Sexual SAAQ Manual PDF (1)

8/21/2019 Sexual SAAQ Manual PDF (1)

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Manual for the Administration and Coding of the

Sexual Activit ies & Attitudes Questionnaire

(SAAQ)

Noll, J.G., P.K. Trickett, and F.W. Putnam, A prospective investigation of theimpact of childhood sexual abuse on the development of sexuality. Journalof Consulting and Clinical Psychology, 2003. 71(3): p. 575-586.

All intellectual content contained within this document isproperty of Dr. Jennie G. Noll.

To request an electronic copy of the SAAQ measure contained on CD-ROM,please contact:

Jennie G NollCincinnati Children’s HospitalBehavioral Medicine and Clinical PsychologyML 30153333 Burnet AvenueCincinnati, OH 45229

[email protected]


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Introduction

The SAAQ is a 44-item self report measure which assesses (I) sexual activitiesas well as (II) sexual attitudes.

I. Sexual activities include1. Age at first intercourse2. Birth control efficacy3. Intercourse partners4. HIV-risk behaviors5. STDs6. Pregnancies7. Sexual behaviors of peers

II. Sexual attitudes assessed include 1. Sexual preoccupation. This subscale assesses positive attitudes

toward, and high frequency of, masturbation, being turned-on by pornographicpictures or sexual themes, and thinking about sex frequently. This scale has 15items (α = .91) and has been shown to be correlated with teen pregnancy andsexual abuse.

2. Sexual permissiveness. This 12-item subscale (α = .96) assessespermissive attitudes toward a relatively normative set of desires and behaviors,including intimate affection, light and heavy petting, and voluntary intercourse.

3. Internal and external pressure to engage in sex. This 6-item subscale(α = .70) assesses the belief that a sense of maturity and respect from friends willbe gained, that is sex is expected, and that one will feel more loved and wantedupon having sex.

4. Negative attitude toward sex. This 10-item subscale (α = .85)assesses attitudes that sex is dirty and embarrassing, being frightened by sex,believing that sex results in the loss of respect for self and from friends, andworrying about becoming pregnant.

5. Sexual Aversion. The SAAQ measures this construct by the followingequation: -1 * (permissiveness) + (negative attitude toward sex). The constructahs been shown to be related to childhood sexual behavior problems earlier indevelopment for sexually abused females.

6. Sexual Ambivalence. The SAAQ measures this construct by thefollowing equation: (preoccupation) + (aversion). Thus, this is a measure ofsimultaneous compulsion coupled with an aversion (see preliminary studiessection1). This construct has been shown to be related to dissociative symptomsearlier in development for adolescents sexually abused in childhood.


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Calculating Subscales for the SAAQ:

Sexual Preoccupation:Items 3, 4a, 4b, 4c, 4d, 4e, 4f, 4g, 4h, 4i, 4j, 4k, 4l, 4m, 4n, 5, 13a, 13i

Sexual Permissiveness:Items 2b, 2c, 2d, 2e, 2f, 8, 10, 10a, 13d

Internal and external pressure to engage in sex:Items 13b, 14c, 14d, 14g, 14i, 14j

Negative attitude toward sex:Items 13c, 13f, 13h, 13j, 13k, 14a, 14b, 14e, 14f, 14h,

Sexual Aversion = (-1*permissiveness) + (negative attitude toward sex)

Sexual Ambivalence = (preoccupation) + (aversion)

Other noteworthy groupings:

Risky sexual behavior = 2g, 2h, 2i, 2j, 2k

Peers exhibiting risky sexual behavior = 12g, 12h, 12i, 12j, 12k, 12l, 12m

Risk for HIV contraction = 24a, 24b, 24c, 24d, 24e, 24f, 24g, 24h, 24i, 24j, 24k

Intercourse ever = 8

If Intercourse ever = 0 then Risk for HIV contraction2 = 24b, 24e, 24f, 24g

HIV Positive = 62

Number of STD’s = 56, 57, 58, 59, 60, 61, 62, 63, 64


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Sexual Attitudes and Activities Questionnaire (SAAQ)

Female V2.2

Introduction:

In this section you will answer some questions having to do with your attitudes and feelingsabout sex and your sexual behavior. For each question choose the answer that best represents

how YOU feel or what YOU do.

Your answers to these questions are strictly confidential. Your name will never be associated

with any of your responses. The information that you provide is very valuable and will help us

understand how adolescents think and feel about sex so it is important that you answer honestlyand as accurately as possible.

In this section we are only interested in your behavior regarding consensual or voluntary sexualexperiences. When asked about sexual behavior, only report about situations when you agreed to participate in sexual activity. Disregard any situations when sex was either forced on you or

when you did not give your full consent.

Now begin to answer all of the questions.

1


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1. Indicate the number of romantic partners with which you have done the following during the

PAST YEAR.

0

none, 1 2 or 3 4-7 8-10 more than 10

never partner partners partners partners partners

a. Gone out on unsupervised dates _____

b. Held hands ______

c. French or tongue kissing ______d. Made out ______

e. Felt their private parts under clothing ______

f. Had your private parts felt under clothing ______

g. Given oral sex (mouth on private parts) ______h. Received oral sex ______

i. Had sexual intercourse in a “one night stand” _____

j. Had sexual intercourse without contraception—hadunprotected sex ______

k. Had sexual intercourse while drunk on alcohol or

high on drugs ______

2. Indicate the number of romantic partners with which you have done the following during the

YOUR ENTIRE LIFETIME.

0

none, 1 2 or 3 4-7 8-10 more than 10


a. Gone out on unsupervised dates _____ b. Held hands ______

c. French or tongue kissing ______

d. Made out ______e. Felt their private parts under clothing ______

f. Had your private parts felt under clothing ______

g. Given oral sex (mouth on private parts) ______

h. Received oral sex ______i. Had sexual intercourse in a “one night stand” _____

j. Had sexual intercourse without contraception—had

unprotected sex ______k. Had sexual intercourse while drunk on alcohol or

high on drugs ______

2


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3. How often do you find yourself thinking a lot about sex?

0 1 2 3 4 5

Never once or twice about once about once several times several times

every few months a month a week a week a day

4. Are you, or do you think you would be, turned on sexually by: (circle a number for each):

not at all a little some a lot very much

4a. Looking at your own body 1 2 3 4 5

4b. Romantic Dancing 1 2 3 4 5

4c. Romantic pictures in magazines or books 1 2 3 4 5

4d. Movie or TV shows that have love scenes 1 2 3 4 5

4e. Songs with romantic or sexy words 1 2 3 4 5

4f. Dreams while you are sleeping 1 2 3 4 5

4g. Women without clothes on 1 2 3 4 5

4h. Men without clothes on 1 2 3 4 5

4i. Fantasies or day dreams about sex 1 2 3 4 5

4j. An attractive male 1 2 3 4 5

4k. An attractive female 1 2 3 4 5

4l. Literature (books/magazines) that tell stories 1 2 3 4 5about sex or have sexual pictures

4m. Websites that have sexual content 1 2 3 4 5

4n. Chat rooms or websites where people chat about 1 2 3 4 5

sexual things.

5. Some people sometimes masturbate, or play with their private parts to have a good feeling.

How often have you done this? (circle one):

0 1 2 3 4 5 Never once or twice about once about once several times almost every

every few months a month a week a week day

3


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6. In the LAST YEAR how many times have you had voluntary sexual intercourse?

0

none, 1 2 or 3 4-7 8-10 more than 10

never time times times times times

IF “NEVER” SKIP TO QUESTION #8.

7. In the LAST YEAR how many voluntary sexual intercourse partners have you had?

0none, 1 2 or 3 4-7 8-10 more than 10


8. How many voluntary sexual intercourse partners have you had in your LIFETIME: (circle one):

0

none, 1 2 or 3 4-7 8-10 more than 10



9. As best you can recall, how old were you the first time you had consensual intercourse? (Please placea check in front of your answer.)

__younger than age 12 __15 years-old __18 years-old __21 years or older

__12 ½ years-old __15 ½ years-old __18 ½ years-old __13 years-old __16 years-old __19 years-old __13 ½ years-old __16 ½ years-old __19 ½ years-old

__14 years-old __17 years-old __20 years-old

__14 ½ years-old __17 ½ years-old __20 ½ years-old

10. How likely is it that you will have sexual intercourse with someone in the next year?

1 sure it won’t happen

2 probably won’t happen3 even chance (50-50) it will happen

4 probably will happen

5 sure it will happen

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10a. How much do you think you would like to have sexual intercourse with someone in the

next year?

1 would dislike very much

2 would dislike a little

3 would neither like nor dislike4 would like a little

5 would like very much

11. If you were to have sexual intercourse with someone in the next year, how likely is it that

you would use birth control?

1 sure I wouldn’t use it

2 probably I wouldn’t use it

3 even chance (50-50) I would use it

4 probably I would use it5 sure I would use it

12. Please indicate whether or not you think your best friend has done each of the following

with a romantic partner.

1= definitely no

2= probably no

3= I don’t really know4= probably yes

5 = definitely yes

12a. Gone out on unsupervised dates _____

12b. Held hands with a partner ______

12c. French or tongue kissed a partner ______

12d. Necked or made-out with a partner ______12e. Felt a partner’s private parts under clothes or without clothes ______

12f. Had private parts felt under clothes or without clothes ______

12g. Given oral sex (mouth on private parts) ______12h. Received oral sex (mouth on private parts) ______

12i. Had sexual intercourse ______

12j. Had sexual intercourse with more than one partner within a few weeks ______12k. Had sexual intercourse in a “one night stand” ______

12l. Had sexual intercourse while drunk or high on drugs ______12m. Had sexual intercourse without contraception—had unprotected sex ______

5


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13. Choose the response that best represents how you think or feel:

s t r

o n g l y

d i s

a g r e

e

d i s

a g r e

e

n e i t h

e r a g r e

e n o

r d i s

a g r e

e

a g r e

e

s t r

o n g l y

a g r e

e

13a.Masturbation doesn’t hurt you 1 2 3 4 5

13b.It is OK for girls my age to do sexual things 1 2 3 4 5 because others expect them to

13c. Sex is dirty. 1 2 3 4 5

13d. It’s okay for people my age to have sex 1 2 3 4 5

13e. There is a lot of pressure to “go further” 1 2 3 4 5in sexual activity than girls really want to

13f. I wish there was no such thing 1 2 3 4 5as sex.

13g. I think about sex even when I don't want to. 1 2 3 4 5

13h. I get frightened when I think about sex 1 2 3 4 5

13i. I sometimes have sexual feelings when I see 1 2 3 4 5

people kiss on TV or movies

13j. Thinking about sex upsets me 1 2 3 4 5

13k. I hope I never have to think about sex again 1 2 3 4 5

13l. I only have sex or plan to have sex with people 1 2 3 4 5

that I love.

13m. It’s okay for people my age to have more than 1 2 3 4 5

one sexual partner at a time

13n. It is important for me to care about a person in 1 2 3 4 5

order to feel okay about having sex with them

6


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14. If you were to have sex next month with someone you know well, how likely do you think

it is that each thing would happen to you?

d e f i n i t

e l y

n o

t

p r o b

a b l y

n o

t

e v e n

c h

a n c

e (

5 0

- 5 0 )

p r o b

a b l y

y e

s

d e f i n i t

e l y

y e

s

14a. I would be embarrassed while having sex 1 2 3 4 5

14b. I would lose the respect of my friends 1 2 3 4 5

14c. I would feel more loved and wanted by the person 1 2 3 4 5

14d. The person would like me more 1 2 3 4 5

14e. I would lose respect for myself 1 2 3 4 5

14f. I would worry about getting pregnant 1 2 3 4 5

14g. It would show the person I liked them 1 2 3 4 5

14h. It would hurt my health 1 2 3 4 5

14i. I would gain the respect of my friends 1 2 3 4 5

14j. I would feel more mature 1 2 3 4 5

15. Are you currently trying to get pregnant? (circle one):

0 1

NO YES

IF YOU HAVE NEVER HAD

VOLUNTARY SEXUAL

INTERCOURSE, PLEASE SKIPTO QUESTION # 17.

IF “YES” PLEASE ANSWER THE

FOLLOWING QUESTIONS WITH

RESPECT TO A TIME WHEN YOUWERE NOT TRYING TO GET

PREGNANT.

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16. How often do you use birth control when you have sex? (circle one):

1 I never use birth control

2 I hardly ever use birth control when I have sex

3 sometimes I use birth control when I have sex, but not very often

4 I use birth control about half of the time I have sex5 almost every time I have sex I use birth control

6 for sure every time I have sex I use birth control

17. If you were to have sexual intercourse with someone in the near future, how likely is it

that you would use birth control? (circle one):

1 I’m sure I wouldn’t use it



4 probably I would use it

5 sure I would use it

18. Indicate if you learned about birth control methods in any of the following ways:

Rate each in the following ways:

0 = NO, never learned this way

1 = YES learned this way but found it to be NOT VERY EFFECTIVE in teaching me about birth

control methods2 = YES learned this way but found it to be ONLY SOMEWHAT EFFECTIVE in teaching me

about birth control methods

3 = YES learned this way and found it to be ADEQUATELY EFFECTIVE in teaching me about birth control methods

4 = YES learned this way and found it to be VERY EFFECTIVE in teaching me about birth

control methods

18a. _____ Learned from an older brother or sister

18b. _____ Learned from my mother (or mother figure)

18c. _____ Learned from my father (or father figure)18d. _____ Learned from another relative (Aunt, Uncle, Cousin, Grandparent)

18e. _____ Learned from a friend

18f. _____ Learned from a boyfriend or romantic partner

18g. _____ Learned from my Doctor18h. _____ Learned in a program at my school

18i. _____ Learned on my own18j. _____ Other explain:__________________

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19. Please rate the following methods of birth control methods according to your preference

for each type of birth control.

Not Somewhat Most

Preferred Preferred Preferred

0 1 2 3 4 5 19a. Rhythm method—timing when I have

sex according to where I am in my

menstrual cycle

0 1 2 3 4 5 19b. Make sure the other person pulls out

in time

0 1 2 3 4 5 19c. Birth control pills

0 1 2 3 4 5 19d. Sponge

0 1 2 3 4 5 19e. Spermicides and/or creams or foams

0 1 2 3 4 5 19f. Intrauterine device (e.g. IUD, coil,

loop)

0 1 2 3 4 5 19g. Monthly vaginal ring, “The Ring”

(e.g. NuvaRing)

0 1 2 3 4 5 19h. Diaphragm or cervical cap

0 1 2 3 4 5 19i. Condoms

0 1 2 3 4 5 19j. “The Shot” (e.g. Depo Provera)

0 1 2 3 4 5 19k. Implant under theskin. (e.g. Norplant)

0 1 2 3 4 5 19l. Contraceptive patch (e.g. Ortho Evra)

0 1 2 3 4 5 19m. “Morning after” pill

0 1 2 3 4 5 19n. None

0 1 2 3 4 5 19o. Other (explain):_________________

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20. Please rate how likely you are to use the following methods of birth control if you choose tohave sexual intercourse in the future.

Least Somewhat MostLikely Likely Likely

0 1 2 3 4 20a. Rhythm method—timing when I havesex according to where I am in my menstrual

cycle

0 1 2 3 4 20b. Make sure the other person pulls out

in time

0 1 2 3 4 20c. Birth control pills

0 1 2 3 4 20d. Sponge

0 1 2 3 4 20e. Spermicides and/or creams or foams

0 1 2 3 4 20f. Intrauterine device (e.g. IUD, coil,loop)

0 1 2 3 4 20g. Monthly vaginal ring, “The Ring”(e.g. NuvaRing)

0 1 2 3 4 20h. Diaphragm or cervical cap

0 1 2 3 4 20i. Condoms

0 1 2 3 4 20j. “The Shot” (e.g. Depo Provera)

0 1 2 3 4 20k. Implant under the skin. (e.g. Norplant)

0 1 2 3 4 20l. Contraceptive patch (e.g. Ortho Evra)

0 1 2 3 4 20m. “Morning after” pill

0 1 2 3 4 20n. None

0 1 2 3 4 20o. Other (explain):_________________

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IF YOU HAVE NEVER HAD VOLUNTARY SEXUAL INTERCOURSE, SKIP TO

QUESTION #22

21. What types or types of birth control did you use the LAST time you had sexual intercourse?

1 0

YES NO

____ ____ 21a. Rhythm method—timing when I have sex according to where Iam in my menstrual cycle

____ ____ 21b. Make sure the other person pulls out in time

____ ____ 21c. Birth control pills ____ ____ 21d. Sponge

____ ____ 21e. Spermicides and/or creams or foams

____ ____ 21f. Intrauterine device (e.g. IUD, coil, loop)

____ ____ 21g. Monthly vaginal ring, “The Ring (e.g. NuvaRing)

____ ____ 21h. Diaphragm or cervical cap ____ ____ 21i. Condoms

____ ____ 21j. “The Shot” (e.g. Depo Provera) ____ ____ 21k. Implant under the skin (e.g. Norplant)

____ ____ 21l. Contraceptive patch (Ortho Evra)

____ ____ 21m. “Morning after” pill ____ ____ 21n. none

____ ____ 21o. I don’t remember or I am unsure

____ ____ 21p. other (explain):_______________________________________

22. How confident are you that your preferred method(s) of birth control would be effective at

preventing pregnancy?

0 1 2 3 4not at all a little in between somewhat very

confident confident confident confident

23. How confident are you that your preferred the method(s) of birth control would be effectiveat preventing the spread of sexually transmitted diseases?

0 1 2 3 4not at all a little in between somewhat very

confident confident confident confident

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12

24. Have you ever:

1 0

YES NO

____ ____ 24a. had sexual intercourse without a condom

____ ____ 24b. engaged in oral sex without a condom or dental dam

____ ____ 24c. had a condom fall off or break during sexual intercourse

____ ____ 24d. had sexual intercourse or oral sex with an intravenous (IV) drug user

____ ____ 24e. used intravenous (IV) drugs (e.g., injected heroine)

____ ____ 24f. shared hypodermic needles with others

____ ____ 24g. had sexual intercourse or oral sex with someone who is bisexual

____ ____ 24h. had sexual intercourse with a homosexual male

____ ____ 24i. had sexual intercourse with someone who was also sexually involved withothers during that same

____ ____ 24j. had sexual intercourse in a “one night stand” relationship

____ ____ 24k. had sexual intercourse while drunk on alcohol or high on drugs

The following questions are about pregnancy:

25. Have you ever been pregnant?

1 YES IF “YES” GO TO QUESTION 26.

0 NO IF “NO” SKIP TO QUESTION 36.

26. How many times have you been pregnant?

1 2 3 4 5 6+


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27. What type or types of birth control were you using when you conceived the…

( If you have only been pregnant once, just fill out the first column, if you’ve been pregnant twice, please fill outthe first column for the first pregnancy and the second column for the second pregnancy, and so on….)

Please make a mark or a check in the box(es) that apply, you may mark more than one.

Type of Birth

Control

FIRST

TIME

SECOND

TIME

THIRD

TIME

FOURTH

TIME

FIFTH

TIME

SIXTH

TIME

a. Rhythm method— timing when I have

sex according to

where I am in mymenstrual cycle

b. Make sure theother person pulls

out in time

c. Birth control pills

d. Sponge

e. Spermicidesand/or creams or

foams

f. Intrauterine device

(e.g. IUD, coil, loop)

g. Monthly vaginalring, “The Ring (e.g.

NuvaRing)

h. Diaphragm or

cervical capi. Condoms

j. “The Shot” (e.g.

Depo Provera)

k. Implant under the

skin (e.g. Norplant)

l. Contraceptive

patch (Ortho Evra)

m. “Morning after”

pill

n. Noneo. I don’t remember

or I am unsure

p. Other (please

describe)

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28. If you answered “None” (meaning you were using NO birth control) for any of

the times you have gotten pregnant, please answer why you were not using birthcontrol at this time.

(Please mark the reason in the same column you answered “None” for above)

Reason for no Birth Control FIRST

time

SECOND

time

THIRD

time

FOURTH

time

FIFTH

time

SIXTH

time

1. I wanted to get pregnant.

2. I did not think I could get pregnant

at the time

3. I was not having sex, regularly.

4. I could not afford birth control.

5. I had my tubes tied.

6. I did not believe in birth control.

7. My partner did not want me to use

birth control.8. I did not know how to get birth

control.

9. I did not know where to find out

about birth control

10. Other (please describe):

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29. How many live births have you had?

0 1 2 3 4 5 6+

IF “0” PLEASE SKIP AHEAD TO QUESTION 31

29. Please record your age at the birth of each child (e.g., if you circled 1 record

your age at the birth of the child, if you circled 2 record your age at the birth of

the first child as well as your age at the birth of the second child and so on).

29a. Age at first birth (record age in years): _____

29b. Age at second birth (record age in years):_____29c. Age at third birth (record age in years): _____

29d. Age at fourth birth (record age in years):_____

29e. Age at fifth birth (record age in years): _____

29f. Age at sixth birth (record age in years): _____

30. How did you know you were pregnant or how was this pregnancy

confirmed?

1= I missed my period.

2= I felt ill.3= I took an over-the-counter pregnancy test.

4= The pregnancy was confirmed by a doctor.

5= Other: explain ____________________.6= The pregnancy was never formally confirmed.

7= I don’t know/don’t remember

30a. Method of confirmation at first birth (choose 1-7 from above):______

30b. Method of confirmation at second birth (choose 1-7 from above):______

30c. Method of confirmation at third birth (choose 1-7 from above):______30d Method of confirmation at fourth birth (choose 1-7 from above):______

30e. Method of confirmation at fifth birth (choose 1-7 from above):______

30f. Method of confirmation at sixth birth (choose 1-7 from above):______

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31. How many abortions have you had?

0 1 2 3 4 5 6+

IF “0” SKIP AHEAD TO QUESTION 34.

32. Please record your age at each abortion (e.g., if you circled 1 record your age

at the first abortion, if you circled 2 record your age at the second abortion and

so on).

32a. Age at first abortion (record age in years): _____

32b. Age at second abortion (record age in years): _____

32c. Age at third abortion (record age in years): _____

32d. Age at fourth abortion (record age in years): _____

32e. Age at fifth abortion (record age in years): _____32f. Age at sixth abortion (record age in years): _____


confirmed?

1= I missed my period.2= I felt ill.

3= I took an over-the-counter pregnancy test.4= The pregnancy was confirmed by a doctor.

5= Other: explain ____________________.

6= The pregnancy was never formally confirmed.


33a. Method of confirmation at first abortion (choose 1-7 from above):______

33b. Method of confirmation at second abortion (choose 1-7 from above):______33c. Method of confirmation at third abortion (choose 1-7 from above):______

33d. Method of confirmation at fourth abortion (choose 1-7 from above):______

33e. Method of confirmation at fifth abortion (choose 1-7 from above):______33f. Method of confirmation at sixth abortion (choose 1-7 from above):______

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34. How many miscarriage or still births have you had?

0 1 2 3 4 5 6+

IF “0” SKIP TO QUESTION 36.

34. Please record your age at each miscarriage (e.g., if you circled 1 record your

age at the first miscarriage, if you circled 2 record your age at the second

miscarriage and so on).

34a. Age at first miscarriage (record age in years): _____34b. Age at second miscarriage (record age in years):_____

34c. Age at third miscarriage (record age in years): _____

34d. Age at fourth miscarriage (record age in years):_____

34e. Age at fifth miscarriage (record age in years): _____

34f. Age at sixth miscarriage (record age in years):_____


confirmed?

1= I missed my period.2= I felt ill.

3= I took an over-the-counter pregnancy test.

4= The pregnancy was confirmed by a doctor.5= Other: explain ____________________.

6= The pregnancy was never formally confirmed.7= I don’t know/don’t remember

35a. Method of confirmation at first miscarriage (choose 1-7 from above):______35b. Method of confirmation at second miscarriage (choose 1-7 from above):______

35c. Method of confirmation at third miscarriage (choose 1-7 from above):______

35d. Method of confirmation at fourth miscarriage (choose 1-7 from above):______35e. Method of confirmation at fifth miscarriage (choose 1-7 from above):______

35f. Method of confirmation at sixth miscarriage (choose 1-7 from above):______

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The following sets of questions are about Sexually

Transmitted Diseases (STD’s):

36. Have you ever had Chlamydia?

0 1 2 3 4 5+


If “NEVER” SKIP TO QUESTION 37

36a. If “1” or greater:How old were you when you first knew you had this? (record age in

years): _____

36b. If “2” or greater:

How old were you the last time you had this? (record age in years): _____

36c. If “1” or greater:

Have you ever received treatment from a doctor or a clinic for thiscondition?

1 0

YES NO

37. Have you ever had Gonorrhea?

0 1 2 3 4 5+never times times times times times


37a. If “1” or greater:

How old were you when you first knew you had this? (record age inyears):_____




Have you ever received treatment from a doctor or a clinic for thiscondition?

1 0YES NO

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38. Have you ever had Syphilis?

0 1 2 3 4 5+




How old were you when you first knew you had this? (record age in years):

_____

38b. If “2” or greater:How old were you the last time you had this? (record age in years): _____


Have you ever received treatment from a doctor or a clinic for this

condition?

1 0YES NO

39. Have you ever had Pelvic Inflammatory Disease (PID)?

0 1 2 3 4 5+never time times times times times



How old were you when you first knew you had this? (record age in

years): _____



39c. If “1” or greater:Have you ever received treatment from a doctor or a clinic for this

condition?

1 0

YES NO

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40. Have you ever had Genital Warts:

1 0

YES NO If “NO” SKIP TO QUESTION 41

40a. If “Yes”:


40b. If “Yes”:

Have you ever received treatment from a doctor or a clinic for this

condition?

1 0YES NO

41. Have you ever had Genital Herpes:

1 0


41a. If “Yes”:


years):_____

41b. If “Yes”:Have you ever received treatment from a doctor or a clinic for this

condition?

1 0

YES NO

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42. Have you been diagnosed with HIV:

1 0


42a. If “Yes”:


years):_____


condition?

1 0

YES NO

43. Have you ever had Fertility Problems:

1 0


43a. If “Yes”:



condition?

1 0

YES NO

21


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22

44. Have you ever had Hepatitis B or Hepatitis C:

1 0

YES NO If “NO” SKIP QUESTIONS 44a & 44b

44a. If “Yes”:


years):_____


condition?

1 0

YES NO

THE END


26/44

Sexual Attitudes and Activities Questionnaire (SAAQ)

Female V2.2

Female / English

RESEARCHER INDICATE THE FOLLOWING:

ID

FAMID

VISIT

Introduction:

In this section you will hear some questions having to do with your attitudes and feelings about sex and

your sexual behavior. For each question choose the answer that best represents how YOU feel or what

YOU do.

Your answers to these questions are strictly confidential. Your responses will go directly into thecomputer and no one will ever know how you, personally answer these questions. Your name will

never be associated with any of your responses. The information that you provide is very valuable andwill help us understand how adolescents think and feel about sex so it is important that you answer

honestly and as accurately as possible.

In this section we are only interested in your behavior regarding consensual or voluntary sexual

experiences. When asked about sexual behavior, only report about situations when you agreed to

participate in sexual activity. Disregard any situations when sex was either forced on you or when youdid not give your full consent.

Now begin to answer all of the questions.


27/44

R1. Indicate the number of romantic partners with which you have done the following during the PAST

YEAR.

0 1 2 3 4 5none, 1 2 or 3 4-7 8-10 more than 10


a. Gone out on unsupervised dates _____

b. Held hands ______

c. French or tongue kissing ______ d. Made out ______


f. Had your private parts felt under clothing ______ g. Given oral sex (mouth on private parts) ______

h. Received oral sex ______

i. Had sexual intercourse in a “one night stand” _____

j. Had sexual intercourse without contraception—hadunprotected sex ______

k. Had sexual intercourse while drunk on alcohol orhigh on drugs ______

R2. Indicate the number of romantic partners with which you have done the following during the YOUR

ENTIRE LIFETIME.

0 1 2 3 4 5none, 1 2 or 3 4-7 8-10 more than 10


a. Gone out on unsupervised dates _____ b. Held hands ______

c. French or tongue kissing ______ d. Necked or made out ______


f. Had your private parts felt under clothing ______ g. Given oral sex (mouth on private parts) ______

h. Received oral sex ______

i. Had sexual intercourse in a “one night stand” _____ j. Had sexual intercourse without contraception—had

unprotected sex ______

k. Had sexual intercourse while drunk on alcohol orhigh on drugs ______

R3. How often do you find yourself thinking a lot about sex?

0 1 2 3 4 5 Never once or twice about once about once several times several times

every few months a month a week a week a day


28/44

R4. Are you, or do you think you would be, turned on sexually by: (circle a number for each):

not at all a little some a lot very muchR4a. Looking at your own body 1 2 3 4 5

R4b. Romantic Dancing 1 2 3 4 5

R4c. Romantic pictures in magazines or books 1 2 3 4 5

R4d. Movie or TV shows that have love scenes 1 2 3 4 5

R4e. Songs with romantic or sexy words 1 2 3 4 5

R4f. Dreams while you are sleeping 1 2 3 4 5

R4g. Women without clothes on 1 2 3 4 5

R4h. Men without clothes on 1 2 3 4 5

R4i. Fantasies or day dreams about sex 1 2 3 4 5

R4j. An attractive male 1 2 3 4 5 R4k . An attractive female 1 2 3 4 5

R4l. Literature (books/magazines) that tell stories 1 2 3 4 5

about sex or have sexual pictures

R4m. Websites that have sexual content 1 2 3 4 5

R4n. Chat rooms or websites where people chat about 1 2 3 4 5

sexual things.

R5. Some people sometimes masturbate, or play with their private parts to have a good feeling. Howoften have you done this? (circle one)

0 1 2 3 4 5 Never once or twice about once about once several times almost every

every few months a month a week a week day

R6. In the last year how many times have you had voluntary sexual intercourse?

0 1 2 3 4 5none, 1 2 or 3 4-7 8-10 more than 10



R7. In the last year how many voluntary sexual intercourse partners have you had?

0 1 2 3 4 5none, 1 2 or 3 4-7 8-10 more than 10



29/44

R8. How many voluntary sexual intercourse partners have you had in your LIFETIME: (circle one):

0 1 2 3 4 5none, 1 2 or 3 4-7 8-10 more than 10never partner partners partners partners partners

IF “NEVER” SKIP TO QUESTION 10. IF SUBJECT ANSWERS “NEVER” TO QUESTION 8,

THEY SHOULD ALSO SKIP 9, 15, 16, 21, 24A, 24C, 24D, 24H, 24I, 24J AND 24K.

R9. As best you can recall, how old were you the first time you had consensual intercourse?

01 _younger than age 12 07 _15 years-old 13 __18 years-old 19 _21 years or older

02 __12 ½ years-old 08 _15 ½ years-old 14 _18 ½ years-old03 _13 years-old 09 _16 years-old 15 _19 years-old

04 _13 ½ years-old 10 _16 ½ years-old 16 _19 ½ years-old

05 _14 years-old 11 _17 years-old 17 _20 years-old

06 __14 ½ years-old 12 _17 ½ years-old 18 _20 ½ years-old

R10. How likely is it that you will have sexual intercourse with someone in the next year?

1 sure it won’t happen

2 probably won’t happen

3 even chance (50-50) it will happen

4 probably will happen

5 sure it will happen

R10a. How much do you think you would like to have sexual intercourse with someone in the next

year?

1 would dislike very much2 would dislike a little

3 would neither like nor dislike

4 would like a little

5 would like very much

R11. If you were to have sexual intercourse with someone in the next year, how likely is it that you

would use birth control?

1 sure I wouldn’t use it


3 even chance (50-50) I would use it4 probably I would use it



30/44

R12. Please indicate whether or not you think your best friend has done each of the following with a

romantic partner.

1= definitely no2= probably no

3= I don’t really know

4= probably yes5 = definitely yes

R12a. Gone out on unsupervised dates _____R12b. Held hands with a partner ______

R12c. French or tongue kissed a partner ______

R12d . Necked or made-out with a partner ______ R12e. Felt a partner’s private parts under clothes or without clothes ______

R12f . Had private parts felt under clothes or without clothes ______

R12g. Given oral sex (mouth on private parts) ______

R12h. Received oral sex (mouth on private parts) ______ R12i. Had sexual intercourse ______

R12j. Had sexual intercourse with more than one partner within a few weeks ______ R12k . Had sexual intercourse in a “one night stand” ______ R12l. Had sexual intercourse while drunk or high on drugs ______

R12m. Had sexual intercourse without contraception—had unprotected sex ______


31/44

R13. Choose the response that best represents how you think or feel:

s t r

o n g l y

d i s

a g r e

e

d i s

a g r e

e

n e i t h

e r a g r e

e n o r

d i s

a g r e

e

a g r e

e

s t r

o n g l y

a g r e

e

R13a.Masturbation doesn’t hurt you 1 2 3 4 5

R13b.It is OK for girls my age to do sexual things 1 2 3 4 5

because others expect them to

R13c. Sex is dirty. 1 2 3 4 5

R13d . It’s okay for people my age to have sex 1 2 3 4 5

R13e. There is a lot of pressure to “go further” 1 2 3 4 5

in sexual activity than girls really want to

R13f . I wish there was no such thing 1 2 3 4 5

as sex.

R13g. I think about sex even when I don't want to. 1 2 3 4 5

R13h. I get frightened when I think about sex 1 2 3 4 5

R13i. I sometimes have sexual feelings when I see 1 2 3 4 5

people kiss on TV or movies

R13j. Thinking about sex upsets me 1 2 3 4 5

R13k . I hope I never have to think about sex again 1 2 3 4 5

R13l. I only have sex or plan to have sex with people 1 2 3 4 5 that I love.

R13m. It’s okay for people my age to have more than 1 2 3 4 5 one sexual partner at a time

R13n. It is important for me to care about a person in 1 2 3 4 5

order to feel okay about having sex with them


32/44

R14. If you were to have sex next month with someone you know well, how likely do you think it is

that each thing would happen to you?

d e f i n i t

e l y

n

o t

p r o b

a b l y

n o t

e v e n

c h

a n c

e (

5 0

- 5 0 )

p r o b

a b l y

y e s

d e f i n i t

e l y

y

e s

R14a. I would be embarrassed while having sex 1 2 3 4 5

R14b. I would lose the respect of my friends 1 2 3 4 5

R14c. I would feel more loved and wanted by the person 1 2 3 4 5

R14d . The person would like me more 1 2 3 4 5

R14e. I would lose respect for myself 1 2 3 4 5

R14f. I would worry about getting pregnant 1 2 3 4 5

R14g. It would show the person I liked them 1 2 3 4 5

R14h. It would hurt my health 1 2 3 4 5

R14i. I would gain the respect of my friends 1 2 3 4 5

R14j. I would feel more mature 1 2 3 4 5

R15. Are you currently trying to get pregnant? (circle one):

0 1

NO YES

IF “YES” PLEASE ANSWER THE FOLLOWING QUESTIONS WITH RESPECT TO A TIME

WHEN YOU WERE NOT TRYING TO GET PREGNANT. ** SUBJECTS WHO ANSWERED

“NONE/NEVER” TO QUESTION 8 WILL SKIP QUESTIONS 16.**

R16. How often do you use birth control when you have sex? (circle one):

1 I never use birth control

2 I hardly ever use birth control when I have sex3 sometimes I use birth control when I have sex, but not very often

4 I use birth control about half of the time I have sex

5 almost every time I have sex I use birth control

6 for sure every time I have sex I use birth control


33/44

R17. If you were to have sexual intercourse with someone in the near future, how likely is it that you

would use birth control? (circle one):

1 sure I wouldn’t use it2 probably I wouldn’t use it


4 probably I would use it


R18. Indicate if you learned about birth control methods in any of the following ways:

Rate each in the following ways:

0 = NO, never learned this way

1 = YES learned this way but found it to be NOT VERY EFFECTIVE in teaching me about birth

control methods2 = YES learned this way but found it to be ONLY SOMEWHAT EFFECTIVE in teaching me about

birth control methods

3 = YES learned this way and found it to be ADEQUATELY EFFECTIVE in teaching me about birthcontrol methods

4 = YES learned this way and found it to be VERY EFFECTIVE in teaching me about birth control

methods

R18a. _____ Learned from an older brother or sister

R18b. _____ Learned from my mother (or mother figure)

R18c. _____ Learned from my father (or father figure)R18d. _____ Learned from another relative (Aunt, Uncle, Cousin, Grandparent)

R18e. _____ Learned from a friend

R18f. _____ Learned from a boyfriend or romantic partner

R18g. _____ Learned from my DoctorR18h. _____ Learned in a program at my school

R18i. _____ Learned on my ownR18j. _____ Other explain:__________________

R19. Please rate the following methods of birth control methods according to your preference for eachtype of birth control?

Not Somewhat Most

Preferred Preferred Preferred

0 1 2 3 4 5 R19a. Rhythm method—timing when I have sexaccording to where I am in my menstrual

cycle0 1 2 3 4 5 R19b. Make sure the other person pulls out

in time0 1 2 3 4 5 R19c. Birth control pills

0 1 2 3 4 5 R19d . sponge

0 1 2 3 4 5 R19e. Spermicides and/or creams or foams0 1 2 3 4 5 R19f. Intrauterine device (e.g. IUD, coil, loop)

0 1 2 3 4 5 R19g. Monthly vagina ring, “The Ring” (e.g.

NuvaRing)


34/44

0 1 2 3 4 5 R19h.Diaphragm or cervical cap

0 1 2 3 4 5 R19i. Condoms

0 1 2 3 4 5 R19j. “The Shot” (e.g. Depo Provera)

0 1 2 3 4 5 R19k. Implant under the skin (e.g. Norplant)0 1 2 3 4 5 R19l. Contraceptive patch (e.g. Ortho Evra)

0 1 2 3 4 5 R19m. “Morning after” pill

0 1 2 3 4 5 R19n. None0 1 2 3 4 5 R19o. Other (explain):_________________

ONLY SUBJECTS WHO ANSWERED “NONE, NEVER” FOR QUESTION #8 SHOULD

ANSWER QUESTION #20.

R20. Please rate how likely you are to use the following methods of birth control if you choose to havesexual intercourse in the future.

Least Somewhat Most

Likely Likely Likely

0 1 2 3 4 R20a. Rhythm method—timing when I havesex according to where I am in my menstrual

cycle

0 1 2 3 4 R20b. Make sure the other person pulls outin time

0 1 2 3 4 R20c. Birth control pills0 1 2 3 4 R20d . Sponge

0 1 2 3 4 R20e. Spermicides and/or creams or foams0 1 2 3 4 R20f . Intrauterine device (e.g. IUD, coil,

loop)0 1 2 3 4 R20g. Monthly vaginal ring, “The Ring”

(e.g. NuvaRing)

0 1 2 3 4 R20h. Diaphragm or cervical cap0 1 2 3 4 R20i. Condoms

0 1 2 3 4 R20j. “The Shot” (e.g. Depo Provera)

0 1 2 3 4 R20k . Implant under the

skin. (e.g. Norplant)

0 1 2 3 4 R20l. Contraceptive patch (e.g. Ortho Evra)0 1 2 3 4 R20m. “Morning after” pill0 1 2 3 4 R20n. None

0 1 2 3 4 R20o. Other (explain):_________________

SUBJECTS WHO ANSWERED “NONE/NEVER” FOR QUESTION # 8 SHOULD SKIP

QUESTION #21.


35/44

R21. What types or types of birth control did you use the LAST time you had sexual intercourse?

1 0

YES NO ____ ____ R21a. Rhythm method—timing when I have sex according to where I

am in my menstrual cycle

____ ____ R21b. Make sure the other person pulls out in time ____ ____ R21c. Birth control pills

____ ____ R21d . Sponge

____ ____ R21e. Spermicides and/or creams or foams ____ ____ R21f . Intrauterine device (e.g. IUD, coil, loop)

R21g. Monthly vaginal ring, “The Ring (e.g. NuvaRing)

____ ____ R21h. Diaphragm or cervical cap ____ ____ R21i. Condoms

____ ____ R21j. “The Shot” (e.g. Depo Provera)

____ ____ R21k. Implant under the skin (e.g. Norplant)

____ ____ R21l. Contraceptive patch (Ortho Evra) ____ ____ R21m. “Morning after” pill

____ ____ R21n. none ____ ____ R21o. I don’t remember or I am unsure ____ ____ R21p. other (explain):________________________________________

R22. How confident are you that your preferred method(s) of birth control would be effective at

preventing pregnancy?

0 1 2 3 4

not at all a little in between somewhat veryconfident confident confident confident

R23. How confident are you that your preferred the method(s) of birth control would be effective at

preventing the spread of sexually transmitted diseases?

0 1 2 3 4

not at all a little in between somewhat veryconfident confident confident confident

R24. Have you ever:

1 0

YES NO ____ ____ R24a. had sexual intercourse without a condom ** (Subjects who answered

“NONE/NEVER” to question 8 will skip this question) ____ ____ R24b. engaged in oral sex without a condom or dental dam

____ ____ R24c. had a condom fall off or break during sexual intercourse ** (Subjects who

answered “NONE/NEVER” to question 8 will skip this question)

____ ____ R24d . had sexual intercourse or oral sex with an intravenous (IV) drug user ** (Subjects

who answered “NONE/NEVER” to question 8 will skip this question)


36/44

____ ____ R24e. used intravenous (IV) drugs (e.g., injected heroine)

____ ____ R24f . shared hypodermic needles with others

____ ____ R24g. had sexual intercourse or oral sex with someone who is bisexual

____ ____ R24h. had sexual intercourse with a homosexual male ** (Subjects who answered

“NONE/NEVER” to question 8 will skip this question)

____ ____ R24i. had sexual intercourse with someone who was also sexually involved withothers during that same period ** (Subjects who answered “NONE/NEVER” to question 8 will

skip this question)

____ ____ R24j. had sexual intercourse in a “one night stand” relationship ** (Subjects who

answered “NONE/NEVER” to question 8 will skip this question)

____ ____ R24k . had sexual intercourse while drunk on alcohol or high on drugs may want to

separate out ** (Subjects who answered “NONE/NEVER” to question 8 will skip this question)

R25. Have you ever been pregnant?

0 1 NO YES

IF “YES” GO TO QUESTION 26.

IF “NO” SKIP TO QUESTION 36.

R26. How many times have you been pregnant?

1 2 3 4 5 6+1 2 3 4 5 6


37/44

R27. What type or types of birth control were you using when you conceived the…

( If you have only been pregnant once, just fill out the first column, if you’ve been pregnant twice, please fill out

the first column for the first pregnancy and the second column for the second pregnancy, and so on….)

Please make a mark or a check in the box(es) that apply, you may mark more than one.

Type of Birth Control FIRST

TIME

SECOND

TIME

THIRD

TIME

FOURTH

TIME

FIFTH

TIME

SIXTH

TIME

a. Rhythm method—

timing when I have sexaccording to where I am

in my menstrual cycle

R271a R272a R273a R274a R275a R276a

b. Make sure the other

person pulls out in time

R271b R272b R273b R274b R275b R276b

c. Birth control pills R271c R272c R273c R274c R275c R276c

d. Sponge

R271d R272d R273d R274d R275d R276d

e. Spermicides and/or

creams or foams R271e R272e R273e R274e R275e R276e

f. Intrauterine device(e.g. IUD, coil, loop) R271f R272f R273f R274f R275f R276f

g. Monthly vaginal ring,

“The Ring (e.g.

NuvaRing)

R271g R272g R273g R274g R275g R276g

h. Diaphragm or cervical

cap R271h R272h R273h R274h R275h R276h

i. Condoms

R271i R272i R273i R274i R275i R276i

j. “The Shot” (e.g. Depo

Provera) R271j R272j R273j R274j R275j R276j

k. Implant under the skin(e.g. Norplant) R271k R272k R273k R274k R275k R276k

l. Contraceptive patch

(Ortho Evra) R271l R272l R273l R274l R275l R276l

m. “Morning after” pill R271m R272m R273m R274m R275m R276m

n. None R271n R272n R273n R274n R275n R276n

o. I don’t remember or I

am unsure

R271o R272o R273o R274o R275o R276o

p. Other (please describe) R271p R272p R273p R274p R275p 276p


38/44

R28. If you answered “None” (meaning you were using NO birth control) for any of the times you

have gotten pregnant, please answer why you were not using birth control at this time.

(Please mark the reason in the same column you answered “None” for above)

Reason for no Birth Control FIRST

time

SECOND

time

THIRD

time

FOURTH

time

FIFTH

time

SIXTH

time

a. I wanted to get pregnant. R281a R282a R283a R284a R285a R286a

b. I did not think I could get pregnant at the

time

R281b R282b R283b R284b R285b R286b

c. I was not having sex, regularly. R281c R282c R283c R284c R285c R2

d. I could not afford birth control.

R281d

R282d

R283d

R284d R285d

R28

e. I had my tubes tied.

R281e

R282e

R283e

R284e R285e

R2

f. I did not believe in birth control.

R281f

R282f

R283f

R284f R285f

R2

g. My partner did not want me to use birth

control. R281g

R282g

R283g

R284g R285g

R28h. I did not know how to get birth control.

R281h

R282h

R283h

R284h R285h

R28

i. I did not know where to find out about birthcontrol R281i

R282i

R283i

R284i R285i

R2

j. Other (please describe):

R281j

R282j

R283j

R284j R285j

R2

R29. How many live births have you had?

0 1 2 3 4 5 6+0 1 2 3 4 5 6

R29. Please record your age at the birth of each child (e.g., if you circled 1 record your

age at the birth of the child, if you circled 2 record your age at the birth of the first childas well as your age at the birth of the second child and so on).

R29a. Age at first birth (record age in years): _____R29b. Age at second birth (record age in years):_____R29c. Age at third birth (record age in years): _____R29d . Age at fourth birth (record age in years):_____

R29e. Age at fifth birth (record age in years): _____R29f. Age at sixth birth (record age in years):____


39/44

R30. How did you know you were pregnant or how was this pregnancy confirmed?


2= I felt ill.

3= I took an over-the-counter pregnancy test.

4= The pregnancy was confirmed by a doctor.5= Other: explain ____________________.



R30a. Method of confirmation at first birth (choose 1-7 from above):______

R30b. Method of confirmation at second birth(choose 1-7 from above):______R30c. Method of confirmation at third birth (choose 1-7 from above):______

R30d Method of confirmation at fourth birth (choose 1-7 from above):______

R30e. Method of confirmation at fifth birth (choose 1-7 from above):______

R30f . Method of confirmation at sixth birth (choose 1-7 from above):______

R31. How many abortions have you had?

0 1 2 3 4 5 6+

0 1 2 3 4 5 6


R32. Please record your age at each abortion (e.g., if you circled 1 record your age at the

first abortion, if you circled 2 record your age at the second abortion and so on).

R32a. Age at first abortion (record age in years): _____

R32b. Age at second abortion (record age in years):_____

R32c. Age at third abortion (record age in years): _____R32d . Age at fourth abortion (record age in years):_____

R32e. Age at fifth abortion (record age in years): _____

R32f . Age at sixth abortion (record age in years):_____



2= I felt ill.

3= I took an over-the-counter pregnancy test.4= The pregnancy was confirmed by a doctor.

5= Other: explain ____________________.




40/44

R33a. Method of confirmation at first abortion (choose 1-7 from above):______R33b. Method of confirmation at second abortion(choose 1-7 from above):______

R33c. Method of confirmation at third abortion (choose 1-7 from above):______

R33d . Method of confirmation at fourth abortion (choose 1-7 from above):______

R33e. Method of confirmation at fifth abortion (choose 1-7 from above):______R33f . Method of confirmation at sixth abortion (choose 1-7 from above):______

R34. How many miscarriage or still births have you had?

0 1 2 3 4 5 6+0 1 2 3 4 5 6


R34. Please record your age at each miscarriage (e.g., if you circled 1 record your age atthe first miscarriage, if you circled 2 record your age at the second miscarriage and so

on).

R34a. Age at first miscarriage (record age in years): _____

R34b. Age at second miscarriage (record age in years):_____R34c. Age at third miscarriage (record age in years): _____

R34d . Age at fourth miscarriage (record age in years):_____

R34e. Age at fifth miscarriage (record age in years): _____R34f. Age at sixth miscarriage (record age in years):_____



2= I felt ill.3= I took an over-the-counter pregnancy test.

4= The pregnancy was confirmed by a doctor.

5= Other: explain ____________________.6= The pregnancy was never formally confirmed.


R35a. Method of confirmation at first miscarriage (choose 1-7 from above):______

R35b. Method of confirmation at second miscarriage(choose 1-7 from above):______

R35c. Method of confirmation at third miscarriage (choose 1-7 from above):______R35d . Method of confirmation at fourth miscarriage (choose 1-7 from above):______

R35e. Method of confirmation at fifth miscarriage (choose 1-7 from above):______

R35f . Method of confirmation at sixth miscarriage (choose 1-7 from above):______


41/44

R36. Have you ever had Chlamydia?

0 1 2 3 4 5

never 1 2 3 4 5+

time times times times times


R36a. If “1” or greater:


_____

R36b. If “2” or greater:


R36c. If “1” or greater:Have you ever received treatment from a doctor or a clinic for this condition?

1 0YES NO

R37. Have you ever had Gonorrhea?

0 1 2 3 4 5

never 1 2 3 4 5+time times times times times



How old were you when you first knew you had this? (record age in years): _____

R37b. If “2” or greater:How old were you the last time you had this? (record age in years): _____


1 0

YES NO


42/44

R38. Have you ever had Syphilis?

0 1 2 3 4 5

never 1 2 3 4 5+



R38a. If “1” or greater:How old were you when you first knew you had this? (record age in years):

_____

R38b. If “2” or greater:


R38c. If “1” or greater:

Have you ever received treatment from a doctor or a clinic for this condition?

1 0

YES NO

R39. Have you ever had Pelvic Inflammatory Disease (PID)?

0 1 2 3 4 5never 1 2 3 4 5+




How old were you when you first knew you had this? (record age in years): _____

R39b. If “2” or greater:How old were you the last time you had this? (record age in years): _____


1 0

YES NO


43/44

R40. Have you ever had Genital Warts:

1 0


R40a. If “Yes”:How old were you when you first knew you had this? (record age in years):

_____

R40b. If “Yes”:


1 0YES NO

R41. Have you ever had Genital Herpes:

1 0



_____

R41b. If “Yes”:


1 0

YES NO

R42. Have you been diagnosed with HIV:

1 0YES NO If “NO” SKIP TO QUESTION 43

R42a. If “Yes”:


_____

R42b. If “Yes”:


1 0YES NO


44/44

R43. Have you ever had Fertility Problems:

1 0



_____

R43b. If “Yes”:


1 0YES NO

R44. Have you ever had Hepatitis B or Hepatitis C:

1 0

YES NO If “NO” SKIP QUESTIONS 44a & 44b


_____

R44b. If “Yes”:


1 0

YES NO

THE END

Documents

Sexual SAAQ Manual PDF (1)