Sexual Behavior Questionnaire

1 Page 1 Sexual Behavior QuestionnaireSexual Behavior QuestionnaireSexual Behavior QuestionnaireSexual Behavior Questionnaire1. Agreement: I have read the procedure described above. I voluntarily agree to participate in the procedure and I have received a copy of this description. 2. If you are under the age of 18 parental consent is needed and therefore you may not participate in this hereby certify that I am 18 years of age or older. 1. consentInformed ConsentProtocol Title: The Association between School-Based Sex Education Programs and Adolescents Contraceptive Use Please read this consent document carefully before you decide to participate in this of the research study:To determine the association between school-based sex education programs and the contraceptive use among adolescents.

2 What you will be asked to do in the study:You will be asked to answer approximately thirty-four questions on a Questionnaire . Time required:20-45 minutesRisks and Benefits:You may experience emotions regarding your Sexual Behavior . There are no potential benefits to participating in this study. Compensation:There is no financial compensation for participating in this research. Confidentiality: Your identity will be kept confidential to the extent provided by law. No identifying information will be obtained for you, with the website being a secured site so that your answers may not be traced back to you. Voluntary participation: Your participation in this study is completely voluntary. There is no penalty for not participating.

3 Right to withdraw from the study: You have the right to withdraw from the study at anytime without consequence. Whom to contact if you have questions about the study:Caroline Payne, Graduate Student, Department of Family, Youth and Community Sciences, 352-353-5105 Rose Barnett, Associate Professor, Department of Family, Youth and Community Sciences, (352) 273-3519 Whom to contact about your rights as a research participant in the study: IRB02 Office, Box 112250, University of Florida, Gainesville, FL 32611-2250; phone 392-0433. **agree nmlkjdisagree nmlkjyes nmlkjno nmlkjPage 2 Sexual Behavior QuestionnaireSexual Behavior QuestionnaireSexual Behavior QuestionnaireSexual Behavior Questionnaire3.

4 Are you:4. How old are you?5. Please select your ethnicity ( all that apply)6. Current UF GPA:7. Who do you live with: (please select all that apply)8. Martial Status:2. Demographicsmale nmlkjfemale nmlkjWhite gfedcBlack or African American gfedcAmerican Indian or Alaska Native gfedcAsian gfedcNative Hawaiian or Other Pacific Islander gfedcOther nmlkjbelow nmlkjNo one I live alone gfedcRoommates (no relatives) gfedcSiblings/ Relatives gfedcMy Child(ren) gfedcParent(s)or guardian(s) gfedcSpouse or significant other gfedcSingle nmlkjMarried nmlkjDivorced nmlkjWidowed nmlkjPage 3 Sexual Behavior QuestionnaireSexual Behavior QuestionnaireSexual Behavior QuestionnaireSexual Behavior Questionnaire9.

5 Mother/mother-figure's marital status: 10. Father/Father figure's marital status:11. My partner(s) are:12. Was your father part of your life during your teenage years?13. Was your mother part of your life during your teenage years?Single nmlkjMarried nmlkjDivorced nmlkjWidowed nmlkjSingle nmlkjMarried nmlkjDivorced nmlkjWidowed nmlkjMale nmlkjFemale nmlkjBoth nmlkjalways nmlkjoften nmlkjsome nmlkjrarely nmlkjnever nmlkjalways nmlkjoften nmlkjsome nmlkjrarely nmlkjnever nmlkjPage 4 Sexual Behavior QuestionnaireSexual Behavior QuestionnaireSexual Behavior QuestionnaireSexual Behavior QuestionnaireFor the following questions please either select the best answer or fill in the Have you been sexually active in the past year ( Sexual activity refers to any type of genital contact or Sexual stimulation between two persons including, but not limited to Sexual intercourse)?

6 15. If you are sexually active or have ever been sexually active, how many partners have you had total?16. Have you ever had Sexual intercourse while under the influence of drugs or alcohol?17. Have you ever had oral sex while under the influence of drugs or alcohol?18. Have you or one of your Sexual partners ever become pregnant?19. If you answered yes to question 18, how long had you and your partner been sexually active at the time of conception?20. If you answered yes to question 18, what decision did you and/or your partner make regarding the pregnancy?3. Sexual Behavior QuestionsYes nmlkjNo nmlkj1-2 nmlkj3-5 nmlkj6-9 nmlkjmore than 10 nmlkjalways nmlkjoften nmlkjsometimes nmlkjrarely nmlkjnever nmlkjalways nmlkjoften nmlkjsometimes nmlkjrarely nmlkjnever nmlkjYes nmlkjNo nmlkjNot that I am aware of nmlkjless than a month nmlkj2-3 months nmlkj4-6 months nmlkj6 months to a year nmlkjlonger than a year nmlkjkept the baby nmlkjabortion nmlkjadoption nmlkjother nmlkjPage 5 Sexual Behavior QuestionnaireSexual Behavior QuestionnaireSexual Behavior QuestionnaireSexual Behavior Questionnaire21.

7 Please indicate on a scale of Never to Daily how often you engage in the following Sexual Sexual Behaviors NeverFew times in lifeFew times a yearFew times a monthOnce a weekFew times a weekDailyKissingnmlkjnmlkjnmlkjnmlkjnmlk jnmlkjnmlkjFrench Kissingnmlkjnmlkjnmlkjnmlkjnmlkjnmlkjnml kjTouching a partner's breast or having your breast touched by a partnernmlkjnmlkjnmlkjnmlkjnmlkjnmlkjnml kjStimulating a partner's penis or having your penis stimulated by a partnernmlkjnmlkjnmlkjnmlkjnmlkjnmlkjnml kjStimulating a partner's vagina or having your vagina stimulated by a partnernmlkjnmlkjnmlkjnmlkjnmlkjnmlkjnml kjPerforming oral sexnmlkjnmlkjnmlkjnmlkjnmlkjnmlkjnmlkjRe ceiving oral sexnmlkjnmlkjnmlkjnmlkjnmlkjnmlkjnmlkjSe xual intercoursenmlkjnmlkjnmlkjnmlkjnmlkjnmlk jnmlkjPage 6 Sexual Behavior QuestionnaireSexual Behavior QuestionnaireSexual Behavior QuestionnaireSexual Behavior Questionnaire22.

8 Please indicate on a scale of 0 (never) to 100% (always)how consistently you currently engage in the following contraceptive behaviors. Please select n/a if the question does not apply to During the last time you were sexually active did you use a form of contraceptive?24. During the last time you had Sexual intercourse what form(s) of contraceptive did you use?25. What form of contraceptive do you prefer to use?26. In the past 12 months I have used condoms:5. Contraceptive Behaviors 025%50%75%100%N/AAny contraceptive use during intercoursenmlkjnmlkjnmlkjnmlkjnmlkjnmlk jAny contraceptive use during oral sexnmlkjnmlkjnmlkjnmlkjnmlkjnmlkjUse of hormonal method contraceptivesnmlkjnmlkjnmlkjnmlkjnmlkjn mlkjUse of male condomnmlkjnmlkjnmlkjnmlkjnmlkjnmlkjUse of the rhythm methodnmlkjnmlkjnmlkjnmlkjnmlkjnmlkjUse of the withdrawal methodnmlkjnmlkjnmlkjnmlkjnmlkjnmlkjInte rcourse without any form of contraceptivenmlkjnmlkjnmlkjnmlkjnmlkjnm lkjOral sex without any form of contraceptivenmlkjnmlkjnmlkjnmlkjnmlkjnm lkjYes nmlkjNo nmlkjN/A nmlkjBirth Control (hormonal methods)

9 GfedcCondom gfedcWithdrawal gfedcRhythm MethodgfedcOther form of barrier method (diaphragm, cervical cap)gfedcNone gfedcN/A gfedcBirth Control (hormonal methods)nmlkjCondom nmlkjWithdrawal nmlkjRhythm MethodnmlkjOther form of barrier method (diaphragm, cervical cap)nmlkjNone nmlkjN/A nmlkjNever nmlkj25% of the timenmlkj50% of the timenmlkj75% of the timenmlkj100% of the timenmlkjN/A nmlkjPage 7 Sexual Behavior QuestionnaireSexual Behavior QuestionnaireSexual Behavior QuestionnaireSexual Behavior Questionnaire27. Please indicate on a scale of never to always how frequently you engage in the following contraceptive behaviors. Please select n/a if the question does not apply to you. neverrarelysomeoftenalwaysnot applicableAny contraceptive use during intercoursenmlkjnmlkjnmlkjnmlkjnmlkjnmlk jAny contraceptive use during oral sexnmlkjnmlkjnmlkjnmlkjnmlkjnmlkjUse of hormonal method contraceptivenmlkjnmlkjnmlkjnmlkjnmlkjnm lkjUse of male condomnmlkjnmlkjnmlkjnmlkjnmlkjnmlkjUse of the rhythm methodnmlkjnmlkjnmlkjnmlkjnmlkjnmlkjUse of the withdrawal methodnmlkjnmlkjnmlkjnmlkjnmlkjnmlkjInte rcourse without any form of contraceptivenmlkjnmlkjnmlkjnmlkjnmlkjnm lkjOral sex without any form of contraceptivenmlkjnmlkjnmlkjnmlkjnmlkjnm lkjPage 8 Sexual Behavior QuestionnaireSexual Behavior QuestionnaireSexual Behavior QuestionnaireSexual Behavior QuestionnaireFor the following

10 Questions please select the best Please indicate what type of school you attended during each of the following grade What size was your high school?30. Where did you attend high school6. School Type Public SchoolPrivate SchoolHome SchoolCombinationElementary School (K- 5th grade )nmlkjnmlkjnmlkjnmlkjMiddle School (6th-8th grade )nmlkjnmlkjnmlkjnmlkjHigh School (9th-12th grade )nmlkjnmlkjnmlkjnmlkjless than 150 students nmlkjless than 400 students nmlkjless than 600 students nmlkjless than 1,000 students nmlkjmore than 1,000 students nmlkjFlorida gfedcSoutheast United States (not Florida) gfedcMidwest United States gfedcNortheast United States gfedcWest United States gfedcOutside the United States gfedcPage 9 Sexual Behavior QuestionnaireSexual Behavior QuestionnaireSexual Behavior QuestionnaireSexual Behavior Questionnaire31.