OMB Clearance Number: 2528-0259
Expires: XX/XX/XXXX
Appendix H
Family Options 12 Year Study
Child Survey (Ages 10-17)
INTRODUCTION
Hello, my name is __________________ and I work for Abt Associates. Are you currently in a safe space where you can talk privately, where other people can’t hear our conversation, and someplace that where you won’t be bothered by anything?
[CAPI DISPLAY CHILD ASSENT FORM.]
[INTERVIEWER: READ ASSENT FORM FOR CHILDREN AND HAVE CHILD SIGN IT]
Remember, your participation is voluntary. You can choose not to answer any question.
Do you have any questions before we begin
[INTERVIEWER: ANSWER QUESTIONS ACCORDINGLY]
The following questions ask about your involvement in school and non-school activities.
During the past 12 months, in how many kinds of school-based activities, such as team sports, cheerleading, choir, band, student government, or clubs, have you participated?
None
1
2
3 or more
Refused
Don’t know
During the past 12 months, in how many different kinds of community-based activities, such as volunteer activities, sports, clubs, or groups have you participated?
None
1
2
3 or more
Refused
Don’t know
During the past 12 months, in how many kinds of church or faith-based activities, such as clubs, youth groups, Saturday or Sunday school, prayer groups, youth trips, service or volunteer activities have you participated?
None
1
2
3 or more
Refused
Don’t know
The next set of questions asks about school, your grades, and your attendance. We also want to understand your feelings about school. We know that sometimes kids do not like to talk about school very much. Please remember you can choose not to answer a question. We can also pause the interview for a bit if you need to.
If you are not currently enrolled in school, or you are enrolled in school but on summer break, please answer these questions about the last time you were in school. [INTERVIEWER: Please note if the child has dropped out of school code A4/A5 as “Not in school”.]
Think about your last grade report. Would you describe the report as…?
Mostly A’s
Mostly B’s
Mostly C’s
Mostly D’s and F’s
IF VOL: Not in school
Refused
Don’t know
How many days in the last month did you miss in-person or remote school?
[FIELD INTERVIEWER NOTE: IF THE CHILD IS NO LONGER IN SCHOOL OR ON SUMMER BREAK ASK: How many days in the last month of in-person or remote school did you miss?]
(INTERVIEWER: A SCHOOL MONTH TYPICALLY HAS 20-23 DAYS M-F)
Number of days: ____________________
Refused
Don’t know
Some kids like school a lot, some kids don’t like it much. In the next set of questions, we really want to know your honest opinions. There are no right or wrong answers, we just want to know what you think.
Thinking back over the past year in school, or the last year you were in school, how often did you...
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Never |
Seldom |
Sometimes |
Often |
Almost Always |
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We know that sometimes kids do not want to talk about certain school experiences. It is ok to pause for a moment if you need to take a break. You can also choose not to answer a question. But remember, we will not tell your parents, your teachers, or anyone else you know about your answers.
In the last year (or last year you were in school), have you…
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Yes |
No |
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We want to know about your thoughts and possible plans for the future. If you haven’t thought about this yet, that’s okay. We just want to know what you think at this time.
How likely do you think it is that you will do each of the following things? [If has already graduated high school, answer “Definitely will”]
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Definitely won’t |
Probably won’t |
Probably will |
Definitely will |
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I’d like to start by reading you some statements about things people do and how people interact with others. For each item, tell me whether it is Not True, Somewhat True or Certainly True. It would help us if you answered all items as best you can even if you are not absolutely certain.
Please give your answers on the basis of how things have been for you over the last six months.
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Not true |
Somewhat true |
Certainly true |
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Some kids use tobacco, alcohol, or other drugs. I am going to ask you some questions about whether you have used any of these substances and if so, when. We will not share this information with your parents or anyone at school. It stays confidential, between me and you, unless you tell me that you or someone else is in danger. If you tell me, you or someone else is in danger, I'll talk with you about that some more and I may need to talk to my supervisor or others in order to make sure you are safe. Even if I have to talk to someone else about your situation, I will keep your information as confidential as possible.
Now I would like to ask you a few questions about smoking habits. Have you ever smoked a cigarette, even a few puffs?
Yes
No
Refused
Don’t know
[ASK IF YES to C.1: “Now I would like to ask you a few questions about smoking habits.] Have you smoked a cigarette in the past 30 days?
Yes
No
Refused
Don’t know
Have you ever used an e-cigarette, even once or twice? (By e-cigarette, we mean devices such as JUUL, Vuse, blu, and Logic. E-cigarettes are battery powered devices that usually contain a nicotine-based liquid that is vaporized and inhaled. You may also know them as e-cigs, vape-pens, e-hookahs, or mods.)
Yes
No
Refused
Don’t know
[ASK IF YES to C.3: “Have you ever used an e-cigarette before] Have you used an e-cigarette in the past 30 days?
Yes
No
Refused
Don’t know
Have you ever used chewing tobacco, snuff, or dip, such as Copenhagen, Grizzly, Skoal, or Longhorn? Have you ever used chewing tobacco, snuff, or dip, even just a small amount?
Yes
No
Refused
Don’t know
[ASK If YES to C.5: “How about chewing tobacco, sniff, or dip…] Have you used chewing tobacco, snuff, or dip in the past 30 days?
Yes
No
Refused
Don’t know
Have you ever had a drink of an alcoholic beverage? (By a drink we mean a can or bottle of beer, a glass of wine, a mixed drink, or a shot of liquor. Do not include childhood sips that you might have had from an older person's drink.)
Yes
No
Refused
Don’t know
[ASK IF YES to C.7: “Have you ever had a drink of an alcoholic beverage…”] Have you had a drink of an alcoholic beverage in the past 30 days?
Yes
No
Refused
Don’t know
[ASK IF YES to C.8: “Have you had a drink… in the past 30 days?] In the last 30 days, have you had something alcoholic to drink, such as a beer, wine, or hard liquor, right before or during school or work hours?
Yes
No
Refused
Don’t know
Have you ever used marijuana, for example: weed, grass or pot, in your lifetime?
Yes
No
Refused
Don’t know
[ASK IF YES to C.10: “Have you ever used marijuana…”] Have you used marijuana, in the past 30 days?
Yes
No
Refused
Don’t know
[ASK IF YES to C.11: “Have you used marijuana… past 30 days?] In the last 30 days have used marijuana right before or during school or work hours?
Yes
No
Refused
Don’t know
Excluding marijuana and alcohol, have you ever used any drugs like cocaine or crack or heroin, or any other substance not prescribed by a doctor, to get high or to achieve an altered state?
Yes
No
Refused
Don’t know
[ASK IF YES to C.13: “Excluding marijuana and alcohol…”] In the last 30 days, did you use this drug or other substance right before or during school or work hours?
Yes
No
Refused
Don’t know
These next questions are about your relationship with your parents. Please remember that your answers are private, we will not share them with your parents. If you need to pause the interview for a bit, we can do that. You can also choose not to answer any questions.
How often do your parents (or stepparents or guardians) do the following?
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Never |
Rarely |
Sometimes |
Often |
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The following questions are about your parents (or stepparents or guardians):
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Never |
Rarely |
Sometimes |
Most of the Time |
Always |
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The following set of questions are about your life experiences.
How often are the following statements true of you?
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Never |
Rarely |
Sometimes |
Often |
Very Often |
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I’m going to read some statements that describe events that can happen in the life of any child or in any family. Some of them may apply to your family, meaning you, your parents or your brothers and sisters. Many of them may not apply to your family.
As I read each statement could you please tell me if it is something that happened to you or your family during the past year that is since [12MONTHPRIORTOINTERVIEWDATE].
If the event happened to you or your family in the past year, please answer yes.
If the event did not happen to you or your family in the past year, please answer no.
Please answer these questions as honestly as you can.
Remember, I won’t tell anyone what you say here. I will keep your answers private. I won’t tell your parents what you say. If you tell me that you or someone in your family is in danger, I will ask you a couple of questions. I may need to talk to my supervisor or others to make sure you are safe. Even if I have to talk to someone else about your situation, I will keep your information as private as possible.
Sometimes people have different reactions to answering questions. If you get upset or need to take a break that is fine, just let me know.
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[IF YES to E.26 – E.29] Condolence Script: I am sorry for your loss. Do you need to take some time before we go on?
The next set of questions asks about how you are currently feeling about several aspects of your life. For each question, please tell me how you feel. The options are completely satisfied, very satisfied, slightly satisfied, neutral, slightly dissatisfied, very dissatisfied, or completely dissatisfied.
How satisfied are you with…?
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Completely satisfied |
Very satisfied |
A little satisfied |
Neutral |
A little dissatisfied |
Very dissatisfied |
Completely dissatisfied |
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That is all the questions I have at this time. Thank you very much for taking the time to talk with me today.
Abt
Associates Family Options 12 Year Study: Child Survey June 2022 ▌
File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
File Title | Abt Single-Sided Body Template |
Author | Katheleen Linton |
File Modified | 0000-00-00 |
File Created | 2023-08-29 |