Form Approved OMB No: 0920-0445 Expiration Date: 10/31/2002 Health Education School Questionnaire Health Education School Questionnaire Questions Standards, Guidelines, and Objectives 1 - 6 Required Health Education 7 - 8 Instructional Content 9 - 35 Staffing and Staff Development 36 - 38 Program Collaboration, Promotion, and Evaluation 39 - 42 Respondent Background 43 - 57 Public reporting burden for this collection of information is estimated to average 45 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to: CDC/ATSDR Reports Clearance Officer, 1600 Clifton Road NE, Mailstop D-24, Atlanta, GA 30333; Attention PRA (0920-0445). Special Instructions This questionnaire will be administered using Computer Assisted Personal Interviewing. The interviewer will read the questions aloud and type responses to the questions into the laptop computer. The interview program will 1) display the correct tense of verbs, 2) provide alternate answers to questions (e.g., not applicable, “I don’t know”), 3) navigate complex skip patterns, 4) access information that was provided in previous contact with a school, and 5) perform other useful functions. The programming specifications for the interview are not included in this printed version of the questionnaire. If you would like more information about this study or would like clarification of any questions in this questionnaire, please call Tim Smith at 1-800-647-9664, extension 6095. Standards, Guidelines, and Objectives What is your job title at the school? (In which role do you spend more time?) 1) Principal 11) Guidance Counselor 2) Asst. Principal/Other School 12) Social Worker Administrator 13) Psychologist 3) School Secretary 14) Other Mental Health/Social Services 4) Physical Ed Teacher Provider 5) Athletic Director 15) Nurse 6) Health Ed Teacher 16) Health Aide 7) Other Teacher 17) Physician 8) Food Service Manager 18) Other Health Services Provider 9) Commercial Food Service Provider 19) SBHC Health Services Staff 10) Other School Food Service Staff 20) SBHC Mental Health/Social Services Staff 50) Other Staff During this interview, I will ask about health education at this school. You have been identified as the person who knows the most about how instruction on health topics is provided throughout all grades at the school. As you think about the questions that I ask, please consider all health education provided to students at this school. Also, please think about the health education requirements for students in general, even though there may be some exceptions. 1. Does this school follow any national, state, or district health education standards or guidelines? Yes 1 No 2 ==> Skip to Q3 2. Are these health education standards or guidelines based on the National Health Education Standards? Yes 1 No 2 3. Are those who teach health education at this school provided with... Yes No a. Goals, objectives, and expected outcomes for health education? 1 2 b. A health education curriculum? 1 2 c. A chart describing the scope and sequence of instruction for health education? 1 2 d. Lesson plans or learning activities for health education? 1 2 e. Plans for how to assess or evaluate students in health education? 1 2 If those who teach health education at this school are provided with a health education curriculum (Q3b is Yes), answer Q4 and Q5. Otherwise, skip to Q6. 4. Are all those who teach health education at this school required to use this curriculum? Yes 1 No 2 5. Do those who teach health education at this school have their own copy of the curriculum? Yes 1 No 2 If those who teach health education at this school are provided with goals, objectives, and expected outcomes for health education (Q3a is Yes), answer Q6. Otherwise, skip to Q7. 6. Do this school’s goals and objectives for health education address student outcomes such as... HEB018 Yes No a. Comprehension of concepts related to health promotion and disease prevention? 1 2 b. The ability to access valid health information and health promoting products and services? 1 2 c. The ability to analyze the influence of culture, media, technology, and other factors on health? 1 2 d. The ability to practice health-enhancing behaviors and reduce health risks? 1 2 e. The ability to use interpersonal communication skills to enhance health? 1 2 f. The ability to use goal-setting and decision-making skills to enhance health? 1 2 g. The ability to advocate for personal, family, and community health? 1 2 Required Health Education SHOW CARD 1 7. I am going to read each of the topics listed on this card. As I read the list, please tell me if students are required to receive instruction on each topic. Are students required to receive instruction on... Yes No a. Personal hygiene? 1 2 b. Dental and oral health? 1 2 c. Nutrition and dietary behavior? 1 2 d. Physical activity and fitness, that is classroom instruction, not a physical activity period? 1 2 e. Growth and development? 1 2 f. Human sexuality? 1 2 g. Pregnancy prevention? 1 2 h. HIV (human immunodeficiency virus) prevention? 1 2 i. STD (sexually transmitted disease) prevention? 1 2 j. Emotional and mental health? 1 2 k. Suicide prevention? 1 2 l. Death and dying? 1 2 m. Tobacco use prevention? 1 2 n. Alcohol or other drug use prevention? 1 2 o. Violence prevention, for example bullying, fighting, or homicide? 1 2 p. Acident or injury prevention? 1 2 q. CPR (cardiopulmonary resuscitation)? 1 2 r. First aid? 1 2 s. Immunizations or vaccinations? 1 2 t. Sun safety or skin cancer prevention? 1 2 u. Consumer health, such as choosing sources of health- related information, products, and services wisely? 1 2 v. Environmental health, such as how air and water quality can affect health? 1 2 If students receive instruction on human sexuality topics (Q7f, g, h, or i is Yes), answer Q8. Otherwise, skip to Q9. 8. Does this school notify parents or guardians before students receive instruction on human sexuality topics?HEB059 Yes 1 No 2 Instructional Content 9. At this school, in which grades do students receive required instruction on health topics? MARK ALL THAT APPLY. K 0 1st 1 2nd 2 3rd 3 4th 4 5th 5 6th 6 7th 7 8th 8 9th 9 10th 10 11th 11 12th 12 Health education not required in any specific grades 13 ==> If this is an elementary school, skip to Q30. If this is a middle, junior, or senior high school, skip to Q13. Answer Q10-Q12 for each grade listed above. 10. How many weeks during the school year are ____ graders scheduled to take health education? _____ Weeks 11. On average, how many days per week are the ____ graders scheduled to take health education? 1 Day 1 2 Days 2 3 Days 3 4 Days 4 5 Days 5 0 Days one week, 1 day the next week 6 1 Day one week, 2 days the next week 7 2 Days one week, 3 days the next week 8 3 Days one week, 4 days the next week 9 4 Days one week, 5 days the next week 10 Other 11 12. On average, how many minutes is each session of health education scheduled to last? _____ Minutes If this is an elementary school, skip to Q30. Otherwise, continue with Q13. 13. Now, I’m asking about courses that include instruction in health education that students are required to take while at this school. I am asking about required courses that students do not have to take during any particular grade. Any courses that are chosen by students or are optional for students we will list in the next set of questions. Are students at this school required to take specific courses that include instruction in health topics? Yes 1 No 2 ==> Skip to Q21 14. Please tell me the names of these specific courses that include instruction in health education that are required for students at this school. ________________________ Course 1 ________________________ Course 9 ________________________ Course 2 ________________________ Course 10 ________________________ Course 3 ________________________ Course 11 ________________________ Course 4 ________________________ Course 12 ________________________ Course 5 ________________________ Course 13 ________________________ Course 6 ________________________ Course 14 ________________________ Course 7 ________________________ Course 15 ________________________ Course 8 ________________________ Course 16 15. ________________________ Course 17 ________________________ Course 25 ________________________ Course 18 ________________________ Course 26 ________________________ Course 19 ________________________ Course 27 ________________________ Course 20 ________________________ Course 28 ________________________ Course 21 ________________________ Course 29 ________________________ Course 22 ________________________ Course 30 ________________________ Course 23 ________________________ Course 31 ________________________ Course 24 ________________________ Course 32 Answer Q16-Q20 for each course named in Q14 and Q15. 16. In what grade do students usually take _____________? 6th 6 7th 7 8th 8 9th 9 10th 10 11th 11 12th 12 No usual grade 13 SHOW CARD 2 17. Which one of the statements listed on this card best describes the class? Is this class... Devoted to health topics, such as alcohol or other drug use prevention? 1 A combined health education and physical education class? 2 Mainly about some subject other than health education, such as science, social studies, or English? 3 18. How many weeks is the course scheduled to last? _____ Weeks 19. On average, how many days per week is the course scheduled to meet? 1 Day 1 2 Days 2 3 Days 3 4 Days 4 5 Days 5 0 Days one week, 1 day the next week 6 1 Day one week, 2 days the next week 7 2 Days one week, 3 days the next week 8 3 Days one week, 4 days the next week 9 4 Days one week, 5 days the next week 10 Other 11 20. On average, how many minutes is each class period scheduled to last? _____ Minutes 21. Some schools have a general health education requirement for which students must select a certain number of courses from a larger set of courses to fulfill the requirement. These courses are sometimes called “required electives”. Next, I am going to ask you about courses that meet this type of general health education requirement. However, please do not include any of the required health education courses that I have already asked you about, including any health education courses required in a certain grade or any other required courses. In addition to the required health education we’ve already talked about, are there any courses at this school that students must choose from to meet this type of general health education requirement? Yes 1 No 2 ==> Skip to Q31 22. Please tell me the names of these courses that meet a general health education requirement at this school. ________________________ Course 1 ________________________ Course 9 ________________________ Course 2 ________________________ Course 10 ________________________ Course 3 ________________________ Course 11 ________________________ Course 4 ________________________ Course 12 ________________________ Course 5 ________________________ Course 13 ________________________ Course 6 ________________________ Course 14 ________________________ Course 7 ________________________ Course 15 ________________________ Course 8 ________________________ Course 16 23. ________________________ Course 17 ________________________ Course 25 ________________________ Course 18 ________________________ Course 26 ________________________ Course 19 ________________________ Course 27 ________________________ Course 20 ________________________ Course 28 ________________________ Course 21 ________________________ Course 29 ________________________ Course 22 ________________________ Course 30 ________________________ Course 23 ________________________ Course 31 ________________________ Course 24 ________________________ Course 32 24. Of the courses you just listed, how many must students take to fulfill the general health education requirement? _____ Number of courses for general health education requirement Answer Q25-Q29 for each course listed in Q22 and Q23. 25. In what grade do students usually take _____________? 6th 6 7th 7 8th 8 9th 9 10th 10 11th 11 12th 12 No usual grade 13 SHOW CARD 2 26. Which one of the statements listed on this card best describes the class? Is this class... Devoted to health topics such as alcohol or other drug use prevention? 1 A combined health education and physical education class? 2 Mainly about some subject other than health education such as science, social studies, or English? 3 27. How many weeks is the course scheduled to last? _____ Weeks 28. On average, how many days per week is the course scheduled to meet? 1 Day 1 2 Days 2 3 Days 3 4 Days 4 5 Days 5 0 Days one week, 1 day the next week 6 1 Day one week, 2 days the next week 7 2 Days one week, 3 days the next week 8 3 Days one week, 4 days the next week 9 4 Days one week, 5 days the next week 10 Other 11 29. On average, how many minutes is each class period scheduled to last? _____ Minutes If this is an elementary school, answer Q30. Otherwise, skip to Q31. SHOW CARD 3 30. My next question is about who teaches health education. Looking at this card, please tell me who teaches health education to students at this school. MARK ALL THAT APPLY. Health education specialist(s) or teacher(s) 1 Physical education specialist(s) or teacher(s) 2 Regular classroom teacher(s) 3 School nurse(s) 4 School counselor(s) 5 Other(s) 6 If this is a middle, junior, or senior high school, answer Q31. Otherwise, skip to Q32. SHOW CARD 4 31. My next question is about who teaches health education. Looking at this card, please tell me who teaches health education to students at this school. MARK ALL THAT APPLY. Health education teacher(s) 1 Physical education teacher(s) 2 Other teacher(s) 3 School nurse(s) 4 School counselor(s) 5 Other(s) 6 If there is no required health education at this school, skip to Q35. Otherwise, continue with Q32. These next questions ask about grading students in required health education. 32. Do students receive letter or numerical grades, pass/fail, or some other type of grades specifically for required health education at this school? MARK ALL THAT APPLY. Letter or numerical grade 1 Pass/Fail 2 Other 3 No grades given for health education 4 ==> Skip to Q35 33. Are grades from required health education used the same as grades from other subject areas when determining grade point averages, honor roll status, or other indicators of academic standing? Yes 1 No 2 34. If students fail required health education, are they required to repeat it? Yes 1 No 2 If this is a middle, junior, or senior high school, answer Q35. Otherwise, skip to Q36. 35. Are there any elective courses at this school that include instruction in health topics? Yes 1 No 2 If there is no required health education at this school, skip to Q58. Staffing and Staff Development 36. Are newly-hired staff who teach health topics required to have undergraduate or graduate training in health education? Yes 1 No 2 37. Are newly-hired staff who teach health topics required to be certified, licensed, or endorsed by the state in health education? Yes 1 No 2 38. Are newly-hired staff who teach health topics required to be Certified Health Education Specialists or CHES? Yes 1 No 2 39. During the past 12 months, have the health education staff worked on health education activities with... Yes No a. Physical education staff from this school? 1 2 b. Health services staff from this school? 1 2 c. Mental health or social services staff from this school? 1 2 d. Food service staff from this school? 1 2 40. During the past 12 months, have the school health education staff worked on health education activities with staff or members from... Yes No a. A local health department? 1 2 b. A local hospital? 1 2 c. A local mental health or social services agency? 1 2 d. A health organization, such as the American Heart Association or the American Cancer Society? 1 2 e. A local college or university? 1 2 f. A local business? 1 2 Program Promotion 41. During the past 12 months, has this school... Yes No a. Provided families with information on the school health education program? 1 2 b. Met with a parents’ organization, such as the PTA, to discuss the health education program? 1 2 c. Invited family members to attend health education classes? 1 2 d. Offered any health education programs to families? 1 2 42. During the past 12 months, has this school... Yes No a. Collected suggestions from students about the health education program? 1 2 b. Collected suggestions from family members of students about the health education program? 1 2 Respondent Background 43. Currently, does someone at this school oversee or coordinate health education? HEB003 Yes 1 No 2 ==> Skip to Q58 44. Are you this person? Yes 1 No 2 ==> Skip to Q58 My last set of questions asks about your educational background and teaching experience. 45. Counting this year as a full year and including years spent teaching health education topics or classes at any other schools, how many years of experience do you have teaching health education topics or classes? HEB118 _____ Years 46. Do you have an undergraduate degree? Yes 1 No 2 ==> Skip to Q52 47. What did you major in? MARK ALL THAT APPLY. Health education and physical education combined 1 Health education 2 Physical education 3 Other education 4 Kinesiology 5 Exercise physiology 6 Exercise science 7 Nursing 8 Nutrition 9 Public health 10 Biology or other science 11 Home economics 12 Other 13 48. Do you have an undergraduate minor?HEC059 Yes 1 No 2 ==> Skip to Q50 49. What did you minor in? MARK ALL THAT APPLY. Health education and physical education combined 1 Health education 2 Physical education 3 Other education 4 Kinesiology 5 Exercise physiology 6 Exercise science 7 Nursing 8 Nutrition 9 Public health 10 Biology or other science 11 Home economics 12 Other 13 50. Do you have a graduate degree? Yes 1 No 2 ==> Skip to Q52 51. In what area or areas? MARK ALL THAT APPLY. Health education and physical education combined 1 Health education 2 Physical education 3 Other education 4 Kinesiology 5 Exercise physiology 6 Exercise science 7 Nursing 8 Nutrition 9 Public health 10 Biology or other science 11 Home economics 12 Other 13 52. Currently, are you certified, endorsed, or licensed by the state to teach health education in... HEB125 Yes No a. Elementary school? 1 2 b. Middle or junior high school? 1 2 c. Senior high school? 1 2 53. Are you a Certified Health Education Specialist or CHES? Yes 1 No 2 SHOW CARD 5 54. As I read the list of topics on this card, please tell me if you received any staff development on each topic during the past 2 years. This might include workshops, conferences, continuing education, graduate courses, or any other kind of in-service. During the past 2 years, did you receive any staff development on... Yes No a. Personal hygiene? 1 2 b. Dental and oral health? 1 2 c. Nutrition and dietary behavior? 1 2 d. Physical activity and fitness, that is classroom instruction, not a physical activity period? 1 2 e. Growth and development? 1 2 f. Human sexuality? 1 2 g. Pregnancy prevention? 1 2 h. HIV prevention? 1 2 i. STD prevention? 1 2 j. Emotional and mental health? 1 2 k. Suicide prevention? 1 2 l. Death and dying? 1 2 m. Tobacco use prevention? 1 2 n. Alcohol or other drug use prevention? 1 2 o. Violence prevention, for example bullying, fighting, or homicide? 1 2 p. Accident or injury prevention? 1 2 q. CPR? 1 2 r. First aid? 1 2 s. Immunizations or vaccinations? 1 2 t. Sun safety or skin cancer prevention? 1 2 u. Consumer health, such as choosing sources of health- related information, products, and services wisely? 1 2 v. Environmental health, such as how air and water quality can affect health? 1 2 55. Which of these topics would you like to receive further staff development on? MARK ALL THAT APPLY. Personal hygiene 1 Dental and oral health 2 Nutrition and dietary behavior 3 Physical activity and fitness, that is, classroom instruction, not a physical activity period 4 Growth and development 5 Human sexuality 6 Pregnancy prevention 7 HIV prevention 8 STD prevention 9 Emotional and mental health 10 Suicide prevention 11 Death and dying 12 Tobacco use prevention 13 Alcohol or other drug use prevention 14 Violence prevention, such as bullying, fighting, or homicide 15 Accident or injury prevention 16 CPR 17 First aid 18 Immunizations or vaccinations 19 Sun safety or skin cancer prevention 20 Consumer health, such as choosing sources of health- related information, products, and services wisely 21 Environmental health, such as how air and water quality can affect health 22 None 23 SHOW CARD 6 56. As I read the list of teaching methods on this card, please tell me if you received any staff development on each one during the past 2 years. During the past 2 years, did you receive any staff development on... Yes No a. Teaching students with permanent physical or cognitive disabilities? 1 2 b. Teaching students of various cultural backgrounds? 1 2 c. Teaching students with limited English proficiency? 1 2 d. Using interactive teaching methods, such as role plays or cooperative group activities? 1 2 e. Encouraging family or community involvement? 1 2 f. Teaching skills for behavior change? 1 2 57. Which of these teaching methods would you like to receive further staff development on? MARK ALL THAT APPLY. Teaching students with permanent physical or cognitive disabilities 1 Teaching students of various cultural backgrounds 2 Teaching students with limited English proficiency 3 Using interactive teaching methods, such as role plays or cooperative group activities 4 Encouraging family or community involvement 5 Teaching skills for behavior change 6 None 7 58. My supervisor may wish to call you to ask about how I conducted this interview. Would you please tell me a telephone number where we might reach you starting with the area code? ( ) - 1) Daytime or 2) Evening/Weekend Thank you very much for taking the time to complete this interview. Health Education School Questionnaire - Final Version — Revised: 10/26/99 24 Health Education School Questionnaire - Final Version — Revised: 10/26/99 Standards, Guidelines, and Objectives Required Health Education Instructional Content Staffing and Staff Development Respondent Background