Baseline Survey
Assent to Participate
You are being asked to take a survey. This survey will ask you questions about yourself, your family, and your behavior. Some questions are about sexual health. These questions will be about romantic relationships, pregnancy, and sexually transmitted infections. The survey takes 30-40 minutes to finish. Your parent or guardian signed a form saying it is okay with them for you to take this survey. But it is your choice. You will not get in trouble if you do not take this survey. Even if you say yes now, you can quit at any time. You can also skip any questions you do not want to answer.
Benefits to You
This survey will help us learn what people your age think, feel, and do. There is no personal benefit to you. Taking this survey may not make your life better.
Risks of Taking this Survey
This survey asks questions that may make you feel uncomfortable. You may also feel embarrassed or upset. We can help you find a trusted adult to talk to about how you feel. You can also call or text any adults you know and trust. At the bottom of this page, we show some names of people and their phone numbers. You can talk to them about any of the questions or how we will use your answers.
How We Will Protect Your Information
We will protect your information. We will keep all information we get about you and from you private. Only study team members will see this information. Your information will be stored in a safe data system that only the study team can see. We will not share your information with your parents or guardians or with anybody else outside of the study team. The only time this rule will change is if you tell us that you or someone else is in danger. Then we have to tell someone whose job it is to keep you and others safe. The survey questions will not ask for your name or address. We will use a special number instead of your name. Nobody will be able to know your answers to the survey questions. When the study is over, the study team will erase your name from our records. When we use or share your data, it will be combined with other youth data. This is called “aggregate data.” This helps to make sure that no one will be able to know your answers to the survey questions. We may report aggregate data in articles or papers we publish. We will also share aggregate data with the U.S. Department of Health and Human Services.
Who to Contact If You Have Questions
If you have questions about the survey or your participation, please talk to <<insert name>> at <<insert phone number>>. You can also call the MITRE Institutional Review Board at <<insert phone number>> if you have questions about your rights as a study participant.
Do you agree to participate?
Yes
No
What is your date of birth?
Year
2003
2004
2005
2006
2007
2008
Month
January
February
March
April
May
June
July
August
September
October
November
December
What grade are you currently in, or if you aren’t in school right now, what grade did you last complete?
4th
5th
6th
7th
8th
9th
10th
11th
12th
Are you a…?
Male
Female
Are you Hispanic or Latino?
Yes
No
What is your race?(Select all that apply)
American Indian or Alaska Native
Asian
Black or African-American
Native Hawaiian or Other Pacific Islander
White
When you are
at home or with your family, what language or languages do you
usually speak?
(Select all that apply)
English
Spanish
Chinese language such as Mandarin or Cantonese
Other ________________________________________________
Which of the following best describes where you live?
You live in one home
You live in two or more homes, and go back and forth
You are homeless (living on the street, in a car or shelter, or staying with friends/relatives)
Other (You live in a residential facility, detention center, or another type of facility)
Do you currently live in a group home?
Yes
No
Who lives in your home? Check all that apply.
Your biological mother
A stepmother or adoptive mother
A foster mother
Your biological father
A stepfather or adoptive father
A foster father
Your parent’s partner, boyfriend or girlfriend
Grandparents
Older brothers or sisters
Younger brothers or sisters
Aunts, uncles, other relatives
Other adults not related to you
Other kids not related to you
You live by yourself
Now think about the other home you live in. Who lives there with you? Check all that apply.
Your biological mother
A stepmother or adoptive mother
A foster mother
Your biological father
A stepfather or adoptive father
A foster father
Your parent’s partner, boyfriend or girlfriend
Grandparents
Older brothers or sisters
Younger brothers or sisters
Aunts, uncles, other relatives
Other adults not related to you
Other kids not related to you
You live by yourself
Are you now, or have you ever been, in foster care?
Yes
No
How old were you when you entered the foster care system?
Less than 1 year old
1 year old
2 years old
3 years old
4 years old
5 years old
6 years old
7 years old
8 years old
9 years old
10 years old
11 years old
12 years old
13 years old
14 years old
15 years old
16 years old
The following
questions are about the food situation in your home during the last
month. Please select the answer that best describes you.
Did you
worry that food at home would run out before your family got money to
buy more?
A lot
Sometimes
Never
The following
questions are about the food situation in your home during the last
month. Please select the answer that best describes you.
Did the
food that your family bought run out, and you didn’t have money
to get more?
A lot
Sometimes
Never
The following
questions are about the food situation in your home during the last
month. Please select the answer that best describes you.
Did
your meals only include a few kinds of cheap foods because your
family was running out of money to buy food?
A lot
Sometimes
Never
The following
questions are about the food situation in your home during the last
month. Please select the answer that best describes you.
How
often were you not able to eat a balanced meal because your family
didn’t have enough money?
A lot
Sometimes
Never
The following
questions are about the food situation in your home during the last
month. Please select the answer that best describes you.
Did you
have to eat less because your family didn’t have enough money
to buy food?
A lot
Sometimes
Never
The following
questions are about the food situation in your home during the last
month. Please select the answer that best describes you.
Has the
size of your meals been cut because your family didn’t have
enough money for food?
A lot
Sometimes
Never
The following
questions are about the food situation in your home during the last
month. Please select the answer that best describes you.
Did you
have to skip a meal because your family didn’t have enough
money for food?
A lot
Sometimes
Never
The following
questions are about the food situation in your home during the last
month. Please select the answer that best describes you.
Were
you hungry but didn’t eat because your family didn’t have
enough food?
A lot
Sometimes
Never
The following
questions are about the food situation in your home during the last
month. Please select the answer that best describes you.
Did you
not eat for a whole day because your family didn’t have enough
money for food?
A lot
Sometimes
Never
In the last 12 months, how often did you attend religious services or activities?
More than once a week
Once a week
1-3 times per month
Less than once a month
Never
How important is religion in your life?
Not at all important
Somewhat important
Very important
The following questions are about your mother or the person you think of as your mother. Do you have mother or a person you think of as a mother, even if she’s not alive now?
Yes
No
The following
questions are about your mother or the person you think of as your
mother.
How far did she go in school?
She finished some high school but didn’t graduate
She graduated from high school
She finished some college but didn’t graduate
She graduated from college
Don’t know
The following
questions are about your mother or the person you think of as your
mother.
Is she alive?
Yes
No
The following
questions are about your mother or the person you think of as your
mother.
How close do you feel to your mother or the person you
think of as a mother?
Not at all close
A little close
Somewhat close
Very close
The following
questions are about your mother or the person you think of as your
mother.
In general, how much do you think she cares about you?
Does not care at all
Cares a little bit
Cares somewhat
Cares very much
The following questions are about your father or the person you think of as a father. Do you have father or a person you think of as a father, even if he’s not alive now?
Yes
No
The following
questions are about your father or the person you think of as a
father.
How far did he go school?
He finished some high school but didn’t graduate
He graduated from high school
He graduated from college
Don’t know
The following
questions are about your father or the person you think of as a
father.
Is he alive?
Yes
No
The following
questions are about your father or the person you think of as a
father.
How close do you feel to your father or the person
you think of as your father?
Not at all close
A little close
Somewhat close
Very close
The following
questions are about your father or the person you think of as a
father.
In general, how much do you think he cares about
you?
Does not care at all
Cares a little bit
Cares somewhat
Cares very much
The next questions are about relationships, abstinence, birth control, and sexually transmitted diseases.
In the past 12
months, have you received information or learned about any of the
following?
Relationships, dating, marriage, or family life
Yes
No
In the past 12
months, have you received information or learned about any of the
following?
Abstinence from sex
Yes
No
In the past 12
months, have you received information or learned about any of the
following?
Methods of birth control
Yes
No
In the past 12
months, have you received information or learned about any of the
following?
Where to get birth control
Yes
No
In the past 12
months, have you received information or learned about any of the
following?
Sexually transmitted diseases, also known as STDs
Yes
No
In the past 12
months, have you received information or learned about any of the
following?
How to talk to your partner about whether to have sex
or whether to use birth control
Yes
No
In the past 12
months, have you received information or learned about any of the
following?
How to say no to sex
Yes
No
In the past 12
months, have you received information or learned about any of the
following?
How babies are made
Yes
No
How much would you be interested in attending a program that gives you information on relationships, abstinence, birth control, and sexually transmitted diseases?
Very interested
A little interested
Not at all interested
In the past
year, how much have you talked to your parent(s) or guardian(s) about
the following topics?
Using condoms
Never talked about this
Talked about this 1 time
Talked about this 2 or 3 times
Talked about this 4 to 6 times
Talked about this 7+ times
In the past
year, how much have you talked to your parent(s) or guardian(s) about
the following topics?
Using other forms of birth control, like
birth control pills
Never talked about this
Talked about this 1 time
Talked about this 2 or 3 times
Talked about this 4 to 6 times
Talked about this 7+ times
In the past
year, how much have you talked to your parent(s) or guardian(s) about
the following topics?
Sexually transmitted diseases (STDs)
Never talked about this
Talked about this 1 time
Talked about this 2 or 3 times
Talked about this 4 to 6 times
Talked about this 7+ times
In the past
year, how much have you talked to your parent(s) or guardian(s) about
the following topics?
HIV/AIDS
Never talked about this
Talked about this 1 time
Talked about this 2 or 3 times
Talked about this 4 to 6 times
Talked about this 7+ times
In the past
year, how much have you talked to your parent(s) or guardian(s) about
the following topics?
Getting pregnant/getting someone else
pregnant
Never talked about this
Talked about this 1 time
Talked about this 2 or 3 times
Talked about this 4 to 6 times
Talked about this 7+ times
In the past
year, how much have you talked to your parent(s) or guardian(s) about
the following topics?
Waiting to have sex until you’re
older or sexual abstinence
Never talked about this
Talked about this 1 time
Talked about this 2 or 3 times
Talked about this 4 to 6 times
Talked about this 7+ times
In the past
year, how much have you talked to your best friend about the
following topics?
Using condoms
Never talked about this
Talked about this 1 time
Talked about this 2 or 3 times
Talked about this 4 to 6 times
Talked about this 7+ times
In the past
year, how much have you talked to your best friend about the
following topics?
Using other forms of birth control, like birth
control pills
Never talked about this
Talked about this 1 time
Talked about this 2 or 3 times
Talked about this 4 to 6 times
Talked about this 7+ times
In the past
year, how much have you talked to your best friend about the
following topics?
Sexually transmitted diseases (STDs)
Never talked about this
Talked about this 1 time
Talked about this 2 or 3 times
Talked about this 4 to 6 times
Talked about this 7+ times
In the past
year, how much have you talked to your best friend about the
following topics?
HIV/AIDS
Never talked about this
Talked about this 1 time
Talked about this 2 or 3 times
Talked about this 4 to 6 times
Talked about this 7+ times
In the past
year, how much have you talked to your best friend about the
following topics?
Getting pregnant/getting someone else pregnant
Never talked about this
Talked about this 1 time
Talked about this 2 or 3 times
Talked about this 4 to 6 times
Talked about this 7+ times
In the past
year, how much have you talked to your best friend about the
following topics?
Waiting to have sex until you’re older
or sexual abstinence
Never talked about this
Talked about this 1 time
Talked about this 2 or 3 times
Talked about this 4 to 6 times
Talked about this 7+ times
In the past year, have you had a boyfriend/girlfriend or someone you liked “more than friends” who you have talked to or hung out with?
Yes (We will call this person a dating partner for the next question)
No
In the past
year, how much have you talked to your dating partner about the
following topics?
Using condoms
Never talked about this
Talked about this 1 time
Talked about this 2 or 3 times
Talked about this 4 to 6 times
Talked about this 7+ times
In the past
year, how much have you talked to your dating partner about the
following topics?
Using other forms of birth control, like birth
control pills
Never talked about this
Talked about this 1 time
Talked about this 2 or 3 times
Talked about this 4 to 6 times
Talked about this 7+ times
In the past
year, how much have you talked to your dating partner about the
following topics?
Sexually transmitted diseases (STDs)
Never talked about this
Talked about this 1 time
Talked about this 2 or 3 times
Talked about this 4 to 6 times
Talked about this 7+ times
In the past
year, how much have you talked to your dating partner about the
following topics?
HIV/AIDS
Never talked about this
Talked about this 1 time
Talked about this 2 or 3 times
Talked about this 4 to 6 times
Talked about this 7+ times
In the past
year, how much have you talked to your dating partner about the
following topics?
Getting pregnant/getting someone else pregnant
Never talked about this
Talked about this 1 time
Talked about this 2 or 3 times
Talked about this 4 to 6 times
Talked about this 7+ times
In the past
year, how much have you talked to your dating partner about the
following topics?
Waiting to have sex until you’re older
or sexual abstinence
Never talked about this
Talked about this 1 time
Talked about this 2 or 3 times
Talked about this 4 to 6 times
Talked about this 7+ times
How many times
in the last 6 months has a boyfriend or girlfriend done these things
to you?
Said things to hurt your feelings on purpose
Never
1-3 times
4-9 times
10 or more times
How many times
in the last 6 months has a boyfriend or girlfriend done these things
to you?
Insulted you in front of others
Never
1-3 times
4-9 times
10 or more times
How many times
in the last 6 months has a boyfriend or girlfriend done these things
to you?
Would not let you do things with other people
Never
1-3 times
4-9 times
10 or more times
How many times
in the last 6 months has a boyfriend or girlfriend done these things
to you?
Threatened to start dating someone else
Never
1-3 times
4-9 times
10 or more times
How many times
in the last 6 months has a boyfriend or girlfriend done these things
to you?
Did something just to make you jealous
Never
1-3 times
4-9 times
10 or more times
How many times
in the last 6 months has a boyfriend or girlfriend done these things
to you?
Blamed you for bad things they did
Never
1-3 times
4-9 times
10 or more times
How many times
in the last 6 months has a boyfriend or girlfriend done these things
to you?
Threatened to hurt you
Never
1-3 times
4-9 times
10 or more times
How many times
in the last 6 months has a boyfriend or girlfriend done these things
to you?
Made you describe where you were every minute of the day
Never
1-3 times
4-9 times
10 or more times
How many times
in the last 6 months has a boyfriend or girlfriend done these things
to you?
Put down your looks
Never
1-3 times
4-9 times
10 or more times
How many times
in the last 6 months has a boyfriend or girlfriend done these things
to you?
Pushed, grabbed, shoved, or kicked you
Never
1-3 times
4-9 times
10 or more times
How many times
in the last 6 months has a boyfriend or girlfriend done these things
to you?
Called you names, put you down, or said really mean
things to you on Snapchat, Instagram, Facebook or other social media
and messaging apps
Never
1-3 times
4-9 times
10 or more times
How many times
in the last 6 months has a boyfriend or girlfriend done these things
to you?
Called your cellphone or sent you messages when you
didn’t want them to, just to make you mad
Never
1-3 times
4-9 times
10 or more times
How many times
in the last 6 months has a boyfriend or girlfriend done these things
to you?
Sent you messages that asked you to engage in sexual
acts when you didn’t want to
Never
1-3 times
4-9 times
10 or more times
How many times
in the last 6 months has a boyfriend or girlfriend done these things
to you?
Spread rumors about you on Snapchat, Instagram, Facebook
or other social media and messaging apps
Never
1-3 times
4-9 times
10 or more times
How many times
in the last 6 months has a boyfriend or girlfriend done these things
to you?
Used your posts or messages on Snapchat, Instagram,
Facebook or other social media and messaging apps to harass you or
put you down
Never
1-3 times
4-9 times
10 or more times
How many times
in the last 6 months has a boyfriend or girlfriend done these things
to you?
Shared private or embarrassing pictures or videos of you
on Snapchat, Instagram, Facebook or other social media and messaging
apps
Never
1-3 times
4-9 times
10 or more times
How many times
in the last 6 months has a boyfriend or girlfriend done these things
to you?
Used Snapchat, Instagram, Facebook or other social media
and messaging apps to threaten to hurt you physically
Never
1-3 times
4-9 times
10 or more times
How many times
in the last 6 months have you done these things to a boyfriend or
girlfriend?
Said things to hurt their feelings on purpose
Never
1-3 times
4-9 times
10 or more times
How many times
in the last 6 months have you done these things to a boyfriend or
girlfriend?
Insulted you in front of others
Never
1-3 times
4-9 times
10 or more times
How many times
in the last 6 months have you done these things to a boyfriend or
girlfriend?
Would not let them do things with other people
Never
1-3 times
4-9 times
10 or more times
How many times
in the last 6 months have you done these things to a boyfriend or
girlfriend?
Threatened to start dating someone else
Never
1-3 times
4-9 times
10 or more times
How many times
in the last 6 months have you done these things to a boyfriend or
girlfriend?
Did something just to make them jealous
Never
1-3 times
4-9 times
10 or more times
How many times
in the last 6 months have you done these things to a boyfriend or
girlfriend?
Blamed them for bad things you did
Never
1-3 times
4-9 times
10 or more times
How many times
in the last 6 months have you done these things to a boyfriend or
girlfriend?
Threatened to hurt them
Never
1-3 times
4-9 times
10 or more times
How many times
in the last 6 months have you done these things to a boyfriend or
girlfriend?
Made them describe where they were every minute of
the day
Never
1-3 times
4-9 times
10 or more times
How many times
in the last 6 months have you done these things to a boyfriend or
girlfriend?
Put down their looks
Never
1-3 times
4-9 times
10 or more times
How many times
in the last 6 months have you done these things to a boyfriend or
girlfriend?
Pushed, grabbed, shoved, or kicked them
Never
1-3 times
4-9 times
10 or more times
How many times
in the last 6 months have you done these things to a boyfriend or
girlfriend?
Called them names, put them down, or said really
mean things to them on Snapchat, Instagram, Facebook or other social
media and messaging apps
Never
1-3 times
4-9 times
10 or more times
How many times
in the last 6 months have you done these things to a boyfriend or
girlfriend?
Called their cellphone or sent them messages when
they didn’t want you to, just to make them mad
Never
1-3 times
4-9 times
10 or more times
How many times
in the last 6 months have you done these things to a boyfriend or
girlfriend?
Sent them messages that asked them to engage in
sexual acts when they didn’t want to
Never
1-3 times
4-9 times
10 or more times
How many times
in the last 6 months have you done these things to a boyfriend or
girlfriend?
Spread rumors about them on Snapchat, Instagram,
Facebook or other social media and messaging apps
Never
1-3 times
4-9 times
10 or more times
How many times
in the last 6 months have you done these things to a boyfriend or
girlfriend?
Used their posts or messages on Snapchat, Instagram,
Facebook or other social media and messaging apps to harass them or
put them down
Never
1-3 times
4-9 times
10 or more times
How many times
in the last 6 months have you done these things to a boyfriend or
girlfriend?
Shared private or embarrassing pictures or videos of
them on Snapchat, Instagram, Facebook or other social media and
messaging apps
Never
1-3 times
4-9 times
10 or more times
How many times
in the last 6 months have you done these things to a boyfriend or
girlfriend?
Used Snapchat, Instagram, Facebook or other social
media and messaging apps to threaten to hurt them physically
Never
1-3 times
4-9 times
10 or more times
The next
question asks about cigarette smoking.
During the
past 30 days, have you smoked cigarettes, even once?
Yes
No
The next
question asks about electronic vapor products, such as JUUL, Vuse,
MarkTen, blu, KandyPens, PaxEraPro, and APX Vape. Electronic vapor
products include e-cigarettes, e-cigars, e-hookahs, marijuana vape
pens, hookah pens, and mods.
During the past 30 days,
have you used an electronic vapor product, even once?
Yes
No
The next
question asks about drinking alcohol. This includes drinking beer,
wine, wine coolers, and liquor such as rum, gin, vodka, or whiskey.
For this question, drinking alcohol does not include drinking a few
sips of wine for religious purposes.
During the past 30
days, have you drank alcohol, even once?
Yes
No
The next
question asks about marijuana use. Marijuana also is called pot,
weed, or cannabis.
During your life, have you ever used
marijuana?
Yes
No
The next
question asks about synthetic marijuana use. Synthetic marijuana also
is called Spice, fake weed, K2, King Kong, Yucatan Fire, or Skunk.
During your life, have you ever used synthetic marijuana?
Yes
No
The next
question asks about the use of prescription pain medicine without a
doctor’s prescription or differently than how a doctor told you
to use it. For this question, count drugs such as codeine, Vicodin,
OxyContin, Hydrocodone, and Percocet.
During your life,
have you ever you taken prescription pain medicine without a doctor’s
prescription or differently than how a doctor told you to use it?
Yes
No
The next question asks about other drugs. During your life, have you ever you used cocaine, heroin, methamphetamines, ecstasy, or hallucinogenic drugs like LSD, acid, or mushrooms?
Yes
No
The next set
of questions are about your sexual history. By sex, we mean vaginal,
oral, or anal sex. Please remember that your answers are strictly
confidential.
Have you ever had any kind of sex?
Yes
No
During your life, with whom have you had sexual contact?
Females
Males
Females and Males
Have you ever had vaginal sex, also called sexual intercourse? This is when a man puts his penis into a woman’s vagina.
Yes
No
The very first time you had sexual intercourse, how old were you? | | | NUMBER OF YEARS OLD YOU WERE — Your best guess is fine.
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
Now please think about the last 3 months. In the last 3 months, did you had sexual intercourse?
Yes
No
In the past 3 months, did you have sexual intercourse without using a condom?
Yes
No
The next question is about your use of the following methods of birth control: Birth control pills The shot (like, Depo Provera) The patch The ring (like, NuvaRing) IUD (like, Mirena or Paragard) Implants (like, Implanaon) In the past 3 months, did you have sexual intercourse without using any of these methods of birth control?
Yes
No
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?
Yes
No
Now please think about the last 3 months. In the last 3 months, did you have oral sex?
Yes
No
In the past 3 months, did you have you oral sex without using a condom or dental dam?
Yes
No
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?
Yes
No
Now please think about the last 3 months. In the last 3 months, did you have anal sex?
Yes
No
In the past 3 months, did you have you anal sex without using a condom?
Yes
No
To the best of your knowledge, have you ever been pregnant, even if no child was born?
Yes
No
To the best of your knowledge, have you ever gotten someone pregnant, even if no child was born?
Yes
No
In the last 12 months, have you been tested by a doctor or nurse for a sexually transmitted disease, or STD, like gonorrhea, Chlamydia, syphilis, or HIV?
Yes
No
In the last 12 months, have you been told by a doctor or other health professional that you had a sexually transmitted disease, or STD?
Yes
No
Don't know
Do you intend to have oral sex in the next year?
Yes, definitely
Yes, probably
No, probably not
No, definitely not
Do you intend to have sexual intercourse in the next year?
Yes, definitely
Yes, probably
No, probably not
No, definitely not
If you have sexual intercourse in the next year, do you intend to use a condom?
Yes, definitely
Yes, probably
No, probably not
No, definitely not
The next question is about your intention to use other methods of birth control, NOT including condoms: Birth control pills The shot (like, Depo Provera) The patch The ring (like, NuvaRing) IUD (like, Mirena or Paragard) Implants (like, Implanaon) If you have sexual intercourse in the next year, do you intend to use any of these other methods of birth control?
Yes, definitely
Yes, probably
No, probably not
No, definitely not
How likely is
it that you will do each of the following things?
Graduate
from high school?
Not at all likely
A little likely
Somewhat likely
Very likely
How likely is
it that you will do each of the following things?
Go to a
technical or vocational school after high school?
Not at all likely
A little likely
Somewhat likely
Very likely
How likely is
it that you will do each of the following things?
Go to
college?
Not at all likely
A little likely
Somewhat likely
Very likely
How likely is
it that you will do each of the following things?
Graduate
from a 2-year or community college program?
Not at all likely
A little likely
Somewhat likely
Very likely
How likely is
it that you will do each of the following things?
Graduate
from a 4-year college program?
Not at all likely
A little likely
Somewhat likely
Very likely
The next
series of questions is about condoms, birth control pills, pregnancy
and sexually transmitted diseases, also called STDs.
If a
condom is used correctly, how much can it decrease the risk of
pregnancy?
Not at all
A little
A lot
How confident are you that your answer is correct?
Not at all confident
A little confident
Somewhat confident
Very confident
If a condom is used correctly, how much can it decrease the risk of getting HIV, the virus that causes AIDS?
Not at all
A little
A lot
Don’t know
If a condom is used correctly, how much can it decrease the risk of getting Chlamydia and gonorrhea?
Not at all
A little
A lot
Don’t know
A condom can be used more than once.
True
False
A sexually active girl can become pregnant if she forgets to take her birth control pills for several days in a row.
True
False
A person who has Genital Herpes must have open sores to give the infection to his or her sexual partner.
True
False
If a person had Gonorrhea in the past he or she is immune (protected) from getting it again.
True
False
Showering, or washing one’s genitals/private parts, after sex keeps a person from getting HIV.
True
False
A person can get HIV from oral sex.
True
False
In your
opinion, how likely or unlikely is it that each of the following
things would happen to you personally if you were to have sexual
intercourse? (If you’ve never had sexual intercourse, please
try to imagine and make your best guess.)
Get pregnant or get
someone pregnant
Very unlikely
Somewhat unlikely
Somewhat likely
Very likely
In your
opinion, how likely or unlikely is it that each of the following
things would happen to you personally if you were to have sexual
intercourse? (If you’ve never had sexual intercourse, please
try to imagine and make your best guess.)
Enjoy it
Very unlikely
Somewhat unlikely
Somewhat likely
Very likely
In your
opinion, how likely or unlikely is it that each of the following
things would happen to you personally if you were to have sexual
intercourse? (If you’ve never had sexual intercourse, please
try to imagine and make your best guess.)
Get a sexually
transmitted disease
Very unlikely
Somewhat unlikely
Somewhat likely
Very likely
In your
opinion, how likely or unlikely is it that each of the following
things would happen to you personally if you were to have sexual
intercourse? (If you’ve never had sexual intercourse, please
try to imagine and make your best guess.)
Feel guilty
Very unlikely
Somewhat unlikely
Somewhat likely
Very likely
In your
opinion, how likely or unlikely is it that each of the following
things would happen to you personally if you were to have sexual
intercourse? (If you’ve never had sexual intercourse, please
try to imagine and make your best guess.)
Be more popular
Very unlikely
Somewhat unlikely
Somewhat likely
Very likely
In your
opinion, how likely or unlikely is it that each of the following
things would happen to you personally if you were to have sexual
intercourse? (If you’ve never had sexual intercourse, please
try to imagine and make your best guess.)
Have fun
Very unlikely
Somewhat unlikely
Somewhat likely
Very likely
In your
opinion, how likely or unlikely is it that each of the following
things would happen to you personally if you were to have sexual
intercourse? (If you’ve never had sexual intercourse, please
try to imagine and make your best guess.)
Nothing about my life
would change
Very unlikely
Somewhat unlikely
Somewhat likely
Very likely
In your
opinion, how likely or unlikely is it that each of the following
things would happen to you personally if you were to have sexual
intercourse? (If you’ve never had sexual intercourse, please
try to imagine and make your best guess.)
Get into trouble with
your parents
Very unlikely
Somewhat unlikely
Somewhat likely
Very likely
In your
opinion, how likely or unlikely is it that each of the following
things would happen to you personally if you were to have sexual
intercourse? (If you’ve never had sexual intercourse, please
try to imagine and make your best guess.)
Get a bad reputation
Very unlikely
Somewhat unlikely
Somewhat likely
Very likely
In your
opinion, how likely or unlikely is it that each of the following
things would happen to you personally if you were to have sexual
intercourse? (If you’ve never had sexual intercourse, please
try to imagine and make your best guess.)
Feel more loved and
wanted
Very unlikely
Somewhat unlikely
Somewhat likely
Very likely
In your
opinion, how likely or unlikely is it that each of the following
things would happen to you personally if you were to have sexual
intercourse? (If you’ve never had sexual intercourse, please
try to imagine and make your best guess.)
Lose your self-respect
Very unlikely
Somewhat unlikely
Somewhat likely
Very likely
In your
opinion, how likely or unlikely is it that each of the following
things would happen to you personally if you were to have sexual
intercourse? (If you’ve never had sexual intercourse, please
try to imagine and make your best guess.)
Feel more attractive
Very unlikely
Somewhat unlikely
Somewhat likely
Very likely
In your
opinion, how likely or unlikely is it that each of the following
things would happen to you personally if you were to have sexual
intercourse? (If you’ve never had sexual intercourse, please
try to imagine and make your best guess.)
Keep your boyfriend or
girlfriend from breaking up with you
Very unlikely
Somewhat unlikely
Somewhat likely
Very likely
In your
opinion, how likely or unlikely is it that each of the following
things would happen to you personally if you were to have sexual
intercourse? (If you’ve never had sexual intercourse, please
try to imagine and make your best guess.)
Feel pleasure
Very unlikely
Somewhat unlikely
Somewhat likely
Very likely
In your
opinion, how likely or unlikely is it that each of the following
things would happen to you personally if you were to have sexual
intercourse? (If you’ve never had sexual intercourse, please
try to imagine and make your best guess.)
Feel closer to your
partner
Very unlikely
Somewhat unlikely
Somewhat likely
Very likely
In your
opinion, how likely or unlikely is it that each of the following
things would happen to you personally if you were to have sexual
intercourse? (If you’ve never had sexual intercourse, please
try to imagine and make your best guess.)
Disappoint people who
are important to you
Very unlikely
Somewhat unlikely
Somewhat likely
Very likely
In your
opinion, how likely or unlikely is it that each of the following
things would happen to you personally if you were to have sexual
intercourse? (If you’ve never had sexual intercourse, please
try to imagine and make your best guess.)
Feel satisfied
Very unlikely
Somewhat unlikely
Somewhat likely
Very likely
In your
opinion, how likely or unlikely is it that each of the following
things would happen to you personally if you were to have sexual
intercourse? (If you’ve never had sexual intercourse, please
try to imagine and make your best guess.)
Get HIV/AIDS
Very unlikely
Somewhat unlikely
Somewhat likely
Very likely
In your
opinion, how likely or unlikely is it that each of the following
things would happen to you personally if you were to have sexual
intercourse? (If you’ve never had sexual intercourse, please
try to imagine and make your best guess.)
Feel excited
Very unlikely
Somewhat unlikely
Somewhat likely
Very likely
In your
opinion, how likely or unlikely is it that each of the following
things would happen to you personally if you were to have sexual
intercourse? (If you’ve never had sexual intercourse, please
try to imagine and make your best guess.)
Feel more grown up
Very unlikely
Somewhat unlikely
Somewhat likely
Very likely
Please select
the answer for each question that best describes how you feel.
I
believe people my age should wait until they are older before they
have sex.
Definitely Yes
Probably Yes
Probably No
Definitely No
Please select
the answer for each question that best describes how you feel.
I
believe it’s OK for people my age to have sex with a steady
boyfriend or girlfriend.
Definitely Yes
Probably Yes
Probably No
Definitely No
Please select
the answer for each question that best describes how you feel.
I
believe condoms (rubbers) should always be used if a person my age
has sexual intercourse.
Definitely Yes
Probably Yes
Probably No
Definitely No
Please select
the answer for each question that best describes how you feel.
I
believe condoms (rubbers) should always be used if a person my age
has sexual intercourse, even if the girl uses hormonal birth control.
Definitely Yes
Probably Yes
Probably No
Definitely No
Please select
the answer for each question that best describes how you feel.
I
believe condoms (rubbers) should always be used if a person my age
has sexual intercourse, even if the two people know each other very
well.
Definitely Yes
Probably Yes
Probably No
Definitely No
Please select
the answer for each question that best describes how you feel.
I
believe condoms (rubbers) should always be used if a person my age
has anal sex.
Definitely Yes
Probably Yes
Probably No
Definitely No
Please select
the answer for each question that best describes how you feel.
I
believe condoms (rubbers) or dental dams should always be used if a
person my age has oral sex.
Definitely Yes
Probably Yes
Probably No
Definitely No
The following
questions ask you about your friends and what they think. Even if
you’re not sure, mark the answer that you think best describes
what they think.
Most of my friends believe people my age should
wait until they are older before they have sex.
Definitely Yes
Probably Yes
Probably No
Definitely No
The following
questions ask you about your friends and what they think. Even if
you’re not sure, mark the answer that you think best describes
what they think.
Most of my friends believe it’s OK for
people my age to have sex with a steady boyfriend or girlfriend.
Definitely Yes
Probably Yes
Probably No
Definitely No
The following
questions ask you about your friends and what they think. Even if
you’re not sure, mark the answer that you think best describes
what they think.
Most of my friends believe condoms (rubbers)
should always be used if a person my age has sexual intercourse.
Definitely Yes
Probably Yes
Probably No
Definitely No
The following
questions ask you about your friends and what they think. Even if
you’re not sure, mark the answer that you think best describes
what they think.
Most of my friends believe condoms (rubbers)
should always be used if a person my age has sexual intercourse, even
if the girl uses hormonal birth control.
Definitely Yes
Probably Yes
Probably No
Definitely No
The following
questions ask you about your friends and what they think. Even if
you’re not sure, mark the answer that you think best describes
what they think.
Most of my friends believe condoms (rubbers)
should always be used if a person my age has sexual intercourse, even
if the two people know each other very well.
Definitely Yes
Probably Yes
Probably No
Definitely No
The following
questions ask you about your friends and what they think. Even if
you’re not sure, mark the answer that you think best describes
what they think.
Most of my friends believe condoms (rubbers)
should always be used if a person my age has anal sex.
Definitely Yes
Probably Yes
Probably No
Definitely No
The following
questions ask you about your friends and what they think. Even if
you’re not sure, mark the answer that you think best describes
what they think.
Most of my friends believe condoms (rubbers) or
dental dams should always be used if a person my age has oral sex.
Definitely Yes
Probably Yes
Probably No
Definitely No
What do you
think about condoms? Please tell us how much you agree or disagree
with the following statements.
It would be embarrassing to buy
condoms (rubbers) in a store.
I strongly agree
I kind of agree
I kind of disagree
I strongly disagree
What do you
think about condoms? Please tell us how much you agree or disagree
with the following statements.
I would feel uncomfortable
carrying condoms (rubbers) with me.
I strongly agree
I kind of agree
I kind of disagree
I strongly disagree
What do you
think about condoms? Please tell us how much you agree or disagree
with the following statements.
It would be wrong to carry a
condom (rubber) with me because it would mean that I’m planning
to have sex.
I strongly agree
I kind of agree
I kind of disagree
I strongly disagree
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| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | Draft - Baseline - V2 |
| Author | Qualtrics |
| File Modified | 0000-00-00 |
| File Created | 2021-01-22 |