Children's Wave Survey 2

Form Approved OMB No. 0990-0325

Exp. Date 08/31/2011

Parents Speak Up National Campaign

Children’s Survey

Q1. Thank you for agreeing to participate in this survey. Once again, your answers will be kept private, and your name will be replaced with an ID number to protect your privacy.

Before we start, are you in a private place where no one can hear your answers?

1. YES

2. NO

[if Q1=2 or skip, ASK Q1_A]

Q1_A. I recommend that you take the survey in a private setting. Would you like to go to another room or phone where I could call you back?

1. YES

2. NO

I will be asking you questions about you and one of your parents, and how you communicate. In the rest of this survey, I will be referring only to your {PARENT}, __________, when we ask you these questions.

____________________________________________________________________________

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0990- . The time required to complete this information collection is estimated to average ( hours)(minutes) per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: U.S. Department of Health & Human Services, OS/OCIO/PRA, 200 Independence Ave., S.W., Suite 537-H, Washington D.C. 20201, Attention: PRA Reports Clearance Officer

C. RELATIONSHIP WITH YOUR PARENT

The next questions are about your relationship with your {PARENT}.

Q2. In the past 30 days, how many times have you done the following things with your {PARENT}? If you're not sure, you can choose an answer that comes closest to what you think might be true for each activity.

Would you say…

At least At least

once once Less

a week a month often Never

1. Gone shopping

2. Gone to a movie,

sport event,

concert, play,

or museum

3. Watched an

entire television

show together

Q3. For the following list of activities, indicate whether this is something you and your {PARENT} do together at least once a week, at least once a month, less often, or never. How often do you. . .

Would you say….

At least At least

once once Less

a week a month often Never

a. Go to religious services or

other religious

activities together 1 2 3 4

b. Do homework or school

projects when school

is in session 1 2 3 4

c. Attend a party or a family

gathering together 1 2 3 4

d. Do volunteer work together

to help other people or

improve your

neighborhood 1 2 3 4

e. Play a game or sport

together 1 2 3 4

Q4. How often would it be true for you to make each of the following statements about your {PARENT}?

Would you say….

Always Often Sometimes Seldom Never

1. You get along well

with him/her 1 2 3 4 5

2. Your {PARENT} and you

make decisions

about your life

together 1 2 3 4 5

3. You just do not

understand him/her 1 2 3 4 5

4. You feel you can

really trust him/her

5. He/she interferes

with your activities 1 2 3 4 5

Q5. How do you think you and your {PARENT} communicate with each other? Please tell me if you agree or disagree with the following statements.

1. When you ask your {PARENT} questions, you get honest answers from {him/her}.

Do you….

2. Strongly agree

3. Agree

4. Disagree, or

5. Strongly disagree?

2. Your {PARENT} helps you to understand yourself better.

Do you….

1. Strongly agree

2. Agree

3. Disagree, or

4. Strongly disagree?

Q6. During the past 12 months, how many times have you argued or had a fight with your {PARENT}?

_______________ # Times

[PROMPT FOR BEST GUESS BY READING RESPONSE OPTIONS IF RESPONDENT CANNOT REMEMBER]

Would you say….

1. 0 times

2. 1 or 2 times

3. 3 to 5 times

4. 6 to 9 times, or

5. 10 or more times?

Q7. Please tell me if you would generally feel more comfortable talking with your mother or your father about each of the following subjects. If you’d feel equally comfortable talking with your mom or your dad about something, or if you wouldn’t feel comfortable talking with either one of them about it, just say so.

What about…

1. The basic facts about sexual reproduction, as in how babies are made

2. Issues about boy-girl relationships

3. Issues about becoming sexually active

4. How to prevent pregnancy and sexually transmitted diseases

Would you say…

1. Your mother,

2. Your father,

3. You’re equally comfortable talking with either parent, or

4. You wouldn’t feel comfortable talking to either parent about this

4. FRIENDS AND OTHERS YOUR AGE

Q8. Do you think young people your age that are sexually active have more friends?

Would you say….

1. Definitely not

2. Probably not

3. Probably yes, or

4. Definitely yes?

Q9. How many of your four closest friends are sexually active?

___________________ # Friends

Q10. How many of your four closest friends are sexually involved with more than one person?

__________________ # Friends

F. ATTITUDES, BELIEFS AND PERCEPTIONS

The next questions ask about your opinions about sexual activity and teens. For each of the following statements, please tell me how much you agree or disagree—that is, whether you “strongly agree, agree, disagree, or strongly disagree.”

Q11. Sexual activity is likely to have harmful psychological effects for teens.

Would you say you…

1. Strongly agree

2. Agree

3. Disagree, or

4. Strongly Disagree?

Q12. Sexual activity is likely to have harmful physical effects for teens.

Would you say you….

1. Strongly agree

2. Agree

3. Disagree

4. Strongly Disagree

Q13. When it comes to your decisions about sex, who is most influential?

Would you say…

1. Parents

2. Morals, values, and/or religious beliefs

3. Friends

4. The media

5. Teachers and sex educators

6. Worries about pregnancy

7. Worries about stds

8. Other, not specified

Q14. How much do you agree or disagree with the following statements: Waiting to have sex is the most effective way to prevent health risks like unwanted pregnancy or HIV/STDs. Do you…. . .

1. Strongly agree

2. Agree

3. Disagree, or

4. Strongly disagree?

Q15. It would be much easier for teens to postpone sexual activity and avoid teen pregnancy if they were able to have more open, honest conversations about these topics with their parents.

Do you….

1. Strongly agree

2. Agree

3. Disagree, or

4. Strongly disagree?

Q16. If you had sex as a teen, it would make it harder for you to have a good marriage one day.

Do you…

1. Strongly Agree

2. Agree

3. Disagree, or

4. Strongly Disagree?

Q17. If you have sex as a teen, it would make it harder for you to grow into a mature, responsible adult.

Do you…

1. Strongly Agree

2. Agree

3. Disagree, or

4. Strongly Disagree?

Q18. You would be able to say no to sex with someone who wants to have sex with you.

Do you….

1. Strongly Agree

2. Agree

3. Disagree, or

4. Strongly Disagree?

Q19. You can say no to someone who wants you to have sex when you don’t want to.

Do you….

1. Strongly Agree

2. Agree

3. Disagree, or

4. Strongly Disagree?

The next questions are about certain topics you may discuss with your {PARENT}. Please tell me how much you agree or disagree with each statement.

Q20. What are your expectations about talking with your {PARENT}? If you talk early and often with your {PARENT} about sexual topics (such as waiting to be sexually active until you are older). . . .

a. . . .you will be less likely to be sexually active as a young teen. Do you…

1. Strongly agree

2. Agree

3. Disagree, or

4. Strongly disagree?

b. . . you will not listen to what your {PARENT} says. Do you…

c. . . you will not think your {PARENT} is judgmental. Do you…

d. . . your {PARENT} will be a hypocrite. Do you…

e. . . you would understand the benefits of waiting to become sexually active. Do you…

f. . . . you would rebel and want to engage in sexual activity even more. Do you…

1. Strongly agree,

2. Agree,

3. Disagree, or

4. Strongly disagree?

Please tell me how much do you agree or disagree with each of the following statements.

Q21. It is easy for you to find time to talk with your {PARENT} about sexual activity and waiting to have sex.

Would you say you…

1. Strongly agree

2. Agree

3. Disagree, or

4. Strongly disagree?

Q22. It would be difficult for you to explain your feelings if you talked with your {PARENT} about sexual activity or waiting to have sex.

Would you say you…

1. Strongly agree

2. Agree

3. Disagree, or

4. Strongly disagree?

Q23. Your {PARENT} disapproves of you being sexually active as a teenager. Do you…

Would you say you…

1. Strongly agree

2. Agree

3. Disagree, or

4. Strongly disagree?

Q24. How often has your {PARENT} initiated conversations with you about sexual activity or waiting to have sex?

Would you say…

1. Often

2. Sometimes

3. Seldom, or

4. Never?

Q25. How often do you and your {PARENT} talk about media messages and images that promote or glamorize teen sexual activity?

Would you say…

1. Every Day

2. Weekly

3. Monthly

4. Every few months , or

5. Never?

H. PARENTAL AND FAMILY INFLUENCES

Q26. How much has your {PARENT} talked to you about being sexually active?

Would you say…

1. A great deal

2. A moderate amount

3. Somewhat, or

4. Not at all (SKIP TO Q38)?

Q27. How much have you and your {PARENT} talked about your being sexually active and each of the following subjects? For each one, please tell me if it’s a great deal, a moderate amount, somewhat, or not at all?

A great A moderate Somewhat Not at all

deal amount

a. The biology of sex

and pregnancy 1 2 3 4

1. Issues about dating

and relationships 1 2 3 4

2. Whether to wait to

be sexually active

until you are married 1 2 3 4

3. The negative or bad

things that would

happen if (ppgender=1: you got

someone pregnant/if ppgender=2: you got)

pregnant? 1 2 3 4

e. The dangers of getting

a sexually transmitted

disease? 1 2 3 4

f. The negative or bad

impact on your

social life because

your would lose

the respect of others? 1 2 3 4

g. The moral issues of

not having sexual

intercourse? 1 2 3 4

Q28. Has your {PARENT} asked or recommended that you wait to have sex?

1. YES

2. NO

I. SOCIAL NETWORKING

Q29. Do you have a profile on any of the following Websites?

[READ LIST AND CODE YES/NO FOR EACH]

1. YES

2. NO

1. MySpace

2. Facebook

3. Friendster

4. Xanga

5. Bebo

6. Other, please specify: _____________

7. No (SKIP to Q48)

Q30. Have you made your profile private using options on the Website(s) so that only other people you approve as "friends" can see your profile and leave comments?

1. YES

2. NO

3. DON’T KNOW

Q31. How often have you visited this (these) website(s) in the past 30 days?

Would you say…

1. Every day

2. A few times per week

3. Once per week

4. Less than once per week, or

5. Haven’t visited in past 30 days? (SKIP to Q48)

Q32. When you visited this (these) site(s) in the past 30 days, how often did you talk about sex with your friends?

Would you say…

1. Always

2. Often

3. Sometimes

4. Rarely, or

5. Never? (SKIP TO Q33)

Q33. When you talked about sex on this (these) site(s), what topics did you talk about?

SPECIFY: _____________________________

J. MODERATOR VARIABLES

The next questions are about your education and background.

Q34. Do you think you will finish high school? Would you say…

1. Definitely yes

2. Probably yes

3. Probably not, or

4. Definitely not?

Q35. If you finish high school, do you think you will go to college or other schools such as a tech school, computer school, etc.? Would you say…

1. Definitely yes

2. Probably yes

3. Probably not, or

4. Definitely not?

The next few statements are about your future goals and your views of a man’s role in relationships. Please tell me how much you agree or disagree with each of these statements.

Q36. You have clear goals about what you want to accomplish in my future.

Would you say you…

1. Strongly agree

2. Agree

3. Disagree, or

4. Strongly disagree?

Q37. You have a clear plan for how you are going to reach your future goals.

Would you say you…

1. Strongly agree

2. Agree

3. Disagree, or

4. Strongly disagree?

Q38. A man always deserves the respect of his wife and children.

Would you say you…

1. Strongly agree

2. Agree

3. Disagree, or

4. Strongly disagree?

Q39. I admire a guy who is totally sure of himself.

Would you say you…

1. Strongly agree

2. Agree

3. Disagree,

4. Strongly disagree?

The next few statements are also about you. Please tell me how much you agree or disagree with each one.

Q40. I like to take risks.

Would you say you…

1. Strongly agree

2. Agree

3. Disagree, or

4. Strongly disagree?

Q41. I would like to explore strange places.

Would you say you…

1. Strongly agree

2. Agree

3. Disagree, or

4. Strongly disagree?

Q42. I like to do frightening things.

Would you say you…

1. Strongly agree

2. Agree

3. Disagree, or

4. Strongly disagree?

Q43. I like new and exciting experiences, even if I have to break the rules.

Would you say you…

1. Strongly agree

2. Agree

3. Disagree, or

4. Strongly disagree?

Q44. I prefer friends who are exciting and unpredictable.

Would you say you…

1. Strongly agree

2. Agree

3. Disagree, or

4. Strongly disagree?

The next few questions are about you and sexual behavior. Remember that all of your answers will be kept confidential and you don’t have to answer any question you are not comfortable answering.

[IF GENDER = MALE, ASK Q45 and Q46:]

Q45. Have you started growing body hair in your arm pits and around your groin area?

1. YES

2. NO

3. NOT SURE

Q46. Have you started growing facial hair (mustache or beard)?

1. YES

2. NO

3. NOT SURE

[IF GENDER = FEMALE, ASK Q47 and Q48:]

Q47. Have you started growing breasts or growing body hair in your arm pits or between your legs?

1. YES

2. NO

3. NOT SURE

Q48. Have you ever had a period or menstruated

1. YES

2. NO

3. NOT SURE

Q49. Have you kissed someone on the lips other than a parent or relative?

1. YES

2. NO

Q50. Have you tongue kissed or French kissed?

1. YES

2. NO

Some of the following questions use the term “having sex.” This means the male’s penis is inside the female’s vagina. Remember, all your answers will be kept private and will not be shared with anyone.

Q51. In the next 12 months, do you intend to have sex?

Would you say…

1. Definitely yes

2. Probably yes

3. Probably not, or

4. Definitely not?

[IF GENDER = FEMALE, ASK Q52:]

Q52. Have you ever had sex with a boy?

1. YES

2. NO

[IF GENDER = MALE, ASK Q53:]

Q53. Have you ever had sex with a girl?

1. YES

2. NO

[IF Q52 = YES or Q53 = YES (EVER HAD SEX), ASK Q54:]

Q54. When was the last time you had sex with a [GIRL/BOY]? Would you say it was…

1. Within the past 4 weeks

2. 2 to 3 months ago

3. 4 to 6 months ago

4. 7 to 12 months ago, or

5. More than one year ago?

[IF Q54 = 2 (HAD SEX WITHIN PAST 3 MONTHS), ASK Q55]

Q55. During the past 3 months, with how many [GIRLS/BOYS] did you have sex?

____________________# people.

[PROMPT WITH RESPONSE OPTIONS IF RESPONDENT IS NOT SURE]

Would you say….

1. 1 person

2. 2 people

3. 3 people

4. 4 people

5. 5 people

6. 6 or more people

Thank you for completing this survey!