Second follow-up survey for youth (Instrument 12)

STREAMS

SECOND FOLLOW-UP survey FOR YOUTH

CONTENTS

Section Page

VERIFICATION AND ASSENT 3

a. YOUR BACKGROUND 7

b. FAMILY AND FRIENDS 14

c. INFORMATION AND OPINIONS 17

d. RELATIONSHIP SKILLS 31

e. YOUR RELATIONSHIPS 37

f. FUTURE CONTACT 43

OMB #: 0970-0481

This collection of information is voluntary and will be used to to examine the effectiveness of healthy marriage and relationship education programs designed to improve intimate relationships. 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. The OMB number and expiration date for this collection are OMB #: 0970-0481 and the expiration date is xx/xx/xxxx. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestionns for reducing this burden to Mathematica Policy Research; P.O. Box 2393 Princeton, NJ 08543-2393.

EXP. DATE: xx/xx/xxxx

Strengthening Relationship Education and Marriage Services (STREAMS) Second Follow-Up Survey for Youth ACASI Version

GENERAL INSTRUCTIONS Thank you for your help with this important study. This survey includes questions about your background, your attitudes about marriage and relationships, and your relationship experiences. Your name will not be on the questionnaire and your responses will remain private to the extent permitted by law. We want you to know that: 1. Your participation in this survey is voluntary. 2. The survey will take about 30 minutes to complete. 3. We hope that you will answer all the questions, but you may skip any questions you do not wish to answer. 4. The answers you give will be kept private to the extent permitted by law. 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. The OMB number for this information collection is 0970-0481and the expiration date is xx/xx/xxxx.

Student Verification

ALL CASES COMPLETEd BY PHONE

First we’d like to verify that we are speaking with the correct person. We are going to reconfirm some of the questions we asked when we last spoke with you about a year ago.

V1. What is your date of birth?

PROGRAMMER: INSERT DROPDOWNS WITH FOLLOWING RANGES

Month Day Year

▼

▼

▼

(1-12) (1-31) (1980 - 2010)

NO RESPONSE M V2

SOFT CHECK: IF V1 = NO RESPONSE; This question is very important. We need to verify your identity before we proceed.

ALL CASES COMPLETEd BY PHONE

V2. When we last spoke with you in [Month/Year of last survey complete], did you live with your biological mother?

Select one only

 Yes, all of the time 1

 Yes, most of the time 2

 Yes, some of the time 3

 No, none of the time 4

NO RESPONSE M

SOFT CHECK: IF V2 = NO RESPONSE; This question is very important. We need to verify your identity before we proceed.

if [BL a2=v1] AND [bl a4=v2] GO TO A1

V3. When we last spoke with you in [Month/Year of last survey complete], did you live with your biological father?

Select one only

 Yes, all of the time 1

 Yes, most of the time 2

 Yes, some of the time 3

 No, none of the time 4

NO RESPONSE M

SOFT CHECK: IF V3 = NO RESPONSE; This question is very important. We need to verify your identity before we proceed.

IF [BL A2 EQUALS V1] AND [BL B1 NE V2] AND [BL B2 NE V3]

IF [BL A2 NE V1] AND [BL B1 EQUALS V2] AND [BL B2 NE V3]

IF [BL A2 NE V1] AND [BL B1 NE V2] AND [BL B2 EQUALS V3]

IF BL NE V1-V3, THEN ROUTE TO V4A

V3a. Thank you for providing those responses. I need to check our records before continuing the interview. Please hold on a moment while I get my supervisor.

DO NOT MOVE ON TO THE NEXT QUESTION UNTIL YOU HAVE NOTIFIED A SUPERVISOR THAT THE 4TH VERIFICATION QUESTION MUST BE READ TO A SAMPLE MEMBER.

V4. Which of the following best described the relationship between your biological mother and biological father when we last spoke with you in [Month/Year of last survey complete]?

Select one only

 They are married to each other 1

 They were married to each other but are now separated or divorced 2

 They were never married to each other 3

 One or both of my biological parents has died 4

 Don’t know 5

NO RESPONSE M

IF Bl matches 2 of the verification items from v1-v4, then route to assent

Thank you for your answer, I will hand the phone back to the interviewer to continue to the survey.

IF [BL A2 NE V1] AND [BL B1 NE V2] AND [BL B2 NE V3]

IF [BL A2 EQUALS V1] AND [BL B1 NE V2] AND [BL B2 NE V3] AND [BL B3 NE V4]

IF [BL A2 NE V1] AND [BL B1 EQUALS V2] AND [BL B2 NE V3] AND [BL B3 NE V4]

IF [BL A2 NE V1] AND [BL B1 NE V2] AND [BL B2 EQUALS V3] AND [BL B3 NE V4]

V4a. I’m sorry. I need to check my records before I can interview you. Is this the best time to reach you in the future?

YES 1

NO, CALL BACK INFO 0

(STRING 20)

INSTRUCTION: RECORD DATE AND TIME FOR CALL BACK.

STUDENT ASSENT

ALL

Strengthening Relationship Education and Marriage Services (STREAMS) Evaluation

Sponsored by the United States Department of Health and Human Services

An adult from Mathematica Policy Research has explained to me the Strengthening Relationship Education and Marriage Services (STREAMS) Evaluation. I was told that I have been selected to be a part of the study and that my parent or guardian has agreed to my participation. The study was described to me and any questions I had were answered. I understand I will be asked to complete this survey and that the information I provide will be kept private to the extent allowed by law, and will not be provided to people outside of the study or shown to my parents or guardians. I also understand that I do not have to answer any questions that make me feel uncomfortable.If I have questions about my rights as a research volunteer or questions about the study, I can call:

• The New England Institutional Review Board, toll-free at 1-800-232-9570.

• Shawn Marsh, Survey Director at Mathematica Policy Research, toll-free at 1-844-309-3641.

I understand that participation is voluntary, and I agree to participate in the study. I understand that I am allowed to stop participating in the study at any time, without punishment.

 Click here if you agree with these statements 1 General

Instructions Screen

 Click here if you do not agree with these statements 0 END

HARD CHECK: IF NO RESPONSE; This question is very important, you must choose a response in order to continue.

This collection of information is voluntary and will be used to to examine the effectiveness of healthy marriage and relationship education programs designed to improve intimate relationships. 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. The OMB number and expiration date for this collection are OMB #: 0970-0481 and the expiration date is xx/xx/xxxx. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestionns for reducing this burden to Mathematica Policy Research; P.O. Box 2393 Princeton, NJ 08543-2393.

We will do everything we can to keep unaffiliated third parties from learning about your participation in this study. To further help us protect your privacy, we have obtained a Certificate of Confidentiality from the U.S. Department of Health and Human Services (DHHS). With this Certificate, we cannot be forced (for example by court order or subpoena) to disclose information that may identify you in any federal, state, local, civil, criminal, legislative, administrative, or other proceedings. The researchers will use the Certificate to resist any demands for information that would identify you, except to prevent serious harm to you or others, and as explained below.

You should understand that a Certificate of Confidentiality does not prevent you, or a member of your family, from voluntarily releasing information about yourself or your involvement in this study. You should understand that we will in all cases, take the necessary action, including reporting to authorities, to prevent serious harm to yourself or others. For example, we will comply with all child abuse and neglect mandatory reporting laws. A Certificate of Confidentiality does not represent an endorsement of the research study by DHHS or the National Institutes of Health.

No Assent Screen:

Thank you for your time. If you have reached this page accidentally and would like to participate in the survey, please wait for the login page to reappear to relogin. If you do not wish to participate in the survey, please sit quietly and raise your hand for a staff member to see.

SECTION A: YOUR BACKGROUND

ALL

A1. Are you male or female?

Select one only

 Male 1

 Female 2

NO RESPONSE M

ALL

A2. What is your date of birth?

PROGRAMMER: INSERT DROPDOWNS WITH FOLLOWING RANGES

Month Day Year

▼

▼

▼

(1-12) (1-31) (1980 - 2010)

NO RESPONSE M

ALL

A3. What is your current grade?

Select one only

 Less than 9th grade 1

 9th grade 2

 10th grade 3

 11th grade 4

 12th grade 5

 College 6

 No longer in school 7 A3a

NO RESPONSE M

A3=7

A3a. What is the highest level of education you have completed?

Select one only

 Did not complete high school or GED 1 A12

 High school: Diploma 2 A12

 High school: General education development or GED 3 A12

 Some college 4 A12

 2-year or 3-year college degree (Associate’s degree) 5 A12

 Vocational/Technical school diploma/certification 6 A12

 4-year college degree (Bachelor’s degree) 7 A12

 Graduate or professional degree (e.g., MA, MBA, Ph.D., JD, MD) 8 A12

NO RESPONSE M A12

A3 NE 7

A4. What kind of grades do you usually get in school?

Select one only

 My courses are not graded 1

 Mostly As 2

 About half As and half Bs 3

 Mostly Bs 4

 About half Bs and half Cs 5

 Mostly Cs 6

 About half Cs and half Ds 7

 Mostly Ds 8

 Mostly below Ds 9

NO RESPONSE M

all

A5. How many times have you ever been suspended or expelled from school?

Select one only

 None 1

 One time 2

 More than one time 3

NO RESPONSE M

(a3=1-5 OR M) oR (A3=7 AND A3a=1)

A5a. On a scale of 1-5, where 1 is low and 5 is high, how likely is it that you will graduate high school?

Not at all likely 1  2  3  4  5  Very likely

NO RESPONSE M

(a3=1-5 OR M) OR (A3=7 AND A3a NE 4-8)

A6. On a scale of 1-5, where 1 is low and 5 is high, how much do you want to go to college?

Not at all 1  2  3  4  5  Very much

NO RESPONSE M

(a3=1-5 OR M) OR (A3=7 AND A3a NE 4-8)

A7. On a scale of 1-5, where 1 is low and 5 is high, how likely is it that you will go to college?

Not at all likely 1  2  3  4  5  Very likely

NO RESPONSE M

all

A8. What is your current employment status?

Select all that apply

 Full time employment (usually work more than 35 hours a week) 1

 Part-time employment (usually work 1-34 hours a week) 2

 Employed, but number of hours changes from week to week 3

 Temporary, occasional, or seasonal employment, or odd jobs for pay 4

 Not currently employed 5

NO RESPONSE M

PROGRAMMER NOTE: If “Not currently employed” is checked, grey out other response options so they can’t be selected.

ALL

A9. How much do you agree or disagree with the following statement?

I have specific goals for my future career.

Select one only

 Strongly agree 1

 Agree 2

 Disagree 3

 Strongly disagree 4

NO RESPONSE M

ALL

A10. How much do you agree or disagree with the following statement?

I have a plan for reaching my future career goals.

Select one only

 Strongly agree 1

 Agree 2

 Disagree 3

 Strongly disagree 4

NO RESPONSE M

ALL

A11. How much do you agree or disagree with the following statement?

Planning a career is not worth the effort.

Select one only

 Strongly agree 1

 Agree 2

 Disagree 3

 Strongly disagree 4

NO RESPONSE M

ALL

A12. How much do you agree or disagree with the following statement?

I haven’t thought much about my future career.

Select one only

 Strongly agree 1

 Agree 2

 Disagree 3

 Strongly disagree 4

NO RESPONSE M

ALL

A13. How much do you agree or disagree with the following statement?

If I have a career, I won’t be able to enjoy other things in life.

Select one only

 Strongly agree 1

 Agree 2

 Disagree 3

 Strongly disagree 4

NO RESPONSE M

ALL

A14. How much do you agree or disagree with the following statement?

Going to college is important for getting a good job.

Select one only

 Strongly agree 1

 Agree 2

 Disagree 3

 Strongly disagree 4

NO RESPONSE M

all

A15. In general, how would you describe your health?

Select one only

 Excellent 1

 Very Good 2

 Good 3

 Fair 4

 Poor 5

NO RESPONSE M

SECTION B: FAMILY AND FRIENDS

ALL

B1. The next few questions ask about your biological parents.

Do you live with your biological mother?

Select one only

 Yes, all of the time 1

 Yes, most of the time 2

 Yes, some of the time 3

 No, none of the time 4

NO RESPONSE M

ALL

B2. Do you live with your biological father?

Select one only

 Yes, all of the time 1

 Yes, most of the time 2

 Yes, some of the time 3

 No, none of the time 4

NO RESPONSE M

all

B3. Which of the following best describes the relationship between your biological mother and biological father?

Select one only

 They are married to each other 1

 They were married to each other but are now separated or divorced 2

 They were never married to each other 3

 One or both of my biological parents has died 4

 Don’t know 5

NO RESPONSE M

all

B4. In the past month, how often did you feel like you could count on at least one of your parent(s) to be there when you needed them?

Select one only

 None of the time 1

 Some of the time 2

 Most of the time 3

 All of the time 4

NO RESPONSE M

all

B5. In the past month, how often did you feel like you could talk with your parent(s) about things that really matter?

Select one only

 None of the time 1

 Some of the time 2

 Most of the time 3

 All of the time 4

NO RESPONSE M

all

B6. In the past month, how often did you feel like you could share your thoughts and feelings with your parent(s)?

Select one only

 None of the time 1

 Some of the time 2

 Most of the time 3

 All of the time 4

NO RESPONSE M

all

B7. In the past month, how often did you feel like you could count on your friends to be there when you needed them?

Select one only

 None of the time 1

 Some of the time 2

 Most of the time 3

 All of the time 4

NO RESPONSE M

all

B8. In the past month, how often did you feel like you could talk with your friends about things that really matter?

Select one only

 None of the time 1

 Some of the time 2

 Most of the time 3

 All of the time 4

NO RESPONSE M

all

B9. In the past month, how often did you feel like you could share your thoughts and feelings with your friends?

Select one only

 None of the time 1

 Some of the time 2

 Most of the time 3

 All of the time 4

NO RESPONSE M

SECTION C: Information and Opinions

All

C1. The next few questions are about things you may have learned in school.

In the past 12 months, did you have any classes on romantic relationships or dating?

 Yes 1

 No 0

NO RESPONSE M

All

C2. In the past 12 months, did you have any classes on dating violence?

 Yes 1

 No 0

NO RESPONSE M

All

C3. In the past 12 months, did you have any classes on teen pregnancy or sexually transmitted infections?

 Yes 1

 No 0

NO RESPONSE M

All

C4. In the past 12 months, did you have any classes on marriage?

 Yes 1

 No 0

NO RESPONSE M

All

C5. In the past 12 months, did you have any classes on career planning or job readiness?

 Yes 1

 No 0

NO RESPONSE M

all

C6. How much do you agree or disagree with the following statement?

Marriages are happy or unhappy and there is not much you can do to change it.

Select one only

 Strongly agree 1

 Agree 2

 Disagree 3

 Strongly disagree 4

NO RESPONSE M

All

C7. How much do you agree or disagree with the following statement?

If you are happily married, you don't need to work on your relationship.

Select one only

 Strongly agree 1

 Agree 2

 Disagree 3

 Strongly disagree 4

NO RESPONSE M

All

C8. How much do you agree or disagree with the following statement?

There is only one true love out there who is right for me to marry.

Select one only

 Strongly agree 1

 Agree 2

 Disagree 3

 Strongly disagree 4

NO RESPONSE M

All

C9. How much do you agree or disagree with the following statement?

In the end, feelings of love should be enough to sustain a happy marriage.

Select one only

 Strongly agree 1

 Agree 2

 Disagree 3

 Strongly disagree 4

NO RESPONSE M

All

C10. How much do you agree or disagree with the following statement?

Living together before marriage will improve a couple’s chances of remaining happily married.

Select one only

 Strongly agree 1

 Agree 2

 Disagree 3

 Strongly disagree 4

NO RESPONSE M

All

C11. How much do you agree or disagree with the following statement?

A boy angry enough to hit his girlfriend must love her very much.

Select one only

 Strongly agree 1

 Agree 2

 Disagree 3

 Strongly disagree 4

NO RESPONSE M

All

C12. How much do you agree or disagree with the following statement?

Girls sometimes deserve to be hit by the boys they date.

Select one only

 Strongly agree 1

 Agree 2

 Disagree 3

 Strongly disagree 4

NO RESPONSE M

All

C13. How much do you agree or disagree with the following statement?

A girl who makes her boyfriend jealous on purpose deserves to be hit.

Select one only

 Strongly agree 1

 Agree 2

 Disagree 3

 Strongly disagree 4

NO RESPONSE M

All

C14. How much do you agree or disagree with the following statement?

Boys sometimes deserve to be hit by the girls they date.

Select one only

 Strongly agree 1

 Agree 2

 Disagree 3

 Strongly disagree 4

NO RESPONSE M

All

C15. How much do you agree or disagree with the following statement?

A girl angry enough to hit her boyfriend must love him very much.

Select one only

 Strongly agree 1

 Agree 2

 Disagree 3

 Strongly disagree 4

NO RESPONSE M

All

C16. How much do you agree or disagree with the following statement?

A boy who makes his girlfriend jealous on purpose deserves to be hit.

Select one only

 Strongly agree 1

 Agree 2

 Disagree 3

 Strongly disagree 4

NO RESPONSE M

All

C17. How much do you agree or disagree with the following statement?

Violence between dating partners can improve the relationship.

Select one only

 Strongly agree 1

 Agree 2

 Disagree 3

 Strongly disagree 4

NO RESPONSE M

All

C18. How much do you agree or disagree with the following statement?

There are times when violence between dating partners is ok.

Select one only

 Strongly agree 1

 Agree 2

 Disagree 3

 Strongly disagree 4

NO RESPONSE M

All

C19. How much do you agree or disagree with the following statement?

It’s okay to stay in a relationship even if you’re afraid of your dating partner.

Select one only

 Strongly agree 1

 Agree 2

 Disagree 3

 Strongly disagree 4

NO RESPONSE M

All

C20. How much do you agree or disagree with the following statement?

Sometimes violence is the only way to express your feelings.

Select one only

 Strongly agree 1

 Agree 2

 Disagree 3

 Strongly disagree 4

NO RESPONSE M

All

C21. How much do you agree or disagree with the following statement?

Some couples must use violence to solve their problems.

Select one only

 Strongly agree 1

 Agree 2

 Disagree 3

 Strongly disagree 4

NO RESPONSE M

All

C22. How much do you agree or disagree with the following statement?

Violence between dating partners is a personal matter and people should not interfere.

Select one only

 Strongly agree 1

 Agree 2

 Disagree 3

 Strongly disagree 4

NO RESPONSE M

all

C23. How much do you agree or disagree with the following statement?

Two people who are in love do not need to use condoms/birth control.

Select one only

 Strongly agree 1

 Agree 2

 Disagree 3

 Strongly disagree 4

NO RESPONSE M

all

C24. How much do you agree or disagree with the following statement?

At my age right now, it is okay to have sexual intercourse if I use protection, like a condom, the pill, etc.

Select one only

 Strongly agree 1

 Agree 2

 Disagree 3

 Strongly disagree 4

NO RESPONSE M

all

C25. How much do you agree or disagree with the following statement?

If my dating partner wanted to have sex, but I didn’t, I would find it pretty hard to say “no.”

Select one only

 Strongly agree 1

 Agree 2

 Disagree 3

 Strongly disagree 4

NO RESPONSE M

all

if a1=2, fill “getting pregnant”

if a1=1, fill “getting a girl pregnant”

if a1=m, fill “getting pregnant or getting a girl pregnant”

C26. How much do you agree or disagree with the following statement?

[Getting pregnant/Getting a girl pregnant/Getting pregnant or getting a girl pregnant] in the next year or two would hurt my chances of being successful in life.

Select one only

 Strongly agree 1

 Agree 2

 Disagree 3

 Strongly disagree 4

NO RESPONSE M

all

if a1=2, fill “got pregnant”

if a1=1, fill “got a girl pregnant”

if a1=m, fill “got pregnant or got a girl pregnant”

C26a. How much do you agree or disagree with the following statement?

If I [got pregnant/got a girl pregnant/got pregnant or got a girl pregnant] in the next year or two, I would have to become a responsible adult before I wanted to.

Select one only

 Strongly agree 1

 Agree 2

 Disagree 3

 Strongly disagree 4

NO RESPONSE M

all

if a1=2, fill “got pregnant”

if a1=1, fill “got a girl pregnant”

if a1=m, fill “got pregnant or got a girl pregnant”

C26b. How much do you agree or disagree with the following statement?

If I [got pregnant/got a girl pregnant/got pregnant or got a girl pregnant] in the next year or two, my life would become a lot better.

Select one only

 Strongly agree 1

 Agree 2

 Disagree 3

 Strongly disagree 4

NO RESPONSE M

all

C26c. How much do you agree or disagree with the following statement?

It is important to finish school before having a child.

Select one only

 Strongly agree 1

 Agree 2

 Disagree 3

 Strongly disagree 4

NO RESPONSE M

all

C26d. How much do you agree or disagree with the following statement?

It is important to have a job and stable income before having a child

Select one only

 Strongly agree 1

 Agree 2

 Disagree 3

 Strongly disagree 4

NO RESPONSE M

all

C26e. Do you think the following statement is true or false?

All sexually transmitted infections (STIs) can be cured.

Select one only

 True 1

 False 2

 I don’t know 3

NO RESPONSE M

all

C26f. Do you think the following statement is true or false?

A sexually active girl can become pregnant if she forgets to take her birth control pills for several days in a row.

Select one only

 True 1

 False 2

 I don’t know 3

NO RESPONSE M

all

C26g. Do you think the following statement is true or false?

Using a condom can help prevent HIV.

Select one only

 True 1

 False 2

 I don’t know 3

NO RESPONSE M

all

C26h. Do you think the following statement is true or false?

You cannot tell if a person has HIV by looking at them.

Select one only

 True 1

 False 2

 I don’t know 3

NO RESPONSE M

all

C26i. Do you think the following statement is true or false?

Latex condoms are 100% effective in preventing pregnancy and STIs (including HIV).

Select one only

 True 1

 False 2

 I don’t know 3

NO RESPONSE M

all

C27. When you think of your future, what do you think are the chances that you will get married?

Select one only

 Almost no chance 1

 Some chance but probably not 2

 A 50-50 chance 3

 A good chance 4

 Almost certain 5

 I am already married 6

NO RESPONSE M

all

C28. How likely is it that you will get married in the next 2 years?

Select one only

 Almost no chance 1

 Some chance but probably not 2

 A 50-50 chance 3

 A good chance 4

 Almost certain 5

 I am already married 6

NO RESPONSE M

all

C28a. When you think of your future, what do you think are the chances that you will be married to one person for life?

Select one only

 Almost no chance 1

 Some chance but probably not 2

 A 50-50 chance 3

 A good chance 4

 Almost certain 5

NO RESPONSE M

all

C29. When you think of your future, what do you think are the chances that you will live with a partner without being married?

Select one only

 Almost no chance 1

 Some chance but probably not 2

 A 50-50 chance 3

 A good chance 4

 Almost certain 5

 I already live with a partner without being married 6

NO RESPONSE M

all

C30. When you think of your future, what do you think are the chances that you will have children?

Select one only

 Almost no chance 1

 Some chance but probably not 2

 A 50-50 chance 3

 A good chance 4

 Almost certain 5

 I already have children 6

NO RESPONSE M

all

C31. When you think of your future, what do you think are the chances that you will have a child without being married?

Select one only

 Almost no chance 1

 Some chance but probably not 2

 A 50-50 chance 3

 A good chance 4

 Almost certain 5

 I already have children 6

NO RESPONSE M

all

if a1=2, fill “get pregnant”

if a1=1, fill “get a girl pregnant”

if a1=m, fill “get pregnant or get a girl pregnant”

C32. How likely is it that you will [get pregnant/get a girl pregnant/get pregnant or get a girl pregnant] in the next 2 years?

Select one only

 Almost no chance 1

 Some chance but probably not 2

 A 50-50 chance 3

 A good chance 4

 Almost certain 5

NO RESPONSE M

SECTION D: Relationship Skills

all

D1. How much do you agree or disagree with the following statement?

I believe I will be able to effectively deal with conflicts that arise in my relationship.

Select one only

 Strongly agree 1

 Agree 2

 Disagree 3

 Strongly disagree 4

NO RESPONSE M

all

D2. How much do you agree or disagree with the following statement?

I feel good about my ability to make a romantic relationship last.

Select one only

 Strongly agree 1

 Agree 2

 Disagree 3

 Strongly disagree 4

NO RESPONSE M

all

D3. How much do you agree or disagree with the following statement?

I am very confident when I think of having a stable, long term relationship.

Select one only

 Strongly agree 1

 Agree 2

 Disagree 3

 Strongly disagree 4

NO RESPONSE M

all

D4. How much do you agree or disagree with the following statement?

I have the skills needed for a lasting stable romantic relationship.

Select one only

 Strongly agree 1

 Agree 2

 Disagree 3

 Strongly disagree 4

NO RESPONSE M

all

D4a. How much do you agree or disagree with the following statement?

I am able to recognize early on the warning signs in a bad relationship.

Select one only

 Strongly agree 1

 Agree 2

 Disagree 3

 Strongly disagree 4

NO RESPONSE M

all

D4b. How much do you agree or disagree with the following statement?

I know what to do when I recognize the warning signs in a bad relationship.

Select one only

 Strongly agree 1

 Agree 2

 Disagree 3

 Strongly disagree 4

NO RESPONSE M

all

D5. How good are you at admitting that you might be wrong during an argument?

Select one only

 I am extremely good at this 1

 I am good at this 2

 I am ok at this 3

 I am bad at this 4

NO RESPONSE M

all

D6. How good are you at avoiding saying things that could turn an argument into a big fight?

Select one only

 I am extremely good at this 1

 I am good at this 2

 I am ok at this 3

 I am bad at this 4

NO RESPONSE M

all

D7. How good are you at accepting another person's point of view even if you don't agree with it?

Select one only

 I am extremely good at this 1

 I am good at this 2

 I am ok at this 3

 I am bad at this 4

NO RESPONSE M

all

D8. How good are you at listening to another person's opinion during an argument?

Select one only

 I am extremely good at this 1

 I am good at this 2

 I am ok at this 3

 I am bad at this 4

NO RESPONSE M

all

D9. How good are you at working through problems without arguing?

Select one only

 I am extremely good at this 1

 I am good at this 2

 I am ok at this 3

 I am bad at this 4

NO RESPONSE M

All

D10. How often do you show respect for teachers and neighbors?

Select one only

 All of the time 1

 Most of the time 2

 Some of the time 3

 None of the time 4

NO RESPONSE M

All

D11. How often do you get along well with other people your age?

Select one only

 All of the time 1

 Most of the time 2

 Some of the time 3

 None of the time 4

NO RESPONSE M

All

D12. How often do you try to understand other people’s feelings?

Select one only

 All of the time 1

 Most of the time 2

 Some of the time 3

 None of the time 4

NO RESPONSE M

All

D13. How often do you try to see things from another person's point of view?

Select one only

 All of the time 1

 Most of the time 2

 Some of the time 3

 None of the time 4

NO RESPONSE M

All

D14. How often do you work hard to listen to what other people have to say?

Select one only

 All of the time 1

 Most of the time 2

 Some of the time 3

 None of the time 4

NO RESPONSE M

All

D15. How often do you say thank you when someone does something nice?

Select one only

 All of the time 1

 Most of the time 2

 Some of the time 3

 None of the time 4

NO RESPONSE M

All

D16. How often do you apologize when you’re wrong?

Select one only

 All of the time 1

 Most of the time 2

 Some of the time 3

 None of the time 4

NO RESPONSE M

SECTION E: Your Relationships

ALL

E1. Have you ever been in a romantic relationship or dated anyone?

 Yes 1

 No 0 E16

NO RESPONSE M E16

E1=1

E2. What is the length of your longest relationship?

Days Weeks Months Years

NO RESPONSE M E3

E2 NE M

E3. Are you still in this relationship?

 Yes 1 E6

 No 0 E4

NO RESPONSE M E6

E3=0

E4. Which of the following reasons best describe why this relationship ended?

Select all that apply

 The two of you were not communicating well or were arguing too much 1

 You lacked support from family members or friends 2

 You two were living too far apart 3

 One of you cheated or was unfaithful 4

 You or partner was abusive or violent 5

 One of you used drugs or alcohol 6

 Some other reason 7

Specify (STRING 200) SOFT CHECK: Please enter your other response

NO RESPONSE M

E3=0

ONLY SHOW RESPONSE OPTION 3 IF E2 NE 1

E5. Do you think it is a good thing for you that you broke up? Would you say…

Select one only

 Definitely yes 1

 Maybe yes 2

 Maybe no 3

 Definitely no 3

NO RESPONSE M

E1=1

if e3=1, fill: how would you define THE STATUS OF this relationship ?

ONLY SHOW RESPONSE OPTION 3 IF E3 NE 1

E6. [How would you define the status of this relationship?/How would you define your current relationship status?]

Select one only

 Seriously dating 1 E7

 Casually dating 2 E7

 Not currently in a relationship or dating 3 E16

NO RESPONSE M E7

E6 NE 3

E7. The following questions are about your current relationship.

On a scale of 0-10, where 0 is not at all happy and 10 is completely happy, how happy would you say your current relationship is?

Not at all happy 0  1  2  3  4  5  6  7  8  9  10  Completely happy

NO RESPONSE M

e6 ne 3

E8. How much do you agree or disagree with the following statement?

I am very satisfied with how my partner and I talk with each other.

Select one only

 Strongly agree 1

 Agree 2

 Disagree 3

 Strongly disagree 4

NO RESPONSE M

e6 ne 3

E9. How much do you agree or disagree with the following statement?

I am very satisfied with how my partner and I treat each other.

Select one only

 Strongly agree 1

 Agree 2

 Disagree 3

 Strongly disagree 4

NO RESPONSE M

e6 ne 3

E10. How much do you agree or disagree with the following statement?

I can turn to my partner for advice about problems.

Select one only

 Strongly agree 1

 Agree 2

 Disagree 3

 Strongly disagree 4

NO RESPONSE M

e6 ne 3

E11. Has your partner ever tried to keep you from seeing or talking with your friends?

 Yes 1

 No 0

NO RESPONSE M

e6 ne 3

E12. Has your partner ever made you feel stupid?

 Yes 1

 No 0

NO RESPONSE M

e6 ne 3

E13. Has your partner ever made you feel afraid that they might hurt you?

 Yes 1

 No 0

NO RESPONSE M

E6 NE 3

E14. How often does your partner criticize your ideas?

Select one only

 None of the time 1

 Some of the time 2

 Half of the time 3

 Most of the time 4

 All of the time 5

NO RESPONSE M

E6 NE 3

E15. When you have a serious disagreement with your partner, how often do you end up throwing things or hitting something? 

Select one only

 None of the time 1

 Some of the time 2

 Half of the time 3

 Most of the time 4

 All of the time 5

NO RESPONSE M

All

E16. Do you consider yourself to be…

Select one only

 Straight 1

 Gay or lesbian 2

 Bisexual 3

 Something else/I am not certain 4

NO RESPONSE M

all

E17. Have you ever had sexual intercourse?

 Yes 1 E18

 No 0 F1a

NO RESPONSE M

E17 = 1

E18. In the past 3 months, have you ever had sexual intercourse?

 Yes 1

 No 0

NO RESPONSE M

E17 = 1 and E18=1

E19. In the past 3 months, have you ever had sexual intercourse without using a condom?

 Yes 1

 No 0

NO RESPONSE M

E17 = 1 and E18=1

E20. The next question is about your use of the following methods of birth control (condoms, birth control pills, the shot (Depo-provera), the patch, the ring (NuvaRing), IUD (Mirena, Paragard, or Skyla), implant (Implanon or Nexplanon). In the past 3 months, have you had sexual intercourse without using any of these methods of birth control?

 Yes 1

 No 0

NO RESPONSE M

a1 = 2 AND E17=1

E21. Are you currently pregnant?

 Yes 1

 No 0

NO RESPONSE M

A1 = 1 AND E17=1

E22. Is anyone currently pregnant with your child?

 Yes 1

 No 0

NO RESPONSE M

E17=1

E23. How many children do you have? (Do not include current pregnancies)

Enter zero if you do not have any children F1a

(RANGE 0-10)

HARD CHECK: IF E23>10; Number must be less than or equal to 10

SECTION F: FUTURE CONTACT

RESPONDENTS COMPLETING VIA PHONE FOLLOW-UP OR WEB (NOT IN SCHOOL)

F1a. Can you please provide me with your full name and mailing address so we can mail your gift card? You should receive your card within two weeks.

First Name

(STRING 200)

Last Name

(STRING 200)

Street Address 1

(STRING 200)

Street Address 2 or Apt

(STRING 200)

City

(STRING 200)

State/Territory

Select▼

(INSERT DROPDOWN)

Zip

(STRING 10)

NO RESPONSE M

ALL

IN-PERSON ADMIN: The next questions are about how to contact you in the future.

OVER THE PHONE: Now I’d like to ask some questions about how to contact you in the future.

IF OVER THE PHONE OR WEB (NOT IN SCHOOL): PROGRAMMER PROVIDE OPTION FOR “Same address as gift card mailing address”

F1. What is your address?

Please only enter your street address here.

Street Address 1

(STRING 200)

Street Address 2 or Apt

(STRING 200)

City

(STRING 200)

State/Territory

Select▼

(INSERT DROPDOWN)

Zip

(STRING 10) F2

NO RESPONSE M F2

ALL

F2 What is your cell phone number?

NO RESPONSE M

F2a. □ Check here if you don’t have a cell phone 1

PROGRAMMER BOX F2a.1

IF CELL PHONE ENTERED (REGARDLESS OF F2a CHECK BOX), CONTINUE TO F3;

IF F2 = M or F2a=1, SKIP TO F4.

F2 HAS PHONE NUMBER ENTERED

F3. May we send you text messages at this number: ([FILL F2_phone])? Message and data rates may apply.

 Yes 1

 No 0

NO RESPONSE M

ALL

F4. What is another phone number where you can be reached?

NO RESPONSE M

F4a. □ Check here if you don’t have another phone number 1

PROGRAMMER BOX F4a.1

IF PHONE ENTERED (REGARDLESS OF F4a CHECK BOX), CONTINUE TO F5;

IF F4 = M or F4a=1, SKIP TO F7.

F4 HAS PHONE NUMBER ENTERED

F5. Is this number, [F4], for a cell phone?

 Yes 1

 No 0

NO RESPONSE M

F4 HAS PHONE NUMBER ENTERED

F6. Whose name is that number listed under?

First name

(STRING 20)

Middle name

(STRING 20)

Last name

(STRING 20)

NO RESPONSE M

F6a. □ Check here if you don’t know 1

PROGRAMMER BOX F6a.1

IF F5 = 1, CONTINUE TO F6b; ELSE, SKIP TO F7.

F5 = 1

F6b. May we send you text messages at this number: ([FILL F4_phone])? Message and data rates may apply.

 Yes 1 F7

 No 0 F7

NO RESPONSE M F7

all

F7. What is the best e-mail address to reach you at?

E-Mail

(STRING 50)

NO RESPONSE M

F7a. □ Check here if you don’t have an e-mail address 1

PROGRAMMER BOX F7a.1

IF An E-MAIL IS ENTERED (REGARDLESS OF F7a CHECKBOX),

CONTINUE TO F8; ELSE, SKIP TO BOX F9.

F7 IS HAS E-MAIL ENTERED

F8. If you have another e-mail address, what is it?

E-Mail

(STRING 50)

NO RESPONSE M F9

F8a. □ Check here if you don’t have another e-mail address 1 F9

ALL

F9. FIRST PERSON:

As part of the study, we may contact you again in the future. In case you move, we would like the name, address and telephone number of up to two relatives (such as your parents or grandparents) or other adults who would know where you are. We will only contact them if we have trouble getting in touch with you directly.

What is the name of the first person who will know where you are?

First name

(STRING 20)

Middle name

(STRING 20)

Last name

(STRING 20)

NO RESPONSE M F17

F9a. □ Check here if there is no one who will know how to contact you 1 F17

F9 = ANSWERED

F10. What is [FILL NAME]’s relationship to you?

 Mother 1 F11

 Father 2 F11

 Sister or Brother 3 F11

 Friend 4 F11

 Grandparent 5 F11

 Aunt or Uncle 6 F11

 Other 7 F11

 Spouse or Partner 8 F11

NO RESPONSE M F11

F9 = ANSWERED

F11. What is [FILL NAME]’s telephone number?

NO RESPONSE M F12

F11a. □ Check here if you can’t find the number. 1 F12

F9 = ANSWERED

F12. What is [FILL NAME]’s address?

Please complete as much of the address as you can.

Street Address 1

(STRING 200)

Street Address 2

(STRING 200)

City

(STRING 200)

State/Territory

Select▼

(INSERT DROPDOWN)

Zip

(STRING 10) F13

NO RESPONSE M F13

F9=ANSWERED AND F9A NE 1

F13. What is the name of another relative or adult who will know how to contact you a year from now?

First name

(STRING 20)

Middle name

(STRING 20)

Last name

(STRING 20)

NO RESPONSE M F17

F13a. □ Check here if there is no one else who will know how to contact you 1 F17

F13 = ANSWERED

F14. What is [FILL NAME]’s relationship to you?

 Mother 1 F15

 Father 2 F15

 Sister or Brother 3 F15

 Friend 4 F15

 Grandparent 5 F15

 Aunt or Uncle 6 F15

 Other 7 F15

 Spouse or Partner 8 F15

NO RESPONSE M F15

F13 = ANSWERED

F15. What is [FILL NAME]’s telephone number?

NO RESPONSE M F16

F15a. □ Check here if you can’t find the number. 1 F16

F13 = ANSWERED

F16. What is [FILL NAME]’s address?

Please complete as much of the address as you can.

Street Address 1

(STRING 200)

Street Address 2

(STRING 200)

City

(STRING 200)

State/Territory

Select▼

(INSERT DROPDOWN)

Zip

(STRING 10)

NO RESPONSE M F17

ALL

F17. How would you like to be contacted in the future?

Select all that apply

 Flyer or letter from school 1 END

 Letter in the mail 2 END

 E-Mail 3 END

 Text message 4 END

 Cell phone 5 END

 Home phone 6 END

 Facebook message 7 END

 Some other way 8 END

Specify (STRING 200) SOFT CHECK: Please enter your other response

NO RESPONSE M END

ALL

END. You’re finished! Thank you for completing the survey!

 Click here and press “Next” to submit your survey. 1

HARD CHECK: IF RADIO BUTTON NOT SELECTED; Please click the button below and press “Next” to submit your survey.