Section One: Facts About You First, we’d like to ask some questions about you. We are not going to use this information to identify you, but instead to talk about what different groups of people have to say. For example, what boys have to say, and how that may be different from what girls have to say. Or how 12-year-olds feel about different things, and how that might be different from what 17-year-olds feel. How would you describe yourself? (Gender)  Male  Female  Other (Specify________) In what year were you born? (Enter all four digits of the year in the boxes below, and fill in corresponding circles) Are you of Hispanic, Latino/a, or Spanish origin? (If yes, you may select one or more categories) No, not of Hispanic, Latino/a, or Spanish origin Yes, Mexican, Mexican American, Chicano/a Yes, Puerto Rican Yes, Cuban Yes, another Hispanic, Latino/a, or Spanish origin What is your race? (Select one or more)  White  Black or African American  American Indian or Alaska Native  Asian Indian  Chinese  Filipino  Japanese  Korean  Vietnamese  Other Asian  Native Hawaiian  Guamanian or Chamorro  Samoan  Other Pacific Islander How would you describe yourself? (Sexual orientation)  Straight or heterosexual  Bisexual  Gay or lesbian  Unsure What is your primary spoken language? (Chinese, Japanese, or other) Indian (Apache, Blackfoot, Navajo, or other) How well do you speak English?  Very well  Well  Not well  Not at all Do you have any health issues that affect your ability to see, hear, move around easily, or do self-care like dress yourself or brush your teeth?  Yes  No With whom do you live? (Mark all that apply)  Alone  With parents  With relatives other than parents  With a foster family  With roommates  Other Describe where you live.  In my own home or apartment  In a relative’s home  In a group home  In campus/dormitory housing  In a foster  Homeless or in a shelter  Other 3 3 1 2 3 4 5 6 1 0 1 2 4 5 6 7 8 9 0 1 2 4 5 6 7 8 9 0 7 8 9
In this section, we are going to ask how you feel about certain things, such as school, substance use, and sexual behavior. We are also going to ask what you know about HIV/AIDS. Remember, your answers are private and will not be used to identify you. What were your most recent grades in school?  I am not in school  Mostly As  Mostly Bs  Mostly Cs  Mostly Ds  Mostly Fs How often do you feel that the school work you are assigned is meaningful and important?  I am not in school  Almost always  Often  Sometimes  Seldom  Never How interesting are most of your classes to you?  I am not in school  Very interesting  Quite interesting  Fairly interesting  Slightly dull  Very dull How important do you think things you are learning in school are going to be for you later in life?  I am not in school  Very important  Quite important  Fairly important  Slightly important  Not at all important The next five questions (20 – 24) ask about your ETHNIC GROUP. An ethnic group is a cultural group that has a shared history, similar customs, traditions, and sometimes shared values. I am active in organizations or social groups that include mostly members of my own ethnic group.  Strongly agree  Agree  Disagree  Strongly disagree I think a lot about how my life is affected by my ethnic group’s history, traditions, and customs.  Strongly agree  Agree  Disagree  Strongly disagree I have often talked to other people about my ethnic background.  Strongly agree  Agree  Disagree  Strongly disagree I am interested in learning more about my ethnic background.  Strongly agree  Agree  Disagree  Strongly disagree I participate in cultural practices of my own ethnic group, such as special food, music, or customs.  Strongly agree  Agree  Disagree  Strongly disagree In general, how important are religious or spiritual beliefs in your day-to-day life?  Very important  Quite important  Fairly important  Slightly important  Not at all important When you have problems or difficulties with your school (education), work, family, friends, or personal life, how often do you seek spiritual guidance and support?
Be sexually active?  Not at all likely  A little likely  Somewhat likely  Very likely Practice safe sex?  Not intending to have any sex during the next 3 months  Not at all likely  A little likely  Somewhat likely  Very likely Please indicate how much you agree or disagree with the following statements. I can get my boyfriend or girlfriend to use a condom, even if he or she does not want to. (If you don’t have a boyfriend or girlfriend right now, suppose you had. How would you answer this question if you did?)  Strongly agree  Agree  Disagree  Strongly disagree I would be able to say to my boyfriend or girlfriend that we should use a condom. (If you don’t have a boyfriend or girlfriend right now, suppose you had. How would you answer this question if you did?)  Strongly agree  Agree  Disagree  Strongly disagree I could refuse if someone wanted to have sex without a condom.  Strongly agree  Agree  Disagree  Strongly disagree I could say no if someone pressured me to have sex when I did not want to.  Strongly agree  Agree  Disagree  Strongly disagree I would be able to say no if a friend offered me a drink of alcohol.  Strongly agree  Agree  Disagree  Strongly disagree I would be able to refuse if a friend offered me drugs, including marijuana.  Strongly agree  Agree  Disagree  Strongly disagree HIV/AIDS – What You Know The next set of questions is about HIV/AIDS. Please indicate whether you think each of the following statements is true or false, or if you don’t know. Only people who look sick can spread the HIV/AIDS virus.  True  False  Don’t know Only people who have sex with gay (homosexual) people get HIV/AIDS.  True  False  Don’t know Birth control pills protect women from getting the HIV/AIDS virus.  True  False  Don’t know There are drugs available to treat HIV that can lengthen the life of a person infected with the virus.  True  False  Don’t know There is no cure for AIDS.  True  False  Don’t know Young people under age 18 need their