Form 1 Safer Sex Intervention Survey

ATTACHMENT D

Form Approved

OMB No. 0990-

                Exp. Date XX/XX/20XX

TPP Replication Study

QUESTIONNAIRE

(Safer Sex Intervention)

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.

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

SECTION 1: YOU AND YOUR BACKGROUND

1.1. In what month and year were you born?

SELECT ONE MONTH AND SELECT 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 grade are you in?
SELECT ONE
 6th	 11th
 7th	 12th
 8th	 Ungraded
 9th	 College/Technical school
 10th	 No currently in school

1.3. Are you Hispanic / Latino?
SELECT ONE
 Yes
 No

1.4. What is your race?
YOU MAY SELECT MORE THAN ONE ANSWER
 American Indian or Alaska Native	 Native Hawaiian or Other Pacific Islander
 Asian	 White
 Black or African American	 Some other race (PRINT OTHER RACE)

1.5. In the past 12 months, have you received any information or learned about any of the following?
SELECT ONE FOR EACH	Yes	No
Relationships or dating		
Marriage or family life		
Abstinence from sex		
Methods of birth control		
Where to get birth control		
Sexually transmitted diseases(STDs)/ sexually transmitted infections (STIs) or HIV		
How to talk to your partner about whether to have sex		
How to talk to your partner about whether to use birth control		
How to say no to sex		
How babies are made		

1.5a. Did you say “yes” to any item a through j in question 1.7 above?
SELECT ONE
 Yes
 No  GO TO 1.7

1.6. Thinking about the past 12 months, how often did you get information or learn about relationships, abstinence, birth control, or sexually transmitted diseases (STDs)/ sexually transmitted infections (STIs) or HIV at each of the following places?
SELECT ONE FOR EACH	VERY OFTEN	OFTEN	SOMETIMES	RARELY	NEVER
School class, workshop, or event					
Church, synagogue, mosque, or religious classes outside of school					
Community center, youth organization, or after-school activity					
Doctor, nurse, or clinic					
Friends or other students					
Parents and other relatives or family members					
Internet and media					
Other  LIST OTHER SOURCE (below):					

1.7. In the past 30 days, how often have you felt that you were unable to control the important things in your life?
SELECT ONE
 Always	 Rarely
 Most of the time	 Never
 Sometimes

1.8. In the past 30 days, how often have you felt difficulties were piling up so high that you could not overcome them?
SELECT ONE
 Always	 Rarely
 Most of the time	 Never
 Sometimes

1.9. How likely is it that you will do each of the following things?
SELECT ONE FOR EACH	NOT AT ALL LIKELY	A LITTLE BIT LIKELY	SOMEWHAT LIKELY	VERY LIKELY
a. Graduate from high school				
b. Go to a technical or vocational school after high school				
c. Go to college				
d. Graduate from a 2-year or community college program				
e. Graduate from a 4-year college program				

SECTION 2: KNOWLEDGE, VIEWS AND PERCEPTIONS

In this section, we will ask you about what you know and your ideas about sex, pregnancy, birth control, and preventing sexually transmitted disease (STD)/ sexually transmitted infection (STI) or HIV.

2.1. Read each statement below and check the answer that fits best.
SELECT ONE FOR EACH	I AM SURE IT’S TRUE	I THINK IT’S TRUE	I DON’T KNOW	I THINK IT’S FALSE	I AM SURE IT’S FALSE
You can’t get infected with HIV if you have sex only once or twice without a condom					
Most high school students are having sex					
Once you are infected with HIV, you are infected for life					
If a young couple has had unprotected sex a few times and a pregnancy did not happen, then they do not have to worry about her getting pregnant					
There is a vaccine or shot available to prevent girls from becoming infected with certain types of HPV (also known as Human Papilloma virus)					
A woman is protected from pregnancy the day she begins taking the pill					
All STDs/ STIs can be cured by taking medicine					
A person with a STD/ STI who looks and feels healthy cannot transmit the infection to others					
Some STDs/ STIs put you at a higher risk of getting Infected with HIV					
About 1 out of 4 sexually active teenagers get an STD/ STI each year.					
The best way to use a condom is to leave some space at the tip for the sperm					
A condom should be completely unrolled before it is placed on the penis					
You can get a sexually transmitted diseas (STD) from having oral sex					

The next set of questions is about your views on condom use.

2.2. If condoms are used correctly and consistently, how much can they decrease the risk of pregnancy?
SELECT ONE
 Not at all	 Completely
 A little	 Don’t Know  GO TO 2.5
 A lot

2.3. If condoms are used correctly and consistently, how much can they decrease the risk of getting HIV, the virus that causes AIDS?
SELECT ONE
 Not at all	 Completely
 A little	 Don’t Know
 A lot

2.4. If condoms are used correctly and consistently, how much can they decrease the risk of getting gonorrhea?
SELECT ONE
 Not at all	 Completely
 A little	 Don’t Know
 A lot

2.5. How strongly do you agree or disagree with the following statements?
SELECT ONE FOR EACH	STRONGLY AGREE	AGREE	DISAGREE	STRONGLY DISAGREE
Condoms should always be used if a person your age has sexual intercourse				
Condoms are too much trouble to use				
Condoms are pretty easy to get				
Condoms are important to make sex safer				
Using condoms means you don’t trust your partner				
Using condoms is morally wrong				
Condoms decrease sexual pleasure				

The next set of questions is about your views on birth control pills.

2.6. If birth control pills are used correctly and consistently, how much can they decrease the risk of pregnancy?
SELECT ONE
 Not at all	 Completely
 A little	 Don’t Know GO TO 2.9
 A lot

2.7. If birth control pills are used correctly and consistently, how much can they decrease the risk of getting HIV, the virus that causes AIDS?
SELECT ONE
 Not at all	 Completely
 A little	 Don’t Know
 A lot

2.8. If birth control pills are used correctly and consistently, how much can they decrease the risk of getting gonorrhea?
SELECT ONE
 Not at all	 Completely
 A little	 Don’t Know
 A lot

The next question asks about birth control, including condoms.

2.9. What, if anything, would persuade you to use birth control?
CHECK ALL THAT APPLY
 Your own desire to prevent an unplanned pregnancy	 Your partner insists
 To prevent STDs/ STIs or HIV	 Someone you know going through an unplanned pregnancy
 A pregnancy scare	 None of these – you won’t use birth control

The next question is about methods of birth control, NOT including condoms.

2.10. How strongly do you agree or disagree with the following statements?
SELECT ONE FOR EACH	STRONGLY AGREE	AGREE	DISAGREE	STRONGLY DISAGREE
Birth control should always be used if a person your age has sexual intercourse				
Birth control is too much trouble to use				
Birth control is pretty easy to get				
Birth control is important to make sex safer				
Birth control has too many negative side effects				
Using birth control is morally wrong				

Now we’d like to know more about your views on engaging in sex.

2.11. It’s OK to have sex with someone…?
PLEASE CHECK ALL THAT APPLY
 Once you're in a committed relationship	 When you know that they are someone else's boyfriend/ girlfriend
 Any time as long as you use protection	 When you know that neither of you is using protection
 On your first date	 If you know they're drunk or high
 The same night you meet them	 With several different people in the same month
 If you're drunk or high	 None of the above

2.12. How sure are you that you would be able to say no to having sexual intercourse....
SELECT ONE FOR EACH	I’M SURE I COULD	I PROBABLY COULD	I PROBABLY COULD NOT	I’M SURE I COULD NOT
If your partner really wanted to, but you were not ready?				
If you just met someone you really liked and that person wanted to have sex, but you didn’t?				
If you had strong sexual feelings for that person?				
If neither you nor your partner had any form of birth control?				
If you have dated for a long time?				
After you have been drinking alcohol?				

2.13. If you were going to have sex could you...
SELECT ONE FOR EACH	I’M SURE I COULD	I PROBABLY COULD	I PROBABLY COULD NOT	I’M SURE I COULD NOT
Get or buy a condom?				
Talk about using condoms with your partner before having sex?				
Insist on using a condom if your partner didn’t want to use one?				
Ask your partner to use condoms even if the two of you had sex before without using condoms?				
Use a condom without spoiling the mood?				
Ask a new partner to use condoms?				
Get a partner to use condoms, even if you’re drunk or high?				
Go to a clinic if you needed to get tested for HIV/AIDS or another sexually transmitted disease (STD)/ sexually transmitted infection (STI)?				

2.14. Which, if any, of the following worries you or makes you anxious when it comes to sex?
PLEASE CHECK ALL THAT APPLY
 Sexually-transmitted diseases (STDs) /sexually transmitted infections (STIs) or HIV	 That my feelings will get hurt
 Pregnancy	 Ruining my reputation
 That I won't know what I'm doing	 That it will be painful
 That my parents or guardians will find out	 That my friends will find out
 Being compared to his or her other sexual partners	 None of these

2.15. Thinking about your life right now, how important is it to you to avoid getting pregnant/ getting someone pregnant?
SELECT ONE
 Not at all important
 A little important
 Somewhat important
 Very important

2.16. What do you think are the benefits not having sex right now?
SELECT ONE FOR EACH	STRONGLY AGREE	AGREE	DISAGREE	STRONGLY DISAGREE
Respect for yourself				
Respect from parents				
Keeping true to religious values				
Respect from friends				
Not having to worry about pregnancy				
Not having to worry about sexually transmitted diseases (STDs)/ sexually transmitted infections (STIs) or HIV				
Better chance for a good marriage in the future				
Fewer distractions so you can focus on school work				

2.17. How likely is it that you will get pregnant between now and age 20?
SELECT ONE
 Not at all likely
 A little likely
 Somewhat likely
 Very likely

2.18. How likely is it that you will get pregnant before getting married?
SELECT ONE
 Not at all likely
 A little likely
 Somewhat likely
 Very likely

2.19. Which of the following best describes how you would feel if you were to get pregnant right now?
SELECT ONE
 It would be a disaster
 It would be challenging, and I'm not sure how I would manage
 It would be challenging, but I could manage
 My life wouldn't change much
 It would make my life better

2.20. How strongly do you agree or disagree with the following statements?
SELECT ONE FOR EACH	STRONGLY AGREE	AGREE	DISAGREE	STRONGLY DISAGREE
You have goals you want to accomplish before you have a child/another child				
It is important for you to finish school before you have a child/another child				
It is important for you to have a job and stable income before you have a child/another child				
Having a good marriage seems possible for you				

2.21. Thinking about the future, how likely do you think it is that you will get HIV?
SELECT ONE
 Not at all likely
 A little likely
 Somewhat likely
 Very likely

2.22. How likely do you think it is that you will get an STD/STI other than HIV?
SELECT ONE
 Not at all likely
 A little likely
 Somewhat likely
 Very likely

The next series of questions ask you about decisions you may make to engage in sexual activity in the next year.

2.23. Do you intend to have oral sex in the next year, if you have the chance?
SELECT ONE
 Yes, definitely
 Yes, probably
 No, probably not
 No, definitely not

2.24. Do you intend to have sexual intercourse in the next year, if you have the chance?
SELECT ONE
 Yes, definitely
 Yes, probably
 No, probably not
 No, definitely not

2.25. If you were to have sexual intercourse in the next year, do you intend to use (or have your partner use) a condom?
SELECT ONE
 Yes, definitely
 Yes, probably
 No, probably not
 No, definitely not

2.26. If you were to have sexual intercourse in the next year, do you intend to use (or have your partner use) any of these types of birth control?
Condoms Birth control pills The shot (Depo-Provera) The patch	The ring (NuvaRing) IUD (Mirena or Paragard) Implants (Implanon)
SELECT ONE
 Yes, definitely
 Yes, probably
 No, probably not
 No, definitely not

The next series of questions asks you about relationships.

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

2.28. Right now, do you have a boyfriend or girlfriend—someone in particular you are going out with?
SELECT ONE
 Yes
 No

2.28a. For the next question, please indicate how often you have talked about each of the topics listed below with your partner (boyfriend or girlfriend) in the last month?  I didn’t have a partner in the last month.  GO TO SECTION 3
SELECT ONE FOR EACH	10 OR MORE TIMES	3 – 9 TIMES	1-2 TIMES	NEVER
Preventing pregnancy				
Birth control				
Preventing sexually transmitted diseases (STDs)/sexually transmitted infections (STIs) or HIV				
What you feel comfortable doing sexually				
What you do not feel comfortable doing sexually

Continue to Section 3

SECTION 3: YOUR BEHAVIORS

The next questions are about your sexual behaviors and experiences. Please be as honest as possible. Your answers are confidential and everything you say will be kept private.

3.1. The very first time you had sexual intercourse, what month and year was it?

SELECT ONE MONTH AND SELECT ONE YEAR

Month of First Sexual Intercourse		Year of First Sexual Intercourse
 January		 2012
 February		 2011
 March		 2010
 April		 2009
 May		 2008
 June		 2007
 July		 2006
 August		 2005
 September		 2004
 October		 2003
 November		 2002
 December		 2001
		 2000 or earlier

3.2. The very first time you had sexual intercourse, how old were you?
	NUMBER OF YEARS OLD YOU WERE – Your best guess is fine.

3.3. Have you had sexual intercourse more than one time?
SELECT ONE
 Yes
 No  GO TO 3.6

3.4. How many DIFFERENT PEOPLE have you ever had sexual intercourse with, even if only one time?
	NUMBER OF PEOPLE – Your best guess is fine.

3.5. The most recent time you had sexual intercourse, what month and year was it?

SELECT ONE MONTH AND SELECT ONE YEAR

Month of Most Recent Sexual Intercourse		Year of Most Recent Sexual Intercourse
 January		 2012
 February		 2011
 March		 2010
 April		 2009
 May		 2008
 June		 2007
 July		 2006
 August		 2005
 September		 2004
 October		 2003
 November		 2002
 December		 2001
		 2000 or earlier

3.6. The most recent time you had sexual intercourse, did you or your partner use…?
SELECT ONE FOR EACH		YES	NO
Condoms			
Birth control pills or the patch			
Depo-Provera or other injectable birth control			
NuvaRing or the ring			
Withdrawal or pulling out			
Another method PRINT OTHER METHOD USED

3.7. Now please think about the past 3 months. In the past 3 months, have you had sexual intercourse, even once?
SELECT ONE
 Yes
 No  GO TO 3.10

3.7a. In the past 3 months, how many times have you had sexual intercourse?
	NUMBER OF TIMES– Your best guess is fine.

3.8. In the past 3 months, have you had sexual intercourse without you or your partner using a condom?
SELECT ONE
 Yes, I have had sexual intercourse without using a condom.
 No, I have used a condom each time I have had sexual intercourse  GO TO 3.10

3.8a. In the past 3 months, how many times have you had sexual intercourse without using a condom?
	NUMBER OF TIMES– Your best guess is fine.

3.9. In the past 3 months, have you had sexual intercourse without you or your partner using any of these methods of birth control?
Condoms Birth control pills The shot (Depo-Provera) The patch	The ring (NuvaRing) IUD (Mirena or Paragard) Implants (Implanon)
SELECT ONE
 Yes, I have had sexual intercourse without using any of these types of birth control.
 No, I have used at least one of these types of birth control each time I had sexual intercourse  GO TO 3.10

3.9a. In the past 3 months, how many times have you had sexual intercourse without using any of these methods of birth control?
	NUMBER OF TIMES– Your best guess is fine.

3.10. 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?
SELECT ONE
 Yes
 No  GO TO 3.15

3.11. The very first time you had oral sex, what month and year was it?

SELECT ONE MONTH AND SELECT ONE YEAR

Month of First Oral Sex		Year of First Oral Sex
 January		 2012
 February		 2011
 March		 2010
 April		 2009
 May		 2008
 June		 2007
 July		 2006
 August		 2005
 September		 2004
 October		 2003
 November		 2002
 December		 2001
		 2000 or earlier

3.12. How many DIFFERENT PEOPLE have you ever had oral sex with, even if only one time?
	NUMBER OF PEOPLE– Your best guess is fine.

3.13. Now please think about the past 3 months. In the past 3 months, have you had oral sex, even once?
SELECT ONE
 Yes
 No  GO TO 3.15

3.13a. In the past 3 months, how many times have you had oral sex?
	NUMBER OF TIMES– Your best guess is fine.
3.14. In the past 3 months, have you had oral sex without using a condom?
SELECT ONE
 Yes, I have had oral sex without using a condom
 No, I have used a condom each time I have had oral sex  GO TO 3.15

3.14a. In the past 3 months, how many times have you had oral sex without using a condom?
	NUMBER OF TIMES– Your best guess is fine.

3.15. 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?
SELECT ONE
 Yes
 No  GO TO 3.20

3.16. How many DIFFERENT PEOPLE have you ever had anal sex with, even if only one time?
	NUMBER OF PEOPLE– Your best guess is fine.

3.17. The very first time you had anal sex, what month and year was it?

SELECT ONE MONTH AND SELECT ONE YEAR

Month of First Anal Sex		Year of First Anal Sex
 January		 2012
 February		 2011
 March		 2010
 April		 2009
 May		 2008
 June		 2007
 July		 2006
 August		 2005
 September		 2004
 October		 2003
 November		 2002
 December		 2001 or earlier

3.18. Now please think about the past 3 months. In the past 3 months, have you had anal sex?
SELECT ONE
 Yes
 No  GO TO 3.20

3.18a. In the past 3 months, how many times have you had anal sex?
	NUMBER OF TIMES– Your best guess is fine.

3.19. In the past 3 months, have you had anal sex without using a condom?
SELECT ONE
 Yes, I have had anal sex without using a condom.
 No, I have used a condom each time I have had anal sex  GO TO 3.20

3.19a. In the past 3 months, how many times have you had anal sex without using a condom?
	NUMBER OF TIMES– Your best guess is fine.

3.20. For the next question please answer how often you do each of the statements below. When you have to make a decision about your sexual behavior, how often do you…?
SELECT ONE FOR EACH	ALWAYS	MOST OF THE TIME	SOMETIMES	RARELY	NEVER
Think of the consequences of each possible choice					
First get as much information as you can					
Make it on the spot without worrying about the consequences					

3.21. What do you think are the benefits of not having sex right now?
SELECT ONE FOR EACH	STRONGLY AGREE	AGREE	DISAGREE	STRONGLY DISAGREE
Respect for yourself				
Respect from parents				
Keeping true to religious values				
Respect from friends				
Not having to worry about pregnancy				
Not having to worry about sexually transmitted diseases (STDs)/ sexually transmitted infections (STIs) or HIV				
Better chance for a good marriage in the future				
Fewer distractions so you can focus on school work				

SECTION 4: YOUR EXPERIENCES

This section asks about pregnancy and sexually transmitted diseases (STDs)/sexually transmitted infections (STIs). Please be as honest as possible, and remember that your answers are confidential.

This section asks about pregnancy and sexually transmitted diseases (STDs)/sexually transmitted infections (STIs). Please be as honest as possible, and remember that your answers are confidential.

4.1. Have you or your partner ever taken a pregnancy test?
SELECT ONE
 Yes
 No
 Don’t know

4.2a. To the best of your knowledge, have you ever been pregnant or gotten someone pregnant, even if no baby was born?
SELECT ONE
 Yes
 No  GO TO 4.3

4.2b. To the best of your knowledge, how many times have you been pregnant or gotten someone pregnant?
	NUMBER OF TIMES
4.2c. How old were you the first time you got pregnant or got someone pregnant?
	NUMBER OF YEARS OLD YOU WERE – Your best guess is fine.

4.2d. Have you ever had a baby or has anyone you got pregnant actually had the baby?
SELECT ONE
 Yes
 No
 Don’t know

4.3. In the past 12 months, have you spoken with a doctor or nurse about sex, birth control or sexually transmitted diseases (STDs)/ sexually transmitted infections (STIs) or HIV?
SELECT ONE
 Yes
 No
4.4. In the past 12 months, have you been tested by a doctor or nurse for a sexually transmitted disease (STD)/ sexually transmitted infection (STI) or HIV?
SELECT ONE
 Yes
 No

4.5. In the past 12 months, have you been told by a doctor or nurse that you had a sexually transmitted disease (STD)/ sexually transmitted infection (STI) or HIV?
SELECT ONE
 Yes
 No  GO TO SECTION 5

4.6. The next series of questions is about the types of sexually transmitted diseases (STDs)/ sexually transmitted infections (STIs) or HIV you have had. In the past 12 months, did you have…?
SELECT ONE FOR EACH	YES	NO	DON’T KNOW
Chlamydia			
Gonorrhea			
Genital herpes			
Syphilis			
HIV infection			
Human Papilloma virus, also known as HPV or genital warts			
Another sexually transmitted disease (STD)/ or sexually transmitted infection (STI) RINT OTHER STD/STI (below)			

SECTION 5: ALCOHOL AND DRUG USE

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

5.1. During the last 30 days, not including any times you just had a sip, on how many days did you have at least one alcoholic beverage?
SELECT ONE
 0 (zero) days  GO TO 5.4
 1 to 4 days
 5 to 10 days
 11 to 25 days
 More than 25 days

5.2. During the last 30 days, on how many days did you have 5 or more drinks in a row?
SELECT ONE
 0 (zero) days
 1 to 4 days
 5 to 10 days
 11 to 25 days
 More than 25 days

5.3. During the past 30 days, on how many days did you get drunk or wasted?
SELECT ONE
 0 (zero) days
 1 to 4 days
 5 to 10 days
 11 to 25 days
 More than 25 days

5.4. During the last 30 days, on how many days did you use marijuana, also called weed or pot?
SELECT ONE
 0 (zero) days
 1 to 4 days
 5 to 10 days
 11 to 25 days
 More than 25 days

5.5. During the past 30 days, on how many days did you use any other type of illegal drugs, an inhalant, or prescription drugs that were not prescribed to you?
SELECT ONE
 0 (zero) days
 1 to 4 days
 5 to 10 days
 11 to 25 days
 More than 25 days

SECTION 6: FRIENDS AND FAMILY

This section contains questions about your friends and family and your relationships with them. Remember that your answers will be kept private and your friends and family will not see your answers.

6.1. In general, how much pressure, if any, do you feel from your friends to have sexual intercourse?
SELECT ONE
 A lot of pressure
 Some pressure
 A little pressure
 No pressure

6.2. How often is each of the following statements true for you?
SELECT ONE FOR EACH	NEVER TRUE	SOMETIMES TRUE	OFTEN TRUE	ALMOST ALWAYS TRUE
I can trust my friends				
My friends want the best for me in my life				
My friends care about me				
My friends are there for me if I need them				

The next questions ask what your parents know about your activities. By parents, we mean the parents or guardians you live with most of the time.

6.3. Thinking about the past month, how often did your parent(s) know where you were after school?
SELECT ONE
 Always	 Rarely
 Most of the time	 Never
 Sometimes

6.4. Thinking about the past month, how often did your parent(s) know who you were going to be with before you went out?
SELECT ONE
 Always	 Rarely
 Most of the time	 Never
 Sometimes	 I did not go out

6.5. Thinking about the past month, how often did your parent(s) know where you were when you went out at night?
SELECT ONE
 Always	 Rarely
 Most of the time	 Never
 Sometimes	 I did not go out at night

6.6. If you are going to be home late, do you call your parents?
SELECT ONE
 Yes
 No

This last set of questions, asks about you 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.

6.7. Is the person you think of as your mother…?
SELECT 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 6.10

6.8. How well can you and she talk about things that are important to you?
SELECT ONE
 Not at all well
 Not very well
 Somewhat well
 Very well

6.9. Is she working now?
SELECT 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. Is the person you think of as your father…?
SELECT 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 6.13

6.11. How well can you and he talk about things that are important to you?
SELECT ONE
 Not at all well
 Not very well
 Somewhat well
 Very well

6.12. Is he working now?
SELECT 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

6.13. 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.
SELECT 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

6.14. Do your biological mother and biological father live together now?
SELECT 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.

6.15. Which of the following best describes where you live?
SELECT ONE
 You live in one home  GO TO 6.16
 You live in two or more homes, and go back and forth  GO TO 6.17
 You are homeless (living on the street, in a car or shelter, or staying with friends/relatives) YOU HAVE FINISHED THE SURVEY

6.16. Who lives with you in your home?
SELECT ALL THAT APPLY
 Your biological mother	 Any grandmothers
 Your biological father	 Any grandfathers
 A stepmother or adoptive mother	 Any older brothers or sisters
 A foster mother	 Any younger brothers or sisters
 A stepfather or adoptive father	 Any aunts, uncles, or other relatives
 A foster father	 Any other people you are not related to
 Your parent’s partner, boyfriend, or girlfriend	 You live by yourself
YOU HAVE FINISHED THE SURVEY

6.17. Who lives with you in each of your homes?
SELECT ALL THAT APPLY
MAIN HOME SELECT all the people who live with you in your MAIN home	OTHER HOME(S) SELECT all the people who live with you in your OTHER home
 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

Thank you for completing this survey!