• SEXUAL RISK AVOIDANCE EDUCATION PROGRAM (SRAE)

  • PARTICIPANT EXIT SURVEY HIGH SCHOOL AND OLDER

  • Thank you for your help with this important study. This survey includes questions about your family, friends, school, and also your attitudes and behaviors. Your name will not be on the survey and your responses will remain private to the extent permitted by law. We want you to know that:

    1. Your participation is voluntary.

    2. We hope that you will answer all of the questions, but you may skip any questions you do not wish to answer.

    3. The answers you give will be kept private to the extent permitted by law.

  • Please answer the following questions as best you can. The first set of questions are about you.

  • 1. How old are you? *Mark only one
  • 2. What grade are you in? (If you are currently on vacation or in summer school, indicate the grade you will be when you go back to school.) *Mark only one
  • 3. When you are at home or with your family, what language or languages do you usually speak? *Mark all that apply
  • 4. Are you Hispanic or Latino? *Mark only one
  • 5. What is your race? *Mark all that apply
  • 6. What is your sex? *Mark only one
  • 7. Are you currently …? *Mark all that apply

  • For questions 8-12, please think about how the program you just completed has affected you, even if the program did not cover the topic. 

     

    8. Has being in the program made you more likely, about the same, or less likely to...

    (Note: If the program has not affected your likelihood to do any of the following, choose “About the same.”)

    *Mark only one answer per row

  • a. make decisions to not drink alcohol?
  • b. make decisions to not smoke cigarettes or cigar products (cigars, cigarillos, or little cigars)? ...................
  • c. make decisions to not use othertobacco products (such as chewingtobacco, snuff, dip, or snus)? .............
  • d. make decisions to not use electronic vapor products (such as JUUL, Vuse, MarkTen, and blu)? (electronic vapor products include e-cigarettes, vapes, vape pens, e-cigars, hookahs, hookah pens, and mods) .................................
  • e. make decisions to not use marijuana (also called pot, weed, or cannabis)?
  • f. make decisions to not take prescription pain medicine without a doctor’s prescription or differently than how a doctor told you to use it?...

  • 9. Has being in the program made you more likely, about the same, or less likely to...

    (Note: If the program has not affected your likelihood to do the following, choose “About the same.”)

    *Mark only one answer per row

  • a. resist or say no to peer pressure?
  • b. manage your emotions in healthy ways (for example, ways that are not hurtful to you or others )?..................
  • c. think about the consequences before making a decision? .............................
  • d. talk with my parent, guardian, or caregiver about sex? ..........................

  • 10. Has being in the program made you more likely, about the same, or less likely to...

    (Note: If the program has not affected your likelihood to do the following, choose “About the same”.)

    *Mark only one answer per row

  • a. make plans to reach your goals?.................
  • b. care about doing well in school?..................

  • 11. Has being in the program made you more likely, about the same, or less likely to...

    (Note: If the program has not affected your likelihood to do the following, choose “About the same.”)

    *Mark only one answer per row

  • a. better understand what makes a relationship healthy?...............................
  • b. resist or say no to someone if they pressure you to participate in sexual acts, such as kissing, touching private parts, or sex?.................................
  • c. talk to a trusted person/adult (for example, a family member, teacher, counselor, coach, etc.) if someone makes you uncomfortable, hurts you, or pressures you to do things you don’t want to do?..........

  • 12. Has being in the program made you more likely, about the same, or less likely to... 

    *Mark only one answer per row

  • a. plan to delay having sexual intercourse until you graduate high school or receive your GED. ...............................................
  • b. plan to delay having sexual intercourse until you graduate college or complete another education or training program
  • c. plan to delay having sexual intercourse until you are married...............................
  • d. plan to be married before you have a child ........................................................
  • e. plan to have a steady full-time job before you get married.......................................
  • f. plan to have a steady full-time job before you have a child......................................

  • The next questions ask about some personal behaviors, including sexual intercourse and pregnancy. Remember, all of your responses will be kept private.

  • 13. As a result of being in the program, are you planning to abstain from sexual intercourse (choose to not have sexual intercourse)?

  • 14. How important are each of these reasons in your decision to not have sexual intercourse?

    (Note: Do not answer this question if you responded “No” or “Not sure” to question 13.)

    *Mark only one answer per row

  • a. how it might affect your plans for the future....
  • b. the possible emotional and social consequences (for example, feeling sadness or regret, disappointing your parent(s) or guardian(s), and/or negative reactions from your peers)......................................................
  • c. the risk of getting a sexually transmitted infection (STI)..................................................
  • d. the risk of getting pregnant or getting someone pregnant. .........................................

  • The next questions ask you about your experiences in the program that you just completed. Think about all of the sessions or classes of the program that you attended.

    15. Even if you didn’t attend all of the sessions or classes in this program, how often in this program...

    *Mark only one answer per row

  • a. did you feel interested in program sessions and classes? ......................................................
  • b. did you feel the material presented was clear?
  • c. did discussions or activities help you to learn program lessons?...............................................
  • d. did you have a chance to ask questions about topics or issues that came up in the program? ............................................................
  • e. did you feel respected as a person? .................

  • Thank you for participating in this survey!

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