Revised: May 22, 2006 PHI Parent Questionnaire Public Health Institute California Adolescent Sexual Health Policy Project Parent Survey Questions Note: These questions were extracted directly from the CATI system and slightly reformatted for readability. Skip patterns, rotated or randomized questions and response options, and quota driven selections are not explicitly described. q01. Where do you think children and teenagers GET MOST of their information about sex and sexuality? [INTEVIEWER Record verbatim. PROBE for one MAIN source if they give more than one ] TYPE VERBATIM _______________________________________________________________ 1, DK ___________________________________________________________________________ 88, REFUSED _____________________________________________________________________ 99, q02. Where do you think children and teenagers SHOULD GET MOST of their information about sex and sexuality? [INTEVIEWER Record verbatim. PROBE for one MAIN source if they give more than one] TYPE VERBATIM _______________________________________________________________ 1, DK ___________________________________________________________________________ 88, REFUSED _____________________________________________________________________ 99, q03. Now you will have three choices. What do you think teenagers should be taught in sex education classes? [INTERVIEWER: Read LETTER before each response option] A ONLY about abstinence: that is, not having sex until marriage ___________________________ B ONLY about how to prevent pregnancies and the spread of sexually transmitted infections if they do decide to have sex ________________________________________________________ or C BOTH about abstinence AND about how to prevent pregnancies and sexually transmitted infections if they do have sex ______________________________________________________ 1 NONE ________________________________________________________________________ 66 DK ___________________________________________________________________________ 88 Missing _______________________________________________________________________ 99 2 3 q03NEW. Why do you feel this way? [INTERVIEWER Probe for clarity and record verbatim. PROBE ”Please tell me a bit more about what you mean by that?] TYPE VERBATIM _______________________________________________________________ DK ___________________________________________________________________________ REFUSED _____________________________________________________________________ 1 1, 88, 99, Revised: May 22, 2006 PHI Parent Questionnaire q031a.Compared with how you feel on other public issues, are your feelings on this issue... extremely strong ________________________________________________________________ 1 very strong_____________________________________________________________________ 2 somewhat strong OR_____________________________________________________________ 3 not strong at all? ________________________________________________________________ 4 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 q031B. If you were voting for a school board member, how important would a candidate’s position on this issue be to you in deciding whether or not to vote for the candidate. Would it be... One of the most important_________________________________________________________ 1 very important __________________________________________________________________ 2 somewhat important or ___________________________________________________________ 3 not important at all_______________________________________________________________ 4 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 2 Revised: May 22, 2006 PHI Parent Questionnaire (Question set 8 and 10 below are rotated so 50% of the respondents get one and 50% get the other.) 8. Abstinence-only classes teach students that they should not have sex until marriage , and DO NOT teach about how someone who is sexually active can prevent unwanted pregnancy and sexually transmitted infections q8a1 Do you think that abstinence-only classes have been very effective, somewhat effective, not too effective, or not at all effective in preventing or reducing HIV/AIDS? Very effective___________________________________________________________________ 1 somewhat effective ______________________________________________________________ 2 not too effective _________________________________________________________________ 3 or not at all effective? ____________________________________________________________ 4 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 q8a2 Do you think that abstinence-only classes have been very effective, somewhat effective, not too effective, or not at all effective in preventing or reducing unwanted pregnancies? Very effective___________________________________________________________________ 1 somewhat effective ______________________________________________________________ 2 not too effective _________________________________________________________________ 3 or not at all effective? ____________________________________________________________ 4 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 q8a3 Do you think that abstinence-only classes have been very effective, somewhat effective, not too effective, or not at all effective in preventing or reducing sex outside marriage? Very effective___________________________________________________________________ 1 somewhat effective ______________________________________________________________ 2 not too effective _________________________________________________________________ 3 or not at all effective? ____________________________________________________________ 4 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 3 Revised: May 22, 2006 PHI Parent Questionnaire q9. What are your reasons for feeling this way about the effectiveness of abstinence-only classes. [INTERVIEWER probe for clarity, completeness, reasons for beliefs and record verbatim] RECORD VERBATIM ____________________________________________________________ 1, DK ___________________________________________________________________________ 88, REFUSED _____________________________________________________________________ 99, q10. Some sex education classes teach abstinence as the best strategy, and ALSO teach how to prevent unwanted pregnancy and sexually transmitted infections for teens who do have sex. This type of sex education is called comprehensive sex education. q10f1 Do you think that comprehensive sex education classes have been very effective, somewhat effective, not too effective, or not at all effective in preventing or reducing HIV/AIDS? Very effective___________________________________________________________________ 1 somewhat effective ______________________________________________________________ 2 not too effective _________________________________________________________________ 3 or not at all effective? ____________________________________________________________ 4 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 q10f2. Do you think that comprehensive sex education classes have been very effective, somewhat effective, not too effective, or not at all effective in preventing or reducing unwanted pregnancies? Very effective___________________________________________________________________ 1 somewhat effective ______________________________________________________________ 2 not too effective _________________________________________________________________ 3 or not at all effective? ____________________________________________________________ 4 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 q10f3 Do you think that comprehensive sex education classes have been very effective, somewhat effective, not too effective, or not at all effective in preventing or reducing sex outside marriage? Very effective___________________________________________________________________ 1 somewhat effective ______________________________________________________________ 2 not too effective _________________________________________________________________ 3 or not at all effective? ____________________________________________________________ 4 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 4 Revised: May 22, 2006 PHI Parent Questionnaire q11. What are your reasons for feeling this way about the effectiveness of comprehensive sex education classes? [INTERVIEWER probe for clarity, completeness, reasons for beliefs AND record verbatim] RECORD VERBATIM ____________________________________________________________ 1, DK ___________________________________________________________________________ 88, REFUSED _____________________________________________________________________ 99, Next, please tell me the earliest school level where you think the following topics should be taught, or if you feel they should not be taught at any school level. The school grade levels are HIGH SCHOOL, that is grades 9 through 12, [PAUSE] MIDDLE SCHOOL, that is grades 6 through 8, [PAUSE] or ELEMENTARY SCHOOL, that is before 6th grade. q04A. First, the basic facts of human reproduction. [INTERVIEWER REPEAT] What do you think is the EARLIEST grade level where this should be taught: high school, middle school, elementary school, or should not be taught at any level? High School ____________________________________________________________________ 1 Middle School __________________________________________________________________ 2 Elementary School or ____________________________________________________________ 3 Should not be taught at any level? __________________________________________________ 4 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 5 Revised: May 22, 2006 PHI Parent Questionnaire q04B. Next, the changes young people go through at puberty and adolescence. [INTERVIEWER REPEAT] What do you think is the EARLIEST grade level where this should be taught: high school, middle school, elementary school, or should not be taught at any level? High School ____________________________________________________________________ 1 Middle School __________________________________________________________________ 2 Elementary School or ____________________________________________________________ 3 Should not be taught at any level? __________________________________________________ 4 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 q04C. The importance of responsible relationships. This includes love, dating, and marriage. [INTERVIEWER REPEAT] What do you think is the EARLIEST grade level where this should be taught: high school, middle school, elementary school, or should not be taught at any level? High School ____________________________________________________________________ 1 Middle School __________________________________________________________________ 2 Elementary School or ____________________________________________________________ 3 Should not be taught at any level? __________________________________________________ 4 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 q04d. Sexual decision making and communication. This includes assertiveness, refusal, and negotiation skills. [INTERVIEWER REPEAT] What do you think is the EARLIEST grade level where this should be taught: high school, middle school, elementary school, or should not be taught at any level? High School ____________________________________________________________________ 1 Middle School __________________________________________________________________ 2 Elementary School or ____________________________________________________________ 3 Should not be taught at any level? __________________________________________________ 4 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 q04e. Pregnancy and childbirth. This explains how pregnancy occurs, the importance of prenatal care, and childbirth.[INTERVIEWER REPEAT] What do you think is the EARLIEST grade level where this should be taught: high school, middle school, elementary school, or should not be taught at any level? High School ____________________________________________________________________ 1 Middle School __________________________________________________________________ 2 Elementary School or ____________________________________________________________ 3 Should not be taught at any level? __________________________________________________ 4 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 6 Revised: May 22, 2006 PHI Parent Questionnaire q04f. Parenting responsibilities. This teaches students about the responsibilities of raising children, including the time, financial demands and overall impact of being a parent. [INTERVIEWER REPEAT] What do you think is the EARLIEST grade level where this should be taught: high school, middle school, elementary school, or should not be taught at any level? High School ____________________________________________________________________ 1 Middle School __________________________________________________________________ 2 Elementary School or ____________________________________________________________ 3 Should not be taught at any level? __________________________________________________ 4 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 q04g. Abstinence. This discusses the reasons for NOT having sexual intercourse, including the prevention of pregnancy and sexually transmitted infections, and develops skills for being abstinent. [INTERVIEWER REPEAT] What do you think is the EARLIEST grade level where this should be taught: high school, middle school, elementary school, or should not be taught at any level? High School ____________________________________________________________________ 1 Middle School __________________________________________________________________ 2 Elementary School or ____________________________________________________________ 3 Should not be taught at any level? __________________________________________________ 4 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 q04h.Information about contraception and protection. This provides information about birth control pills, condoms , and other types of protection, and their role in preventing pregnancy and sexually transmitted infections. [INTERVIEWER REPEAT] What do you think is the EARLIEST grade level where this should be taught: high school, middle school, elementary school, or should not be taught at any level? High School ____________________________________________________________________ 1 Middle School __________________________________________________________________ 2 Elementary School or ____________________________________________________________ 3 Should not be taught at any level? __________________________________________________ 4 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 7 Revised: May 22, 2006 PHI Parent Questionnaire q04i. Information about sexually transmitted infections such as HIV/AIDS, herpes, and syphilis. This includes information about how these infections spread, preventing these infections, the harm they can cause, their symptoms, and their treatment. [INTERVIEWER REPEAT] What do you think is the EARLIEST grade level where this should be taught: high school, middle school, elementary school, or should not be taught at any level? High School ____________________________________________________________________ 1 Middle School __________________________________________________________________ 2 Elementary School or ____________________________________________________________ 3 Should not be taught at any level? __________________________________________________ 4 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 q04k. Information about homosexuality. This includes information about, and understanding of, individuals who are attracted to persons of the same sex. [INTERVIEWER REPEAT] What do you think is the EARLIEST grade level where this should be taught: high school, middle school, elementary school, or should not be taught at any level? High School ____________________________________________________________________ 1 Middle School __________________________________________________________________ 2 Elementary School or ____________________________________________________________ 3 Should not be taught at any level? __________________________________________________ 4 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 q04j. Information about sexual abuse and assault, including date rape and statutory rape. This provides information about forced sexual activity and ways to prevent it, the laws in California, and where to go for help. [INTERVIEWER REPEAT] What do you think is the EARLIEST grade level where this should be taught: high school, middle school, elementary school, or should not be taught at any level? High School ____________________________________________________________________ 1 Middle School __________________________________________________________________ 2 Elementary School or ____________________________________________________________ 3 Should not be taught at any level? __________________________________________________ 4 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 8 Revised: May 22, 2006 PHI Parent Questionnaire The following requirements are sometimes applied to sex education classes. Please tell me if you agree or disagree with each requirement. q5a. All information provided in sex education classes must be medically accurate. Do you strongly agree, somewhat agree, somewhat disagree, or strongly disagree with this requirement? strongly agree __________________________________________________________________ 1 somewhat agree ________________________________________________________________ 2 somewhat disagree ______________________________________________________________ 3 strongly disagree? _______________________________________________________________ 4 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 q5b. Students should be encouraged to communicate with parents or guardians about sex and sexuality. Do you strongly agree, somewhat agree, somewhat disagree, or strongly disagree? strongly agree __________________________________________________________________ 1 somewhat agree ________________________________________________________________ 2 somewhat disagree ______________________________________________________________ 3 strongly disagree? _______________________________________________________________ 4 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 q5c. Respect for marriage and committed relationships should be taught. strongly agree __________________________________________________________________ 1 somewhat agree ________________________________________________________________ 2 somewhat disagree ______________________________________________________________ 3 strongly disagree? _______________________________________________________________ 4 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 q5d. Sex education should teach that all sexual activity outside of marriage is likely to have harmful psychological and physical effects. strongly agree __________________________________________________________________ 1 somewhat agree ________________________________________________________________ 2 somewhat disagree ______________________________________________________________ 3 strongly disagree? _______________________________________________________________ 4 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 9 Revised: May 22, 2006 PHI Parent Questionnaire Question set 7 is rotated to ask about middle school students (50%), or high school students (50%). 7a. Different approaches to sex education sometimes have different goals. I would like to know your opinion on the importance of each goal, thinking about sex education classes for <%q7rot> (middle/high) school students. q7b1. How important is teaching <%q7rot> students to have healthy and positive relationships with someone they are dating... Very important __________________________________________________________________ 1 somewhat important _____________________________________________________________ 2 not important ___________________________________________________________________ 3 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 q7b2. How important is teaching <%q7rot> students to AVOID dating relationships... Very important __________________________________________________________________ 1 somewhat important _____________________________________________________________ 2 not important ___________________________________________________________________ 3 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 q7b3. How important is teaching <%q7rot> students to develop healthy and positive attitudes about their sexuality... Very important __________________________________________________________________ 1 somewhat important _____________________________________________________________ 2 not important ___________________________________________________________________ 3 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 q7b4. How important is teaching <%q7rot> students to avoid sexual intercourse... Very important __________________________________________________________________ 1 somewhat important _____________________________________________________________ 2 not important ___________________________________________________________________ 3 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 10 Revised: May 22, 2006 PHI Parent Questionnaire q7b5. How important is teaching <%q7rot> students how to avoid pregnancy and sexually transmitted infections if they do have sex... Very important __________________________________________________________________ 1 somewhat important _____________________________________________________________ 2 not important ___________________________________________________________________ 3 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 For the next questions, we need to know the ages of your children 18 years of age and younger. What are their ages? [INTERVIEWER: this is a MULTIPLE response question] (CHECK ALL THAT APPLY.) LIST OF ALL AGES FOR INTERVIEWER TO PUNCH LESS THAN 1 1 2, 3, ETC. IF THE RESPONDENT IS NOT A PARENT OF A CHILD 8 OR OLDER, SKIP TO QUESTION 16 TARGETKIDAGE 8_____________________________________________________________________________ 1 9_____________________________________________________________________________ 2 10____________________________________________________________________________ 3 11____________________________________________________________________________ 4 12____________________________________________________________________________ 5 13____________________________________________________________________________ 6 14____________________________________________________________________________ 7 15____________________________________________________________________________ 8 16____________________________________________________________________________ 9 17____________________________________________________________________________ 10 18____________________________________________________________________________ 11 11 Revised: May 22, 2006 PHI Parent Questionnaire What is the gender of the <%targetkidage> year old? Male__________________________________________________________________________ 1 Female________________________________________________________________________ 2 REFUSED _____________________________________________________________________ 99 q12a. Thinking about your <%targetkidage> year old, have you ever talked with <(targetkidgender(male))/him/her> about...The basic facts of human reproduction? Yes __________________________________________________________________________ 1 No ___________________________________________________________________________ 2 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 q12b. Issues involved in becoming sexually active? Yes __________________________________________________________________________ 1 No ___________________________________________________________________________ 2 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 q12c. The advantages for a young person of avoiding sexual intercourse? Yes __________________________________________________________________________ 1 No ___________________________________________________________________________ 2 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 q12d. HIV/AIDS and other sexually transmitted infections? Yes __________________________________________________________________________ 1 No ___________________________________________________________________________ 2 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 q12e. The importance of using protection, such as condoms, to prevent pregnancy or diseases if he/she becomes sexually active? Yes __________________________________________________________________________ 1 No ___________________________________________________________________________ 2 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 12 Revised: May 22, 2006 PHI Parent Questionnaire q12f. Where to get condoms? Yes __________________________________________________________________________ 1 No ___________________________________________________________________________ 2 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 q13. Overall, how COMFORTABLE do you feel talking with your <%targetkidage> year old about sex and relationships? Very comfortable ________________________________________________________________ 1 Somewhat comfortable ___________________________________________________________ 2 Somewhat uncomfortable _________________________________________________________ 3 Very uncomfortable ______________________________________________________________ 4 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 q14. And how KNOWLEDGEABLE do you feel talking with your <%targetkidage> year old about sex and relationships? Very knowledgeable _____________________________________________________________ 1 Somewhat knowledgeable ________________________________________________________ 2 Somewhat unknowledgeable ______________________________________________________ 3 Very unknowledgeable ___________________________________________________________ 4 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 q15. What is the most difficult part for you in talking to your child about sex and relationships? [INTERVIEWER probe for clarity and record verbatim] RECORD VERBATIM ____________________________________________________________ 1, DK ___________________________________________________________________________ 88, REFUSED _____________________________________________________________________ 99, q16. In general would you say that young people today get information about the benefits of abstinence, that is, avoiding sexual intercourse... Too soon ______________________________________________________________________ 1 at about the right time ____________________________________________________________ 2 or too late _____________________________________________________________________ 3 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 13 Revised: May 22, 2006 PHI Parent Questionnaire q17. In general would you say that young people today get information about birth control and protection against sexually transmitted infections ... Too soon ______________________________________________________________________ 1 at about the right time ____________________________________________________________ 2 or too late _____________________________________________________________________ 3 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 q18. How good or poor a job do you think the public schools in your area are doing in providing sex education to their students? a very good job _________________________________________________________________ 1 a good job _____________________________________________________________________ 2 a poor job _____________________________________________________________________ 3 a very poor job__________________________________________________________________ 4 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 q19. How good or poor a job do you think the public schools in your area are doing in providing SCIENCE EDUCATION to their students? a very good job _________________________________________________________________ 1 a good job _____________________________________________________________________ 2 a poor job _____________________________________________________________________ 3 a very poor job__________________________________________________________________ 4 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 q21a. The next few questions are about condoms. Please tell me whether or not you agree with each the following statements... [INTERVIEWER PLEASE PAUSE] Teenagers need information about how to correctly use condoms to prevent the spread of HIV and other sexually transmitted infections. Do you ... strongly agree __________________________________________________________________ 1 somewhat agree ________________________________________________________________ 2 somewhat disagree ______________________________________________________________ 3 or strongly disagree?_____________________________________________________________ 4 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 14 Revised: May 22, 2006 PHI Parent Questionnaire q21b. Teenagers who use condoms during sex are being responsible. Do you... strongly agree __________________________________________________________________ 1 somewhat agree ________________________________________________________________ 2 somewhat disagree ______________________________________________________________ 3 or strongly disagree?_____________________________________________________________ 4 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 q21c1. High schools should be ALLOWED to teach teenagers about how to use condoms to prevent the spread of HIV and other sexually transmitted infections. Do you... strongly agree __________________________________________________________________ 1 somewhat agree ________________________________________________________________ 2 somewhat disagree ______________________________________________________________ 3 or strongly disagree?_____________________________________________________________ 4 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 q21c2. High schools should be FORBIDDEN from teaching teenagers about how to use condoms to prevent the spread of HIV and other sexually transmitted infections. Do you... strongly agree __________________________________________________________________ 1 somewhat agree ________________________________________________________________ 2 somewhat disagree ______________________________________________________________ 3 or strongly disagree?_____________________________________________________________ 4 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 q21c3. High schools should be REQUIERED to teach teenagers about how to use condoms to prevent pregnancy and the spread of HIV and other sexually transmitted infections. Do you... strongly agree __________________________________________________________________ 1 somewhat agree ________________________________________________________________ 2 somewhat disagree ______________________________________________________________ 3 or strongly disagree?_____________________________________________________________ 4 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 15 Revised: May 22, 2006 PHI Parent Questionnaire q21d. High school classroom lessons about condoms should include actual condoms so students can see and touch them. Do you... strongly agree __________________________________________________________________ 1 somewhat agree ________________________________________________________________ 2 somewhat disagree ______________________________________________________________ 3 or strongly disagree?_____________________________________________________________ 4 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 q21e. Condoms should be made available to students in high schools. Do you... strongly agree __________________________________________________________________ 1 somewhat agree ________________________________________________________________ 2 somewhat disagree ______________________________________________________________ 3 or strongly disagree?_____________________________________________________________ 4 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 q22a. If used properly, how effective do you think condoms are in...Preventing the transmission of HIV? Would you say... very effective ___________________________________________________________________ 1 somewhat effective ______________________________________________________________ 2 not too effective or_______________________________________________________________ 3 not at all effective _______________________________________________________________ 4 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 q22b. Preventing sexually transmitted infections other than HIV? Would you say... very effective ___________________________________________________________________ 1 somewhat effective ______________________________________________________________ 2 not too effective or_______________________________________________________________ 3 not at all effective _______________________________________________________________ 4 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 16 Revised: May 22, 2006 PHI Parent Questionnaire q22c. Preventing pregnancy? very effective ___________________________________________________________________ 1 somewhat effective ______________________________________________________________ 2 not too effective or_______________________________________________________________ 3 not at all effective _______________________________________________________________ 4 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 The next three questions apply to parents of girls or female teens. Do you have a daughter living at home with you? Yes __________________________________________________________________________ 1 No ___________________________________________________________________________ 2 REFUSED _____________________________________________________________________ 99 HPV, or Human Papilloma Virus, is the most common sexually transmitted infection among teenagers and can lead to cervical cancer. A vaccine against HPV is currently being developed. The HPV vaccine would be most beneficial if given before age 13, preferably before a person becomes sexually active. It could greatly reduce a woman’s chance of developing cervical cancer as an adult. q23. If an HPV vaccine were available, how likely would you be to have your daughter vaccinated before her 13th birthday? very likely______________________________________________________________________ 1 somewhat likely _________________________________________________________________ 2 somewhat unlikely or_____________________________________________________________ 3 Very unlikely ___________________________________________________________________ 4 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 q24. If an HPV vaccine were available, how likely would you be to have your daughter vaccinated before her 16th birthday? very likely______________________________________________________________________ 1 somewhat likely _________________________________________________________________ 2 somewhat unlikely or_____________________________________________________________ 3 Very unlikely ___________________________________________________________________ 4 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 17 Revised: May 22, 2006 PHI Parent Questionnaire q24b. What are your reasons for feeling this way about vaccinating your daughter? Type verbatim and probe for clarity__________________________________________________ 77, DK ___________________________________________________________________________ 88, REFUSED _____________________________________________________________________ 99, Now I have just a few more questions so we can learn more about the people who took part in our survey . . . q25. What is your zip code? [INTERVIEWER is it <%zip> ? If not please enter it in the next question] yes ___________________________________________________________________________ 1 no____________________________________________________________________________ 2 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 q25a.What is your zip code? ENTER 88888 for DK and 99999 for REF 1-5 q26. What county do you live in? [ <%county> INTERVIEWER is it the same as listed?] yes ___________________________________________________________________________ 1 no____________________________________________________________________________ 2 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 18 Revised: May 22, 2006 PHI Parent Questionnaire q26a.Enter the new county? ENTER 888 for DK and 999 for REF Alpine_________________________________________________________________________ 1 Amador _______________________________________________________________________ 2 Butte _________________________________________________________________________ 3 Calaveras _____________________________________________________________________ 4 Colusa ________________________________________________________________________ 5 Del Norte ______________________________________________________________________ 6 El Dorado _____________________________________________________________________ 7 Glenn _________________________________________________________________________ 8 Humboldt ______________________________________________________________________ 9 Inyo __________________________________________________________________________ 10 Lake__________________________________________________________________________ 11 Lassen ________________________________________________________________________ 12 Mendocino _____________________________________________________________________ 13 Modoc ________________________________________________________________________ 14 Mono _________________________________________________________________________ 15 Nevada _______________________________________________________________________ 16 Placer ________________________________________________________________________ 17 Plumas________________________________________________________________________ 18 Shasta ________________________________________________________________________ 19 Sierra _________________________________________________________________________ 20 Siskiyou _______________________________________________________________________ 21 Sutter _________________________________________________________________________ 22 Tehama _______________________________________________________________________ 23 Trinity_________________________________________________________________________ 24 Yolo __________________________________________________________________________ 25 Yuba _________________________________________________________________________ 26 Fresno ________________________________________________________________________ 27 Kern __________________________________________________________________________ 28 Kings _________________________________________________________________________ 29 Madera _______________________________________________________________________ 30 Mariposa ______________________________________________________________________ 31 Merced________________________________________________________________________ 32 Sacramento ____________________________________________________________________ 33 San Joaquin ___________________________________________________________________ 34 Stanislaus _____________________________________________________________________ 35 Tulare ________________________________________________________________________ 36 Tuolumne _____________________________________________________________________ 37 Alameda ______________________________________________________________________ 38 Contra Costa ___________________________________________________________________ 39 Marin _________________________________________________________________________ 40 Monterey ______________________________________________________________________ 41 19 Revised: May 22, 2006 PHI Parent Questionnaire Napa _________________________________________________________________________ 42 San Benito _____________________________________________________________________ 43 San Francisco __________________________________________________________________ 44 San Luis Obispo ________________________________________________________________ 45 San Mateo _____________________________________________________________________ 46 Santa Barbara __________________________________________________________________ 47 Santa Clara ____________________________________________________________________ 48 Santa Cruz ____________________________________________________________________ 49 Solano ________________________________________________________________________ 50 Sonoma _______________________________________________________________________ 51 Ventura _______________________________________________________________________ 52 Los Angeles____________________________________________________________________ 53 Imperial _______________________________________________________________________ 54 Orange________________________________________________________________________ 55 Riverside ______________________________________________________________________ 56 San Bernardino _________________________________________________________________ 57 San Diego _____________________________________________________________________ 58 Specify________________________________________________________________________ 59 DK ___________________________________________________________________________ 888 REFUSED _____________________________________________________________________ 999 q27. How many separate phone lines do you have in your house, not counting fax or computer-only lines, and not counting cell phones? One line _______________________________________________________________________ 1 Two lines ______________________________________________________________________ 2 Three lines_____________________________________________________________________ 3 Four lines______________________________________________________________________ 4 Five lines ______________________________________________________________________ 5 Six lines _______________________________________________________________________ 6 Seven lines ____________________________________________________________________ 7 Eight lines _____________________________________________________________________ 8 Nine or more lines _______________________________________________________________ 9 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 20 Revised: May 22, 2006 PHI Parent Questionnaire q28. What is your age? Are you... Under 20 ______________________________________________________________________ 1 20 to 29 _______________________________________________________________________ 2 30 to 39 _______________________________________________________________________ 3 40 to 49 _______________________________________________________________________ 4 50 to 59 _______________________________________________________________________ 5 60 or older _____________________________________________________________________ 6 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 q29 What is the highest grade or class you completed in school? Less than high school ____________________________________________________________ 1 High School graduate ____________________________________________________________ 2 GED or Vocational School_________________________________________________________ 3 Some college___________________________________________________________________ 4 College Graduate _______________________________________________________________ 5 Graduate School ________________________________________________________________ 6 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 q30. Are you of Latino background, such as Mexican, Central American, or some other Hispanic background? Yes __________________________________________________________________________ 1 No ___________________________________________________________________________ 2 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 q31. What is your race? Are you... white _________________________________________________________________________ 1 black or African American _________________________________________________________ 2 Asian _________________________________________________________________________ 3 or some other race (specify)? ______________________________________________________ 4 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 21 Revised: May 22, 2006 PHI Parent Questionnaire q32 Were you born in the United states, or in another country? USA __________________________________________________________________________ 1 Another Country ________________________________________________________________ 2 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 q32b. What country were you born? Mexico ________________________________________________________________________ 1 Other South or Central American ___________________________________________________ 2 China _________________________________________________________________________ 3 Other Asian ____________________________________________________________________ 4 European country _______________________________________________________________ 5 Other _________________________________________________________________________ 6 Specify________________________________________________________________________ 7 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 q33. Do you have a child or teenager living at home who is enrolled in a public school - and by that we mean either elementary, middle, or high school? Yes __________________________________________________________________________ 1 No ___________________________________________________________________________ 2 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 q34. What is your religious preference, if any? Catholic _______________________________________________________________________ 1 Protestant _____________________________________________________________________ 2 Lutheran ______________________________________________________________________ 3 Presbyterian ___________________________________________________________________ 4 Baptist ________________________________________________________________________ 5 Episcopalian ___________________________________________________________________ 6 Jewish ________________________________________________________________________ 7 Muslim ________________________________________________________________________ 8 Buddhist ______________________________________________________________________ 9 Mormon _______________________________________________________________________ 10 OTHER CHRISTIAN _____________________________________________________________ 11 NONE ________________________________________________________________________ 66 Other specify ___________________________________________________________________ 77 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 22 Revised: May 22, 2006 PHI Parent Questionnaire q35. Would you describe yourself as Evangelical or Born Again Christian? Yes __________________________________________________________________________ 1 No ___________________________________________________________________________ 2 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 q36 In a typical month, how often do you attend religious services? Would you say... Rarely or never _________________________________________________________________ 1 a few times a year _______________________________________________________________ 2 one to three times a month ________________________________________________________ 3 once a week ___________________________________________________________________ 4 more than once a week ___________________________________________________________ 5 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 q37. Are you registered to vote? Yes __________________________________________________________________________ 1 No ___________________________________________________________________________ 2 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 What is your political affiliation? Are you... Republican ____________________________________________________________________ 1 Democrat ______________________________________________________________________ 2 Independent ___________________________________________________________________ 3 or Other _______________________________________________________________________ 4 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 q39. Politically, do you consider yourself to be... very conservative _______________________________________________________________ 1 somewhat conservative___________________________________________________________ 2 middle of the road _______________________________________________________________ 3 somewhat liberal ________________________________________________________________ 4 very liberal? ____________________________________________________________________ 5 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 23 Revised: May 22, 2006 PHI Parent Questionnaire Including yourself, how many people live in your household 1_____________________________________________________________________________ 1 2_____________________________________________________________________________ 2 3_____________________________________________________________________________ 3 4_____________________________________________________________________________ 4 5_____________________________________________________________________________ 5 6_____________________________________________________________________________ 6 7_____________________________________________________________________________ 7 8_____________________________________________________________________________ 8 9_____________________________________________________________________________ 9 10____________________________________________________________________________ 10 11____________________________________________________________________________ 11 12____________________________________________________________________________ 12 13____________________________________________________________________________ 13 14____________________________________________________________________________ 14 15____________________________________________________________________________ 15 Other specify ___________________________________________________________________ 77 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 q40. Last year, that is in 2005, what was your total household income from all sources, BEFORE taxes? Just stop me when I get to the right category. Under $20,000__________________________________________________________________ 1 $20,000 to under $40,000 _________________________________________________________ 2 $40,000 to under $60,000 _________________________________________________________ 3 $60,000 to under $100,000 ________________________________________________________ 4 $100,000 or more _______________________________________________________________ 5 DK ___________________________________________________________________________ 88 REFUSED _____________________________________________________________________ 99 q42. Do you have any other comments you would like to make about any of the issues covered on this survey? Write verbatim __________________________________________________________________ 77, No other comments ______________________________________________________________ 88, Thank you very much for taking the time to answer the questions on this survey. We really appreciate it. Have a nice evening. INTERVIEWER Record gender of respondent Male__________________________________________________________________________ 1 Female________________________________________________________________________ 2 24