Pre-test

Spring 1994

HEALTHY OAKLAND TEENS SURVEY

We are interested in learning more about your thoughts, opinions, and

feelings about health and what you do to stay healthy.
We hope you will help us by completing this survey. We will use your answers
to improve school health education programs in Oakland. None of your
answers will be available to anyone at any time. All the information you give us
will be kept private. Do not put your name anywhere on this questionnaire.
Whether or not you answer the questions will not affect your grades. If you
decide not to participate, your teacher will provide you with some other activity
during this class. However, we really need your help to keep young people in
Oakland healthy!

Please remember:

Do not put your name on this form.

Your answers are private. We will not tell anyone what you write.
You are not being graded on this exercise.
Please take your time and answer carefully.

Put the sticker with your ID number in the box below!

I.D. #

1a.

Sex: Please check

one box.

Male

1b.

When were you born?

month

1c.

/
day

Female

(DO NOT put todays date!)

year

What is your race or ethnic background?

Please check

all that apply to you.

American Indian/Native American ............................ 1

Black/African American............................................ 2
Chinese..................................................................... 3
Filipino ..................................................................... 4
Hispanic/Latino............................................................. 5
Japanese .................................................................. 6
Korean ...................................................................... 7
Vietnamese, Cambodian, Laotian, or Mien................. 8
White ........................................................................ 9
Other
1d.

) 10

(What?

Do you live with your parents?

Please check

ONE box below.

a. I live with both of my parents ................................ 1

b. I live with my mother only ..................................... 2
c. I live with my father only ....................................... 3
d. I live with other relatives/guardian(s) .................... 4

2a.

What language is spoken most in your home?

Check

ONE box below.

1
Spanish ........................ 2
Cantonese..................... 3
Vietnamese ................... 4
Tagalog ......................... 5
Other ............................ 6
English .........................

2b.

If other, what?: _______

Are you comfortable speaking and reading English?

Please check

ONE box below.

Yes, all of
the time

2c.

Most of
the time

About half
of the time

Some of
the time

No, almost none

of the time

How many family members or other people live in your home?

(Include brothers, sisters, cousins, and yourself.)
Write

the number in the space below.

____________ people live in my house.

Below are some statements about AIDS.

If you don't know the answer, check the box labeled Dont Know.
Remember, we are very interested in what you think.

For each question, check the box

correct.

for the answer you think is

3a. Only people who look sick can spread the AIDS virus.

True

False

Don't Know

3b. Condoms reduce the risk of getting the AIDS virus. (A condom is a piece
of rubber that fits over the penis.)

True

False

Don't Know

3c. A person can get the AIDS virus even if he or she has sexual intercourse
(putting a penis in a vagina) just one time without a condom.

True

False

Don't Know

Go on to the next page!

3d. A person can get AIDS by touching or hugging someone with AIDS.

True

False

Dont Know

3e. Most people who have the AIDS virus show signs of being sick right away.

True

False

Dont Know

3f. You can get AIDS by having anal sex without a condom (By anal sex we
mean putting a penis in another persons anus [butt].)

True

False

Dont Know

3g. You can get AIDS by being bitten by a mosquito that has bitten someone
with AIDS.

True

False

Dont Know

Go on to the next page!

3h. Only people who have sexual intercourse with gay (homosexual) people
get AIDS.

True

3i.

Dont Know

You can get AIDS from kissing someone who has AIDS.

True

3j.

False

False

Dont Know

You can get AIDS by having sexual intercourse with someone who has
shared drug needles.

True

False

Dont Know

3k. Birth control pills protect a woman from getting the AIDS virus.

True

False

Dont Know

Below are some questions about expressing your opinions to others.

You may not have actually done these things, but we would like you to
tell us how confident you are that you COULD do them.
Please check

ONLY ONE box for each question below.

4a. Could you talk with your friends about someone you would like to have as
a boyfriend or girlfriend?

I definitely
could

I probably
could

I probably
could not

4b. Could you talk about sex with your friends?

I definitely
could

I probably
could

I probably
could not

I definitely
could not

I definitely
could not

4c. Could you talk with your friends about diseases you can get from having
sexual intercourse?

I definitely
could

I probably
could

I probably
could not

Go on to the next page!

9

I definitely
could not

4d. Could you talk about sex with your boyfriend/girlfriend without being
embarrassed?

I definitely
could

I probably
could

I probably
could not

I definitely
could not

4e. Could you start a conversation about condoms with your

boyfriend/girlfriend?

I definitely
could

I probably
could

I probably
could not

I definitely
could not

4f. Could you talk about AIDS with your friends?

I definitely
could

I probably
could

I probably
could not

I definitely
could not

4g.Could you talk about AIDS with your boyfriend/girlfriend?

I definitely
could

I probably
could

I probably
could not

Go on to the next page!

10

I definitely
could not

4h. Could you talk about diseases you could get from having sex with your
boyfriend/girlfriend?

I definitely
could

I probably
could

I probably
could not

I definitely
could not

4i. Could you start a conversation about condoms with your friends?

I definitely
could

I probably
could

I probably
could not

I definitely
could not

4j. Could you ask someone you like romantically to spend time with you or go
out with you?

I definitely
could

I probably
could

I probably
could not

I definitely
could not

4k. Could you tell your boyfriend/girlfriend that you dont want to make out
with him/her?

I definitely
could

I probably
could

I probably
could not

11

I definitely
could not

Go on to the next page!

12

4l. Could you tell your boyfriend/girlfriend that you dont want to have sex with
him/her?

I definitely
could

I probably
could

I probably
could not

I definitely
could not

4m. Could you tell your girlfriend/boyfriend to stop touching you sexually?

I definitely
could

I probably
could

I probably
could not

The Fun Continues

13

I definitely
could not

These questions are about you and your parent(s) or the adult(s) you live
with.
Have you ever talked with your parent(s) or the adult(s) you live with about
the following topics?
Please check

ONLY ONE box for each topic below.

5a. Have you ever talked with your parent(s) or the adult(s) you live with about
sex?
1

Yes

No

5b. Have you ever talked with your parent(s) or the adult(s) you live with about
diseases you can get from having sexual intercourse?
1

Yes

No

5c. Have you ever talked with your parent(s) or the adult(s) you live with about
AIDS?
1

Yes

No

5d. Have you ever talked with you parent(s) or the adult(s) you live with about
pregnancy?
1

Yes

No

5e. Have you ever talked with your parent(s) or the adult(s) you live with about
using condoms?
1

Yes

14

No

How comfortable do you feel talking about each of these topics with your
parent(s) or the adult(s) who you live with?
Please check

ONLY ONE box for each topic below.

6a. How comfortable do you feel talking with your parent(s) or the adult(s) you
live with about sex ?

I feel very
comfortable

I feel
somewhat
comfortable

I feel
somewhat
uncomfortable

I feel very
uncomfortable

6b. How comfortable do you feel talking with your parent(s) or the adult(s) you
live with about diseases you can get from having sex?

I feel very
comfortable

I feel
somewhat
comfortable

I feel
somewhat
uncomfortable

I feel very
uncomfortable

6c. How comfortable do you feel talking with your parent(s) or the adult(s) you
live with about AIDS ?

I feel very
comfortable

I feel
somewhat
comfortable

I feel
somewhat
uncomfortable

15

I feel very
uncomfortable

 Go on to the next page!

16

Please check

ONLY ONE box for each topic below.

6d. How comfortable do you feel talking with your parent(s) or the adult(s) you
live with about pregnancy ?

I feel very
comfortable

I feel
somewhat
comfortable

I feel
somewhat
uncomfortable

I feel very
uncomfortable

6e. How comfortable do you feel talking with your parent(s) or the adult(s) you
live with about using condoms?

I feel very
comfortable

I feel
somewhat
comfortable

Please check

I feel
somewhat
uncomfortable

I feel very
uncomfortable

the box that shows how worried you are about

the following things.

7a. How worried are you that you might get AIDS?

Not at all worried

Somewhat worried

Very worried

7b. How worried are you that you might get a disease from having sex?

Not at all worried

Somewhat worried

Very worried

7c. How worried are you that you might get pregnant if you are a girl, or that
you might get a girl pregnant if you are a boy?

17

Not at all worried

Somewhat worried

18

Very worried

We are interested in your thoughts about what your friends (or the
kids you hang around with) think and do.
You may not know exactly what they think or do.
That's okay. Just put down your best guess.
Please check the box that shows what you think.

8a. How many of your friends think condoms are too much trouble to use?

None

A few

About half

Most

All

8b. How many of your friends do you think have had sexual intercourse?

None

A few

About half

Most

All

8c. How many of your friends do you think use condoms when they have sex?

None

A few

About half

Most

All

8d. How many of your friends do you think have had sexual intercourse
without a condom because they were high from drinking alcohol?

None

A few

About half

Most

All

8e. How many of your friends do you think have had sexual intercourse
without a condom because they were high from using crack or marijuana
("weed"/"pot")?

19

None

A few

About half

20

Most

All

This time we want to know what you think makes a person "cool" or
popular.
Please check

the box that shows what you think.

9a. Having sexual intercourse makes a boy popular.

Strongly
Agree

Agree

Disagree

Strongly
Disagree

9b. Having sexual intercourse makes a girl popular.

Strongly
Agree

Agree

Disagree

Strongly
Disagree

9c. Having sexual intercourse at my age is a "cool" thing for a boy to do.

Strongly
Agree

Agree

Disagree

Strongly
Disagree

9d. Having sexual intercourse at my age is a "cool" thing for a girl to do.

Strongly
Agree

Agree

Disagree

21

Strongly
Disagree

 Go on to the next page!

22

9e. Having sexual intercourse with someone besides her steady partner makes
a girl "cool" or popular.

Strongly
Agree

Agree

Disagree

Strongly
Disagree

9f. Having sexual intercourse with someone besides his steady partner makes
a boy "cool" or popular.

Strongly
Agree

Agree

Disagree

Strongly
Disagree

Youre doing great! Full Speed Ahead!

23


10.

Please check the 3 places where you have learned the most about
AIDS. If you have learned about AIDS from only 1 or 2 places, just
check those places.
Please check

UP TO

3 BOXES.

a. School ...........................................................

b. Television ......................................................

c. Radio.............................................................

d. Doctors..........................................................

e. Church ..........................................................

f. Newspapers or magazines ..............................

g. Friends ..........................................................

h. Parents or adult relatives ...............................

i. Sisters, brothers, or teenage relatives.............

10
k. Pamphlets or flyers ........................................ 11
l. Billboards ...................................................... 12
j. Boyfriend/girlfriend .......................................

m. Other (what?) ______________ ___ ..................

24

13

Please check

ONLY ONE BOX for each question.

11a. What do you think the chances are that you will get AIDS someday?

No chance
at all

Might
Happen

Very Likely
to happen

11b. What do you think the chances are that you will get a disease that you
can get from having sex?

No chance
at all

Might
Happen

Very Likely
to happen

11c. What do you think the chances are that you will get pregnant or get a
girl pregnant before you are 20?

No chance
at all

Might
Happen

Very Likely
to happen

Please check

the box that best describes what you would do.

Please think about how you would handle these situations. If youve
never had sexual intercourse, just tell us what you would do.
12a.

I would refuse to have sexual intercourse without a condom.

I definitely
would refuse

I probably
would refuse

I probably
would not

25

I definitely
would not

refuse

26

refuse

12b.

I would insist on using a condom even if my partner didnt want to.

I definitely
would insist

I probably
would insist

Please check

I probably
would not
insist

I definitely
would not
insist

the box that best describes how you feel

about using condoms.

13a. If the person I was about to have sex with suggested using a condom, I
would feel like that person cared about me.

I definitely
would

I probably
would

I probably
would not

I definitely
would not

13b. If the person I was about to have sex with suggested using a condom, I
would feel less worried.

I definitely
would

I probably
would

I probably
would not

I definitely
would not

13c. I would respect my partner if he or she suggested using a condom.

I definitely
would

I probably
would

I probably
would not

27

I definitely
would not

Remember, we would like all of you to answer these questions, whether

you have had sexual intercourse or not. If you have never had sexual
intercourse, tell us how you think you would feel.
Please check

the box that best describes how you feel.

14a. It would really bother me to stop having sexual intercourse to put on a

condom.

It definitely
would

It probably
would

It probably
would not

It definitely
would not

14b. Condoms would be too much trouble to use.

They definitely They probably

would
would

They probably They definitely

would not
would not

14c. It would not feel as good to use a condom during sexual intercourse.

It definitely
would not

14d.

It probably
would not

It probably
would

It definitely
would

I would be embarrassed to buy condoms.

I definitely
would

I probably
would

I probably
would not

28

I definitely
would not

Now wed like to know what you think is true about condoms. You
may have used them before or maybe not, but tell us what you think.

)RUHDFKVWDWHPHQWSOHDVHFKHFN WKHER[WKDWVKRZVZKDW\RXWKLQN
LVWUXH

15a.

Condoms break easily.

They
They
definitely do probably do

15b.

They probably They definitely

do not
do not

If you choose to have sexual intercourse, using condoms correctly is the

best way to prevent getting the AIDS virus and other diseases you can
get from having sex.

It definitely
is

15c.

It probably
is

It probably
is not

It definitely
is not

Condoms slip off easily.

They
definitely do

15d.

They
probably do

They probably They definitely

do not
do not

People who carry condoms have sex with a lot of people.

They
definitely do

They
probably do

They probably They definitely

do not
do not

29

30

Please check

the box that best describes what you would do

in these situations.

Think about the situation, then tell us what you would do.
If you have never had sexual intercourse, or if youre not planning to
have sexual intercourse right away, tell us what you think you would
do.

16a.

Im worried about catching AIDS so I would be sure to use a condom,

even in the heat of the moment.

I definitely
would

16b.

I probably
would

I probably
would not

If I didnt have a condom, I would have sexual intercourse anyway.

I definitely
would

16c.

I definitely
would not

I probably
would

I probably
would not

I definitely
would not

I would use a condom even if I were drunk or high.

I definitely
would

I probably
would

I probably
would not

31

I definitely
would not

 YouRe Almost DoNe!

32

These next questions help us to find out what young people IN

GENERAL are doing so we can know what to teach you about
health.
REMEMBER: nobody who knows you will see your answers!

17a.

Check YES or NO to tell us whether you have done the following things.

Have you ever

Yes
talked to a girl you like, if you're a boy?
talked to a boy you like, if you're a girl? ............................................. 1

No

Yes
Have you ever
gone out on a date?.............................................................................. 1

No

Yes
Have you ever
kissed a girlfriend on the lips, if you're a boy?
kissed a boyfriend on the lips, if you're a girl?.................................... 1

No

Have you ever

Yes
tongue kissed (French kissed)? ........................................................... 1

No

Yes

No

Have you ever

touched a girl's breasts, if you're a boy?

had your breasts touched, if you're a girl? ........................................... 1

Yes

Have you ever

touched a girl's vagina, if you're a boy?

touched a boy's penis, if you're a girl?................................................. 1
17b.

2
2
2
2

2
No

Have you ever had sexual intercourse? (By sexual intercourse, we mean putting a penis
in a vagina.) Please check ONLY ONE BOX.
1

Yes ................................. 1

No .................................. 2

33

17c.

Have you ever had oral sex? (By oral sex, we mean one persons mouth touching the
penis or vagina of another person.)
Please check ONLY ONE BOX.

17d.

Yes ................................. 1

No .................................. 2

Have you ever had anal sex? (By anal sex, we mean putting a boys penis in another
persons anus [butt].)
Please check ONLY ONE BOX.
Yes ................................. 1
No .................................. 2

17e.

Up to this time, I have chosen

not to have sexual intercourse.
Yes ................................. 1
No .................................. 2

34

18a.

18b.

If youve had sexual intercourse, how young were you the first time you had sexual
intercourse? (putting a penis in a vagina)
Please write your age at that time in the space below.
I have never had sexual intercourse

I was ____ years old the first time I had sexual intercourse.

If youve had sexual intercourse (putting a penis in a vagina), how many different people
have you had sexual intercourse with in your lifetime?
Please check ONLY ONE BOX.
I have never had sexual intercourse ..................

1 person..............................................................

2-3 people...........................................................

4-5 people...........................................................

6-7 people...........................................................

8-9 people...........................................................

10 or more people ..............................................

35

18c.

How often do you have sexual intercourse?

Please check ONLY ONE BOX.
I have never had sexual intercourse ........................

About once a month or less......................................

2-4 times a month.....................................................

Twice a week ...........................................................

3 times a week or more ............................................

18d. If youre a boy, how often do you use a condom (rubber) when you have sexual intercourse
(putting a penis in a vagina)? Or if youre a girl, how often does the guy use a condom
when you have sexual intercourse?
Please check ONLY ONE BOX.
I have never had sexual intercourse....................... 1
Always.................................................................... 2
More than half the time .......................................... 3
About half the time................................................. 4
Less than half the time............................................ 5
Never ...................................................................... 6
18e. Did you or the other person use a condom (rubber) the last time you had sexual intercourse?
Please check ONLY ONE BOX.
I have never had sexual intercourse .................. 1
Yes ..................................................................... 2

36

No....................................................................... 3

37

THESE QUESTIONS ARE ONLY ABOUT THE PAST 2 MONTHS.

19a.

In the past 2 months, how many times did you have sexual intercourse?
Please WRITE the number of times you've had sexual intercourse in the
space below.
If you have never had sexual intercourse, put a zero ("0") in the space.

I have had sexual intercourse _________ times in the last 2 months.

19b.

If youve had sexual intercourse in the last 2 months, how many times did you or your
partner use a condom (rubber)?

Please WRITE the number of times in the space below.

If you have never had sexual intercourse, put a zero ("0") in the space.

I / my partner have used a condom _________ times in the last 2 months.

19c. In the past 2 months, how many different people have you had sexual
with?

intercourse

Please check ONLY ONE BOX.

I have not had sexual intercourse in the past 2 months ................................................. 1
I have had sexual intercourse with one person in the past 2 months............................. 2
I have had sexual intercourse with 2 people in the past 2 months ................................ 3
I have had sexual intercourse with 3 people in the past 2 months ................................ 4
Ive had sexual intercourse with 4 or more people in the past 2 months ....................... 5

38

19d.

In the past 2 months, how often have you or your sex partner(s) used a condom when
you had sexual intercourse?
Please check ONLY ONE BOX.
I have not had sexual intercourse in the past 2 months .................... 1
Always............................................................................................... 2
More than half the time ..................................................................... 3
About half the time............................................................................ 4
Less than half the time....................................................................... 5
Never ................................................................................................. 6

20.

In the last 2 months, have you used any of the following methods to prevent pregnancy?
I havent had sexual intercourse in the last 2 months ....................... 0
IF YOU HAVENT HAD SEXUAL INTERCOURSE IN THE LAST 2 MONTHS,
LEAVE THESE BLANK!

Yes

Condoms .....................................................................................
Birth control pills ........................................................................
Spermicidal cream or jelly ..........................................................
Vaginal sponge ............................................................................
Diaphragm ...................................................................................
Withdrawal ("pulling out")..........................................................
Sexual intercourse with no method of birth control....................
21a.

No
1
1
1
1
1
1
1

2
2
2
2
2
2
2

If you have ever tried alcohol, how young were you when you had your first drink (not
just a sip or a taste )?
Please WRITE your age at that time in the space below.

I have never had more than a sip or taste of alcohol ........................ 1

I was _________ years old the first time I drank alcohol.

39

21b.

How often do you drink?

Please check ONLY ONE BOX.
I have never had more than a sip of alcohol .............................. 1
Only on religious occasions with my family.............................. 2
Ive tried it only once .................................................................. 3
Only a few times a year .............................................................. 4
Once or twice a month ............................................................... 5
Once or twice a week ................................................................. 6
3 times or more a week - but not every day................................ 7
Almost every day........................................................................ 8

21c.

How often do you get "really drunk" (Drink so much alcohol that you are out of
control)?
Please check ONLY ONE BOX.
I have never been really drunk ................................................. 1
Ive only been really drunk once............................................... 2
Only a few times a year ............................................................ 3
Once or twice a month ............................................................. 4
Once or twice a week ............................................................... 5
3 or more times a week - but not every day............................. 6
Almost every day...................................................................... 7

40

21d.

If you have ever drunk alcohol before having sexual intercourse, how often did you or
your partner use a condom after drinking?
Please check ONLY ONE BOX.

Always used a condom after drinking .........................................

Usually used a condom................................................................
Used a condom about half of the time.........................................
Usually didnt use a condom........................................................
Never used a condom after drinking ...........................................

I have never had sexual intercourse after drinking.....................

21e.

21f.

2
3
4
5
6

If you have ever tried marijuana, how young were you the first time you tried it?
Please write your age at that time in the space below.

I have never tried marijuana ..................................... 1

I was _________ years old the first time I used marijuana.

How often do you use marijuana?

Please check ONLY ONE BOX.

Ive tried marijuana only once ...............................................

Only a few times a year .........................................................
Once or twice a month ..........................................................
Once or twice a week ............................................................
3 times or more a week - but not every day...........................
Almost every day...................................................................

I have never tried marijuana.................................................

41

1
2
3
4
5
6
7

21g.

How often do you get "really high" or "really stoned" on marijuana (smoke so much
that you are out of control)?
Please check ONLY ONE BOX.
I have never tried marijuana............................................................. 1
Ive only been really high once .......................................................... 2
Only a few times a year ..................................................................... 3
Once or twice a month ...................................................................... 4
Once or twice a week ........................................................................ 5
3 times or more a week - but not every day....................................... 6
Almost every day............................................................................... 7

21h.

If you have ever smoked marijuana before having sexual intercourse, how often did
you or your partner use a condom after smoking?
Please check ONLY ONE BOX.

Always used a condom after smoking marijuana........................

Usually used a condom................................................................
Used a condom about half of the time.........................................
Usually didnt use a condom........................................................
Never used a condom after smoking marijuana ..........................

I have never had sex after smoking marijuana............................

42

1
2
3
4
5
6

How old are THE BOYS OR GIRLS ARE THAT YOU GO OUT WITH ?

22a. Please check

ONLY ONE BOX below.

Ive never gone out with anyone..............................

Younger than me by 3 or more years ......................

A little younger than me (1-2 years)........................

My age ...................................................................

A little older than me (1-2 years) ............................

Older than me by 3 or more years ..........................

How old are most of your FRIENDS ?

22b. Please check

ONLY ONE BOX below.

Younger than me by 3 or more years ......................

A little younger than me (1-2 years)........................

My age ...................................................................

A little older than me (1-2 years) ............................

Older than me by 3 or more years ..........................

43

Please check the box which shows how you feel about each
statement AT THIS MOMENT.

23a. I feel that I can change what will happen tomorrow by what I do today.

Completely
True

Somewhat
True

Not
True

23b. I believe most of what happens in life is just meant to happen.

Completely
True

Somewhat
True

44

Not
True

 You finished!
Fantastic!

Thank

you for your help!

(April 11, 2003)

45