N^o

QUESTIONS

CODE

01

Do you consume the following products: A. Alcohol […]; B. Cigarettes […]; C. Illicit substances […]; D. None […]

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02

If yes, how much of each substance per month? ...........................

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03

Do you have a boyfriend (s)? 1. Yes; 2. No If no, go to section VII

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04

If so, at what age did you have your first boyfriend? ............

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05

How many sexual partners do you currently have? ………… ..

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06

How old are they? .................

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