Pre-Survey

Smart Sex for Men and Women

University of Pittsburgh at Bradford

Please answer the following questions honestly and openly. All individual answers will be kept anonymous. Thank you for your participation in Smart Sex for Men and Women.

Circle one.
1.Are you male or female?M F
2.Have you purchased a condom within the last 6 months? Y N
3.Have you ever had unprotected intercourse (no protection)?YN
4.Have you had unprotected intercourse within the last 6 months?YN
5.Have you ever had intercourse using a condom for protection?YN
6.Have you had intercourse using a condom within the last 6 months?YN
7.Have you ever been treated for a sexually transmitted disease?YN
8.Have you ever had an HIV test?YN
9.Have you ever encouraged your peers to practice safer sex?YN
10.Have you ever chosen abstinence as an option?YN
11.If in an intimate relationship, are you comfortable discussing safe sex?YN

Rate each of the following methods of protection according to effectiveness of disease prevention. Use the scale of one to five. (1 = least effective and 5 = most effective.)

____ Early withdrawal
____ Douching after intercourse
____ Hoping (using no protection)
____ Rhythm method
____ Birth control pill
____ IUD
____ Norplant underarm implant
____ Abstinence
____ Latex condom
____ Contraceptive foam
____ Secondary Virginity
____ Contraceptive Sponge
____ Female condom
____ Dental dam
____Unprotected intercourse in a mutually
faithful and monogamous relationship,
in which both have tested
negative for HIV
Survey written by Lydia P. Smith, Graduate Assistant/Health Educator, Student Health Services, University of Pittsburgh at Bradford, Bradford, PA 16701, 1995.

Post-Survey

Smart Sex for Men and Women

University of Pittsburgh at Bradford

Please answer the following questions honestly and openly. Your honesty will provide us with information on how to serve our campus community more effectively. We can also relay the successes of our program to other campuses nationwide. All individual answers will be kept anonymous. Thank you for participating in Smart Sex for Men and Women.

Circle one.

1.Are you a male or female?M F
2.Are you more willing to practice safer sex?Y N
3.Would you choose to use a condom for protection as a means of safer sex?Y N
4.Would you choose to practice faithful monogamy, after you and your partner had HIV testing done and had both tested negative?Y N
5.Will you encourage your peers to use a condom as a method of safer sex?Y N
6.Will you encourage your peers to practice abstinence or secondary virginity?Y N
7.Would you chose abstinence or secondary virginity?Y N
8.Will you feel more comfortable negotiating safe sex with your partner?Y N
9.Will you enforce your partner to practice smart sex with you?Y N
10.Would you recommend attending Smart Sex for Men and Women to your friends?Y N
11.What did you think of this Smart Sex program? Your suggestions will be very helpful in planning future programs.

Thank you for your participation in Smart Sex for Men and Women.

Survey written by Lydia P. Smith, Graduate Assistant/Health Educator, Student Health Services, University of Pittsburgh at Bradford, Bradford, PA 16701, 1995.

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