GYT: Get Yourself Tested Instrument

Evaluation of the Get Yourself Tested (GYT) Campaign

Attach 6 SurveyInstrument GYT

GYT: Get Yourself Tested

OMB: 0920-0957

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Expiration Date: 00/00/0000






Attachment 6:

GYT: Get Yourself Tested

Survey instrument







Public reporting burden for this collection of information is estimated to average 30 minutes per response, including 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 currently 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 Reports Clearance Officer, 1600 Clifton Road, MS D-74, Atlanta, GA 30333, ATTN:PRA (0920-####)



Knowledge, Attitudes and Preferences

  1. For each topic below, check the box that is closest to your opinion:

I think this topic is…

A major concern for people my age

A minor concern for people my age

Not a concern at all for people my age

Don’t know

HIV/AIDS





Genital Herpes





Other STDs (not HIV) [define like Chlamydia, gonorrhea, syphilis, trichomoniasis]





Unintended or Unplanned Pregnancy








  1. For each topic below, check the box that is closest to your opinion

What are the chances that this will happen?

Almost impossible

A small chance

About a 50-50 chance

Greater than 50% chance

I become infected with HIV/AIDS





I become infected with Genital Herpes





I become infected with other STDs (not HIV) [define like Chlamydia, gonorrhea, syphilis, trichomoniasis]





I get pregnant (female) or get a girl pregnant (male)









  1. For each topic below, check the box that is closest to your opinion.

If I found out that I had the following conditions, it would be…

A major problem

A minor problem

Not a problem at all

I don’t know what this is

HIV/AIDS





Genital Herpes





Other STDs (not HIV) [define like Chlamydia, gonorrhea, syphilis, trichomoniasis]





Pregnancy






  1. Think about the information you’ve learned about sex and sexual health from all the different people or places in your life. Check all the sources of information that helped you learn about….


Parents

Other trusted adult

Brother or sister

Boyfriend or Girlfriend

Friends

Doctor or other health care provider

Online experts or question-answer websites

Searching the Internet

Social media like Facebook, Twitter etc

Television or radio

Magazines or other printed material

Classes or programs at school

Religious institution

No source of info

Whether/when to have sex















What to expect in a sexual or intimate relationship















Mechanics of sex















Morals and values about sex















Emotions about sex















Pregnancy















Birth control















Forced sex or rape















HIV















STDs other than HIV















How to prevent HIV/STDs during sex
















  1. Thinking about the places where you might learn about sex and sexual health, would you say these information sources are…(check all that apply)


Comfortable for me

Accurate

Trustworthy

Confidential

Nonjudgmental

Easily accessed or approachable

Not applicable to me (I’ve never looked for sex-related info from this source)

Parents or Guardians








Other trusted adult








Brother or sister








Boyfriend or Girlfriend








Friends








Doctors or health care providers








Searching the Internet








Social media like Facebook, Twitter or text message service








Television or radio








Magazines, newspapers or other printed material








Classes or programs at school








Religious institution










  1. Now, thinking about all the different STDs, including HIV, about how many sexually active young people in this country do you think will get an STD by age 25?

    1. 1 in 2000

    2. 1 in 200

    3. 1 in 20

    4. 1 in 2

    5. Don’t know


  1. Which items below are true and which are false?

    1. You can get an STD from a person who has no signs or symptoms of an STD.

    2. You can get an STD even if you only have sex with one person.

    3. You can get tested for all STDs with one test.

    4. Certain STDs can cause some kinds of cancer.

    5. All STDs can be completely cured. (Rollover definition: “cured” means that the disease is completely gone from your body.)

    6. Using condoms reduces the risk of STDs, including HIV.

    7. If you have an STD, your risk of getting HIV (if exposed to a partner with HIV) is higher.

    8. Some STDs can lead to infertility (problems getting pregnant), if left untreated.

    9. Women automatically get tested for all STDs when they get a Pap test or Pap smear.

    10. You can tell if someone has an STD by looking.

    11. All STDs can be treated. (Rollover definition: “treated” means that the disease is still in your body, but the symptoms are reduced or the symptoms disappear)


  1. Below is a list of reactions or thoughts you might have if your boyfriend or girlfriend asked that you get tested for an STD. Check the boxes that might describe your thoughts if your boyfriend or girlfriend suggested that you get tested (check all that apply).

    1. S/He cares about me

    2. S/He thinks I’m having sex with someone else

    3. S/he is probably having sex with someone else

    4. It is smart to make sure we are both healthy

    5. S/He thinks I’m dirty

    6. S/He does not trust me

    7. S/He is being careful

    8. S/He is being responsible

    9. None of the above


  1. Please tell us what you think about people who have STDs (check all that apply). “People who have STDs…”

  • Should be avoided

  • may not even know it

  • are dirty

  • are no different than those who don’t have STDs

  • have obviously slept with a lot of people

  • may just have had bad luck

  • have poor morals

  • should be given the benefit of the doubt

  • should be ashamed of themselves

  • can still have healthy, normal relationships

  • don’t take care of themselves

  • hang with the wrong crowd

  • should not be afraid to tell their close friends

  • should be able to tell their friends without feeling judged

  • none of the above

 

  1. Please tell us what you think about people who get tested for STDs (check all that apply). “People who get tested for STDs…”

    • are taking care of their sexual health

    • must have “slipped up”

    • are probably cheating on their boy/girlfriend

    • are responsible sex partners/lovers

    • must have slept with a lot of people

    • should do it regularly, as part of their routine health care

    • must be dirty

    • none of the above

 

  1. Please tell us how you would feel if you got diagnosed with an STD (check all that apply). “If I was diagnosed with an STD (other than HIV), I would….”

    • be devastated

    • be surprised

    • keep in mind that STDs are really common

    • feel alone

    • look to a close friend/family member/partner for support

    • feel ashamed

    • feel confident that I could do what I needed to do to treat it

    • be afraid of what this will mean for my reputation

    • know that this doesn’t change or define who I am

    • hide it, even from my closest friends and family members

    • be able to talk about it with a close friend or family member

    • [none of the above]



  1. In your opinion, how effective are condoms (if used from start-to-finish when you have sex) at each of the following?


Condoms are very effective

Condoms are somewhat effective

Condoms are not at all effective

I don’t know how effective condoms are

Preventing pregnancy





Preventing HIV





Preventing bacterial STDs like chlamydia or gonorrhea





Preventing viral STDs like genital herpes or human papillomavirus (HPV)







Sexual Behavior and Experience

  1. There are many different kinds of behaviors that could be considered sexual. Thinking back on your whole life, check which of these you have done or had:

    1. Kissing

    2. Touching another person sexually (define: touching breasts, vagina, penis)

    3. Giving oral sex (define: putting your mouth on someone else’s penis or vagina)

    4. Receiving oral sex (define: someone else’s mouth on your penis or vagina)

    5. Vaginal intercourse (define: a penis inserted into a vagina)

    6. Anal intercourse (define: a penis in inserted into an anus)


  1. (If any of 13e-f is checked indicating intercourse): How old were you when you had sexual intercourse (rollover definition: vaginal or anal sex) for the first time? ______



  1. (If any of 13e-f is checked indicating intercourse): With how many people have you had sexual intercourse(rollover definition: vaginal or anal sex) in your life? _____


  1. There are many types of sexual relationships. Think back over all the relationships you have had. Check all that you have had:

(for all options below: define sex: oral, vag, anal)

  • Sex with a male

  • Sex with a female

  • Anonymous sex (rollover definition: sex with someone whose name you didn’t know)

  • Sex with someone you had just met

  • Sex with someone you didn’t know very well

  • Sex with a friend(define: having sex with friends, but it isn’t considered dating)

  • Sex with boyfriend or girlfriend (define: a person you are “dating”)

  • Sex with someone with whom you are in a serious, committed relationship

  • Never had sex with another person


  1. Are you involved in one of these sexual situations now? (Check all that apply)

    • Recent Sex with someone you just met or don’t know very well

    • Sex with a friends (define: having sex with friends, but it isn’t considered dating)

    • Sex with a boyfriend or girlfriend (define: a person you are “dating”)

    • Sex with someone with whom you are in a serious, committed relationship

    • Same-sex sexual relationship

    • Not in a sexual relationship


  1. Different people have different opinions about what they value in relationships.  Which of the following possible aspects of relationships are important to you, either in a relationship you have or would like to have?

  

 

Very important to me

Important to me

Not very  important to me

Not at all important to me






Emotional aspects

How your relationship helps you feel good about or happy with yourself and your life

 

 

 

 

Social aspects

How your relationship helps you feel connected to others in your world 

 

 

 

 

Pleasure

The overall level of enjoyment you get from the relationship

 

 

 

 

Spiritual aspects

How your relationship adds to a deeper sense of meaning and purpose in life

 

 

 

 

Mutual aspects

How your relationship benefits everyone in it

 

 

 

 

Mental

How your relationship satisfies you on an intellectual level 

 

 

 

 

Physical aspects

How your relationship meets your needs for sexual intimacy; (e.g., kissing, sex)

 

 

 

 

 



  1. Do you and/or your partner use any of the following as part of your sexual relationships?

    1. Birth control pills

    2. Other birth control like depo shots, implants, the patch, the ring, IUD, diaphragm or cervical cap

    3. Withdrawal

    4. Calendar or rhythm method

    5. Condoms

  • Every time

  • Most of the time

  • About half of the time

  • Some of the time

  • None of the time


  1. Have you ever had sexual intercourse without using a condom at all?

    1. Yes

    2. No

[If yes to Q20]: Please tell us about the time(s) you have had sex without using a condom (check all that apply).

  • We got carried away in the moment

  • We didn’t have condoms readily available

  • I wanted to feel as close as possible to my partner

  • We were both virgins

  • My partner convinced me we didn’t need condoms

  • I convinced my partner we didn’t need condoms

  • I knew my partner well

  • I trusted my partner

  • I was drunk or high

  • My partner was drunk or high

  • My partner looked clean

  • My partner and I had talked about being exclusive (not having sex with others)

  • My partner and I had talked about our HIV status

  • My partner and I had talked about our STD status (STDs other than HIV)

  • My partner and I had gotten tested together

  • My partner and I had talked about what we would do in case we got pregnant





  1. Think about your current boyfriend/girlfriend or your most recent boyfriend/girlfriend. Did you talk with this person about any of the following topics?

    1. HIV or AIDS

    2. STDs other than HIV, such as chlamydia or genital herpes

    3. Getting tested for HIV

    4. Getting tested for STDs other than HIV, such as chlamydia

    5. Using condoms

    6. Using birth control other than condoms

    7. What you would do if you (or she) got pregnant


  1. Has a health care provider ever suggested that you be tested for HIV?

    1. Yes

    2. No

    3. Don’t remember


  1. Have you ever been tested for HIV?

    1. Yes, more than 12 months ago

    2. Yes, in the past 12 months

    3. Yes, but I can’t remember when it was

    4. No

    5. Don’t know


  1. Has a health care provider ever suggested that you get tested for STDs other than HIV, such as chlamydia or gonorrhea?

    1. Yes

    2. No

    3. Don’t remember


  1. Have you ever been tested for STDs other than HIV, such as chlamydia or gonorrhea?

    1. Yes, more than 12 months ago

    2. Yes, in the past 12 months

    3. Yes, but I can’t remember when it was

    4. No

    5. Don’t know


  1. (If yes to 25 indicating testing for STDs): How did you know you were tested for STDs other than HIV? Check all that apply.

    1. I asked to be tested

    2. The doctor or nurse told me I was being tested

    3. The doctor or nurse called with my results

    4. It is part of my routine health care

    5. Other (explain)


  1. (If yes to 25 indicating testing for STDs): The last time you were tested for STDs other than HIV, did you specifically go to get tested for STDs, 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 (explain)


  1. (If yes to 25 indicating testing for STDs): The last time you were tested for an STD, where did you receive the test?

    1. Private doctor’s office

    2. Family Planning Clinic or Planned Parenthood

    3. School or School-based clinic

    4. STD clinic

    5. Community health clinic, community clinic, public health clinic

    6. Some other place (specify)


  1. (If yes to 25 indicating testing for STDs): There are a lot of reasons why people might get tested for STDs other than HIV. Check all the reasons why you were tested:

    1. I was concerned that I had an STD

    2. I had signs or symptoms of an STD

    3. My health care provider suggested I get tested

    4. A partner suggested or asked that I get tested

    5. It is something I do on a regular basis

    6. It just seemed like a good idea

    7. Learned that a lot of people have STDs

    8. It seems everyone else who’s sexually active is doing it

    9. Heard about nearby testing

    10. My friends were going and suggested I do it too



  1. (If NO to 25 indicating NOT testing for STDs):There are a lot of reasons why people might NOT get tested for STDs. In the list below, place a check mark by each of the reasons that apply to you:

    1. It is too expensive

    2. People might think badly about me

    3. I do not want my parents to find out

    4. I am worried about confidentiality

    5. I am not at risk for STDs

    6. My doctor or health care provider has never suggested I get tested

    7. I don’t want to know if I have an STD

    8. I do not know where to get tested

    9. I don’t know what is involved in getting tested

    10. It might be painful to get tested

    11. It is embarrassing or difficult to ask to be tested

    12. It is inconvenient to go get tested

    13. I would know if I had an STD

    14. Some other reason (specify)


  1. Have you ever been in any of the following situations?

    1. Thought you might have an STD or HIV

    2. Thought your partner might have an STD or HIV

    3. Been given medication or a prescription for STDs by a doctor or nurse

    4. Been given medication or a prescription for STDS by a doctor or nurse to give to your partner

    5. Been given medication or a prescription for STDs by your partner

    6. Given medication or a prescription for STDs to your partner

    7. Had an STD or HIV

    8. Had sex with someone who had (or thought they had) an STD or HIV

    9. Had a friend or family member who had an STD

    10. Had a friend or family member who had HIV


  1. Please indicate whether you have done any of the following:

    1. Talked to a health care provider about STDs or getting tested for STDs

    2. Talked with someone you were involved with romantically about STDs or getting tested for STDs

    3. Talked with friends about STDs or getting tested for STDs

    4. Looked online for information about STDs or getting tested for STDs

    5. Talked with a family member about STDs or getting tested for STDs


  1. Are you or your current sex partner pregnant or trying to get pregnant?

    1. Yes

    2. No

    3. I don’t know


  1. Did you see a doctor or nurse in the past year for any of the following reasons?






A regular check-up or physical

0

No



when you weren’t sick or injured

1

Yes








Sickness (like a fever or infection)

0

No




1

Yes








Ongoing illness (like asthma or diabetes)

0

No




1

Yes








An injury (like a broken bone or cut)

0

No




1

Yes








A sexual health checkup

0

No




1

Yes








Birth control

0

No




1

Yes








A test or treatment for an

0

No



STD like Chlamydia,

1

Yes



gonorrhea, herpes, or HIV






GYT Awareness and Impact

  1. Have you ever been to a Planned Parenthood health center or clinic?

      • Yes, more than 12 months ago

      • Yes, in the past 12 months

      • Yes, but I don’t remember when it was

      • No

      • Don’t know



  1. During the last year, how much, if anything, have you personally seen, heard, or read about STDs or testing for STDs? Have you heard a lot, some, only a little, or nothing at all?

      • A lot

      • Some

      • Only a little

      • Nothing at all



  1. During the last year, do you recall seeing or hearing any ads or messages or other programming about STDs or testing for STDs?

    • Yes

    • No

    • Don’t know



  1. In the past 12 months, do you recall seeing or hearing any ads or messages about STDs or testing for STDs in the following places?

      1. Television

      2. The radio

      3. Billboards or other outdoor advertising spaces

      4. The internet

      5. School

      6. Doctor’s office or health clinic

      7. A concert

      8. A college event

      9. A community event

      10. Other. __________________________







  1. Please indicate whether you have ever heard of each one of the following public service campaigns.

  1. Above the Influence

      • Yes, have heard of

      • No, have not heard of

      • Don’t know

  1. Bedsider

      • Yes, have heard of

      • No, have not heard of

      • Don’t know

  1. GYT: Get Yourself Tested

      • Yes, have heard of

      • No, have not heard of

      • Don’t know

  1. It’s Your (Sex) Life

      • Yes, have heard of

      • No, have not heard of

      • Don’t know

  1. Lock It or Leave It

      • Yes, have heard of

      • No, have not heard of

      • Don’t know

  2. Power of 12

      • Yes, have heard of

      • No, have not heard of

      • Don’t know

  3. A Thin Line

      • Yes, have heard of

      • No, have not heard of

      • Don’t know





  1. Have you ever seen this image? [GYT LOGO]

      • Yes

      • No

      • Don’t know





  1. Have you ever seen any of these images? [COMPILATION OF CAMPAIGN IMAGES]

      1. Yes

      2. No

      3. Don’t know



[IF RECALL GYT] What is the campaign trying to get you to do? (Check all that apply):

  • Abstain from sex

  • Become a youth leader

  • Exercise

  • Follow my dreams

  • Get tested for STDs

  • Talk about STDs/testing with my partner

  • Talk about STDs/testing with a doctor or health care provider

  • Use condoms

  • None of the above

  • I don’t know



  1. [IF RECALL GYT] You had mentioned that you had heard of a public service campaign called GYT: Get Yourself Tested. Do you recall seeing or hearing about GYT: Get Yourself Tested in any of the following places?

  1. MTV

      • Yes

      • No

      • Don’t know

  2. Other television network

      • Yes

      • No

      • Don’t know

  3. Internet

      • Yes

      • No

      • Don’t know

  4. School , including school health centers

      • Yes

      • No

      • Don’t know

  5. Doctor’s office or health clinic, like Planned Parenthood

      • Yes

      • No

      • Don’t know

  6. Special Event (e.g. a neighborhood party or concert)

      • Yes

      • No

      • Don’t know

  7. Other

      • [OPEN-ENDED]




  1. Recently there have been several media campaigns about STDs or STD testing, some of which you mentioned seeing. How big an impact do you think messages like these have on people your age? A very big impact, somewhat of an impact, not too big an impact, or no impact at all?

  • People talk more openly about testing

  • People joke more about testing and getting STDs

  • People think differently about testing

  • It has become more socially acceptable to get tested for STDs

  • GYT” has become a term that people use




  1. How much, if any, impact would messages about STDs and testing for STDs have on you personally?

  • A very big impact

  • Somewhat of an impact

  • Not too big an impact

  • No impact at all





  1. Please tell me if programming or messages about STDs or STD testing have made you more likely or less likely to do each of the following – or if they haven’t made much difference either way.

  1. Think more positively about getting tested for STDs

      • More likely

      • Less likely

      • Haven’t made much difference either way


  1. Talk openly about STDs and testing with friends

      • More likely

      • Less likely

      • Haven’t made much difference either way


  1. Use condoms if/when you have sex

      • More likely

      • Less likely

      • Haven’t made much difference either way

  1. Talk to a partner about STDs or testing for STDs

      • More likely

      • Less likely

      • Haven’t made much difference either way

  1. Talk to a doctor or health care provider about STDs or testing for STDs

      • More likely

      • Less likely

      • Haven’t made much difference either way

  1. Talk to the person I’m with about STDs/testing when I see the ad/message

      • More likely

      • Less likely

      • Haven’t made much difference either way

  2. Get tested for STDs

      • More likely

      • Less likely

      • Haven’t made much difference either way





  1. How often, if ever, do you watch MTV, including watching on TV or on a computer, tablet, smartphone, or other platform?

      • Every day

      • A couple times a week

      • Once a week

      • About once a month

      • Less than once a month

      • Never



  1. [OF THOSE WHO WATCH MTV AT LEAST ONCE A WEEK] On average, about how much time do you spend watching MTV?

      • Several hours a day

      • About an hour a day

      • Several hours a week

      • About an hour a week

      • Less than an hour a week



  1. [OF THOSE WHO EVER WATCH MTV] You mentioned earlier that you sometimes watch MTV. Do you remember seeing any public service ads or specials or other shows on MTV about STDs or testing for STDs?

      • Yes

      • No

      • Don’t know


  1. Please indicate whether you have ever seen one of the following shows?

    1. 16 and Pregnant

  • Yes

  • No

    1. Teen Mom

  • Yes

  • No

    1. Savage U

  • Yes

  • No

    1. Awkward

  • Yes

  • No





Demographics



  1. How old are you? (enter a number ______)



  1. What is your sex?

      • Male

      • Female




  1. Are you currently attending school?

      • Yes, High School

      • Yes, College

      • Yes, Business, Technical or Vocational School after high school

      • No




  1. [If in COLLEGE] Is your college recognized as a (check all that apply):

    • Historically Black College or University (HBCU)

    • Minority Postsecondary Institution (MPI)

    • Hispanic Serving Institute (HSI)

    • Tribal College or University (TCU)

    • Alaskan Native or Native Hawaiian serving institution (ANNH)

    • Faith-based institution

    • Community college

    • Technical or trade School

    • None of the above

    • Don’t know



  1. [If in high school] What have you gone to your school nurse or clinic for? Please mark all that apply.

E3x We don’t have a clinic or nurse at school

E3y We have a nurse or clinic but I have never been

E3a. Immunizations (shots) o No o Yes

E3b. A check-up or sports physical o No o Yes

E3c. Sickness (like a fever or infection) o No o Yes

E3d. An injury (like a broken bone or cut) o No o Yes

E3e. Ongoing illness (like asthma or diabetes) o No o Yes

E3f. A sexual health checkup o No o Yes

E3g. Birth control o No o Yes

E3h. A test or treatment for a sexually

transmitted disease (STD) o No o Yes

E3j. Information about sex o No o Yes

E3k. Condoms?

E3l. Information about my health o No o Yes




  1. What grade of school are you currently in or what is the last grade or class you completed in school?

      1. None, or grade 1-8

      2. High school incomplete (grades 9-11)

      3. High school graduate (grade 12 or GED certificate)

      4. Business, technical, or vocational school after high school

      5. 2-year college or “junior college”

      6. Some college, no 4-year degree

      7. College graduate (BS, BA, or other 4-year degree)

      8. Post-graduate or professional schooling after college



  1. Are you financially dependent on your parents?

    1. Totally dependent

    2. Mostly dependent

    3. Somewhat dependent

    4. Not dependent

    5. Don’t know


  1. Who lives with you? (Check all that apply)

    1. I live alone (no one lives with me)

    2. Friend or friends

    3. Roommate

    4. Boyfriend or girlfriend

    5. Fiancée or spouse

    6. Siblings (brothers and sisters)

    7. Parent or parents

    8. Family members who are not parents or siblings

    9. Landlord or tenant





  1. Are you of Hispanic or Latino origin?

1.         Yes

2.         No

3.         Don’t know

4.         Refuse to answer



  1. Which of the following best describes your race? (Check all that apply)

1. American Indian or Alaska Native

2. Asian

3. Black or African American

4. Native Hawaiian or Other Pacific Islander

5. White

6. Don’t know

7. Refuse to answer


  1. Do you consider yourself to be:

    1. Straight or heterosexual

    2. Gay or Lesbian

    3. Bisexual

    4. Transgender

    5. Queer”

    6. Not sure

    7. Other (specify:____________________)


  1. Currently, how important is religion or spirituality in your daily life?

    1. Very important

    2. Somewhat important

    3. Not very important

    4. Not important at all


  1. What is your religious affiliation?

    1. Roman Catholic

    2. Christian but not Catholic (Protestant)

    3. Jewish

    4. Muslim

    5. Mormon

    6. Greek or Russian Orthodox

    7. Atheist

    8. Agnostic

    9. No religious affiliation

    10. Other (specify)









  1. What language is usually spoken in your home? Check all that apply.

      1. English

      2. Spanish

      3. Other




  1. Do you have any kind of health care coverage, including private health insurance, prepaid plans such as HMOs, or government plans such as Medicaid or Indian Health Services? By health care coverage, we do not mean dental or vision plans, but insurance that pays for your other medical bills.

    1. Yes, have private health insurance

    2. Yes, have [Medicaid/name of state plan] or other government plan

    3. No

    4. Refused

    5. Don‘t know / Not sure



  1. Was there an adult in the room with you while you were taking this survey?

  1. Yes, for some or all of the time

  2. No

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorBonds, Constance (CDC/OID/NCHHSTP)
File Modified0000-00-00
File Created2021-01-30

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