Teen Survey

Teen Survey

PYP/YMCA Chase Program


	~ Pre Test ~
		2002-2003

This is an important and confidential survey. The following questions are intended to help us understand what teenagers think and how they feel about their experiences. Your opinions and thoughts are very important, so please answer each question carefully.

1. This is a confidential questionnaire.

2. This is not like a test where there are right and wrong answers. Just tell us what you think.

3. If you answer no to a question or a question does not apply to you, skip to the question number indicated.

4. All of your answers will be grouped with those of other students. There is no way that your answers will be connected to you personally.

5. Do not talk to others while you are answering the questions, or while they are working on theirs.

6. Read each question carefully so that you will respond correctly.

Thank you

Thank you for participating in this important survey. Your ideas and opinions are valuable. If this survey has raised any questions or concerns for you, be sure to talk to your parents, a counselor or teachers.

Very Important Note: Sexual activity refers to any type of genital contact or sexual stimulation including, but not limited to, sexual intercourse.

School
	Teacher or Mentor

First 3 letters of your mother's first name	Sample:Sandy Enter SAN
First 3 letters of your last name		Sample: Juan Garcia Enter GAR

Grade
		Month Day Year
	Gender	Male Female
Race
What is the highest grade of education that your father completed?
	What is the highest grade of education that your mother completed ?
		How important would you say religion is to you?
	About how often do you attend religious services?
		Strongly Disagree	Disagree	Not Sure	Agree	Strongly Agree
Having sex before marriage is against my religious and/or my personal beliefs.


Do you smoke now?
Yes No	If "No" go to next section.
		How many cigarettes a day do you smoke?

Have you ever been drunk? Yes No	If "No" go to next section.
		Have you been drunk during the past four weeks? Yes No

Would your friends approve or disapprove of young people your age having sexual intercourse?

The sexual choice that makes the most sense for me and my future is:

	Getting a sexually transmitted disease would significantly affect my future. My life would be		Why?
If you did have a child while unmarried, how would it affect your life? I would:
I plan to save sexual activity for marriage.	Yes	No	Don't know

Have you and your parents discussed specific dating guidelines.

	Strongly Disagree	Disagree	Not Sure	Agree	Strongly Agree
It is normal for me to have strong feelings and thoughts about sex, but not OK for me to have sex. ______________________________________________

	Not At All	Not Very	Somewhat	Quite	Very
It is very important to me to be accepted by others my age.
I feel confident that I can make a decision that is wise.
My life is usually determined by things that are beyond my control.
I avoid situations that put me at risk of sexual advances.
If a person tries to pressure me to have sex, I can say NO.




	Strongly Disagree	Disagree	Not Sure	Agree	Strongly Agree
It is important to talk with my parents/guardian about sex.
I feel that I can go to my parents with questions about relationships and sex.
I have a lot of respect for my parents' ideas and opinions about sex.
My parents/guardian would want me to practice sexual abstinence until marriage.

	Never	Once	A Few Times	Sometimes	Often


It is OK for unmarried teens to have sex if they: Mark all that apply
	Use birth control Love each other Use sex as the next step in their relationship Don’t talk about it with friends It is not ok

It is OK for a girl to have sex: Mark all that apply.
	On a first date if the boy agrees It is the if it is the only way to keep her boyfriend After dating the boy for a few weeks If she loves the boy and they have known each other for a long time Only after marriage

It is OK for a boy to have sex:
Mark all that apply Only after marriage If he loves the girl, and they have known each other for a long time After dating the girl for a few weeks If it’s the only way to keep the girlfriend On the first date if the girl agrees


	I hope to get married and have a family someday.	Yes No Don't know
Do you think that having sex as a teenager would make it harder for you to have a good marriage and family life in the future?
		Strongly Disagree	Disagree	Not Sure	Agree	Strongly Agree
Having sex or fathering a baby at my age can mess up my chances of being able to do things in the future, like going to homecoming, school activities, or going to college like other teens.
Abstaining from sexual activity until marriage will help me to accomplish my goals in life.
	I plan to wait until marriage to have sex.
I believe having sex as a young person could mess up my future.
In the future do you think you will have sexual intercourse at any time before you get married?


	A person who has been sexually active is able to choose abstinence for the future?			Yes	No	Don't know

Thank you

Not

At All

Not

Very