Teen pregnancy

Are you...

• male
• female

What is your age range

• 7-12
• 12-18
• 18-21
• 21-over

Are you or have you ever been sxually active?

• yes
• no

If sxually active, do you use condoms?

• yes
• no
• only sometimes
• not sxually active

If you dont use condoms, why not (choose all that apply)

Please select all that apply.

• I or my partner use other forms of birth control
• the feeling isn't the same
• cant afford them
• my partner didnt want to
• I was too shy to buy them
• It was spur or the moment and i didnt have any at hand
• I dont believe in them (personal or religious reasons)
• not sxually active

Do you or your partner use any other forms of birth control? (choose all that apply

Please select all that apply.

• pull out
• the pill
• cervical cap
• the patch
• nuva ring
• female condom
• rhythm method (counting days in a calendar)
• IUD
• spermicidal jellies or foam
• other not listed
• not sxually active

were you aware of all those forms of birth control?

• yes
• no

Do you engage in other forms of sxual l contact other than sx

• yes
• no

How many times have you had sx without protection?

• 1-5
• 6-15
• 16-up

how many sxual partners have you ever had

• 1
• 2-4
• 5-up

Ever been tested for an std?

• yes
• no

Why did you begin having sx?

• I felt i was ready
• I was pressured
• not sxualy active

Are you dating someone older than you by 5 years?

• yes
• no

Do you participate in any other activies viewed as risky? such as drinking smoking or partying?

• yes
• no

ever been pregnant or impregnated someone

• yes
• no

Ever had a pregnancy scare

• yes
• no

ever decide on an abortion

• yes
• no
• never been pregnant

How many times have you used plan B

• 1
• 2-4
• 5- up

ever had a miscarriage

• yes
• no
• never been pregnant

Are you a parent

• yes
• no

What's your race/ethnicity

• hispanic
• african american
• caucasian
• asian
• other

Which class do you belong to?

• upper
• middle
• lower

Have you ever been sxually molested

• yes
• no

Would you consider yourself religous or spiritiual

• yes
• somewhat
• no

Do you think about the sxual education you got at school?

• It was good
• It was good enough
• They didnt do enough

If you think the sx ed you got at school wasnt enough, why (choose all that apply)

Please select all that apply.

• they didnt teach enough on prevention
• how to say no
• the difficulty of real life situations
• it was enough

Do you and your parents have good communication/trust

• yes
• no

Did your parents ever give you the "talk"

• yes
• no

If you got the talk from your parents, what was it like? (choose all that apply)

• Just dont have sx until im married
• never have sx, ever!
• have sx when i feel im ready
• when i have sx to use protection
• never got the talk

Do you feel you can talk to your parents about sx?

• yes
• no

If you ever needed condoms/birth control, or got pregnant/got someone pregnant; do you feel you can turn to your parents

• yes
• no
• yes but i would be scared