree with the following statements?

	Strongly agree	Agree	Neither agree nor disagree	Disagree	Strongly disagree
a. [CAWI: I am; CATI: You are] confident that [CAWI: I; CATI: you] know where to seek information about sexual and reproductive health
b. [CAWI: I am; CATI: You are] confident using the internet or telephone to find information about sexual and reproductive health
c. [CAWI: I am; CATI: You are] confident talking with a healthcare provider, like a doctor or nurse, to get information about sexual and reproductive health
d. [CAWI: I am; CATI: You are] confident [CAWI: I; CATI: you] have access to resources (e.g., provider, internet, friends) about sexual and reproductive health
e. [CAWI: I am; CATI: You are] confident sharing information about sexual and reproductive health with a healthcare provider through virtual platforms (e.g., a video call)

[GRID SP; 4, 3, 3]

Q55.

Have you <u>ever</u> received information from a <u>website</u> about the following topics?

	[CAWI: Yes; CATI: YES]	[CAWI: No; CATI: NO]
How to prevent pregnancy
How to prevent sexually transmitted infections (STIs), including HIV
Where to get healthcare services for sexual and reproductive health, like birth control or STI testing
Where to get help for stress, anxiety, and depression
Dangers of smoking cigarettes, using e-cigarettes or vaping devices, drinking alcohol, and using marijuana or other drugs
How to avoid online risks like chatting with strangers
How to keep information private while using the internet
Your relationships with your friends
Treating people of different races or ethnicities fairly and equally
The range of sexual orientations (such as gay, lesbian, bisexual, heterosexual) and gender identities (such as cisgender, non-binary/conforming, transgender)

[GRID, SP; 4, 3, 3]

Q56.

Have you <u>ever</u> received information from <u>social media</u> about the following topics?

	[CAWI: Yes; CATI: YES]	[CAWI: No; CATI: NO]
How to prevent pregnancy
How to prevent sexually transmitted infections (STIs), including HIV
Where to get healthcare services for sexual and reproductive health, like birth control or STI testing
Where to get help for stress, anxiety, and depression
Dangers of smoking cigarettes, using e-cigarettes or vaping devices, drinking alcohol, and using marijuana or other drugs
How to avoid online risks like chatting with strangers
How to keep information private while using the internet
Your relationships with your friends
Treating people of different races or ethnicities fairly and equally
The range of sexual orientations (such as gay, lesbian, bisexual, heterosexual) and gender identities (such as cisgender, non-binary/conforming, transgender)

[DISPLAY – SECTJ_2]

The following questions are about school health education in general, not limited to mental health or sexual and reproductive health.

[GRID, SP; 3, 2]

Q57.

How much do you agree or disagree with the following statements?

[SPACE]

"The health-related information and skills [CAWI: I; CATI: you] received in school have helped [CAWI: me; CATI: you] to…"

	Strongly agree	Agree	Neither agree nor disagree	Disagree	Strongly disagree
a. Know how to get information and services that [CAWI: I; CATI: you] can trust
b. Understand how family, peers, culture, and media/technology influence [CAWI: my; CATI: your] health
c. Communicate with others (like family, friends, doctors, or romantic partners) to improve [CAWI: my; CATI: your] health
d. Make decisions to help maintain healthy behaviors or change unhealthy behaviors
e. Encourage [CAWI: my; CATI: your] family, peers, and people in [CAWI: my; CATI: your] community to practice healthy behaviors

[GRID, SP; 3, 4, 3]

[SHOW SP "N/A" ON FIRST SCREEN ONLY; IF SELECTED, HIDE GRID AND DO NOT SHOW OTHER SCREENS]

Q58.

Thinking about your health education classes in the past 12 months, how much did your health education teachers do the following things?

	Very much	Quite a bit	Somewhat	Very little	Not at all
a. Keep the class on task and not waste time
b. Follow through with consequences when students break classroom rules or agreements
c. Handle students who are distracting others, off-task, or causing disruption during class
d. Use students’ chosen names and pronouns
e. Make themselves available to help or talk when students need them
f. Make students feel that they really care and value everyone
g. Use hands-on activities that help students learn
h. Answer questions with accurate information
i. Relate health topics to students’ "real-life" situations
j. Give feedback on assignments that help students learn material

--[SP] N/A - no health education in the past 12 months

Section K. Health Services

[DISPLAY – SECTK_INTRO]

The next questions ask about health services. This includes your experiences with healthcare providers and your satisfaction with the healthcare you’ve received.

[SHOW IF S_AGE>=18]

[SP]

Q59.

Are you currently covered by any kind of health insurance or health plan?

1. Yes

2. No

77. [CAWI: I; CATI: You] don’t know

[SHOW IF Q59=1]

[SP]

Q60.

What kind of health insurance do you currently have?

1. Public insurance (such as Medicaid or CHIP)

2. Private insurance

77. [CAWI: I; CATI: You] don’t know

[SP]

Q61.

Where do you usually go for healthcare? Mark the one best option.

1. Doctor’s office or clinic

2. School-based health center

3. School nurse’s office

4. Emergency room

5. Health department

6. Community health center

7. Family planning center (e.g., Planned Parenthood)

8. Urgent care or walk-in clinic (e.g., Minute Clinic, CVS, Walgreens)

9. Other, please specify: __[SMALL TEXTBOX]____

10. No usual place

77. [CAWI: I’m; CATI: You’re] not sure

[DISPLAY – SECTK_1]

The next question asks about your last preventive care visit. Preventive visits are visits to a doctor or other healthcare provider for a routine exam or checkup. This does not include times someone goes to a healthcare provider because they are sick or injured.

[SP]

Q62.

When was the last time you had a preventive care visit, such as a physical or checkup?

1. 1 year or less

2. More than 1 year but less than 2 years

3. Between 2 years and 5 years

4. More than 5 years

5. Never

77. [CAWI: I; CATI: You] don’t know

[DISPLAY – SECTK_2]

The next questions ask about your time alone with a doctor or other healthcare provider (such as a nurse practitioner) without a parent or caregiver in the room. This could include a time when [IF Q3B=1,77,98,99, insert 'your parent/caregiver'; else insert DOV_CARENAME] stepped out of the room during your appointment so that you could talk with your provider privately or a time when you had a healthcare visit on your own.

[SP]

Q63.

Would you like time alone with a healthcare provider so that you could talk with them about certain things privately without a parent or caregiver being in the room?

1. Yes

2. No

77. [CAWI: I; CATI: You] don’t know

[SP]

Q64.

Has a doctor or other healthcare provider ever spent any time alone with you without your parent or caregiver in the room?

1. Yes

2. No

77. [CAWI: I; CATI: You] don’t remember

[SHOW IF Q64=1 and Q62=1, 2, 3, 4]

[SP]

Q65.

The last time you had a preventive care visit, did a doctor or other health provider spend any time alone with you without a parent or caregiver in the exam room?

1. Yes

2. No

77. [CAWI: I; CATI: You] don’t know

[SHOW IF Q64=1 or Q65=1]

[SP]

Q66.

How comfortable or uncomfortable were you having time alone with a healthcare provider?

1. Very comfortable

2. Comfortable

3. Neither comfortable nor uncomfortable

4. Uncomfortable

5. Very uncomfortable

[SHOW IF Q62=5, 77, 98, 99 (never had/dk preventative visit) and Q64=2, 77, 98 (never spent time alone with doctor/dk)]

[SP]

Q67.

How comfortable or uncomfortable would you be having time alone with a provider?

1. Very comfortable

2. Comfortable

3. Neither comfortable nor uncomfortable

4. Uncomfortable

5. Very uncomfortable

[SHOW IF Q66=4, 5 or Q67=4,5]

[MP]

Q68.

What would make you feel more comfortable with having time alone with a provider?

[CAWI - REMOVE BOLD] <i> Please select all that apply. </i>

[CATI] SELECT ALL THAT APPLY

1. Knowing ahead of time that [CAWI: I; CATI: you] would have time alone with a provider

2. Preparing questions for the provider ahead of time

3. Knowing more about [CAWI: my; CATI: your] health history so [CAWI: I; CATI: you] could talk about it with the provider

4. Having another staff person (e.g., a nurse, medical assistant) in the exam room too

5. Knowing that what [CAWI: I; CATI: you] told the provider would not be shared with [CAWI: my; CATI: your] parents(s)/caregiver(s) or anyone else

6. Knowing that [CAWI: my; CATI: your] parents are comfortable with [CAWI: me; CATI: you] having time alone with a provider

7. Other

8. None of the above [SP]

[SHOW IF Q68=7, show on same page as Q68]

[MEDIUM TEXTBOX]

Q68_OE.

Please tell us in more detail what would make you feel more comfortable with having alone time with a healthcare provider.

__[MEDIUM TEXTBOX]__

[SHOW IF Q62=1, 2, 3, 4]

[SP]

Q69.

Has a healthcare provider ever talked with you about confidentiality in receiving healthcare?

[SPACE]

This means that the things you talk about and the services you receive are kept between you and your provider and are not to be shared with other people, including your parent(s)/caregiver(s), unless you wanted them to be.

CAWI RESPONSE OPTIONS:

1. Yes

2. No

CATI RESPONSE OPTIONS:

1. YES

2. NO

[SHOW IF Q62=1, 2, 3, 4]

[MP]

Q70.

Which of the following methods of birth control have you ever discussed with a healthcare provider?

[CAWI - REMOVE BOLD] <i> Please select all that apply. </i>

[CATI] SELECT ALL THAT APPLY

[RESPONDENTS ASSIGNED MALE AT BIRTH GET RESPONSE OPTIONS 8-11 ONLY.]

1. [IF Q5=2] Birth control pills

2. [IF Q5=2] An IUD (such as Mirena or ParaGard)

3. [IF Q5=2] An implant (such as Nexplanon)

4. [IF Q5=2] A shot (such as Depo-Provera)

5. [IF Q5=2] A patch (such as Ortho Evra)

6. [IF Q5=2] A birth control ring (such as NuvaRing)

7. [IF Q5=2] Emergency contraception (such as Plan B)

8. Condoms

9. Withdrawal (pull-out)

10. Other, please specify: __[SMALL TEXTBOX]____

11. [CAWI: I; CATI: You] have never discussed methods of birth control with a healthcare provider [SP]

[SHOW IF Q62=1, 2, 3, 4]

[DISPLAY – SECTK_3]

Now we’re going to ask you about your last preventive visit. As a reminder, preventive visits are visits to a doctor or other healthcare provider for a routine exam or checkup. This does not include times someone goes to a healthcare provider because they are sick or injured.

[SHOW IF Q62=1, 2, 3, 4]

[GRID, SP; 4, 4, 4] [DO NOT SHOW NUMERIC LABELS]

Q71.

At your last preventive care visit, did your provider talk with you about the following topics?

	[CAWI: Yes; CATI: YES]	[CAWI: No; CATI: NO]	[CAWI: I; CATI: You] don’t remember
	1	2	77
A. Mental health and emotional issues (such as stress, anxiety, and depression)
B. Substance use (such as alcohol, tobacco, vaping, marijuana or other drugs)
C. Gender identity (how you see your own gender)
D. Whether you’ve had sex
E. Consent for sex
F. How to say no to sex
G. Sexual orientation (for example, being attracted to boys or girls)
H. Sexuality and sexual health
I. How to prevent sexually transmitted infections (STIs), including HIV
J. [SHOW IF Q70=1-10] Methods of birth control
K. How to get sexual and reproductive health services (such as getting birth control or testing for sexually transmitted infections (STIs), including HIV)
L. Where to get mental health care
M. The importance of communication with parents
N. Use of technology, screen time, or media use
O. Getting a healthy amount of sleep
P. Developing your strengths (qualities that help you become a healthy, contributing adult)

[SHOW IF Q62=1, 2, 3, 4]

[GRID, SP]

Q72.

Thinking about your regular provider, how much do you agree or disagree with the following statements?

By regular provider, we mean a pediatrician or general or family physician, physician’s assistant, or nurse practitioner you see for general, routine healthcare.

	Strongly agree	Agree	Neither agree nor disagree	Disagree	Strongly disagree
a. [CAWI: I; CATI: You] get the information [CAWI: I; CATI: you] need about [CAWI: my; CATI: your] health from [CAWI: my; CATI: your] healthcare provider
b. [CAWI: My; CATI: Your] healthcare provider spends enough time with [CAWI: me; CATI: you]
c. [CAWI: I; CATI: You] trust the information [CAWI: my; CATI: your] healthcare provider gives [CAWI: me; CATI: you] about [CAWI: my; CATI: your] health
d. [CAWI: My; CATI: Your] healthcare provider treats [CAWI: me; CATI: you] in a supportive and caring manner

[SP]

Q73.

During the past <u>12 months</u>, have you received any treatment or counseling from a mental health professional? Mental health professionals include psychiatrists, psychologists, psychiatric nurses, and clinical social workers.

1. Yes

2. No, but [CAWI: I; CATI: you] needed to see a mental health professional

3. No, but [CAWI: I; CATI: you] did not need to see a mental health professional

[SHOW IF S_AGE>=18 AND IF Q73=1, 2]

[SP]

Q74.

How difficult was it to get the mental health treatment or counseling that you needed?

1. Not difficult

2. Somewhat difficult

3. Very difficult

Section L. Sexual Health

[DISPLAY-SECTL_INTRO]

The next questions ask about your sexual activity and sexual health.

[MP]

Q75.

During your life, with whom have you had any sexual contact? By sexual contact, we mean kissing, mutual masturbation, oral, anal, or vaginal sex.

[CAWI - REMOVE BOLD] <i> Please select all that apply. </i>

[CATI] SELECT ALL THAT APPLY

1. [CAWI: I; CATI: You] have never had any sexual contact [SP]

2. Females

3. Males

4. Transgender people

5. Nonbinary/Enby people

[SHOW IF Q75=2, 3, 4, or 5]

[NUMBOX 0-100; record DK=777, SKP=998, REF=999]

Q76.

During your life, with how many people have you had sex? By sex we mean vaginal or anal sex. Enter the number in the box below.

CATI: PLEASE ENTER A NUMBER BETWEEN 0 AND 100; PLEASE ENTER 777 FOR DON'T KNOW & 999 FOR REFUSED

_____[numbox 0-100]______

[SHOW IF Q76=1 - 100]

[NUMBOX 0 to S_AGE]

[CUSTOM PROMPT IF Q77>S_AGE: The age you entered is older than your current age.]

Q77.

How old were you when you had vaginal or anal sex for the first time?

CATI: PLEASE ENTER A NUMBER BETWEEN 0 AND THE TEEN’S AGE; PLEASE ENTER 777 FOR DON'T KNOW & 999 FOR REFUSED

____[numbox 0-S_AGE]____years old

[SHOW IF Q76=1 - 100]

[GRID, SP; 2, 2, 2]

Q78.

How much do you agree or disagree with the following statements? We’re interested in what YOU think about these issues; there are no “right” or “wrong” answers.

	Strongly agree	Agree	Neither agree nor disagree	Disagree	Strongly disagree
a. It is not that big of a deal to have sex without a condom once in a while
b. Unless you have a lot of sexual partners you don’t need to use condoms
c. Buying condoms is embarrassing
d. Condoms break a lot
e. It is hard to bring up the topic of condoms with partners
f. Sex without a condom is worth the risk

[SHOW IF Q76=1 - 100]

[SP]

Q79.

What do you think is the main reason to use a condom when having sex?

1. To prevent pregnancy

2. To prevent sexually transmitted infections (STIs), including HIV

3. To prevent both pregnancy and sexually transmitted infections (STIs), including HIV

4. For some other reason

[SHOW IF Q76=1 - 100]

[MP]

Q80.

The last time you had vaginal sex with an opposite-sex partner, what methods did you or your partner use <u>to prevent pregnancy</u>?

[CAWI - REMOVE BOLD] <i> Please select all that apply. </i>

[CATI] SELECT ALL THAT APPLY

1. No method was used to prevent pregnancy [SP]

2. Birth control pills

3. Condoms

4. An IUD (such as Mirena or ParaGard)

5. An implant (such as Nexplanon)

6. A shot (such as Depo-Provera)

7. A patch (such as Ortho Evra)

8. A birth control ring (such as NuvaRing)

9. Withdrawal (pull-out)

10. Emergency contraception (such as Plan B)

11. Some other method

12. Never had vaginal sex with an opposite-sex partner [SP]

77. [CAWI: I’m; CATI: You’re] not sure [SP]

[SHOW IF Q76=1 - 100]

[MP]

Q81.

The last time you had sex, what did you or your partner use <u>to prevent sexually transmitted infections (STIs), including HIV</u>?

[CAWI - REMOVE BOLD] <i> Please select all that apply. </i>

[CATI] SELECT ALL THAT APPLY

1. No method was used to prevent STIs, including HIV [SP]

2. Condom or other barrier methods (e.g., dental dams)

3. HIV Pre-exposure prophylaxis (PrEP)

4. Routine STI/HIV testing

5. Mutual monogamy (two partners agreeing to be sexually active with only each other)

6. Some other method

77. [CAWI: I’m; CATI: You’re] not sure [SP]

*note, range 0-100 is intentional; not using Q76 response for upper limit*

[SHOW Q78 and Q79 ON SAME PAGE]

[SHOW IF Q76=1 – 100 and Q75=3 (males)]

[NUMBOX 0-100; record DK=777, SKP=998, REF=999]

Q82_1.

During the past <i>12 months</i>, how many <u>males</u> have you had vaginal or anal sex with?

CATI: PLEASE ENTER A NUMBER BETWEEN 0 AND 100; PLEASE ENTER 777 FOR DON'T KNOW & 999 FOR REFUSED

___[numbox 0 - 100 response]_____ males

[SHOW IF Q76=1 – 100 and Q75=2 (Females)]

[NUMBOX 0-100; record DK=777, SKP=998, REF=999]

Q82_2.

During the past <i>12 months</i>, how many <u>females</u> have you had vaginal or anal sex with?

CATI: PLEASE ENTER A NUMBER BETWEEN 0 AND 100; PLEASE ENTER 777 FOR DON'T KNOW & 999 FOR REFUSED

____[numbox 0 – 100 response]_____ females

[SHOW IF Q76=1 – 100]

[SP]

Q83.

During the past <i>12 months</i>, have you been tested for a sexually transmitted infection (STI) other than HIV, such as chlamydia or gonorrhea?

1. Yes

2. No

77. Don’t know

99. Prefer not to answer

[SHOW IF Q83=1]

[SP]

Q84.

The last time you were tested for a sexually transmitted infection (STI) other than HIV, did you specifically go to get tested for STIs, or did it happen as part of another type of health visit?

1. Specifically went to get tested

2. As part of another visit

3. Other, please specify: __[SMALL TEXTBOX]____

[SHOW IF Q76=1 – 100]

[SP]

Q85.

Have you ever been tested for HIV, the virus that causes AIDS? (Do not count tests done if you donated blood)

1. Yes

2. No

77. Don’t know

99. Prefer not to answer

[SHOW IF Q76=1 – 100]

[SP]

Q86.

Have you ever been told by a doctor or nurse that you have a sexually transmitted infection (STI), other than HIV, such as chlamydia, gonorrhea, or herpes?

1. Yes

2. No

77. Don’t know

99. Prefer not to answer

[SHOW IF Q86=1]

[SP]

Q87.

Did a doctor or nurse tell you this during the past <i>12 months</i>?

1. Yes

2. No

77. Don’t know

99. Prefer not to answer

[SHOW IF Q76=1 – 100]

[DISPLAY – SECTL_1]

This next section is about the last person with whom you have had vaginal or anal sex.

[SHOW IF Q76=1 – 100]

[SP]

Q88.

Is the person you last had vaginal or anal sex with older, younger, or the same age as you?

1. 3 or more years younger than me

2. 1-2 years younger than me

3. The same age as me

4. 1-2 years older than me

5. 3 or more years older than me

77. Don’t know

99. Prefer not to answer

[SHOW IF Q76=1 – 100]

[SP]

Q89.

Which of the following best describes your relationship with the last person you had sex with?

1. A main partner (or someone that you have sex with and you consider to be the person who you are serious about)

2. A casual partner (or someone that you have sex with but you do not consider to be a main partner. This person can be someone you’ve had sex with only once, or a few times, or you have sex with them on an ongoing, casual basis. The important thing, however, is that this person is not a main partner to you)

3. A transactional partner (someone that you have sex with in exchange for money, gifts, or other services)

77. Don’t know

99. Prefer not to answer

[SHOW IF Q76=1 – 100]

[SP]

Q90.

The last time you had vaginal or anal sex, did you drink alcohol or use drugs beforehand?

CAWI RESPONSE OPTIONS:

1. Yes

2. No

CATI RESPONSE OPTIONS:

1. YES

2. NO

[SHOW IF Q76=1 – 100]

[SP]

Q91.

The last time you had vaginal or anal sex, did you or your partner use a condom?

CAWI RESPONSE OPTIONS:

1. Yes

2. No

CATI RESPONSE OPTIONS:

1. YES

2. NO

[MP]

Q92.

Which of the following have you ever done or experienced?

[CAWI - REMOVE BOLD] <i> Please select all that apply. </i>

[CATI] SELECT ALL THAT APPLY

1. Felt pressured to share a sexual photo of yourself with someone

2. Shared a sexual photo of yourself with someone (through text message, email, IM)

3. Received a sexual photo of someone else

4. Shared a sexual photo of someone without their permission

5. Had someone else share a sexual photo of you without your permission

6. None of these [SP]

Section M. Substance Use

[SP]

Q93.

The next question asks about drinking alcohol. This includes things like drinking beer, wine, flavored alcoholic beverages, and liquor such as rum, gin, vodka, or whiskey. For these questions, drinking alcohol does not include things like drinking a few sips of wine for religious purposes.

[IF Q5=1] During the past <i>30 days</i>, on how many days did you have 5 or more drinks of alcohol in a row, that is, within a couple of hours?

[IF Q5=2] During the past <i>30 days</i>, on how many days did you have 4 or more drinks of alcohol in a row, that is, within a couple of hours?

[IF Q5=77, 98, 99] During the past <i>30 days</i>, on how many days did you have 4 or more drinks of alcohol in a row, that is, within a couple of hours (if you are female) or 5 or more drinks of alcohol in a row, that is, within a couple of hours (if you are male)?

1. 0 days

2. 1 day

3. 2 days

4. 3 to 5 days

5. 6 to 9 days

6. 10 to 19 days

7. 20 or more days

[SP]

Q94.

The next question asks about marijuana use. Marijuana is also called pot or weed. For this question, do not count CBD-only or hemp products, which come from the same plant as marijuana, but do not cause a high when used alone.

During the past <i>30 days</i>, how many times did you use marijuana?

1. 0 times

2. 1 or 2 times

3. 3 to 9 times

4. 10 to 19 times

5. 20 to 39 times

6. 40 or more times

[SP]

Q95.

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.

Have you ever taken prescription pain medicine without a doctor's prescription or differently than how a doctor told you to use it?

CAWI RESPONSE OPTIONS:

1. Yes

2. No

CATI RESPONSE OPTIONS:

1. YES

2. NO

[SHOW IF Q95=1]

[SP]

Q96.

During the past <i>30 days</i>, how many times did you take prescription pain medicine without a doctor's prescription or differently than how a doctor told you to use it?

1. 0 times

2. 1 or 2 times

3. 3 to 9 times

4. 10 to 19 times

5. 20 to 39 times

6. 40 or more times

[SP]

Q97.

The next questions ask about electronic vapor products, such as JUUL, SMOK, Suorin, Vuse, and blu. Electronic vapor products include e-cigarettes, vapes, vape pens, e-cigars, e-hookahs, hookah pens, and mods.

Have you ever used an electronic vapor product?

CAWI RESPONSE OPTIONS:

1. Yes

2. No

CATI RESPONSE OPTIONS:

1. YES

2. NO

[SHOW IF Q97=1]

[SP]

Q98.

During the past <i>30 days</i>, on how many days did you use an electronic vapor product?

1. 0 days

2. 1 or 2 days

3. 3 to 5 days

4. 6 to 9 days

5. 10 to 19 days

6. 20 to 29 days

7. All 30 days

RE-COMPUTE QUAL=1 “COMPLETE”

SET CO_DATE, CO_TIME, CO_TIMER VALUES HERE

CREATE MODE_END

1=CATI

2=CAWI

SCRIPTING NOTES: PUT QFINAL1, QFINAL2, QFINAL3 in the same screen.

[SINGLE CHOICE]

QFINAL1.

Thank you for your time today. To help us improve the experience of AmeriSpeak members like yourself, please give us feedback on this survey.

[RED TEXT – CAWI ONLY] If you do not have any feedback for us today, please click “Continue” through to the end of the survey so we can make sure your opinions are counted and for you to receive your AmeriPoints reward.

Please rate this survey overall from 1 to 7 where 1 is Poor and 7 is Excellent.

Poor						Excellent
1	2	3	4	5	6	7

[SINGLE CHOICE – CAWI ONLY]

QFINAL2.

Did you experience any technical issues in completing this survey?

1. Yes – please tell us more in the next question

2. No

[TEXT BOX] [CATI version needs “no” option]

QFINAL3.

Do you have any general comments or feedback on this survey you would like to share? If you would like a response from us, please email [email protected] or call (888) 326-9424.

[DISPLAY]

END.

[CATI version]

Those are all the questions we have. We will add [INCENTWCOMMA] AmeriPoints to your AmeriPoints balance for completing the survey. If you have any questions at all for us, you can email us at [email protected] or call us toll-free at 888-326-9424. Let me repeat that again: email us at [email protected] or call us at 888-326-9424. Thank you for participating in our new AmeriSpeak survey! 

[CAWI version]

Those are all the questions we have. We will add [INCENTWCOMMA] AmeriPoints to your AmeriPoints balance for completing the survey. If you have any questions at all for us, you can email us at [email protected] or call us toll-free at 888-326-9424. Thank you for participating in our new AmeriSpeak survey! 

You can close your browser window now if you wish or click Continue below to be redirected to the AmeriSpeak member website.

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