Say Something Youth Initiative Pre-test 2022 Survey

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* 1. Please enter the name of the street where you lived when you were first born plus the number of siblings (that is, brothers and sisters) you have and your birth order. For example, if you lived on a street called “Elm Street” and you have four siblings and you are the second born, you would enter “Elm42” in this box

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* 2. Empathy means... (check all that apply)

Imagining how someone else feels in a situation.

Taking action to fix a situation after we are told about it.

Knowing how someone else feels because I went through something similar.

Seeing situations from another person's point of view.

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* 3. Which of the following about consent is not true.

Consent is important because it is how we tell other people what is and isn't okay within our relationship

If I give someone consent I cannot change my mind later

Consent only applies in sexual relationships

Consent is important when building a relationships that both people feel respected in

It is important to ask for consent in advance

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* 4. Some examples of unhealthy behaviors in a relationship are... (Check all that apply)

Being told what to, or not to, wear by a partner

Using name-calling or insults towards a partner when they upset you

Your partner encourages you to do things you love

Cancelling plans with friends because my partner doesn't like them

Being confident in bringing up hard conversations with my partner

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* 5. When deciding whether or not to intervene as a bystander, it is important to..

Stop the person doing harm immediately.

Yell louder than the person causing harm so they feel intimidated.

Judge our own emotional and physical safety before deciding to intervene

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* 6. Please select Strongly Agree, Somewhat Agree, Somewhat Disagree, Strongly Disagree, or I don't know for each of the following statements.

	strongly agree	somewhat agree	somewhat disagree	strongly disagree	I don't know
If the person I’m talking to rejects me when I ask them to be in a relationship, I can communicate my disappointment	If the person I’m talking to rejects me when I ask them to be in a relationship, I can communicate my disappointment strongly agree	If the person I’m talking to rejects me when I ask them to be in a relationship, I can communicate my disappointment somewhat agree	If the person I’m talking to rejects me when I ask them to be in a relationship, I can communicate my disappointment somewhat disagree	If the person I’m talking to rejects me when I ask them to be in a relationship, I can communicate my disappointment strongly disagree	If the person I’m talking to rejects me when I ask them to be in a relationship, I can communicate my disappointment I don't know
I feel confident in my ability to communicate my sexual needs in my relationship	I feel confident in my ability to communicate my sexual needs in my relationship strongly agree	I feel confident in my ability to communicate my sexual needs in my relationship somewhat agree	I feel confident in my ability to communicate my sexual needs in my relationship somewhat disagree	I feel confident in my ability to communicate my sexual needs in my relationship strongly disagree	I feel confident in my ability to communicate my sexual needs in my relationship I don't know
I believe abuse happens in teen dating relationships.	I believe abuse happens in teen dating relationships. strongly agree	I believe abuse happens in teen dating relationships. somewhat agree	I believe abuse happens in teen dating relationships. somewhat disagree	I believe abuse happens in teen dating relationships. strongly disagree	I believe abuse happens in teen dating relationships. I don't know
When I set a limit in a relationship, it is usually respected	When I set a limit in a relationship, it is usually respected strongly agree	When I set a limit in a relationship, it is usually respected somewhat agree	When I set a limit in a relationship, it is usually respected somewhat disagree	When I set a limit in a relationship, it is usually respected strongly disagree	When I set a limit in a relationship, it is usually respected I don't know
A person should ask if it's okay to post or share something online about another person before doing so	A person should ask if it's okay to post or share something online about another person before doing so strongly agree	A person should ask if it's okay to post or share something online about another person before doing so somewhat agree	A person should ask if it's okay to post or share something online about another person before doing so somewhat disagree	A person should ask if it's okay to post or share something online about another person before doing so strongly disagree	A person should ask if it's okay to post or share something online about another person before doing so I don't know
I can identify the differences between healthy, unhealthy, and abusive behaviors in a relationship	I can identify the differences between healthy, unhealthy, and abusive behaviors in a relationship strongly agree	I can identify the differences between healthy, unhealthy, and abusive behaviors in a relationship somewhat agree	I can identify the differences between healthy, unhealthy, and abusive behaviors in a relationship somewhat disagree	I can identify the differences between healthy, unhealthy, and abusive behaviors in a relationship strongly disagree	I can identify the differences between healthy, unhealthy, and abusive behaviors in a relationship I don't know
I have the skills to help a friend who is experiencing violence	I have the skills to help a friend who is experiencing violence strongly agree	I have the skills to help a friend who is experiencing violence somewhat agree	I have the skills to help a friend who is experiencing violence somewhat disagree	I have the skills to help a friend who is experiencing violence strongly disagree	I have the skills to help a friend who is experiencing violence I don't know
I feel like I have strong leadership skills	I feel like I have strong leadership skills strongly agree	I feel like I have strong leadership skills somewhat agree	I feel like I have strong leadership skills somewhat disagree	I feel like I have strong leadership skills strongly disagree	I feel like I have strong leadership skills I don't know
It is okay to use violence to express my feelings	It is okay to use violence to express my feelings strongly agree	It is okay to use violence to express my feelings somewhat agree	It is okay to use violence to express my feelings somewhat disagree	It is okay to use violence to express my feelings strongly disagree	It is okay to use violence to express my feelings I don't know

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* 7. What is your self-identified race/ethnicity?

American Indian/Alaska Native

Asian

Black

Native Hawaiian/Pacific Islander

White

Hispanic or Latino

Cape Verdean

Multiracial

another race

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* 8. What is your self-identified gender?

Woman

Man

Agender

Transgender

Genderqueer

I'd rather not say

Other

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* 9. What is your sexual orientation?

Lesbian

Gay

Bisexual

Queer

Asexual

Straight

other

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* 10. Do you have any of the following disabilities? (Select all that apply)

mobility

visual

hearing

developmental

learning

mental health/psychiatric

substance use

other