12IDHS-NM 2012 INDONESIA DEMOGRAPHIC AND HEALTH SURVEY

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12IDHS-NM 2012 INDONESIA DEMOGRAPHIC AND HEALTH SURVEY NEVER-MARRIED MEN'S QUESTIONNAIRE Confidential

  2012 IDHS SAMPLE CODE . RESPONDENT LINE NUMBER .

INTERVIEWER VISITS

1 2 3 FINAL VISIT DATEDAY MONTH 2 1 2 YEAR INTERVIEWER’S NAME INT. NUMBERRESULT***) RESULT NEXT VISIT DATETOTAL NUMBER OF TIME VISITS 1 COMPLETED 3 POSTPONED 5 PARTLY COMPLETED 7 OTHER 2 NOT AT HOME 4 REFUSED 6 INCAPACITATED (SPECIFY)FIELD EDITOR SUPERVISOR OFFICE KEYED BY EDITOR NAME NAME DATE DATE

PARENT/GUARDIAN CONSENT

  08 OTHER 96(SPECIFY) 2 2 2 2 2 2 2 2 NOT AT ALL . 1121 2118 2 2 2 2 2 2 2 NOT AT ALL .

2. KNOWLEDGE AND EXPERIENCE ABOUT HUMAN REPRODUCTION SYSTEM Now I want to ask you about changes from childhood to adolescence, the reproductive system, and related issues

  QUESTIONS AND FILTERS CODE SKIP TO When a boy begins to change from childhood to adolescence,201 DEVELOP MUSCLES . GROWTH OF FACIAL HAIR, PUBIC HAIR, UNDERARM HAIR, CHEST, LEGS AND ARMS .

CIRCLE ALL MENTIONED. OTHER

  X (SPECIFY)DON’T KNOW . Can you tell me what they UNDERARM HAIR .

CIRCLE ALL MENTIONED

IN BOTH 201 AND 205

  Z 203 CHECK 201 AND 202:NO CODE 'Z' CIRCLED CODE 'Z' CIRCLED OR CODE 'Z' CIRCLED IN ONE QUESTION ONLY 202 Where did you get the information about the physical changes204 FRIENDS . Before you had wet dreams, did anyone talk to you about wet 206YES .

DO NOT READ OUT RESPONSES. OTHER

  YES 1 Men can be careful and pull out before climax NO . YES 1 As an emergency measure after unprotected sexual intercourse, women can take special pills at any time NO .

YES NO

  1 2 Do you think you will use a family planning method some time NO . 2 DON'T KNOW .

INCREASE CONSUMPTION OF DO NOT READ OUT RESPONSES

3. MARRIAGE AND CHILDREN Let us now talk about marriage and having children

  1 2 8 2 8 1 2 8 2 8 5 DON’T KNOW . Z403 CHECK 104 CODE '1' CODE '2' 2 2 2 2 2 2 2 2 402FRIENDS .

5. SMOKING, DRINKING AND DRUGS

  C OTHER X(SPECIFY) Have you ever asked/influenced a friend/someone to smoke?508 YES . 2 525 Have you ever asked/influenced a friend/someone to drinkYES .

6. HIV/AIDS . . . . . . . . . . . . .

  2 616601A From which sources of information have you learned RADIO . BLOOD TEST/VCT 8 B BEHAVIOUR CHANGES A PHYSICAL CHANGES 8609 2 2 YES .

7. DATING AND SEXUAL BEHAVIOUR Now I want to ask questions about sexual activity. We are interested in finding out whether people your age are sexually active

  1 PENDS 8 717 Do you approve if:YES NO DE- 1 NO . 2 735 Have you ever advised/influencd a friend/someone to abort a YES .

INTERVIEWER'S OBSERVATIONS

COMMENTS ON SPECIFIC QUESTIONS:ANY OTHER COMMENTS:

SUPERVISOR'S OBSERVATIONS

TO BE FILLED IN AFTER COMPLETING INTERVIEW COMMENTS ABOUT RESPONDENT: NAME OF SUPERVISOR: DATE: EDITOR'S OBSERVATIONS

NAME OF EDITOR:

DATE:
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