Children Hopital of Los Angeles/Project AIM

Form approved

OMB No. 0990-0382

Exp. Date: xx/xx/20xx

FOLLOW-UP QUESTIONNAIRE

CHLA

CONFIDENTIALITY

Thank you for your help with this important study. It will help us understand what things are like for people your age today. Your answers are confidential and everything you say will be kept private. Your name will not be on the questionnaire. Please answer all questions as well as you can.

We want you to know that:

1. We hope that you will answer all the questions, but you may skip any questions you do not wish to answer.

2. The answers you give will never be identified as yours. Your responses will be combined with those of other people your age.

Mathematica Policy Research

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 0990-0382. The time required to complete this information collection is estimated to average 36 minutes per response, including the time to review instructions 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 336-E, Washington D.C. 20201, Attention: PRA Reports Clearance Officer

GENERAL INSTRUCTIONS

1

If the color of your eyes is brown, you would mark (X) the first box as shown.

. PLEASE MARK ALL ANSWERS WITHIN THE WHITE BOXES PROVIDED! USE A PEN OR PENCIL.

PLEASE READ EACH QUESTION CAREFULLY. There are different ways to answer the questions in this survey. It is important that you follow the instructions when answering each kind of question. Here are some examples.

EXAMPLE 1: MARK (X) ONE ANSWER

What is the color of your eyes?

MARK (X) ONE

Brown

Blue

Green

Another color

2

If the color of your hair is purple, you would mark (X) the last box and write the word “purple” in the blank as shown. BE SURE TO WRITE CLEARLY.

. EXAMPLE 2: MARK (X) ONE ANSWER and FILL IN THE BLANK

What is the color of your hair?

MARK (X) ONE

Brown

Black

Blond

Red

Some other color PRINT OTHER COLOR purple

3

If you plan to rent a movie and go to a baseball game next week, you would mark (X) both boxes.

. EXAMPLE 3: YOU MAY MARK (X) MORE THAN ONE ANSWER

Do you plan to do any of the following next week?

YOU MAY MARK (X) MORE THAN ONE ANSWER

Rent a movie

Go to a baseball game

Study at a friend’s house

4

Fill in the boxes with the correct number. For any number less than 10, put a zero (0) in the first box. For example, if you had eaten 2 chocolate bars in the last 7 days, you would write “0” in the first box and “2” in the second box. If you had eaten 15 chocolate bars, you would write “1” in the first box and “5” in the second box.

. EXAMPLE 5: FILL IN THE NUMBER

In the last seven (7) days, how many chocolate bars have you eaten?

NUMBER OF CHOCOLATE BARS – Your best guess is fine.

5. EXAMPLE 6: MARK (X) ONE ANSWER FOR EACH QUESTION In the last 12 months, have you done any of the following? MARK (X) ONE FOR EACH QUESTION
		YES	NO
	a. Walked a dog on a leash
	b. Played Frisbee
	c. Weeded a garden
	d. Eaten a piece of fresh fruit
	e. Played a piano
	f. Watched a movie
	Mark (x) either “yes” or “no” for each of the six (6) questions (a–f) by marking (x) one of the of two boxes in each row.

6

If you finished elementary school in June of 2009, you would mark (X) the box next to June and mark (X) the box next to 2009.

. EXAMPLE 7: MARK (X) ONE MONTH AND ONE YEAR

In what month and year did you finish elementary school?

M ARK (X) ONE MONTH AND ONE YEAR

Month finished		Year finished
January		2010
February		2009
March		2008
April		2007
May		2006
June		2005
July		2004
August		2003
September		2002
October		2001
November		2000
December		1999

SECTION 1: YOU AND YOUR BACKGROUND

1.1. In what month and year were you born?

M ARK (X) ONE MONTH AND ONE YEAR

Month born		Year born
January		2002
February		2001
March		2000
April		1999
May		1998
June		1997
July		1996
August		1995
September		1994
October		1993
November		1992
December		1991

1.2. What is the last grade you completed?

MARK (X) ONE

Less than 6th grade

6th

7th

8th

9th

10th

11th

12^th GO TO 1.6

Completed GED pretest GO TO 1.4

Completed GED GO TO 1.6

Some school after high school

1.3. What type of schooling did you complete after high school?

MARK (X) ONE

Some adult education classes

Some technical or vocation school

Some classes at a 2-year college

Some classes at a 4-year college or university

1.4. Did you go back to school or a GED program after having your first baby?

MARK (X) ONE

Yes – I went back to my old high school

Yes – I went back to a different school

Yes – I went back to a GED program

I never stopped school

No, I did not go back

1 .5. How old was your baby when you returned to school or your GED program?

NUMBER OF MONTHS OLD

1.6. What is your current school status?

MARK (X) ONE

Enrolled in public or private middle or high school

Enrolled in a continuation/alternative school or court/community school

Enrolled in adult education classes

Enrolled in technical or vocation school

Enrolled in 2-year college

Enrolled in 4-year college or university

Not currently enrolled in any school or classes

1.7. What is the highest level of education you expect to complete?

MARK (X) ONE

Graduate from high school or obtain a GED

Attend technical or vocational school

Graduate from a 2-year community college (Associate’s degree)

Graduate from a 4-year college (Bachelor’s degree)

Obtain a graduate degree (Masters, PhD, MD, etc.)

1.8. Are you currently working?

MARK (X) ONE

Yes – full-time

Yes – part-time

No – but currently looking for a job

No – and not currently looking for a job

1.9. Do you make enough money in this job to support yourself?

MARK (X) ONE

Yes

No

1.10. Do you plan on staying in this job for the next two years?

MARK (X) ONE

Yes

No

1.11. Are you…?

MARK (X) ONE

Not currently seeing anyone GO TO 2.1

Casually dating

Seriously dating

Engaged

Married

1.12. Is this person the father of your first child?

MARK (X) ONE

Yes

No

SECTION 2: FAMILY

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

MARK (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 (Please specify)

Don’t have a mother or person I think of as my mother GO TO 2.3

Please answer the questions below about your mother or the person you think of as your mother that you identified in the previous question. 2.2. How much do you agree with the following statements about your mother or the person you think of as your mother? MARK (X) ONE FOR EACH
	STRONGLY DISAGREE	DISAGREE	NEITHER DISAGREE NOR AGREE	AGREE	STRONGLY AGREE
a. My mother supports me to be a good parent
b. My mother’s help with the baby is just about right
c. My mother criticizes the way I take care of my baby
d. My mother gives me too much help with my baby

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

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

MARK (X) ONE

You live in one home

You live in two or more homes, and go back and forth GO TO 2.5

You live in a residential program GO TO 2.6

You are homeless (living on the street, in a car or shelter, or staying with friends/relatives) GO TO 2.6

2.4. Who lives with you in your home?

MARK (X) ALL THE PEOPLE WHO LIVE WITH YOU

Your mother, or the person you think of as your mother

Your father, or the person you think of as your father

Any grandmothers

Any grandfathers

Any brothers or sisters

Any aunts, uncles, or other relatives

Your baby

The father of your baby

The parent(s) of the father of your baby

Your current boyfriend/partner who is not the father of your baby

Friends or roommates

You live by yourself

AFTER ANSWERING GO TO 2.6

2.5 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 mother, or the person you think of as your mother	Your mother, or the person you think of as your mother
Your father, or the person you think of as your father	Your father, or the person you think of as your father
Any grandmothers	Any grandmothers
Any grandfathers	Any grandfathers
Any brothers or sisters	Any brothers or sisters
Any aunts, uncles, or other relatives	Any aunts, uncles, or other relatives
Your baby	Your baby
The father of your baby	The father of your baby
The parent(s) of the father of your baby	The parent(s) of the father of your baby
Your current boyfriend/partner who is not the father of your baby	Your current boyfriend/partner who is not the father of your baby
Friends or roommates	Friends or roommates
You live by yourself	You live by yourself

2.6. How many times have you moved in the past 6 months?

None

NUMBER OF TIMES – Your best guess is fine.

SECTION 3: SERVICES

3.1. In the past 12 months, have you received any information about the following: MARK (X) ONE FOR EACH
	YES	NO
a. Methods of birth control?
b. Where to get birth control?

FOR THOSE WHO RECEIVED ANY INFORMATION ABOUT METHODS OF BIRTH CONTROL AND/OR WHERE TO GET BIRTH CONTROL 3.2. In the past 12 months, did you receive information about…? MARK (X) ONE FOR EACH
	YES	NO
a. Condoms
b. Birth control pills
c. The shot (Depo-Provera)
d. The patch
e. The ring (NuvaRing)
f. IUD (Mirena or Paragard)
g. Implant (Implanon)

FOR THOSE WHO RECEIVED ANY INFORMATION ABOUT METHODS OF BIRTH CONTROL AND/OR WHERE TO GET BIRTH CONTROL

3.3. Where did you receive information about birth control?

MARK (X) ALL THAT APPLY

At a hospital

At a clinic from a doctor, nurse or other health professional

At home from a nurse, social worker, or other health care professional

At school in a class

In an after-school program/activity

From a friend

Other (Please specify)

3.4. What services have you received or what programs have you been involved in over the past 12 months?

MARK (X) ALL THAT APPLY

School or community-based program for pregnant or parenting teens

Parenting education

Case Management

WIC

CalLearn

AFLP

Other (Please specify)

3.5. Do you know anyone who has participated in the AIM 4 Teen Moms program?

MARK (X) ONE

Yes

No

3.6. Who do you know that has participated in AIM 4 Teen Moms?

MARK (X) ALL THAT APPLY

Your sister

Another relative

Close friend

Acquaintance

3.7 Have you discussed any of the following with the women who participated in AIM 4 Teen Moms?

MARK (X) ALL THAT APPLY

A IM 4 TeenMoms Portfolio (worksheets, resume, and certificate)

What they learned about long term contraceptive use

Job aspirations

SECTION 4: BEHAVIORS

4.1. The next questions are about sexual intercourse. By sexual intercourse, we mean a male putting his penis into a female’s vagina.

Now please think about the past 3 months. Have you had sexual intercourse in the past 3 months?

MARK (X) ONE

Yes

No GO TO 4.6

4.2. In the past 3 months, how many TIMES have you had sexual intercourse?

None GO TO 4.6

NUMBER OF TIMES – Your best guess is fine.

4.3. In the past 3 months, how many TIMES have you had sexual intercourse without you or your partner using a condom?

NUMBER OF TIMES – Your best guess is fine.

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

• Condoms

• Birth control pills

• The shot (Depo-Provera)

• The patch

• The ring (NuvaRing)

• IUD (Mirena or Paragard)

• Implant (Implanon)

In the past 3 months, how many TIMES have you had sexual intercourse without you or your partner using any of these methods of birth control?

None GO TO 4.6

NUMBER OF TIMES – Your best guess is fine.

4.5. There are different reasons people give for not using contraception. Please mark ALL of the reasons that are true for you.

MARK (X) all that apply

I just haven’t gotten around to getting anything yet

I don’t think I can get pregnant right now

My partner doesn’t want me to use contraception

I don’t use it because of the side effects for me or my baby

Other (Please specify)

4.6. Now please think about the past 12 months. Have you had sexual intercourse in the past 12 months?

MARK (X) ONE

Yes

No GO TO 4.9

4 .7. How many DIFFERENT PEOPLE have you had sexual intercourse with, even if only one time, in the past 12 months?

None GO TO 4.9

NUMBER OF PEOPLE – Your best guess is fine.

4.8. Thinking about the past 12 months, in which months were you sexually active (had sexual intercourse)?

MARK (X) ONE FOR EACH

YES NO

January

February

March

April

May

June

July

August

September

October

November

December

(NOTE: Relevant months will appear based on baseline date.)

4.9. Have you used any of the following birth control methods in the past 12 months?

MARK (X) ONE FOR EACH

YES NO

a. Condom

b. Emergency contraception, also known as “Plan B” or “Preven”,

or “morning after pills”

c. Birth control pills

d. The shot (Depo-Provera)

e. The patch

f. The ring (NuvaRing)

g. IUD (Mirena or Paragard)

h. Implant (Implanon)

i. Foam

j. Sponge

k. Female condom

l. Withdrawal

m. Other (Please specify)

(NOTE: Specific questions on each method of contraception will only be asked of those who indicate using that method of contraception in 4.9.)

FOR CONDOM USE

4.10. In which months did you use condoms?

MARK (X) ALL THAT APPLY

January

February

March

April

May

June

July

August

September

October

November

December

4.11. In the months you used a condom, would you say you used a condom with your partner for sexual intercourse…?

MARK (X) ONE

Every time

Most of the time

About half of the time

Some of the time

None of the time

FOR EMERGENCY CONTRACEPTION USE

4 .12. How many different times have you used emergency contraception (Plan B) in the past 12 months?

NUMBER OF TIMES– Your best guess is fine.

FOR BIRTH CONTROL PILLS USE:

4.13. In which months did you use birth control pills?

MARK (X) ALL THAT APPLY

January

February

March

April

May

June

July

August

September

October

November

December

4.14. In general over this time, would you say you took your birth control pills consistently…?

Taking your birth control pills consistently means taking your pills every day. Some types of pills have a set of 7 different colored pills that do not contain any hormones. Women may opt not to take these 7 pills only.

MARK (X) ONE

All of the time

Most of the time

Some of the time

None of the time

4.15. During the last month you used birth control pills, how many pills that you were supposed to take did you miss…?

MARK (X) ONE

None

One

Two or more

4.16. Did you miss two or more pills in a row?

MARK (X) ONE

Yes

No

4.17. Some people try a method and then don’t use it again, or stop using it. What was the reason or reasons why you stopped using birth control pills?

MARK (X) ALL THAT APPLY

Too expensive

Too difficult to use

Too messy

Your partner did not like it

You had side effects

You were worried you might have side effects

You worried the method would not work

The method failed, you became pregnant

The method did not protect against disease

Because of other health problem, a doctor told you that you should not use the method again

The method decreased your sexual pleasure

Too difficult to obtain the method

Did not like the changes to your menstrual cycle

You got pregnant

You were trying to get pregnant

FOR THE SHOT (DEPO-PROVERA) USE

4.18. In which months did you receive the shot (Depo-Provera)?

MARK (X) ALL THAT APPLY

January

February

March

April

May

June

July

August

September

October

November

December

4.19. Some people try a method and then don’t use it again, or stop using it. What was the reason or reasons why you stopped using the shot (Depo-Provera)?

MARK (X) ALL THAT APPLY

Too expensive

Too difficult to use

Too messy

Your partner did not like it

You had side effects

You were worried you might have side effects

You worried the method would not work

The method failed, you became pregnant

The method did not protect against disease

Because of other health problem, a doctor told you that you should not use the method again

The method decreased your sexual pleasure

Too difficult to obtain the method

Did not like the changes to your menstrual cycle

You got pregnant

You were trying to get pregnant

FOR THE PATCH (ORTHO-EVRA) USE

4.20. In which months did you use the patch (Ortho-Evra)?

MARK (X) ALL THAT APPLY

January

February

March

April

May

June

July

August

September

October

November

December

4.21. In general over this time, would you say you used the patch consistently…?

Using the patch consistently means applying a new patch the same day each week for 3 weeks. You would not use a patch in week 4 then would resume using the patch on the same day in week 5.

MARK (X) ONE

All of the time

Most of the time

Some of the time

None of the time

4.22. During the last month you used the patch, were you one or more days late in changing the patch?

MARK (X) ONE

Yes

No GO TO 4.24

4.23. Please indicate all the weeks that you were late in changing the patch.

MARK (X) ONE

First week

Second week

Third week

4.24. Some people try a method and then don’t use it again, or stop using it. What was the reason or reasons why you stopped using the patch (Ortho-Evra)?

M ARK (X) ALL THAT APPLY

Too expensive

Too difficult to use

Too messy

Your partner did not like it

You had side effects

You were worried you might have side effects

You worried the method would not work

The method failed, you became pregnant

The method did not protect against disease

Because of other health problem, a doctor told you that you should not use the method again

The method decreased your sexual pleasure

Too difficult to obtain the method

Did not like the changes to your menstrual cycle

You got pregnant

You were trying to get pregnant

FOR IUD (MIRENA OR PARAGARD) USE

4.25. In which months did you have the IUD (Mirena or Paragard) inserted?

MARK (X) ALL THAT APPLY

January

February

March

April

May

June

July

August

September

October

November

December

4.26. Have you had the IUD removed since then?

MARK (X) ONE

Yes

No GO TO 4.29

4.27. In which months did you have the IUD (Mirena or Paragard) removed?

MARK (X) ALL THAT APPLY

January

February

March

April

May

June

July

August

September

October

November

December

4.28. Did you have the IUD inserted a second time?

MARK (X) ONE

Yes

No

4.29. Some people try a method and then don’t use it again, or stop using it. What was the reason or reasons why you stopped using the IUD (Mirena or Paragard)?

M ARK (X) ALL THAT APPLY

Too expensive

Too difficult to use

Too messy

Your partner did not like it

You had side effects

You were worried you might have side effects

You worried the method would not work

The method failed, you became pregnant

The method did not protect against disease

Because of other health problem, a doctor told you that you should not use the method again

The method decreased your sexual pleasure

Too difficult to obtain the method

Did not like the changes to your menstrual cycle

You got pregnant

You were trying to get pregnant

FOR THE RING (NUVARING) USE

4.30. In which months did you use the ring (NuvaRing)?

MARK (X) ALL THAT APPLY

January

February

March

April

May

June

July

August

September

October

November

December

4.31. In general over this time, would you say you used the ring consistently…?

Using the ring consistently means removing the ring on the same day 3 weeks after it was inserted and inserting a new one on the same day one week after it was removed (even if your period has not stopped).

MARK (X) ONE

All of the time

Most of the time

Some of the time

None of the time

4.32. Some people try a method and then don’t use it again, or stop using it. What was the reason or reasons why you stopped using the ring (NuvaRing)?

MARK (X) ALL THAT APPLY

Too expensive

Too difficult to use

Too messy

Your partner did not like it

You had side effects

You were worried you might have side effects

You worried the method would not work

The method failed, you became pregnant

The method did not protect against disease

Because of other health problem, a doctor told you that you should not use the method again

The method decreased your sexual pleasure

Too difficult to obtain the method

Did not like the changes to your menstrual cycle

You got pregnant

You were trying to get pregnant

FOR IMPLANT (IMPLANON) USE

4.33. In which months did you have the implant (Implanon) inserted?

MARK (X) ALL THAT APPLY

January

February

March

April

May

June

July

August

September

October

November

December

4.34. Have you had it removed since then?

MARK (X) ONE

Yes

No GO TO 4.36

4.35. In which month did you have the implant removed?

MARK (X) ALL THAT APPLY

January

February

March

April

May

June

July

August

September

October

November

December

4.36. Some people try a method and then don’t use it again, or stop using it. What was the reason or reasons why you stopped using the implant (Implanon)?

M ARK (X) ALL THAT APPLY

Too expensive

Too difficult to use

Too messy

Your partner did not like it

You had side effects

You were worried you might have side effects

You worried the method would not work

The method failed, you became pregnant

The method did not protect against disease

Because of other health problem, a doctor told you that you should not use the method again

The method decreased your sexual pleasure

Too difficult to obtain the method

Did not like the changes to your menstrual cycle

You got pregnant

You were trying to get pregnant

4.37. Do you intend to have sexual intercourse in the next year, if you have the chance?

MARK (X) ONE

Yes, definitely

Yes, probably

No, probably not

No, definitely not

4.38. If you were to have sexual intercourse in the next year, do you intend to use a condom?

MARK (X) ONE

Yes, definitely

Yes, probably

No, probably not

No, definitely not

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

• Birth control pills

• The shot (Depo-Provera)

• The patch

• The ring (NuvaRing)

• IUD (Mirena or Paragard)

• Implant (Implanon)

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

MARK (X) ONE

Yes, definitely

Yes, probably

No, probably not

No, definitely not

4.40. Which of the following do you plan on using?

MARK (X) ALL THAT APPLY

Oral Contraceptives/birth control pill

The shot (Depo-Provera)

The patch

The ring (NuvaRing)

IUD (Mirena or Paragard)

Implants (Implanon)

Other (Please specify)

4.41. The next question is about methods of birth control, NOT including condoms. How strongly do you agree or disagree that…? MARK (X) ONE FOR EACH
	STRONGLY AGREE	AGREE	NEITHER AGREE NOR DISAGREE	DISAGREE	STRONGLY DISAGREE
a. Birth control should always b e used if a person your age has sexual intercourse
b. Birth control is a hassle to use
c. Birth control is pretty easy to get
d. Birth control is important to make sex safer
e. Birth control has too many negative side effects
f. Using birth control is morally wrong

4 .42. The next questions are about oral sex. Oral sex is when someone puts his or her mouth on another person’s penis or vagina, OR lets someone else put his or her mouth on their penis or vagina.

Have you ever had oral sex?

MARK (X) ONE

Yes

No GO TO 4.45

4 .43. How many DIFFERENT PEOPLE have you ever had oral sex with, even if only one time?

NUMBER OF PEOPLE – Your best guess is fine.

4 .44. Now please think about the past 3 months. In the past 3 months, how many TIMES have you had oral sex?

None GO TO 4.46

NUMBER OF TIMES – Your best guess is fine.

4 .45. In the past 3 months, how many TIMES did you have oral sex without using a condom?

None

NUMBER OF TIMES – Your best guess is fine.

4 .46. The next questions are about anal sex. Anal sex is when a male puts his penis in someone else’s anus, or their butt, or someone lets a male put his penis in their anus or butt.

Have you ever had anal sex?

MARK (X) ONE

Yes

No GO TO 4.50

4 .47. How many DIFFERENT PEOPLE have you ever had anal sex with, even if only one time?

NUMBER OF PEOPLE – Your best guess is fine.

4 .48. Now please think about the past 3 months. In the past 3 months, how many TIMES did you have anal sex?

None GO TO 4.50

NUMBER OF TIMES – Your best guess is fine.

4.49. In the past 3 months, how many TIMES did you have anal sex without using a condom?

None

NUMBER OF TIMES – Your best guess is fine.

4.50. These next questions ask about sexually transmitted diseases, or STDs. In the past 12 months, have you been told by a doctor or nurse that you had a sexually transmitted disease (STD)?

MARK (X) ONE

Yes

No

4.51. In the past 12 months, did you have…? MARK (X) ONE FOR EACH QUESTION
		YES	NO	DON’T KNOW
	a. Chlamydia
	b. Gonorrhea
	c. Genital herpes
	d. Syphilis
	e. HIV infection or AIDS
	f. Human Papilloma virus, also known as HPV or genital warts
	g. Another sexually transmitted disease (STD) PRINT OTHER STD

SECTION 5: PREGNANCY AND RELATIONSHIP WITH BABY’S FATHER

The next questions ask about your pregnancy and your relationship with your baby’s father.

5.1. Are you currently pregnant?

MARK (X) ONE

Yes

No GO TO 5.6

5.2. When is your baby due?

Month Year

5.3. When you got pregnant this time, were you trying to get pregnant?

MARK (X) ONE

Yes

No

5.4. What is your relationship with the father of your current pregnancy?

MARK (X) ONE

No contact

Have contact but don’t get along

Just friends, not dating

Casually dating

Seriously dating

Engaged

Married

Other (Please specify)

5.5. To the best of your knowledge, were you pregnant any other time since the birth of your first child?

MARK (X) ONE

Yes GO TO 5.7

No GO TO 5.13

5.6. To the best of your knowledge, have you been pregnant since the birth of your first child?

MARK (X) ONE

Yes

No GO TO 5.13

5 .7. How many times have you been pregnant since the birth of your first child?

NUMBER OF TIMES – Your best guess is fine.

5.8. Have you given birth since your first child was born?

MARK (X) ONE

Yes

No GO TO 5.13

5 .9. Please list the birth date for each child you have given birth to since your first child.

Month Day Year

5.10. When you got pregnant with your youngest child, were you trying to get pregnant?

MARK (X) ONE

Yes

No

5.11. What is your relationship with the father of your youngest child?

MARK (X) ONE

No contact

Have contact but don’t get along

Just friends, not dating

Casually dating

Seriously dating

Engaged

Married

Other (Please specify)

5.12. Do all of your children have the same biological father?

MARK (X) ONE

Yes

No

5.13. How much is your first child’s father involved in raising that child?

MARK (X) ONE

A lot

A little

Not very much

Not at all

5.14. How likely do you think it is that you will be pregnant again before your child turns two?

MARK (X) ONE

I am sure I will

I probably will

There is a 50/50 chance I will

I probably will not

I am sure I will not

5.15. Ideally, when would you want to get pregnant again?

MARK (X) ONE

Before my baby is 1 year old

When my baby is between 1 and 2 years old

When my baby is between 2 and 3 years old

When my baby is over three years old

I don’t know if I want to get pregnant again

Unsure

SECTION 6: ATTITUDES

6.1. Please indicate how true each of the following statements are for you, using the numbers 1 through 9, with 1 being NOT AT ALL TRUE and 9 being VERY TRUE. MARK (X) ONE FOR EACH
	Not at All True								Very True
	1	2	3	4	5	6	7	8	9
a. In general, I am focused on preventing negative events in my life
b. I am anxious that I will fall short of my responsibilities and obligations
c. I frequently imagine how I will achieve my hopes and aspirations
d. I often think about the person I am afraid I might become in the future
e. I often think about the person I would ideally like to be in the future
f. I typically focus on the success I hope to achieve in the future
g. I often imagine myself experiencing bad things that I fear might happen to me
h. I frequently think about how I can prevent failures in my life
i. I see myself as someone who is primarily striving to reach my “ideal self”—to fulfill my hopes, wishes, and aspirations
j. I see myself as someone who is primarily striving to become the self I “ought” to be – to fulfill my duties, responsibilities, and obligations
k. In general, I am focused on achieving positive outcomes in my life
l. I often imagine myself experiencing good things that I hope will happen to me
m. Getting pregnant before my baby is 2 will lower my chances of getting the future I want for myself and my family
n. Contraception is an important way that I can be a responsible parent
o. Focusing on my education and work experience now will help me achieve a successful future
p. Having another baby too soon may make it much harder on myself and my family
q. I plan to put extra effort into my education or experience to get a (better) job
r. I plan to stop doing things that interfere with my job preparation

6.2. For the following statements, indicate to what degree the statement reflects your own thoughts and feelings using the numbers 1 through 6, with 1 being STRONGLY AGREE and 6 being STRONGLY DISAGREE. If a statement has more than one part, please indicate your reaction to the whole statement. MARK (X) ONE FOR EACH
	STRONGLY AGREE					STRONGLY DISAGREE
	1	2	3	4	5	6
a. I just can’t decide what to do as a parent, there are so many possibilities
b. I’ve thought a lot about the kind of mother I want to be, but there’s no question that I will follow what my “mother” says to do
c. My “mom” tells me how to be a parent to my child, and that’s what I do
d. I haven’t really decided what kind of mother I want to be. I’m just taking it day by day
e. I’m sure it will be pretty easy to change the kind of mother I am when I’m ready
f. It took me awhile to figure it out, but now I know for sure what direction to move in as a parent
g. It took me a while to figure it out, but now I know what kind of mother I want to be
h. I’m still trying to decide how capable I am as a person and what kind of parenting is right for me
i. I just can’t decide what to do for a career. There are so many possibilities
j. I might have thought about a lot of different jobs, but there’s really never been any question since my parents said what they wanted
k. My parents decided a long time ago what I should go into for employment and I am following through with their plans
l. It took me a while to figure it out, but now I know for sure what direction to move in for a career
m. I’m still trying to decide how capable I am as a person and what jobs will be right for me
n. It took me a while to figure it out, but now I really know what I want for a career
o. When I’m ready, I’m sure it’ll be pretty easy to change or get the kind of job that’s right for me
p. I haven’t chosen the occupation I really want to get into, and I’m just working at what is available until something better comes along

6.3. Who will you be in fifteen years? Each of us has some image or picture of what we will be like and what we want to avoid being like in the future. Think about 15 years from now—imagine what you’ll be like, and what you’ll be doing.

In the lines below, write what you expect you will be like and what you expect to be doing.

• In the space next to each expected goal, mark “No” (X) if you are not currently working on that goal or expectation and mark “Yes” (X) if you are currently doing something to get to that expectation or goal.

• For each expected goal that you marked “Yes”, use the space to the right to write what you are doing this year to attain that goal.

EXAMPLE:

In 15 years, I expect to be…	Am I am doing something now about this?		What I am doing now is…
	No	Yes
(P1) a cosmetologist			(s1) practice hair braiding on my friends and little sister
(P2) a home owner			(s2) getting my GED

1. In 15 years, I expect to be…

Am I doing something to be that way?

(IF YES) What I am doing now to be that way in 15 years?

Yes

No

( P1)

( s1)

( P2)

(s2)

( P3)

(s3)

( P4)

(s4)

6.3a. Was your first or second goal about a job or an occupation?

MARK (X) ONE

Yes

No GO TO 6.4

6.3b. Thinking of your first occupational goal listed, how much do you hope for the kind of work that occurs with this occupational goal?

MARK (X) ONE

Barely

Not much

Somewhat

Very much

6.3c. Thinking of your first occupational goal, please indicate how likely it will be that you obtain this possible self, using the numbers 1 through 7, with 1 being very unlikely and 7 being very likely.
Very unlikely						Very likely
1	2	3	4	5	6	7

6.4. In addition to expectations and expected goals, we all have images or pictures of what we DON’T want to be like; what we don’t want to do or want to avoid being. First, think a minute about ways you would not like to be in 15 years—things you are concerned about or want to avoid being like.

• Write those concerns or selves to-be-avoided in the lines below.

• Next to each concern or to-be-avoided self, mark “No” (X) if you are not currently working on avoiding that concern or to-be-avoided self and mark “Yes” (X) if you are currently doing something so this will not happen in 15 years.

• For each concern or to-be-avoided self that you marked “Yes”, use the space at the end of each line to write what you are doing this year to reduce the chances that this will describe you in 15 years.

EXAMPLE:

Next year, I want to avoid…	Am I doing something to avoid this?		(IF YES) What I am doing now to avoid being that way next year?
	No	Yes
(P5) Unemployed			(s5) finding out how to get some part time job experience
(P6) In debt_____			(s6) _____________________________

1. In 15 years, I want to avoid…

Am I doing something to avoid this?

(IF YES) What I am doing now to avoid being that way in 15 years?

Yes

No

( P5)

( s5)

( P6)

(s6)

( P7)

(s7)

( P8)

(s8)

6.5. For each sentence, please think about how you are in most situations. Rate each statement in a way that describes YOU the best using the numbers 0 through 5, with 0 being NONE OF THE TIME and 5 being ALL OF THE TIME. MARK (X) ONE FOR EACH
	None of the Time					All of the Time
	0	1	2	3	4	5
a. I can do what it takes to get the specific work I choose
b. I know how to prepare for the kind of work I want to do
c. When I look into the future, I have a clear picture if what my work life will be like
d. I have a difficult time identifying my own goals for the next five years