Evaluation of the "Yes You Can... Make Smart Choices!" Curriculum
Phase: NA
Conditions: Pregnancy in Adolescence, Adolescent Health
Sponsor: New Jersey Physicians Advisory Group

 
 
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COVER PAGE 
 
 
 
 
 
 
 
 
 
NJPAG PREIS STUDY PROTOCOL 
 
Protocol ID: NJPAG12131922E 
 
ClinicalTrials.Gov ID: NCT05320666 
 
May 30th, 2023 
 
 

 
 
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Table of Contents 
Introduction ............................................................................................................................................................. 4 
Intervention Activities ........................................................................................................................................ 4 
Logic Model ........................................................................................................................................................ 5 
Target Population ................................................................................................................................................ 6 
Impact Evaluation ................................................................................................................................................... 6 
Impact Evaluation Overview .............................................................................................................................. 6 
Research Questions ......................................................................................................................................... 6 
Study Registration ........................................................................................................................................... 8 
Conflicts of Interest......................................................................................................................................... 8 
Treatment and Comparison Conditions .............................................................................................................. 8 
Treatment Condition ....................................................................................................................................... 8 
Control/Comparison Condition ....................................................................................................................... 8 
Sample Identification, Selection, and Retention ................................................................................................. 8 
Anticipated Sample Size ................................................................................................................................. 8 
Identification and selection of clusters (if applicable) .................................................................................... 9 
Identification and selection of individuals ...................................................................................................... 9 
Tracking and Retention of Individuals ......................................................................................................... 10 
Data Collection ................................................................................................................................................. 10 
Data Collection Plan ..................................................................................................................................... 10 
Specific Measures, Tools, and Instruments .................................................................................................. 14 
Anticipated Challenges ................................................................................................................................. 16 
Data Sharing/ Data Use Agreements ............................................................................................................ 16 
Analysis............................................................................................................................................................. 16 
Analysis Plan ................................................................................................................................................ 16 
Contrasts ........................................................................................................................................................... 17 
Subgroups (optional) ..................................................................................................................................... 17 
Minimum Detectable Effect for Planned Sample ......................................................................................... 17 
Timeline ............................................................................................................................................................ 18 
Approvals and Data Security ................................................................................................................................ 19 
Plan for IRB Approval ...................................................................................................................................... 19 
Plan for federal Wide Assurance ...................................................................................................................... 19 
Data Security & Privacy ................................................................................................................................... 19 
Evaluation Roles and Responsibilities .............................................................................................................. 20 
Appendix A. Logic Model .................................................................................................................................... 21 
Appendix B. Contrast Table ................................................................................................................................. 22 
Appendix C: Parental Written Notice ................................................................................................................... 28 
Appendix D: Enrollment Form ............................................................................................................................. 30 
Appendix E: Survey .............................................................................................................................................. 31 
YOUTH ASSENT FORM ................................................................................................................................ 31 
DEMOGRAPHICS ........................................................................................................................................... 39 
PROGRAM SATISFACTION QUESTIONS .................................................................................................. 40 
COMMUNICATION SKILLS ......................................................................................................................... 40 
DATING CHOICES ......................................................................................................................................... 41 
AWARENESS OF RELATIONSHIP SAFETY .............................................................................................. 42 
KNOWLEDGE OF SEXUAL RISKS .............................................................................................................. 43 
SKILLS TO RESIST PRESSURE (COERCION) TO HAVE SEX ................................................................ 44 
SEXUAL INTIMACY SPECTRUM ................................................................................................................ 45 
SEXUAL INITIATION .................................................................................................................................... 46 
INTENTIONS TO ENGAGE IN SEXUAL INTERCOURSE ........................................................................ 47 

 
 
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INTENT TO CONSISTENTLY USE CONDOMS ......................................................................................... 47 
CONDOM & CONTRACEPTIVE USAGE .................................................................................................... 48 
GOAL ATTAINMENT .................................................................................................................................... 49 
FINANCIAL LITERACY ................................................................................................................................ 49 
END OF SURVEY ........................................................................................................................................... 50 
 
 
 

 
 
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Introduction 
 
 
The New Jersey Physicians Advisory Group (NJPAG) previously created the Yes You Can…Make Smart 
Choices! (YYC…MSC!) program with the goal of preventing teen pregnancy and enhancing character 
development in youth. YYC…MSC! is a fully developed intervention that NJPAG has experience 
implementing that is grounded in a theoretical framework with promising evidence of effectiveness. 
However, this intervention has not yet undergone a rigorous evaluation with a control or comparison group. 
This evaluation aims to conduct a randomized control trial (RCT) to determine the program's effectiveness. 
This evaluation will focus on the entire PREIS planned intervention, YYC…MSC!. The intervention will be 
implemented in 10 Newark Public Schools in New Jersey, including Weequahic High School and Newark 
School of Global Studies. Findings from this study will expand the evidence base on adolescent pregnancy 
prevention through this innovative program. After the study, findings will be disseminated to encourage 
program interest, support, and adoption in real-world service systems or communities, including schools. 
Intervention Activities 
 
 
The YYC…MSC! is an 11-lesson curriculum that will be delivered to 9th graders in Newark, New Jersey 
public schools during 40-minute health classes (see Table 1 for content covered in each lesson). The 
curriculum will be delivered in-person over approximately 2 weeks by NJPAG educators. The goal of the 
program is to prevent teen pregnancy and enhance character development in youth. The PREIS funding is 
supporting the implementation and evaluation of the program. Each time an NJPAG educator is in the 
classroom, they will deliver a single lesson of the curriculum. All NJPAG educators have received internal 
training for the program; their training includes: (1) studying the curriculum and completing 
activity/learning pages, (2) practicing teaching to other educator in a mock classroom setting, followed by 
feedback from the team, (3) observing a seasoned educator teaching the curriculum in its entirety, (4) co-
teach the curriculum with a seasoned educator, and (5) teaching on their own, with observation. 
YYC…MSC! is delivered like a traditional classroom curriculum, including lectures and activities, meaning 
all students in a given classroom will receive the lectures concurrently. The intervention addresses the 
following adult preparation subjects: parent-child communication, healthy relationships, healthy life skills, 
adolescent development, and financial literacy. 
 
Table 1. YYC…MSC! Curriculum Lesson Goals 
Lesson 
Goal 
Lesson 1: Truth, Dare, 
or Consequences? 
Students will understand the influences and consequences of sexual activity.  
Lesson 2: Dare To Be 
You 
Students will understand how others influence their character development 
and decision-making.  
Lesson 3: Intimacy 
Students will understand intimacy and when to be intimate in relationships. 
Lesson 4: Relationship 
Health Part 1 
Students will begin to understand what love is and how to have healthy 
relationships.  
Lesson 5: Relationship 
Health Part 2 
Students will continue to understand what love is and know the difference 
between a healthy and unhealthy relationship. 

 
 
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Lesson 6: Pregnancy 
Students will understand pregnancy, how to prevent it, and the consequences 
of teen pregnancy. 
Lesson 7: Finances and 
Future Planning 
Students will understand the basics of financial literacy and creating financial 
goals.  
Lesson 8: Avoiding 
Risk 
Students will understand HIV/AIDs, STDs/STIs, unintended pregnancy, and 
how to prevent them. 
Lesson 9: What Are We 
Waiting For? 
Students will understand the benefits of refraining from sexual activity. 
Lesson 10: Establishing 
Healthy Boundaries 
Students will understand personal boundaries and how to resist and refuse 
sexual activity. 
Lesson 11: Effective 
Communication 
Students will understand and obtain skills for effective communication, 
including with parents/guardians.  
 
Logic Model 
 
 
See Appendix A for the intervention logic model. Since its inception in 2004, NJPAG has been a non-profit 
in New Jersey with the goal of addressing the societal problems of teen pregnancy, teen STDs/STIs, and 
single-parent teen families. To meet this goal, NJPAG has created various curricula to educate youth in New 
Jersey and beyond, including the YYC…MSC! curriculum for this intervention. NJPAG has a positive, 
existing relationship with the Newark Public Schools (NPS) Board of Education. As a result of this 
relationship, NJPAG has the approval to provide the intervention as part of all NPS's 9th-grade health 
classes. Schools with potentially high rates of language barriers were eliminated because the program is 
only taught in English. After eliminating schools with potentially high rates of language barriers, 10 NPS 
schools were selected to participate in the evaluation, five control schools, and five treatment schools.  
 
Internally, NJPAG has a Board of Directors, Executive Director, Program Director, and educators. After 
receiving training, NJPAG educators will go into Newark public high schools to build rapport with the 
school's teachers, staff, and students and explain the intervention and related processes. Once rapport is 
built, NJPAG will go to classes and disseminate the written notice form for youth to bring home to parents 
to inform parents of the program their child/student will receive and give the parents the option to opt their 
child/student out of the evaluation. Two weeks after the written notice is disseminated, an Educator will go 
back to the classroom and collect any forms returned by parents who opted their child out of the evaluation. 
Upon receiving opt-outs, an educator will facilitate the pre-survey. The following school day after the pre-
survey, the educator will go back to the classroom to begin program delivery, starting with lesson 1 and 
subsequently teaching a lesson every time they go to the classroom. Each lesson addresses a different topic 
related to pregnancy prevention and has lesson goals (see Table 1). 
 
We expect all lessons to work together to achieve the program goal. For intermediate outcomes, we expect 
that treatment school youth, e.g., those that receive the intervention, will report an increase in pregnancy 
prevention knowledge, skills, and confidence and a decrease in activity that could lead to unwanted 
pregnancy. We believe this intervention will impact youth who received the program long-term by 
improving life skills, such as emotional coping and sexual, cognitive, and social health, decreasing 
incidences of unwanted pregnancy, decreasing incidences of STIs, and enhancing character development.  

 
 
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Target Population 
 
NJPAG has been serving New Jersey public schools for almost two decades. Recently, NJPAG was approved to 
provide sex education programming to 9th-grade health class students in NPS by the Newark Board of 
Education.  
 
The target population is youth in 9th grade in urban school districts in the Northeast region without any severe 
cognitive, mental, or behavioral impairments. 
 
The total population of youth who would receive the intervention is approximately 2,000 students. The average 
expected age of participants is 14. Consistent with the NPS district student population race/ethnicity breakdown, 
the expected race/ethnicity breakdown of participants is as follows: Black (38.8%), Hispanic (51.0%), White 
(8.4%),  Asian (< 1%), Native Hawaiian/ Pacific Islander (< 1%), American Indian (< 1%), Unspecified (< 1%).   
 
Impact Evaluation 
 
This study will utilize an RCT design, in which randomization is done at the school level. Ten NPS schools are 
participating in the evaluation, indicating five treatment and five control schools.  
 
Impact Evaluation Overview 
 
Research Questions 
 
The intervention being tested is the YYC…MSC! program and the target population are youth in 9th grade in 
urban school districts in the Northeast region without any severe cognitive, mental, or behavioral impairments. 
The counterfactual condition is business as usual for control schools. The intervention occurs over 11 
consecutive school days in health classes.  
The primary research question is, “What is the effect of the 2-week YYC…MSC! program on 9th grade 
students in Northeast urban school districts’ reports of engaging in sexual intercourse 12-months after the pre-
survey compared to those that do not receive the program?” The outcome for the primary research questions is 
sexual intercourse in the last 3 months and the domain is sexual activity. 
There are 12 secondary research questions; including (1) What is the effect of the 2-week YYC…MSC! 
program on 9th grade students in Northeast urban school districts’ reports of engaging in oral sex compared to 
those that do not receive the program?  [domain: sexual activity, outcome: oral sex], (2) What is the effect of the 
2-week YYC…MSC! program on 9th grade students in Northeast urban school districts’ reports of intent to 
engage in sexual activity compared to those that do not receive the program? [domain: intent to engage in 
sexual activity, outcome: intent to engage in sexual activity], (3) What is the effect of the 2-week YYC…MSC! 
program on 9th grade students in Northeast urban school districts’ reports intent to consistently use 
contraception compared to those that do not receive the program? [domain: sexual risk avoidance intent, 
outcome: consistent contraception use], (4) What is the effect of the 2-week YYC…MSC! program on 9th 
grade students in Northeast urban school districts’ reports of having unprotected sex compared to those that do 
not receive the program?  [domain: sexual risk avoidance, outcome: unprotected sex], (5) What is the effect of 
the 2-week YYC…MSC! program on 9th grade students in Northeast urban school districts’ reports of 

 
 
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increased financial literacy compared to those that do not receive the program?” [domain: life skills, outcome: 
financial literacy], (6) What is the effect of the 2-week YYC…MSC! program on 9th grade students in 
Northeast urban school districts’ knowledge of HIV/STDs/STIs compared to those that do not receive the 
program?  [domain: sexual health knowledge, outcome: knowledge of HIV/STIs/STDs], (7) What is the effect 
of the 2-week YYC…MSC! program on 9th grade students in Northeast urban school districts’ reports of their 
ability to resist negative pressures to have sex compared to those that do not receive the program? [domain: 
sexual risk avoidance skills, outcome: skills to resist pressure], (8) What is the effect of the 2-week 
YYC…MSC! program on 9th grade students in Northeast urban school districts’ reports of future orientation 
and setting life goals compared to those that do not receive the program? [domain: life skills, outcome: goal 
setting], (9) What is the effect of the 2-week YYC…MSC! program on 9th grade students in Northeast urban 
school districts’ reports of healthy life skills compared to those that do not receive the program? [domain: life 
skills, outcome: healthy life skills], (10) What is the effect of the 2-week YYC…MSC! program on 9th grade 
students in Northeast urban school districts’ knowledge of healthy relationships compared to those that do not 
receive the program? [domain: life skills, outcome: healthy relationships], (11) What is the effect of the 2-week 
YYC…MSC! program on 9th grade students in Northeast urban school districts’ increased communication 
skills compared to those that do not receive the program?  [domain: life skills, outcome: communication], and 
(12) What is the effect of the 2-week YYC…MSC! program on 9th grade students in Northeast urban school 
districts’ engaging in sexual intercourse 3-months after the pre-survey? [domain: sexual activity, outcome: 
sexual intercourse in the last 3-months]. 
Research Question / Hypothesis 
Primary 
 or 
Secondary? 
Domain 
Outcome 
What is the effect of the 2-week 
YYC…MSC! program on 9th grade 
students in Northeast urban school 
districts’ reports of …that do not 
receive the program? 
 
 
 
RQ 0.… engaging in sexual 
intercourse 12-months after the pre-
survey? 
Primary 
Sexual Activity 
Sexual Intercourse in 
the last 3-months 
RQ 1.… engaging in oral sex? 
Secondary 
Sexual Activity 
Oral sex 
RQ 2. …intent to engage in sexual 
activity? 
Secondary 
Intent to Engage in Sexual 
Activity 
Intent to Engage in 
Sexual Activity 
RQ 3.… their intent to consistently 
use contraception? 
Secondary 
Sexual Risk Avoidance 
Intent 
Consistent 
Contraception Use 
RQ 4.… having unprotected sex? 
Secondary 
Sexual Risk Avoidance 
Unprotected Sex 
RQ 5.… increased financial 
literacy?  
Secondary 
Life Skills 
Financial Literacy 
RQ 6.… knowledge of HIV/ 
STDs/STIs? 
Secondary 
Sexual Health Knowledge Knowledge of 
HIV/STI/STDs 
RQ 7.… their ability to resist 
negative pressure to have sex? 
Secondary 
Sexual Risk Avoidance 
Skills 
Skills to Resist 
Pressure 
RQ 8.… future orientation and 
setting life goals? 
Secondary 
Life Skills  
Goal Setting 
RQ 9.… healthy life skills? 
Secondary 
Life Skills 
 
Healthy Life Skills 

 
 
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RQ 10.… knowledge of healthy 
relationships? 
Secondary 
Life Skills 
Healthy Relationships 
RQ 11.… communication skills? 
Secondary 
Life Skills 
Communication 
RQ 12 …. engaging in sexual 
intercourse 3-months after the pre-
survey? 
Secondary 
Sexual Activity 
Sexual Intercourse in 
the last 3-months 
 
Study Registration 
The evaluation will be registered at clinicaltrials.gov.  
 
Conflicts of Interest 
 
There are no conflicts of interest. 
Treatment and Comparison Conditions 
 
Treatment Condition 
 
The intervention/treatment participants in the treatment condition will be exposed to NJPAG's YYC…MSC! 
program. The program is designed to be delivered five days a week for two weeks and contains 11 lessons (see 
Table 1 for lessons and goals). 
Control/Comparison Condition 
 
The control schools were randomly selected out of a list of eligible schools (a total of 10) in the Newark Public 
School system. Control schools will receive their health class as "business-as-usual" with no additional 
programming. There is no other place that provides the YYC…MSC! program in which participants could 
receive programming or information. Also, there are no future plans to provide the control group with the 
intervention. To our knowledge, there is no other similar programming operating in the Newark Public School 
area. 
 
Sample Identification, Selection, and Retention 
 
The YYC… MSC! program is approved as the Newark Board of Education sexual education curriculum. All 9th 
graders in the ten selected NPS schools will be asked to participate in the evaluation. Newark public schools 
with a high percentage of English Language Learners (ELL) students since the program is only provided in 
English. Participants will be identified by being in a school that is randomly assigned to be a treatment school. 
Ninth graders in participating NPS treatment schools will receive the YYC…MSC! program.   
Program attrition is predicted to be minimal, given it is a school-based program. However, attrition is likely for 
students who move out of the district or to another school within the district. To try to reach students that move, 
we are collecting contact information (phone number and personal email address) on our enrollment form. 
Cluster-level attrition is predicted to be unlikely given the rapport NJPAG has previously built with the Newark 
Public Schools individually and as a district.  
 
Anticipated Sample Size 
 

 
 
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We currently have ten public schools that are engaged in this study, five that will be randomly assigned to 
the treatment group and five that will be randomly assigned to the control group. On average, there are four 
health classes in each school, each of which has approximately 25 students. Therefore, each year we will 
enroll approximately 1,000 students in the study (25 x 4 x 10 = 1,000); 500 in the treatment group and 500 
in the control group. Unless we are able to recruit more schools (we are currently having conversations with 
several charter schools in the Newark School District), we anticipate having to run the study for two full 
years, in order to meet the sample size requirements needed to achieve adequate power. We will then have 
2,000 students enrolled in the study (1,000 in the treatment group and 1,000 in the control group). 
 
Identification and selection of clusters (if applicable) 
 
The 10 eligible Newark Public Schools were selected as clusters. There is only one exclusionary criterion for 
schools, and that is a high percentage of ELL students because the program is only offered in English. Given the 
buy-in from the Newark Board of Education, recruiting schools is not anticipated to be a problem. NJPAG has 
started building rapport with the department chairs at each of the participating schools and providing a $1,000 
incentive for their cooperation. The level of randomization is at the school-level, meaning we will randomly 
assign each of the 10 schools to either treatment or control. Random assignment will be conducted using a 
random number generator from 0-1 in Excel. After generating random numbers, the ten schools will be ordered 
based on their number assignment and the five with the smallest number will be assigned control and the five 
with the highest number will be assigned treatment. All students included in the impact analysis will be students 
of the participating schools prior to random assignment. Students will be notified of their schools’ random 
assignment after the parental written notice is distributed and enrollment is completed. 
 
Identification and selection of individuals 
 
Youth served and recruited will be limited to 9th graders from health classrooms at the NPS sites participating in 
this program who do not have severe cognitive, mental, or behavioral impairments. Students with an Individual 
Education Plan (IEP) who are in a restricted placement due to such issues will not be able to participate in the 
program as they will not be a part of the mainstream classrooms where the program will take place. Students 
with an IEP who are placed in regular classroom settings (i.e., mainstreamed) will be included in the program.  
 
New Jersey law only requires passive parental consent to be obtained, using a written notice about the 
evaluation provided to students to bring home with an option for parents to sign the notice to opt their 
child/student out of the evaluation. If parents wish to opt their child/student out of the evaluation, the child will 
still receive the program because it is the Newark Board of Education-approved sexual education curriculum 
treatment group health classes. When the Educator goes back to the classroom to pre-survey, they will collect 
any 'opt-out' notices and survey only those students whose parents have not elected to 'opt-out' their child. 
 
Ineligible students include students with IEP who are in a restricted placement and students that bring back 'opt-
out' written notices. Since we are using the same form for treatment and control schools (making it unclear to 
parents what group their child is in), we do not expect differences in opt-out rates between treatment and control 
schools. 
 
Given NJPAG’s relationship with the Newark Board of Education, recruitment of schools is not expected to be 
challenging. NJPAG will contact each of the eligible schools to communicate about the program, program 
delivery, and the timeline. Schools will be randomized and maintain their randomization category for the 
entirety of the evaluation for pragmatic reasons (e.g., NJPAG-school communication, building rapport, etc.). 
After randomization, NJPAG Educators will go into schools to tell the students about the evaluation. Students at 
this time will not know if they are receiving the program. Following that, students are told to bring home the 

 
 
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written notice and provide it to their parents for the option to opt out of the evaluation. Additionally, health 
class teachers are given an incentive ($25 gift card) per participating health class to show the program's 
appreciation for their cooperation For each school, the timeline goes as follows: Educator goes into school and 
health classes to disseminate the written notice for youth to bring home to their parents, the Educator comes 
back 2 weeks later to pre-survey all participating youth, the next school day the Educator comes back to start 
the program and consistently teaches a lesson for the next 11 school days, the next school day a different 
Educator goes into the school health classes to collect post-survey data, 3-months after the pre-survey date a 
different Educator goes into the school health classes to collect follow-up data, and 12-months after the pre-
survey date a different Educator goes into the school health classes to collect follow-up data.  
 
For the current study, no program enrollment is necessary because the NPS Board of Education approved the 
YYC…MSC! program as a designated sexual health curriculum for 9th graders. Therefore, all students in NPS 
treatment sites will be automatically enrolled in the program; but parents can opt their child out of the 
evaluation. Evaluation enrollment will be obtained via parental opt-out forms.  
 
The process for each cohort is the following: NJPAG Educator goes into school, tells youth about the program 
and evaluation, and disseminates parental written notices. 
(1) Educators collect any 'opt-out' notices that were returned. 
(2) All participating students take the pre-survey. 
(3)  Students receive full YYC…MSC! Programming. 
(4) All participating students take the post-survey. 
Follow-Up 
(5) Participating students take a follow-up survey 3-months after the pre-survey date. 
(6) Participating students take a follow-up survey 12 months after the pre-survey date.  
 
Tracking and Retention of Individuals  
 
Because the YYC…MSC! program was approved by the Newark Board of Education as a sex education 
program for NPS 9th graders required health classes; program dosage and attendance will be consistent with 
students' health class attendance. For follow-up data collection, NJPAG Educators will go back into the school 
building and pull participating students from their classes to participate in follow-up surveys. If a given 
participant is not there when the NJPAG Educator goes back to the school to collect follow-up data, we will 
communicate with the school district contact to attempt to locate the participating students to survey them at 
their new school. If a participating student moves out of the Newark school district, we will contact them via 
phone or email and ask them to participate in the survey. The anticipated response rate for each round of data 
collection is as follows: pre-survey (95%), post-survey (85%), three months (80%), and 12 months (70%). 
Participating students will receive $0 for completing the pre-survey, $20 after completing the post-survey, $30 
after completing the 3-month follow-up survey, and $40 after completing the 12-month follow-up survey. 
Data Collection 
 
Data Collection Plan 
 
Participants in the treatment group will be determined to have completed their engagement in the intervention if 
they received 80% of the program lessons (e.g., 9 out of 11). The data collection window for each time point is 
two weeks. The data collection window will be managed by reviewing participants' timestamp (e.g., the time 
and date they started the survey) on their survey completion. There are no costs associated with measures 
because they were all created for this project specifically. 

 
 
11 
The timing of data collection for the pre-survey is before the first lesson is administered, approximately 2 weeks 
after disbursing the written notice for students to bring home to their parents. The post-survey is collected 
immediately following the completion of the program. The 3-month follow-up survey is collected 3-months 
from the pre-survey date. The 12-month follow-up is collected 12-months from pre-survey. 
Corresponding survey questions for all research questions will be collected at all timepoints. In the below table, 
data collection times in which the data will be collected but not analyzed is characterized by a black X. Orange 
Xs in the below table represent the timepoint in which we will analyze the data for the research question.  
Note: The following are constants in the below table for each research question: 
 
Data source (and measures): Self-report surveys by student participants 
 
Sample: All treatment and control group participants 
 
Party responsible for data collection: NJPAG educators 
 
Data collection method: Electronic surveys via Alchemer 
 
Impact research question 
Data Collection Timing 
Pre-
Survey/ 
Baseline 
Post-Survey 
3-Month 
After Pre-
Survey  
12-Month 
After Pre-
Survey 
RQ 0 – Primary: 
What is the effect of the 2-week YYC…MSC! 
program on 9th grade students in Northeast 
urban school districts’ reports of engaging in 
sexual intercourse 12-months after the pre-
survey compared to those that do not receive the 
program? 
X 
X 
X 
X 
RQ 1 – Secondary:  
What is the effect of the 2-week YYC…MSC! 
program on 9th grade students in Northeast 
urban school districts’ reports of engaging in 
oral sex compared to those that do not receive 
the program?   
X 
X 
X 
X 
RQ 2 – Secondary:  
What is the effect of the 2-week YYC…MSC! 
program on 9th grade students in Northeast 
urban school districts’ reports of intent to engage 
in sexual activity compared to those that do not 
receive the program? 
X 
X 
X 
X 
RQ 3 – Secondary:  
What is the effect of the 2-week YYC…MSC! 
program on 9th grade students in Northeast 
urban school districts’ reports intent to 
consistently use contraception compared to those 
that do not receive the program? 
X 
X 
X 
X 

 
 
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Impact research question 
Data Collection Timing 
Pre-
Survey/ 
Baseline 
Post-Survey 
3-Month 
After Pre-
Survey  
12-Month 
After Pre-
Survey 
RQ 4 – Secondary:  
What is the effect of the 2-week YYC…MSC! 
program on 9th grade students in Northeast 
urban school districts’ reports of having 
unprotected sex compared to those that do not 
receive the program?   
X 
X 
X 
X 
RQ 5 – Secondary:  
What is the effect of the 2-week YYC…MSC! 
program on 9th grade students in Northeast 
urban school districts’ increased financial 
literacy compared to those that do not receive 
the program?  
X 
X 
X 
X 
RQ 6 – Secondary:  
What is the effect of the 2-week YYC…MSC! 
program on 9th grade students in Northeast 
urban school districts’ knowledge of 
HIV/STDs/STIs compared to those that do not 
receive the program?   
X 
X 
X 
X 
RQ 7 – Secondary:  
What is the effect of the 2-week YYC…MSC! 
program on 9th grade students in Northeast 
urban school districts’ reports of their ability to 
resist negative pressures to have sex compared to 
those that do not receive the program?  
X 
X 
X 
X 
RQ 8 – Secondary:  
What is the effect of the 2-week YYC…MSC! 
program on 9th grade students in Northeast 
urban school districts’ reports of future 
orientation and setting life goals compared to 
those that do not receive the program?  
X 
X 
X 
X 
RQ 9 – Secondary:  
What is the effect of the 2-week YYC…MSC! 
program on 9th grade students in Northeast 
urban school districts’ reports of healthy life 
skills compared to those that do not receive the 
program?  
X 
X 
X 
X 
RQ 10 – Secondary:  
What is the effect of the 2-week YYC…MSC! 
program on 9th grade students in Northeast 
urban school districts’ knowledge of healthy 
relationships compared to those that do not 
receive the program? 
X 
X 
X 
X 

 
 
13 
Impact research question 
Data Collection Timing 
Pre-
Survey/ 
Baseline 
Post-Survey 
3-Month 
After Pre-
Survey  
12-Month 
After Pre-
Survey 
RQ 11 – Secondary:  
What is the effect of the 2-week YYC…MSC! 
program on 9th grade students in Northeast 
urban school districts’ increased communication 
skills compared to those that do not receive the 
program?   
X 
X 
X 
X 
RQ 12 – Secondary:  
What is the effect of the 2-week YYC…MSC! 
program on 9th grade students in Northeast 
urban school districts’ engaging in sexual 
intercourse 3-months after the pre-survey? 
X 
X 
X 
X 
 
 
 

 
 
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Specific Measures, Tools, and Instruments 
  
Domain 
Outcome 
Measure 
Rationale for Selection 
Sexual 
Activity 
Sexual 
Intercourse in 
the last 3-
months 
1-item measure asking participants how 
many times they engaged in sexual 
intercourse in the past 3-months recoded to 
a dummy variable (1 = had sex in the last 3-
months, 0 = did not have sex in the last 3-
months) 
Reducing sexual intercourse 
rates in youth, to, in turn, 
reduce teen pregnancy, is the 
primary goal of this 
intervention.  
Sexual 
Activity 
Oral sex  
8-item Sexual Intimacy Spectrum scale with 
a 5-point frequency scale 
 
Two 1-item measures asking participants if 
they ever engaged in oral sex if so, how 
many times have they done it in the past 3-
months 
Following the success 
sequence, the program 
teaches youth that engaging 
in sexual activity before they 
are ready and have hit life 
milestones can have 
unwanted consequences. 
Intent to 
Engage in 
Sexual 
Activity 
Intent to 
Engage in 
Sexual Activity 
8-item Sexual Initiation scale with a 5-point 
success sequence response scale 
 
5-item Intentions to Engage in Sexual 
Intercourse scale with a 6-point Agree scale 
Following the success 
sequence, the program 
teaches youth that engaging 
in sexual activity before they 
are ready and have hit life 
milestones can have 
unwanted consequences.  
Sexual Risk 
Avoidance 
Intent 
Consistent 
Contraceptive 
Use 
 
Two 1-item measures asking: 
"If you have sexual intercourse tomorrow, 
will you make sure a condom is used?" & 
"If you have sexual intercourse tomorrow, 
will you make sure birth control is used?" 
 
Both questions use the same 5-point 
response scale: “Yes; No; Only if my 
partner agrees; I don't know/I'm not sure; 
This question does not apply to me because 
I do not plan to have sexual intercourse 
soon” 
Contraceptive use is 
important because the 
intervention teaches youth 
about pregnancy prevention.  
 
It is important to assess all 
students' intention to use 
contraception if they have 
sexual intercourse because 
the program is a pregnancy 
prevention program. 
Sexual Risk 
Avoidance 
Unprotected 
Sex 
Four 1-item measures asking if youth or 
their partner have used the following 
methods in the last month and what they 
intend to use in the future: condoms, pull-
out method, birth control, other 
contraceptives 
 
If youth indicate that they have engaged in 
sexual intercourse at some time in the last 3-
months, they will respond to two 1-item 
It is important to assess all 
student's rates of unprotected 
sex because the program is a 
pregnancy prevention 
program. 

 
 
15 
measures & one 2-item measure asking if 
they have used conceptive during sexual 
intercourse 
 
In the past 3 months (90 days), how many 
times did you or your partner use a condom 
when engaging in sexual intercourse? 
Response: 0-10+ 
 
In the past 3 months (90 days), how many 
times did you or your partner use the pull-
out method when engaging in sexual 
intercourse?  
Response:  0-10+ 
 Or I don't know what this is. 
 
In the past 3 months, have you or your 
partner used either of the following methods 
to prevent pregnancy: 
1. Birth control pills 
2. Other forms of contraceptive 
methods, not including a condom 
(e.g., shot, patch, IUD, etc.).  
Response options: Yes, No, Unsure 
 
Life Skills 
Financial 
Literacy  
6-item Financial Literacy scale – 3 items are 
true/false, and the other 3 are strongly 
disagree-strongly agree 
Financial literacy is a lesson 
in the YYC…MSC! program. 
Sexual 
Health 
Knowledge 
Knowledge of 
HIV/ 
STDs/STIs 
7-item Knowledge of Sexual Risks scale 
with True/False/Unsure response scale 
The intervention teaches a 
lesson on HIV/STD/ STIs 
and how to prevent them. 
Sexual Risk 
Avoidance 
Skills 
 
Skills to Resist 
Pressure 
6-item Skills to Resist Pressure (Coercion) 
to Have Sex scale with a 5-point Confidence 
response scale 
There are multiple lessons in 
the intervention that teach 
participants about negotiating 
sexual risk avoidance and not 
falling for pressures to have 
sex. 
Life Skills 
Goal Setting 
5-item Goal Attainment scale with a 6-point 
Agree response scale 
In addition to pregnancy 
prevention, the program 
encourages and teaches youth 
to think about their life goals 
and how, if they were to get 
pregnant, that could 
negatively impact their goals.  
Life Skills 
Healthy Life 
Skills 
Combination of all scales except Financial 
Literacy  
An overall theme of the 
intervention is increasing 
healthy life skills (e.g., 

 
 
16 
emotional, cognitive, and 
social) for youth.  
Life Skills 
Healthy 
Relationships 
6-item Awareness of Relationship Safety 
scale with a 6-point strongly disagree-
strongly agree response scale 
 
7-item Dating Choices scale with a 4-point 
Likelihood response scale 
The intervention teaches 
youth about healthy 
relationships for their age and 
when to know if they are in 
an unhealthy relationship. 
Life Skills 
Communication  7-item Communication Scale with a 5-point 
Confidence scale 
The intervention teaches 
youth communication skills.  
Note: The following are constant for all outcomes: 
 
Intended participants: Student participants 
Psychometric Information: All scales will go through reliability testing using pilot study data. 
Citations: N/A – All measures were adapted or created specifically for this project. Scales that were 
adapted for this project were adapted from AMTC created and unpublished scales for other AMTC 
clients. Validity and reliability will be conducted after data collection.  
 
Anticipated Challenges 
 
All data is self-report through surveys; however, sexual behavioral questions may make youth uncomfortable, 
so we predict that this data may be most challenging to collect. To mitigate this, we have ordered the survey to 
go from the least uncomfortable topics to the most uncomfortable topics in hopes of " building up" to the most 
uncomfortable topics. Another anticipated challenge is following up with students for the follow-up surveys, the 
current strategies for this include (1) going back to the schools to survey youth, so if they are in attendance at 
school, they will take the survey, and if the students no longer attend that school or are not present on follow-up 
survey dates (2) we have collected their phone number and email to send them a link to the survey to complete 
the survey. Most participating youth will be surveyed as a group when Educators go back to classrooms; 
however, youth that has left the district will be contacted via email and/or phone to find a way to provide them 
with a survey link that they can complete within the two- week survey completion window. Youth that receive 
the survey via email will receive reminder emails to complete the survey. 
 
Data Sharing/ Data Use Agreements 
 
N/A – there are no data/sharing agreements for the project. 
 
Analysis 
 
Analysis Plan 
 
All analyses will be conducted using SPSS. Outliers will be identified as three standard deviations above the 
mean and removed from the data. When appropriate, missing data will be handled by using mean imputation. 
This will only occur when feasible. For example, if participants have skipped over a subset of items on a 
particular measurement scale, we can use mean imputation for their missing data. However, we will be unable 
to use mean imputation for behavioral outcomes that are only measured by a single item. Participant data will 

 
 
17 
be utilized for analyses if they completed 75% of scale items within a given scale. We will use categorial data 
analysis, such as logistic regression, to analyze  any outcomes that are measured using a single item. We will 
use multiple regression to analyze outcomes that are measured using multiple items. Baseline/pre-survey data 
will be used as a covariate in all models . Level 1 covariates include race, gender, age, and sexual orientation. 
There is one Level 2 covariate, school size. 
Contrasts 
 
See Appendix B. 
 
Subgroups (optional) 
 
We will analyze data by demographic groups, including gender identity, sexual orientation, and race to explore 
different programmatic impacts and experiences based on these categories.  
 
 
Minimum Detectable Effect for Planned Sample 
 
Power Analysis 
 
Our evaluation is a two-level simple cluster random assignment design. Level 1 (unit of analysis) is individual 
students, and Level 2 (unit of assignment) is schools. The alpha level is set to 0.05 following conventional 
statistics, as we only have one primary research question. The test will be a two-tailed test to assess for any 
positive or negative change resulting from the program. Following conventional statistics, Power is set to 0.80. 
Rho (ICC) is set to 0.02 because we expect little variable in outcome between clusters. We will randomly assign 
the ten schools to treatment and control, resulting in five schools in treatment and five in control (P = 0.50). 
Following suggestions from the Program Officer, we set our R2 values to 0.20. We will have one Level 2 
covariate, e.g., school size. We expect 150 participating students in each school. We currently have ten 
guaranteed schools in the study but are exploring adding more.  
 

 
 
18 
 
 
 
Timeline 
 
Impact Evaluation Activity 
Start Date 
End Date 
IRB submission 
3/1/2023 
4/1/2023 
Registering the study 
4/1/2023 
5/1/2023 
COHORT 1 – FALL 2023 
Baseline/pre-survey data collection 
9/25/2023 
10/2/2023 
Post-survey data collection 
10/2/2023 
10/16/2023 
3-month follow-up data collection 
1/2/2024 
1/16/2023 
12-month follow-up data collection 9/25/2024 
10/2/2024 
COHORT 2 – SPRING 2024 
Baseline data collection 
3/1/2024 
3/15/2024 
Post-survey data collection 
3/15/2024 
3/30/2024 
3-month follow-up data collection 
6/1/2024 
6/15/2024 
12-month follow-up data collection 3/1/2025 
3/15/2025 
COHORT 3 – FALL 2024 
Baseline data collection 
9/25/2024 
10/2/2024 
Post-survey data collection 
10/2/2024 
10/16/2024 
3-month follow-up data collection 
1/1/2025 
1/15/2025 

 
 
19 
Impact Evaluation Activity 
Start Date 
End Date 
12-month follow-up data collection 9/25/2025 
10/2/2025 
COHORT 4 – SPRING 2025  
Baseline data collection 
3/1/2025 
3/15/2025 
Post-survey data collection 
3/15/2025 
3/30/2025 
3-month follow-up data collection 
6/1/2025 
6/15/2025 
12-month follow-up data collection 3/1/2026 
3/15/2026 
ANALYSIS & DISSEMINATION  
Analysis 
3/15/2026 
5/15/2026 
Reporting 
5/15/2026 
8/15/2026 
Dissemination 
8/15/2026 
12/31/2026 
 
Approvals and Data Security 
 
Plan for IRB Approval 
 
We have obtained the Biomedical Research Alliance of New York Institutional Review Board (BRANY IRB) 
approval. All staff, including evaluators and NJPAG Educators, have received human subjects protection 
training.  
 
Plan for federal Wide Assurance 
 
The FWA for the current study was obtained from Research Analytics Consulting and is FWA00031511 
(Expiration date: July 21st, 2026). 
 
Data Security & Privacy 
 
Survey data collection will be captured electronically via Alchemer.com, ensuring the quality and security of 
both data collection and data storage. Individual-level federal reporting and tracking data is captured and stored 
on AMTC & Associates Online Participant Tracking System (OPTS) (further security information can be found 
below). Data collectors are trained in the protection of human subjects and best practices for successful data 
collection.  
 
Electronic surveys will be collected using online surveys from Alchemer.com. Alchemer is committed to 
ensuring the quality and security of its data collection software and has robust monitoring software used to 
monitor performance and notify any issues.  
 
All staff working with Personally Identifiable Information (PII) and sensitive data complete training on the 
program policy and sign a confidentiality form agreeing not to share participant-level PII or sensitive data. 
Access to data will only be granted to project staff who need access and sign a confidentiality agreement such 

 
 
20 
as staff responsible for data collection, entry and/or electronic or hard copy transmission; these staff must be 
trained on and sign the receipt of this policy and confidentiality agreement. Those who may only need limited 
access will be trained and will sign the receipt of the policy. Limited access to data may include only having 
access to the necessary data to understand the number of responses for each school, class, and teacher. For 
example, facilitators may collect attendance data but may not need access to survey data, and yet attendance 
data may be related to sensitive data. Additionally, identifiable data from surveys will only be available to the 
analysts tasked with de-identifying the data. Documents containing PII (e.g., completed parent consent forms) 
will be saved on a secure computer server away from survey data. Data will be de-identified. To link entry, exit, 
and follow-up surveys, a pseudo-ID will be created by asking the youth for their first and last initials, birth 
month, and birth date on each survey administered. These individual survey items will be concatenated to create 
a unique ID for each respondent. 
If a data breach occurs, Evaluators will notify NJPAG, pause data collection, identify any vulnerable parties, fix 
any issues resulting from a breach, and ensure any improperly shared information is deleted.  
Evaluation Roles and Responsibilities   
Name 
Contact 
Information 
Experience 
Organization 
Role in 
Evaluation 
Peggy 
Cowan 
pcowan@njphysic
ians.org  
19 years of experience as the President of 
NJPAG, previously contributing to 
program evaluation and managing grants.  
NJPAG 
President of 
PREIS 
Recipient  
Debbie 
Marchione 
debbie@njphysici
ans.org  
10+ years of experience working for 
NJPAG in a variety of capacities, 
contributing to program evaluation and 
managing grants. 
NJPAG 
Program 
Director of 
PREIS program 
Dr. Cindy 
M. Walker 
cindy@researchan
alyticsconsulting.c
om 
25+ years of experience conducting 
research and evaluations with various 
partners (e.g., community-based 
organizations, government entities. State 
and local school districts), including 
projects related to pregnancy prevention 
and sexual risk avoidance in youth 
Research 
Analytics 
Consulting 
Leading 
Evaluator 
Helena 
Lucia 
Swanson 
helena@researcha
nalyticsconsulting
.com 
6 years of experience working with 
community partners on research and 
evaluation 
Research 
Analytics 
Consulting 
Assistant 
Evaluator 
Angela 
Turner 
angela.turner@am
tcassociates.com 
25+ years of experience consulting for 
partners from national to local levels, 
including many projects related to 
pregnancy prevention and sexual risk 
avoidance in youth 
AMTC 
Guiding 
Evaluator 
 

 
 
21 
 
Appendix A. Logic Model 
 
 
 
 
 
 
 

 
 
22 
 
Appendix B. Contrast Table 
 
Note: The following are constants for all contrasts in the below table: 
 
Design = RCT 
Target Population = Youth in 9th grade in urban school districts in the Northeast region, without any severe cognitive, mental, or behavioral 
impairments 
Sample Eligibility Criteria: All students enrolled in health classes in participating schools 
 
Treatment Description: Youth receiving YYC…MSC! program 
 
Control Description: Business as usual 
Baseline Unit of assignment/observation: Measure [Scale]: The same measurement will be used at baseline and outcome; therefore, only the 
outcome is detailed in the table 
 
Research Question: 
Primary/ Secondary 
Outcome 
Domain 
Unit of assignment/ observation:  
Measure 
[Scale] 
Timing of measurement 
RQ 0 – Primary: 
 
What is the effect of the 2-
week YYC…MSC! program 
on 9th grade students in 
Northeast urban school 
districts’ reports of engaging 
in sexual intercourse 12-
months after the pre-survey 
compared to those that do not 
receive the program? 
 
Sexual Activity 
Individual participants: Survey – sexual 
intercourse in the last 3 months. 1-item 
measure asking participants how many 
times they engaged in sexual intercourse 
in the past 3-months recoded to a dummy 
variable (1 = had sex in the last 3-months, 
0 = did not have sex in the last 3-months) 
12-months after pre-survey 
RQ 1 – Secondary:  
 
What is the effect of the 2-
week YYC…MSC! program 
on 9th grade students in 
Sexual Activity  
Individual participants: Survey – 8-item 
Sexual Intimacy Spectrum scale with a 5-
point frequency scale 
 
3-months after pre-survey, 12-months 
after pre-survey 

 
 
23 
Northeast urban school 
districts’ reports of engaging 
in oral sex compared to those 
that do not receive the 
program?   
 
Individual participants: Survey – Two 1-
item measures asking participants if they 
ever engaged in oral sex if so, how many 
times have they done it in the past 3-
months 
RQ 2 – Secondary:  
 
What is the effect of the 2-
week YYC…MSC! program 
on 9th grade students in 
Northeast urban school 
districts’ reports of intent to 
engage in sexual activity 
compared to those that do not 
receive the program? 
 
Intent to Engage in Sexual Activity 
8-item Sexual Initiation scale with a 5-
point success sequence response scale 
 
Individual participants: Survey – 5-item 
Intentions to Engage in Sexual Intercourse 
scale with a 6-point Agree scale 
Post-survey, 3 months after pre-
survey, 12 months after pre-survey 
RQ 3 – Secondary: 
  
What is the effect of the 2-
week YYC…MSC! program 
on 9th grade students in 
Northeast urban school 
districts’ reports intent to 
consistently use 
contraception compared to 
those that do not receive the 
program? 
Sexual Risk Avoidance Intent 
Individual participants: Survey – Two 1-
item measures asking: 
"If you have sexual intercourse tomorrow, 
will you make sure a condom is used?" & 
"If you have sexual intercourse tomorrow, 
will you make sure birth control is used?" 
 
Both questions use the same 5-point 
response scale: Yes, No, Only if my 
partner agrees, I don't know/I'm not sure. 
This question does not apply to me 
because I do not plan to have sexual 
intercourse soon 
 
Individual participants: Survey – Four 1-
item measures asking if youth or their 
partner have used the following methods 
in the last month and what they intend to 
Post-survey, 3 months after pre-
survey, 12 months after pre-survey 

 
 
24 
use in the future: condoms, pull-out 
method, birth control, other contraceptives 
RQ 4 – Secondary:  
 
What is the effect of the 2-
week YYC…MSC! program 
on 9th grade students in 
Northeast urban school 
districts’ reports of having 
unprotected sex compared to 
those that do not receive the 
program?   
Sexual Risk Avoidance 
Individual participants: Survey – If youth 
mentioned previously having sexual 
intercourse: 
 
In the past 3 months (90 days), how 
many times did you or your partner use a 
condom when engaging in sexual 
intercourse? Response: 0-10+ 
 
In the past 3 months (90 days), how 
many times did you or your partner use 
the pull-out method when engaging in 
sexual intercourse?  
Response:  0-10+ 
 Or I don't know what this is. 
 
In the past 3 months, have you or your 
partner used either of the following 
methods to prevent pregnancy: 
1. Birth control pills 
2. Other forms of contraceptive 
methods, not including a condom 
(e.g., shot, patch, IUD, etc.).  
Response options: Yes, No, Unsure 
3 months after pre-survey & 12 
months after pre-survey 
RQ 5 – Secondary:  
 
What is the effect of the 2-
week YYC…MSC! program 
on 9th grade students in 
Northeast urban school 
districts’ increased financial 
literacy compared to those 
that do not receive the 
program? 
Life Skills  
Individual participants: Survey – 6-item 
Financial Literacy scale – 3 items are 
true/false, and the other 3 are strongly 
disagree-strongly agree 
Post-survey, 3 months after pre-
survey, 12 months after pre-survey 

 
 
25 
  
RQ 6 – Secondary:  
 
What is the effect of the 2-
week YYC…MSC! program 
on 9th grade students in 
Northeast urban school 
districts’ knowledge of 
HIV/STDs/STIs compared to 
those that do not receive the 
program?   
 
Sexual Health Knowledge 
Individual participants: Survey – 7-item 
Knowledge of Sexual Risks scale with 
True/False/Unsure response scale 
Post-survey, 3 months after pre-
survey, 12 months after pre-survey 
RQ 7 – Secondary:  
 
What is the effect of the 2-
week YYC…MSC! program 
on 9th grade students in 
Northeast urban school 
districts’ reports of their 
ability to resist negative 
pressures to have sex 
compared to those that do not 
receive the program?  
 
Sexual Risk Avoidance Skills 
 
Individual participants: Survey – 6-item 
Skills to Resist Pressure (Coercion) to 
Have Sex scale with a 5-point Confidence 
response scale 
Post-survey, 3 months after pre-
survey, 12 months after pre-survey 
RQ 8 – Secondary:  
 
What is the effect of the 2-
week YYC…MSC! program 
on 9th grade students in 
Northeast urban school 
districts’ reports of future 
orientation and setting life 
goals compared to those that 
do not receive the program? 
 
 
Life Skills 
 
Individual participants: Survey – 5-item 
Goal Attainment scale with 6-point Agree 
response scale 
Post-survey, 3 months after pre-
survey, 12 months after pre-survey 

 
 
26 
RQ 9 – Secondary:  
 
What is the effect of the 2-
week YYC…MSC! program 
on 9th grade students in 
Northeast urban school 
districts’ reports of healthy 
life skills compared to those 
that do not receive the 
program?  
 
 
Life Skills 
 
Individual participants: Survey – 
Combination of all scales except Financial 
Literacy  
Post-survey, 3 months after pre-
survey, 12 months after pre-survey 
RQ 10 – Secondary:  
 
What is the effect of the 2-
week YYC…MSC! program 
on 9th grade students in 
Northeast urban school 
districts’ knowledge of 
healthy relationships 
compared to those that do not 
receive the program? 
 
Life Skills 
Individual participants: Survey – 6-item 
Awareness of Relationship Safety scale 
with 6-point strongly disagree-strongly 
agree response scale 
 
Individual participants: Survey – 7-item 
Dating Choices scale with a 4-point 
Likelihood response scale 
Post-survey, 3 months after pre-
survey, 12 months after pre-survey 
RQ 11 – Secondary:  
 
What is the effect of the 2-
week YYC…MSC! program 
on 9th grade students in 
Northeast urban school 
districts’ increased 
communication skills 
compared to those that do not 
receive the program?   
 
Life Skills 
Individual participants: Survey – 7-item 
Communication Scale with a 5-point 
Confidence scale 
Post-survey, 3 months after pre-
survey, 12 months after pre-survey 
RQ 12 – Secondary:  
Sexual Activity 
Individual participants: Survey – sexual 
intercourse in the last 3 months. 1-item 
3-months after pre-survey  

 
 
27 
What is the effect of the 2-
week YYC…MSC! program 
on 9th grade students in 
Northeast urban school 
districts’ engaging in sexual 
intercourse 3-months after 
the pre-survey? 
measure asking participants how many 
times they engaged in sexual intercourse 
in the past 3-months recoded to a dummy 
variable (1 = had sex in the last 3-months, 
0 = did not have sex in the last 3-months) 
 
 
 

 
 
28 
 
Appendix C: Parental Written Notice 
Parent/Guardian Written Notice 
YES You Can… Make Smart Choices! Evaluation Study 
 
Introduction 
Your child's/student's school has agreed to participate in the evaluation of character development and pregnancy 
prevention program called Yes You Can... Make Smart Choices! The information provided in this written notice 
is to inform you of what your child/student could participate in.  
 
What will your child/student be asked to do? 
If your child/student participates in the evaluation, they will be asked to: 
• Complete an entry survey 
• Complete three follow-up surveys 2 weeks after the entry survey, 3 months from the entry survey 
date, and 12 months from the entry survey date.  
 
Why is this study being done on this program? 
• To: 
o Determine the impact of the program on participants' attitudes, knowledge, and behaviors. 
o Collect information that will help: 
▪ improve the program; and  
▪ provide the funder, the federal government, with data required on programs they support.  
 
These surveys will address a variety of relationship and sexual health topics, including behaviors, sexual 
activity, contraception use, and knowledge of STDs/HIV. It will also ask them to provide their demographic 
information (i.e., gender, race/ethnicity, etc.). 
 
Will students receive gift cards? 
Yes, every student that participates in the survey responses will receive $20 after completing the second survey, 
$30 after the third, and an additional $40 after completing the 4th survey, totaling $90 over a year's time.   
 
What are the benefits of the evaluation study? 
Students will receive no direct benefits, other than gift cards, for participating in the evaluation study. However, 
their participation will help the developer of the curriculum, NJ Physicians Advisory Group (NJPAG), 
determine the impact of the YES You Can…Make Smart Choices! program. 
 
Are there any risks to students involved in the study? 
A potential risk is that some students might find certain questions to be sensitive. Students may skip questions 
that they do not want to answer. In any study, there is always some risk of a breach of confidentiality. However, 
the survey has been designed to protect your child's privacy. Students will not put their names on the survey. 
There will be a confidential ID that links surveys to each other, using their first and last initials and their month 
and day of birth. However, this information will only be accessible to the researchers. Also, no class or student 
will ever be mentioned by name in the final report of the results.  
 
Certificate of Confidentiality 
To further protect your child's privacy, the researchers involved in the study have applied for a Certificate of 
Confidentiality from the National Institutes of Health. Researchers with this certificate agree to keep your 
child's responses private to the extent permitted by New Jersey law. 
 
Do students have to participate in this study? 

 
 
29 
No, this study is voluntary. Parents/guardians may choose to opt their child/student out of the study by 
completing this form and the student returning it on time. Students may decline to participate or withdraw at 
any time. They will also be assured that refusing to participate in the evaluation study will not impact their 
classroom work or grade in any way.  
 
What if a student does not want to participate in the study? 
If a student does not want to participate, then they will not be included in the study, and there will be no 
penalty.  
 
Will all students participating in the study have the YES You Can! Program taught? 
Not all participating students in this study will be selected to receive the program. Classes will be randomly 
selected to receive this program, and classes NOT selected for the program will receive alternative lessons and 
will complete a total of four (4) surveys to receive gift cards, totaling $90. 
 
How will students' privacy and confidentiality be protected if they decide to participate in this study? 
Privacy and confidentiality will be protected since students will remain anonymous to NJPAG, parents, and the 
school district. Survey responses will be stored on the cloud on a password-protected computer and the only 
people who will have access to individual responses are the researchers, located in another state, who are 
conducting the evaluation.  
 
If it becomes necessary for an Institutional Review Board to review the study records, information that can be 
linked to your child will be protected to the extent permitted by law. Your child's research records will not be 
released without your consent unless required by law or a court order.  
 
Future Use of Information 
Even if researchers, not detailed in this consent form, were ever to review the data for research purposes, no 
data will contain information that could be associated with your child. 
 
Clinically Relevant Research Results 
The results of this evaluation study will not be shared with participants. 
 
Who should I contact with questions about the evaluation study?  
Prior, during, or after providing your consent you can contact Dr. Cindy Walker, Consultant for AMTC and 
Associates (AMTC) at (414) 218-2442. AMTC is the organization responsible for the evaluation of this 
program. If you have any questions about your child/student's rights, as a participant in this research, or if you 
feel your child has been placed at risk, you can contact the BRANY IRB Office at (516) 318-6877. 
 
Parents/guardians, THERE IS NO ACTION NEEDED IF YOU AGREE TO YOUR CHILD/STUDENT 
PARTICIPATING IN THE EVALUATION STUDY.   
 
Following New Jersey Bill A5597 (see link below), parents/guardians may opt their child/student out of the 
evaluation study by checking the box below and telling the student to return this form to their health class 
before the deadline.  
☐   I would like to opt my child/student out of the evaluation study. 
 
Parent's/Guardian's name ___________________________________________________________________  
 
 
Child's/Student's name _____________________________________________________________________  
 
 
Today's Date _____________________________________________________________________________   

 
 
30 
Appendix D: Enrollment Form 
New Jersey Physicians Advisory Group (NJPAG)  
Yes You Can…Make Smart Choices!  
 
Enrollment Form 
 
Note: Please write as neatly as possible on this form.  
 
1. What is your FIRST NAME? _______________________________________________________________ 
 
2. What is your LAST NAME?________________________________________________________________ 
 
3. How old are you? (MARK ONLY ONE ANSWER) 
a. 10 
b. 11 
c. 12 
d. 13 
e. 14 
f. 15 
g. 16 
h. 17 
i. 18 
 
4. Are you Hispanic or Latino? (MARK YES OR NO) 
a. Yes 
b. No 
 
5. What is your race? (MARK ALL THAT APPLY) 
a. American Indian or Alaska Native 
b. Asian 
c. Black or African American 
d. Native Hawaiian or Other Pacific Islander 
e. White or Caucasian 
f. Other (specify): ____________________________________________________ 
 
6. What is your sex? (MARK ONLY ONE ANSWER) 
a. Male 
b. Female 
 
We are asking for your contact information in the case we need to contact you to participate in follow-up 
surveys. If you participate in follow-up surveys you are given a $30 gift card for the 3-month follow-up, a $40 
gift card for the 12-month follow-up survey, and you will be entered into a raffle to win prizes 
 
7. What is a reliable phone number you can be reached at via text or  call?  
 
__________________________________________________________________________________ 
 
8. What is a reliable email you can be reached at?  
 
 
____________________________________________________________________________________  
 
 CHECK THIS BOX IF YOU AGREE FOR US TO TEXT, CALL OR EMAIL YOU IN REGARD 
TO THE STUDY.  

 
 
31 
Appendix E: Survey 
YOUTH ASSENT FORM 
 
You are being asked to participate in the evaluation of the New Jersey Physician Advisory Group Yes You 
Can…Make Smart Choices! program by completing the following questionnaire. The program is designed to 
teach youth about pregnancy prevention and further their character development. This evaluation will help to 
improve and ensure the program is interesting and helpful. Upon receiving parental consent, youth will be asked 
to participate in four (4) data collection periods.   
 
Your participation in this survey is voluntary, meaning you do not have to participate if you do not want to.  
 
Some of the questions that you will be asked are personal. We hope that you will answer all of the questions, 
but you may skip any questions you do not wish to answer.  
 
The answers you give will be kept private to the extent permitted by law. This means that none of your 
responses will be shared with any of your teachers, or anyone at your school, or any of your family and friends. 
The only person who will have access to your responses are external consultants. In addition, no one will report 
any individual responses to this survey - we will only report on the combined responses across all of the 
students that take part in the Yes You Can…Make Smart Choices! program. 
 
Thank you! 
 
Do you agree to participate in the evaluation? 
a. Yes (Continue to Performance Measures) 
b. No (Skip to END OF SURVEY) 
 
 
 
 
 
THE PAPERWORK REDUCTION ACT OF 1995 
Public reporting burden for this collection of information is estimated to average 16 minutes per response, 
including the time for reviewing questions, 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 information collected 
will help policy makers and other stakeholders understand the experiences of youth today and identify ways to 
reduce risky behaviors. The information will also inform programs on how best to serve their participants. The 
collection of information is voluntary, and responses will be kept private to the extent allowed by law. THE 
OMB number for this information collection is 0970-0497 and the expiration date is 06/30/2023. 
 
 

 
 
32 
PLEASE READ EACH QUESTION CAREFULLY: There are different ways to answer the questions in 
this survey. It is important that you follow the instructions when answering each kind of question. Here 
are some examples 
 
1.     EXAMPLE 1: MARK ONLY ONE ANSWER 
 
What is the color of your eyes? 
 
       MARK ONLY ONE ANSWER 
 
☒  Brown 
 
☐  Blue 
 
☐  Green 
 
☐  Another color 
 
 
 
2.     EXAMPLE 2: MARK ALL THAT APPLY 
 
Do you plan to do any of the following next week? 
 
       MARK ALL THAT APPLY 
 
☒  Watch a movie 
 
☒  Go to a baseball game 
 
☐  Study at a friend's house 
 
If you plan to watch a movie and go to a 
baseball game next week, you would 
mark both boxes. 
If the color of your eyes is brown, you 
would mark (X) the first box as shown. 

 
 
33 
1. How old are you? (MARK ONLY ONE ANSWER) 
a. 10 
b. 11 
c. 12 
d. 13 
e. 14 
f. 15 
g. 16 
h. 17 
i. 18 
j. 19 
k. 20 
l. 21 
 
2. What grade are you in? (If you are currently on vacation or in summer school, indicate the grade you will be 
in when you go back to school.) (MARK ONLY ONE ANSWER) 
a. 5th  
b. 6th  
c. 7th 
d. 8th 
e. 9th 
f. My school does not assign grade levels 
g. I dropped out of school, and I am working on getting a high school diploma or GED 
h. I am working toward a GED 
i. I have a high school diploma or GED, but I am not currently enrolled in college or technical school 
j. I have a high school diploma or GED and I am currently enrolled in college or technical school 
 
3. When you are home or with your family, what language or languages do you usually speak? (MARK ALL 
THAT APPLY) 
a. English 
b. Spanish 
c. Other (please specify): _____ 
 
4. Are you Hispanic or Latino? (MARK YES OR NO) 
a. Yes 
b. No 
 
5. What is your race? (MARK ALL THAT APPLY) 
a. American Indian or Alaska Native 
b. Asian 
c. Black or African American 
d. Native Hawaiian or Other Pacific Islander 
e. White or Caucasian 
f. Other (specify): ______ 
 
6. What is your sex? (MARK ONLY ONE ANSWER) 
a. Male 
b. Female 
 
7. Are you currently…? (MARK ALL THAT APPLY) 

 
 
34 
a. Living with family [parent(s), guardian, grandparents, or other relatives] 
b. In foster care, living with a family 
c. In foster care, living in a group home 
d. Couch surfing or moving from home to home 
e. Living outside in a tent city or homeless camp, in a car, in an abandoned vehicle or in an abandoned 
building 
f. Staying in an emergency shelter or transitional living program 
g. Staying in a hotel or motel 
h. In juvenile detention center, juvenile group home, and/or under the supervision of a probation office 
i. None of the above 
 
For questions 8-12, please think about how the program you just completed has affected you.  
 
8. Even if your program didn't cover this topic, would you say that being in the program made you more likely, 
about the same or less likely to… (Note: If the program has not affected your likelihood to do the following, 
choose "About the same".)  
 
MARK ONLY ONE ANSWER PER ROW. 
 
 
Much 
more 
likely 
Somewhat 
more 
likely 
About the 
same 
Somewhat 
less likely 
Much 
less 
likely 
a. ….resist or say no to peer pressure? 
 
 
 
 
 
b. ….manage your emotions in healthy ways 
(for example, ways that are not hurtful to 
you or others)? 
 
 
 
 
 
c. …make decisions to not use drugs and 
alcohol? 
 
 
 
 
 
d. …think about the consequences before 
making a decision? 
 
 
 
 
 
 
9. Even if your program didn't cover this topic, would you say that being in the program made you more likely, 
about the same or less likely to… (Note: If the program has not affected your likelihood to do the following, 
choose "About the same".)  
 
MARK ONLY ONE ANSWER PER ROW. 
 
 
Much 
more 
likely 
Somewhat 
more 
likely 
About 
the 
same 
Somewhat less 
likely 
Much 
less 
likely 
a. ….make plans to reach your goals? 
 
 
 
 
 
b. …care about doing well in school? 
 
 
 
 
 
c. …graduate high school or get your 
GED? 
 
 
 
 
 
d. …get more education or training after 
high school or completing your GED? 
 
 
 
 
 
e. …get a steady full-time job after school? 
 
 
 
 
 

 
 
35 
 
 
10. Even if your program didn't cover this topic, would you say that being in the program made you more likely, 
about the same or less likely to… (Note: If the program has not affected your likelihood to do the following, 
choose "About the same".)  
 
MARK ONLY ONE ANSWER PER ROW. 
 
 
Much more 
likely 
Somewhat 
more likely 
About 
the 
same 
Somewhat 
less likely 
Much less 
likely 
a. …save money to get things you 
want? 
 
 
 
 
 
b. …feel confident about how to 
open a bank account? 
 
 
 
 
 
c. …feel confident about how to 
prepare a budget?  
 
 
 
 
 
d. …feel confident about how to 
track your expenses? 
 
 
 
 
 
e. …understand the costs 
associated with raising a child? 
 
 
 
 
 
 
11. Even if your program didn't cover this topic, would you say that being in the program made you more likely, 
about the same or less likely to… (Note: If the program has not affected your likelihood to do the following, 
choose "About the same".)  
 
MARK ONLY ONE ANSWER PER ROW. 
 
 
Much 
more 
likely 
Somewhat 
more likely 
About the 
same 
Somewhat 
less likely 
Much 
less 
likely 
a. …talk with your parent, guardian, or 
caregiver about things going on in your 
life? 
 
 
 
 
 
b. …talk with your parent, guardian, or 
caregiver about sex? 
 
 
 
 
 
 
12. Even if your program didn't cover this topic, would you say that being in the program made you more likely, 
about the same or less likely to… (Note: If the program has not affected your likelihood to do the following, 
choose "About the same".)  
 
MARK ONLY ONE ANSWER PER ROW. 
 
 
Much 
more 
likely 
Somewhat 
more 
likely 
About the 
same 
Somewhat 
less likely 
Much less 
likely 
a. …better understand what makes a 
relationship healthy? 
 
 
 
 
 

 
 
36 
b. …resist or say no to someone if they 
pressure you to participate in sexual 
acts, such as kissing, touching 
private parts, or sex? 
 
 
 
 
 
c. …talk to a trusted person/adult (for 
example, a family member, teacher, 
counselor, coach, etc.) if someone 
makes you uncomfortable, hurts 
you, or pressures you to do things 
you don't want to do? 
 
 
 
 
 
 
The next questions ask about sexual intercourse. 
 
13. As a result of being in the program, are you planning to abstain from sexual intercourse (choose to not have 
sexual intercourse) for at least the next 3 months? 
a. Yes (Skip to Question 14) 
b. No (Skip to Question 15) 
c. Not sure (Skip to Question 15) 
 
14. How important are each of these reasons for your decision to not have sexual intercourse for at least the next 
3 months? MARK ONLY ONE ANSWER PER ROW. 
 
 
Not at all 
important 
Not too 
important 
Somewhat 
important 
Very 
important 
a. …how it might affect your plans for the future? 
 
 
 
 
b. …the possible emotional and social consequences 
(for example, feeling sadness or regret, 
disappointing your parent(s) or guardian(s), and/or 
negative reactions from your peers)? 
 
 
 
 
c. …the risk of getting a sexually transmitted infection 
(STI)? 
 
 
 
 
d. …the risk of getting pregnant or getting someone 
pregnant? 
 
 
 
 
 
 
 IF YOU ANSWERED "YES" TO QUESTION 13, GO TO QUESTION 14 
IF YOU ANSWERED "NO" OR "NOT SURE" TO QUESTION 13: SKIP QUESTION 14 
AND GO TO QUESTION 15 ON THE NEXT PAGE 
 
 
 

 
 
37 
15. The next few questions refer to sexual intercourse and your risk of pregnancy and sexually transmitted 
infections (STIs). Remember, all your responses will be kept private.  
 
Has being in the program made you more likely, about the same, or less likely to… (Note: If the program has 
not affected your likelihood to do the following, choose "About the same".) 
 
a. …have sexual intercourse in the next 3 months? MARK ONLY ONE ANSWER.  
a. Much more likely 
b. Somewhat more likely 
c. About the same 
d. Somewhat less likely 
e. Much less likely 
 
b. …use (or ask your partner to use) a condom if you were to have sexual intercourse in the next 3 months? 
MARK ONLY ONE ANSWER.  
a. This question does not apply to be because I choose to not have sexual intercourse in the next 3 
months 
b. Much more likely 
c. Somewhat more likely 
d. About the same 
e. Somewhat less likely 
f. Much less likely 
 
c. …use (or ask your partner to use) birth control OTHER than condoms if you were to have sexual 
intercourse in the next 3 months? By birth control, we mean methods that can prevent pregnancy, like 
using birth control pills, the shot, the patch, the ring, IUD, or implant. 
a. This question does not apply to be because I choose to not have sexual intercourse in the next 3 
months 
b. Much more likely 
c. Somewhat more likely 
d. About the same 
e. Somewhat less likely 
f. Much less likely 
 
 
 

 
 
38 
16. The next questions ask you about your experiences in the program that you just completed. Think about all 
the sessions or classes of the program that you attended.  
 
Even if you didn't attend all sessions or classes in this program, how often in this program…  
 
MARK ONLY ONE ANSWER PER ROW. 
 
 
All of 
the time 
Most of 
the time 
Some of 
the time 
None 
of the 
time 
a. …did you feel interested in program sessions and 
classes? 
 
 
 
 
b. …did you feel the material presented was clear? 
 
 
 
 
c. …did the discussions or activities help you learn 
program lessons? 
 
 
 
 
d. …did you have a chance to ask questions about topics 
or issues that came up in the program? 
 
 
 
 
e. …did you feel respected as a person? 
 
 
 
 
 
17. Thinking about the program, how satisfied are you with… 
 
MARK ONLY ONE ANSWER PER ROW. 
 
 
Very 
satisfied 
Somewhat 
satisfied 
A little 
satisfied 
Not at 
all 
satisfied 
a. …the amount of information you received about 
abstaining from sex (choosing to not have sex)? 
 
 
 
 
b. …the amount of information you received about 
condoms and birth control? 
 
 
 
 
 
 
 

 
 
39 
DEMOGRAPHICS 
 
The following questions allow us to link the pre-, post-, and follow-up surveys to provide more confidentiality 
for you.  
 
What is the first letter in your first name? (Example: J ohn) 
(Drop down with A-Z) 
 
What is the first letter in your last name? (Example: S mith) 
(Drop down with A-Z) 
 
What is the month of your birthday? 
(Drop down with Jan-Dec) 
 
What day of the month is your birthday? 
(Drop down with 1-31) 
 
The following questions will be used to help us describe whom the program is serving.  
 
What gender do you identify with?  
a. Boy 
b. Girl 
c. Non-binary/ Gender-fluid 
 
Do you identify as transgender?  
a. Yes 
b. No 
c. I am not sure 
d. I do not know what this question is asking 
 
Which of the following best describes you? 
a. Heterosexual (straight) 
b. Gay or lesbian 
c. Bisexual 
d. I am not sure about my sexual identity (questioning) 
e. I do not know what this question is asking 
f. None of the above 
 
Are you in a romantic relationship right now (e.g., going out or hanging out with someone)? 
a. Yes 
b. No 
c. Unsure/It's complicated 
 
Were you in a romantic relationship at any point in the last 3-months?  
a. Yes 
b. No 
c. Unsure/It's complicated 
 
 

 
 
40 
In the past 12 months, have you learned about any of the following topics in a school or other formal learning 
setting (e.g., Boys and Girls Club, church)? 
 
 
Yes 
No 
a. Relationships, dating, or marriage 
 
 
b. Waiting until you are ready to engage in sexual activity 
 
 
c. Methods of birth control, such as condoms, pills, etc. 
 
 
d. Sexually transmitted diseases also known as STDs or STIs 
 
 
e. Communication 
 
 
f. Financial literacy 
 
 
 
PROGRAM SATISFACTION QUESTIONS 
 
The next two questions ask you to reflect on your experiences while taking the program.  
 
How likely are you to recommend this program to a friend? 
a. Not at all likely 
b. Somewhat likely 
c. Likely 
d. Very likely 
 
What is the best thing you learned about yourself in the program? [OPEN-ENDED] 
 
COMMUNICATION SKILLS 
 
How CONFIDENT are you that you could do each of the following things: 
 
 
Not at all 
confident 
A little 
confident 
Somewhat 
confident 
Confident Completely 
confident 
Show that you care about someone else's 
feelings.  
 
 
 
 
 
Calmly explain how you feel. 
 
 
 
 
 
Suggest a compromise to end an argument. 
 
 
 
 
 

 
 
41 
Agree to try a solution someone else 
suggested to end an argument. 
 
 
 
 
 
Clearly communicate your thoughts to 
someone else. 
 
 
 
 
 
Listen carefully to what someone else is 
telling you.  
 
 
 
 
 
Show that you care about someone else's 
opinion. 
 
 
 
 
 
 
DATING CHOICES 
 
Thinking of yourself right now, how likely are you to date someone who…  
 
Not at all likely 
Somewhat 
likely 
Likely 
Very likely 
… is much older than you.  
 
 
 
 
… keeps you a secret from 
others.  
 
 
 
 
… calls you names when they 
are upset.  
 
 
 
 
… respects your boundaries.  
 
 
 
 
… that tries to control you.  
 
 
 
 
… tells you who you can and 
cannot talk to.  
 
 
 
 
… shares your likes/dislikes.  
 
 
 
 
 

 
 
42 
 
AWARENESS OF RELATIONSHIP SAFETY  
 
How much do you agree with each of the following statements.  
 
Strongly 
Disagree Disagree Somewhat 
Disagree 
Somewhat 
Agree 
Agree Strongly 
Agree 
If my partner ever hit me, we would 
have to break up.  
 
 
 
 
 
 
If I were afraid of my partner, I would 
know where to go for help. 
 
 
 
 
 
 
It is acceptable for me to hit my 
partner if I am angry.  
 
 
 
 
 
 
I would end a relationship with 
someone if they tried to force me to do 
things I didn't want to do.  
 
 
 
 
 
 
If my partner always tried to tell me 
what to do, we would have to break 
up.  
 
 
 
 
 
 
I would stay with my partner if they 
called me names and put me down, as 
long as they said they love me.  
 
 
 
 
 
 
 

 
 
43 
KNOWLEDGE OF SEXUAL RISKS 
 
Pick either True, False, or Unsure for the following questions: 
 
 
True 
False 
Unsure 
A girl can get pregnant the first time she has unprotected 
vaginal sexual intercourse.  
 
 
 
Using a condom will always prevent a sexually transmitted 
disease/infection (STD/STI) 
 
 
 
A person with NO symptoms can still spread an STD/STI 
through sexual activity.  
 
 
 
The only sure way to prevent pregnancy is to avoid sexual 
activity.   
 
 
 
A person can get an STD/STI from oral sex.  
 
 
 
The only way to prevent an STD/STI is to avoid sexual 
activity.  
 
 
 
If someone has unprotected sexual intercourse, even once, 
they can get an STD/STI like HIV.  
 
 
 
 
 
 

 
 
44 
SKILLS TO RESIST PRESSURE (COERCION) TO HAVE SEX  
 
How CONFIDENT are you that you could do each of the following?  
 
 
Not at all 
confident 
A little 
confident 
Somewhat 
confident 
Confident 
Completely 
confident 
Avoid situations that could lead to unwanted 
sexual activity (like being alone with someone in 
a bedroom). 
 
 
 
 
 
Avoid people who make you feel pressured to 
have sexual intercourse. 
 
 
 
 
 
Firmly say "no" to sexual activity, even if 
someone is pressuring you. 
 
 
 
 
 
Firmly say "no" to your partner if you do not 
want to have sexual intercourse. 
 
 
 
 
 
End a relationship with someone pressuring you 
to have sexual intercourse when you do not want 
to. 
 
 
 
 
 
Wait until you are ready to have sexual 
intercourse.  
 
 
 
 
 
 
 
 

 
 
45 
SEXUAL INTIMACY SPECTRUM 
 
In the following items, we are talking about voluntary intimate/ sexual activity. 
 
In the past month, how often have you engaged in these intimate activities with a romantic partner? 
 
 
Never 
A few times in 
the last month 
Once a week 
A few times a 
week 
Daily 
Kissing 
 
 
 
 
 
Spending time alone together in a 
private space (e.g., bedroom) 
 
 
 
 
 
Laying down together 
 
 
 
 
 
Sexting (e.g., sending, receiving, or 
forwarding sexually explicit 
messages, photographs, or videos 
digitally via mobile phones or 
through social media) 
 
 
 
 
 
Touching under clothing 
 
 
 
 
 
Oral sex 
 
 
 
 
 
Sexual intercourse 
 
 
 
 
 
Other sexual activity (please 
specify):  
 
 
 
 
 
 
 
 

 
 
46 
SEXUAL INITIATION 
 
When do you think you may engage in each of the following activities: 
 
Within the next 
12 months 
Before 
graduating 
high school 
After 
graduating 
high school 
After starting a 
career 
After an adult 
committed 
relationship, 
like marriage 
Kissing 
 
 
 
 
 
Spending time alone 
together in a private 
space (e.g., bedroom) 
 
 
 
 
 
Laying down together 
 
 
 
 
 
Sexting (e.g., sending, 
receiving, or 
forwarding sexually 
explicit messages, 
photographs, or videos 
digitally via mobile 
phones or through 
social media) 
 
 
 
 
 
Touching under 
clothing 
 
 
 
 
 
Oral sex 
 
 
 
 
 
Sexual intercourse 
 
 
 
 
 
Other sexual activity 
(please specify):  
 
 
 
 
 
 
 
 
 

 
 
47 
INTENTIONS TO ENGAGE IN SEXUAL INTERCOURSE 
 
Indicate your level of agreement with each of the following statements:  
 
 
Strongly 
disagree 
Disagree 
Somewhat 
Disagree 
Somewhat 
Agree 
Agree Strongly 
Agree 
Engaging in sexual intercourse at this time 
could prevent me from reaching my goals. 
 
 
 
 
 
 
Engaging in sexual intercourse right now is 
probably not a good idea. 
 
 
 
 
 
 
I think it's a good idea to finish high school 
before engaging in sexual intercourse. 
 
 
 
 
 
 
I am strongly committed to wait until marriage 
to have sexual intercourse. 
 
 
 
 
 
 
I do not plan to have sexual intercourse any 
time soon. 
 
 
 
 
 
 
 
INTENT TO CONSISTENTLY USE CONDOMS 
 
If you have sexual intercourse tomorrow, will you make sure a condom is used? 
a. Yes 
b. No 
c. Only if my partner agrees 
d. I don't know / I'm not sure 
e. This question does not apply to me because I do not plan to have sexual intercourse soon. 
 
If you have sexual intercourse tomorrow, will you make sure birth control is used? 
a. Yes 
b. No 
c. Only if my partner agrees 
d. I don't know / I'm not sure 
e. This question does not apply to me because I do not plan to have sexual intercourse soon. 
 
SEXUAL ACTIVITY 
 
In the following items, we are talking about voluntary intimate/ sexual activity. 
 
[Qualifying question]: Have you ever had oral sex? Response: Y/N 
 
[Branch questions if Y to previous question, Qualifying question]:  
 
In the past 3 months (90 days), how many times have you had oral sex? Response:0-10+ 
 

 
 
48 
 [Qualifying question]: Have you ever had sexual intercourse? Response: Y/N 
 
[Branch question if Y to previous question, Qualifying question]:  
 
In the past 3 months (90 days), how many times have you had sexual intercourse? 
Response: 0-10+ 
 
CONDOM & CONTRACEPTIVE USAGE 
 
[Branch section if more than 0 to the following question: In the past 3 months (90 days), how many times have 
you had sexual intercourse?]  
 
There are different types of contraceptives that may be used including condoms, birth control pills, the 
pull-out method, and other contraceptives (e.g., shot, patch, IUD, etc.).  
 
In the past 3 months (90 days), how many times did you or your partner use a condom when 
engaging in sexual intercourse? Response: 0-10+ 
 
In the past 3 months (90 days), how many times did you or your partner use the pull-out 
method when engaging in sexual intercourse?  
Response:  
0-10+ 
I don't know what this is. 
 
 
In the past 3 months, have you or your partner used either of the following methods to prevent 
pregnancy:  
 
Yes 
No 
Unsure 
Birth control pills 
 
 
 
Other forms of contraceptive 
methods, not including a condom 
(e.g., shot, patch, IUD, etc.) 
 
 
 
 
 
 
 

 
 
49 
GOAL ATTAINMENT 
 
How much you agree with each of the following statements: 
 
 
Strongly 
Disagree Disagree Somewhat 
Disagree 
Somewhat 
Agree 
Agree Strongly 
Agree 
I know how to set goals. 
 
 
 
 
 
 
I know what I want for my future.  
 
 
 
 
 
 
I know what steps to take to achieve 
my goals.  
 
 
 
 
 
 
If I or my partner were to become 
pregnant now, it could prevent me 
from reaching my long-term goals.  
 
 
 
 
 
 
I know I can reach my long-term 
goals, even if challenges occur.  
 
 
 
 
 
 
 
FINANCIAL LITERACY 
 
Please respond to the following questions with either True, False, or Unsure.  
 
 
True 
False 
Unsure 
When you use a debit card, you are borrowing money 
from the bank that you must pay back. 
 
 
 
Missing only one credit card payment will impact your 
credit score. 
 
 
 
I understand the difference between credit cards and debit 
cards. 
 
 
 
 
 
Please respond to the following questions: 
 
 
Strongly 
Disagree Disagree Somewhat 
Disagree 
Somewhat 
Agree 
Agree Strongly 
Agree 

 
 
50 
I know how to create a budget for 
earning, spending, and saving my 
money.  
 
 
 
 
 
 
I am too young to start thinking about 
budgeting my money. 
 
 
 
 
 
 
I know how to set financial goals.  
 
 
 
 
 
 
 
END OF SURVEY  
 
 
 
Thank you!