Non Sexually active youth Part B2 of the baseline survey to be used with youth who have

OMB Control No:

Expiration Date:

BASELINE QUESTIONNAIRE

(Part B2)

For Reducing the Risk and Cuidate! participants who have never had sex

Please be sure that you have the correct Part B.

If you answered “No” to the last question of Part A, you have the correct version of Part B. If you answered “Yes,” please put this version back in your envelope and fill out Part B1 instead.

Thank you.

THE PAPERWORK REDUCTION ACT OF 1995

Public reporting burden for this collection of information is estimated to average 30 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, 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 currently valid OMB control number.

Form Approved

OMB No. 0990-

                Exp. Date XX/XX/20XX

4.1. This booklet is for youth who have not had sex. We want to be sure you are in the correct booklet. We know we asked this before but…

Just to confirm, have you ever had sexual intercourse, oral sex, or anal sex?

MARK (X) ONE

Yes THIS IS THE WRONG PART B BOOKLET. PLEASE PUT THIS BOOKLET

BACK IN THE ENVELOPE AND FILL OUT PART B1.

No CONTINUE WITH THIS BOOKLET

4.2. The first two questions in this booklet are about your schooling.

Do you expect that you will graduate from high school?

MARK (X) ONE

Yes

I already graduated from high school

No GO TO QUESTION 4.4

4.3. In what month and year do you expect to graduate from high school? (If you already graduated, in what month and year did you graduate from high school?)

MARK (X) ONE MONTH AND ONE YEAR

Month of Graduation		Year of Graduation
January		2018 or later
February		2017
March		2016
April		2015
May		2014
June		2013
July		2012
August		2011
September		2010
October		2009
November	2008
December		2007 or earlier

4.4. The next questions are about where you live.

In the last 7 days, did you spend any nights somewhere like a shelter, someone else’s home, in a car, on the street or in any other temporary housing because you did not have a regular place to stay?

M ARK (X) ONE

Yes GO TO QUESTION 4.11

No

4.5. In how many homes, places, or households do you live: one, two, or three or more?

MARK (X) ONE

1 home GO TO QUESTION 4.9

2 homes

3 or more homes

4.6. Do you consider one of these homes to be your main home?

MARK (X) ONE

Yes

No

4.7. Thinking about the past 30 days, how many nights did you spend in each home?

FILL IN TWO OR THREE NUMBERS

Number of nights at home #1 – Your best guess is fine.

Number of nights at home #2 – Your best guess is fine.

Number of nights at another home or other homes – Your best guess is fine.

4.8. Is there anyone who moves with you from home to home?

MARK (X) ONE

Yes

No

4.9. Is your home or any of your homes a group home or halfway house?

MARK (X) ONE

Yes

No

4.10. This question is about who lives with you in your home. If you have more than one home, please think about your main home.

How many people usually live in your home, including all children and anyone who normally lives there even if they are not there now, like someone who is away traveling or in a hospital?

NUMBER OF PEOPLE

4.11. These next few questions are about you and your friends. How strongly do you agree or disagree that… MARK (X) ONE FOR EACH QUESTION
	STRONGLY AGREE	AGREE	DISAGREE	STRONGLY DISAGREE
a. You have friends who will give you good advice?
b. You have a friend who cares about you?
c. You have a friend you can talk to when you need to?
d. You have someone who you can call your best friend?

4.12. How strongly do you agree or disagree that… MARK (X) ONE FOR EACH QUESTION
	STRONGLY AGREE	AGREE	DISAGREE	STRONGLY DISAGREE
a. When you start a project, you finish it?
b. You only work as hard as you have to?
c. You are someone people can count on?
d. When you do work, you do a good job?

4.13. Here are some reasons people your age might choose NOT to have sexual intercourse. How important is each of these reasons to you? MARK (X) ONE FOR EACH QUESTION
	VERY IMPORTANT	SOMEWHAT IMPORTANT	NOT TOO IMPORTANT	NOT AT ALL IMPORTANT
a. I don’t want to get a sexually transmitted disease, also known as an STD
b. I don’t want to disappoint my parents
c. I am too young to have sex
d. My boyfriend or girlfriend doesn’t want to have sex
e. I want to wait until I’m married
f. It is against my personal values
g. I haven’t met the right person yet
h. I haven’t had the chance
i. I don’t want to
j. FOR GIRLS I do not want to get pregnant
k. FOR BOYS I do not want to get a girl pregnant

4.14. FOR GIRLS

a. Have you ever had your period, that is, a menstrual period?

M ARK (X) ONE

Yes

No GO TO QUESTION 4.16

b. How old were you when you had your first period, that is, your first menstrual period?

NUMBER OF YEARS OLD YOU WERE – Your best guess is fine. GO TO QUESTION 4.16

4.15. FOR BOYS

a. People reach puberty at different ages. Signs of puberty for males include physical changes such as developing pubic or facial hair, or their voices cracking or lowering. Which of the following best describes these changes for you?

MARK (X) ONE

These changes have not yet started GO TO QUESTION 4.16

These changes have barely started

These changes are definitely underway

These changes seem complete

b. How old were you when these changes started?

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

4.16. Have you ever done any of the following? MARK (X) ONE FOR EACH QUESTION
	YES	NO
a. Kissed someone on the lips?
b. French kissed, that is put your tongue in someone’s mouth while kissing?
c. Touched another person’s private parts?
d. Let someone touch your private parts?

4.17. Have you ever been in a situation where someone touched you in a sexual way that you did not want, or someone forced you to touch him or her in a sexual way that you did not want to?

MARK (X) ONE

Yes

No

4.18. Have you ever been fearful that someone you were dating might physically hurt you?

MARK (X) ONE

Yes

No

I have never dated anyone

4.19. In the last 12 months, have you spoken with a doctor or nurse about sex, birth control or sexually transmitted diseases, also known as STDs?

MARK (X) ONE

Yes

No

4.20. If you decided to have sexual intercourse outside of marriage, how likely is it that you would use a condom or other contraceptive method?

MARK (X) ONE

Not at all likely

A little bit likely

Somewhat likely

Very likely

Don’t plan to have sexual intercourse outside of marriage

THIS PAGE IS INTENTIONALLY BLANK

Please continue on the next page with Section 5: Tobacco, Alcohol and Drug Use.

SECTION 5: TOBACCO, ALCOHOL AND DRUG USE

5.1. The next questions are about tobacco, alcohol and drugs. Please be as honest as possible, and remember that everything you tell us will be kept private.

Have you ever smoked a cigarette?

MARK (X) ONE

Yes

No GO TO QUESTION 5.4

5.2. The very first time you smoked a cigarette, how old were you?

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

5.3. During the last 30 days, on how many days did you smoke one or more cigarettes?

MARK (X) ONE

More than 25 days

5 to 25 days

1 to 4 days

0 (zero) days

5.4. Have you ever had an alcoholic drink, such as beer, wine or other liquor, NOT counting any times you just had a sip?

MARK (X) ONE

Yes

No GO TO QUESTION 5.8

5.5. The very first time you had an alcoholic drink, how old were you?

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

5.6. During the last 30 days, not including any times you just had a sip, on how many days did you have one or more alcoholic beverages?

MARK (X) ONE

More than 25 days

5 to 25 days

1 to 4 days

0 (zero) days

5.7. During the last 30 days, on how many days did you have 5 or more drinks in a row?

MARK (X) ONE

More than 25 days

5 to 25 days

1 to 4 days

0 (zero) days

5.8. Have you ever used marijuana, also called weed or pot?

MARK (X) ONE

Yes

No GO TO QUESTION 5.10

5.9. During the last 30 days, on how many days did you use marijuana?

MARK (X) ONE

More than 25 days

5 to 25 days

1 to 4 days

0 (zero) days

5.10. Have you ever used any other type of illegal drug, for example, Methamphetamine, speed, PCP, ecstasy or any form of cocaine, such as crack?

MARK (X) ONE

Yes

No

5.11. Have you ever used any prescription pills or other prescription drugs that were not prescribed for you?

MARK (X) ONE

Yes

No

5.12. Have you ever used an inhalant, such as sniffed glue, breathed the contents of spray cans, or inhaled any paints or solvents to get high?

MARK (X) ONE

Yes

No

SECTION 6: FRIENDS, family AND RELATIONSHIPS

6.1. How many of your friends who are your age think the following things? Your best guess is fine. MARK (X) ONE FOR EACH
	NONE	SOME	HALF	MOST	ALL	DON’T KNOW
a. Having sexual intercourse is a good thing for them to do at their age
b. It would be okay for them to have sexual intercourse as long as they used birth control, like a condom
c. It would be okay for them to have sexual intercourse if they were dating the same person for a long time
d. They should wait until they are older to have sexual intercourse
e. They should wait until later to have sexual intercourse

6.2. How many of your friends who are your age have done the following things? MARK (X) ONE FOR EACH
	NONE	SOME	HALF	MOST	ALL	DON’T KNOW
a. Had sexual intercourse
b. Had oral sex

6.3. In general, how much pressure, if any, do you feel from your friends to have sexual intercourse?

M ARK (X) ONE

A lot of pressure

Some pressure

A little pressure

No pressure

6.4. People are different in their sexual attraction to other people. Which of the following best describes your feelings?

MARK (X) ONE

I am only attracted to males

I am attracted to both males and females

I am only attracted to females

I am not attracted to either males or females

I am not sure

6.5. How much do you feel that your friends care about you?

MARK (X) ONE

Do not care at all

Care a little bit

Care somewhat

Care very much

For this last set of questions, we will be asking yourself and your family. You cannot personally be identified by your answers. The information you provide will be combined with the information provided by all the other students completing this survey.

6.6. Now we have some questions about your mother, or the person you think of as your mother. Is this person…?

M ARK (X) ONE

Your biological mother, that is, the woman who gave birth to you

Your stepmother or adoptive mother

Your foster mother

Your grandmother

Your aunt or your older sister

Some other adult

Don’t have a mother or person I think of as my mother GO TO 6.14

6.7. The following questions are about the person you marked as your mother or the person you think of as your mother.

Did she graduate from high school?

MARK (X) ONE

Yes

No

Don’t know

6.8. Did she graduate from a 4-year college?

MARK (X) ONE

Yes

No

Don’t know

6.9. Is she working now?

MARK (X) ONE

She is not working at a paid job

Yes, she is working part-time or less than 30 hours a week

Yes, she is working full-time or at more than one job for 30 hours a week or more

Yes, she works, but I don’t know how many hours

Don’t know if she is working

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

M ARK (X) ONE

Not at all close

A little close

Somewhat close

Very close

6.11. 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

6.12. Whether you have done this or not, how would she feel about you having sex at this time in your life?

MARK (X) ONE

Strongly approve

Approve

Neither approve nor disapprove

Disapprove

Strongly disapprove

6.13. How would she feel about you having a baby at this time in your life?

MARK (X) ONE

Strongly approve

Approve

Neither approve nor disapprove

Disapprove

Strongly disapprove

6.14. Next we have some questions about your father, or the person you think of as your father. Is this person…?

MARK (X) ONE

Your biological father, that is, the man who is genetically related to you

Your stepfather or adoptive father

Your foster father

Your grandfather

Your uncle or your older brother

Some other adult

Don’t have a father or person I think of as my father GO TO 6.22a

6.15. The following questions are about the person you marked as your father or the person you think of as your father.

Did he graduate from high school?

M ARK (X) ONE

Yes

No

Don’t know

6.16. Did he graduate from a 4-year college?

MARK (X) ONE

Yes

No

Don’t know

6.17. Is he working now?

M ARK (X) ONE

He is not working at a paid job

Yes, he is working part-time or less than 30 hours a week

Yes, he is working full-time or at more than one job for 30 hours a week or more

Yes, he works, but I don’t know how many hours

Don’t know if he is working

6.18. 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

6.19. 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

6.20. Whether you have done this or not, how would he feel about you having sex at this time in your life?

MARK (X) ONE

Strongly approve

Approve

Neither approve nor disapprove

Disapprove

Strongly disapprove

6.21. How would he feel about you having a baby at this time in your life?

MARK (X) ONE

Strongly approve

Approve

Neither approve nor disapprove

Disapprove

Strongly disapprove

6.22a. Which of the following best describes the relationship between your biological mother and biological father? If one or both of your biological parents have passed away, please answer about their relationship when both were alive.

MARK (X) ONE

They are married to each other

They used to be married to each other, but are now separated

They used to be married to each other, but are now divorced

They have never been married to each other

I don’t know

6.22b. Do your biological mother and biological father live together now?

MARK (X) ONE

Yes

No

One or both of my biological parents have passed away

I don’t know

The next questions are about where you live and who lives with you.

6.23. Which of the following best describes where you live?

MARK (X) ONE

You live in one home GO TO 6.24

You live in two or more homes, and go back and forth GO TO 6.25

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

6.24. Who lives with you in your home? MARK (X) ALL THAT APPLY
Your biological mother
Your biological father
A stepmother or adoptive mother
A foster mother
A stepfather or adoptive father
A foster father
Your parent’s partner, boyfriend, or girlfriend
Any grandmothers
Any grandfathers
Any older brothers or sisters
Any younger brothers or sisters
Any aunts, uncles, or other relatives
Any other people you are not related to
You live by yourself
	6.25. Who lives with you in each of your homes? MARK (X) ALL THAT APPLY
	MAIN HOME	OTHER HOME(S)
	Mark (X) all the people who live with you in your MAIN home	Mark (X) all the people who live with you in your OTHER home(s)
	Your biological mother	Your biological mother
	Your biological father	Your biological father
	A stepmother or adoptive mother	A stepmother or adoptive mother
	A foster mother	A foster mother
	A stepfather or adoptive father	A stepfather or adoptive father
	A foster father	A foster father
	Your parent’s partner, boyfriend, or girlfriend	Your parent’s partner, boyfriend, or girlfriend
	Any grandmothers	Any grandmothers
	Any grandfathers	Any grandfathers
	Any older brothers or sisters	Any older brothers or sisters
	Any younger brothers or sisters	Any younger brothers or sisters
	Any aunts, uncles, or other relatives	Any aunts, uncles, or other relatives
	Any other people you are not related to	Any other people you are not related to
	You live by yourself	You live by yourself

6.26a	Thinking about this past summer, did you participate in any Summer Youth Employment Programs?
	(Check one)
	 Yes
	 No  Go To End
	 Don’t know  Go To End

	6.26b	Did you participate in a week-long workshop called Gen.M (Gender Matters)?
		(Check one)
		 Yes
		 No
		 Don’t know

We thank you for

completing this survey!

TPP Replication Study Draft – Part B2 (Cuidate! and Reducing the Risk) 0