HE_School - public use Form Approved OMB No: 0920-0445 Expiration Date: 11/30/2008 Health Education School Questionnaire Health Education School Questionnaire Questions Standards, Guidelines, and Objectives 1 - 6 Required Health Education 7 - 33 Staffing and Staff Development 34 - 37 Collaboration 38 - 39 Promotion 40 Health Education Coordinator 41 - 53 Public reporting burden for this collection of information is estimated to average 20 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-74, Atlanta, GA 30333; Attention PRA (0920-0445). NOTE: THROUGHOUT THIS QUESTIONNAIRE, TEXT THAT APPEARS IN ALL CAPITAL LETTERS WILL NOT BE READ ALOUD TO RESPONDENTS. THIS QUESTIONNAIRE WILL BE ADMINISTERED USING COMPUTER ASSISTED PERSONAL INTERVIEW TECHNOLOGY. 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, AND 4) PERFORM OTHER USEFUL FUNCTIONS. THE PROGRAMMING SPECIFICATIONS FOR THE INTERVIEW ARE NOT INCLUDED IN THIS PRINTED VERSION OF THE QUESTIONNAIRE. 1. What is your job title at the school? (In which role do you spend more time?) 1) Principal 11) School Counselor 2) Asst. Principal/Other School 12) Social Worker Administrator 13) Psychologist 3) School Secretary 14) Other Mental Health/Social 4) Physical Ed Teacher Services 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. By health education, I mean any instruction on health topics, including instruction that occurs outside of health education courses. 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. Please consider instruction on any health topic, even if it does not occur in health education courses. Also, please think about the health education requirements for students in general, even though there may be some exceptions. The first questions ask about your school’s standards, guidelines, and objectives for teaching health education. 2. Does this school follow any national, state, or district health education standards or guidelines? Yes 1 No 2-->SKIP TO Q4 3. Are these health education standards or guidelines based on the National Health Education Standards? Yes 1 No 2 4. 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 IF Q4B IS “YES” SKIP TO Q5. 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 ALL SKIP TO THE INSTRUCTIONS BEFORE Q6. 5. Are all those who teach health education at this school required to use this curriculum? Yes 1-->RETURN TO Q4C No 2-->RETURN TO Q4C IF THOSE WHO TEACH HEALTH EDUCATION AT THIS SCHOOL ARE PROVIDED WITH GOALS, OBJECTIVES, AND EXPECTED OUTCOMES FOR HEALTH EDUCATION (Q4A IS “YES”), ANSWER Q6. OTHERWISE, SKIP TO THE INTRODUCTION TO Q7. 6. Do this school’s goals and objectives for health education address... Yes No a. Comprehending concepts related to health promotion and disease prevention? 1 2 b. Accessing valid health information and health promoting products and services? 1 2 c. Analyzing the influence of culture, media, technology, and other factors on health? 1 2 d. Practicing health-enhancing behaviors and reducing health risks? 1 2 e. Using interpersonal communication skills to enhance health? 1 2 f. Using goal-setting and decision-making skills to enhance health? 1 2 g. Advocating for personal, family, and community health? 1 2 Now I’d like to ask you about health education requirements at your school. SHOW CARD 1 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. 7. Are students required to receive instruction on... Yes No a. Alcohol or other drug use prevention? 1 2 b. Tobacco use prevention? 1 2 c. Nutrition and dietary behavior? 1 2 d. Physical activity and fitness, that is classroom instruction, not a physical education period? 1 2 e. Pregnancy prevention? 1 2 f. HIV or human immunodeficiency virus prevention? 1 2 g. Other STD or sexually transmitted disease prevention? 1 2 h. Human sexuality? 1 2 i. Emotional and mental health? 1 2 j. Suicide prevention? 1 2 k. Violence prevention, for example bullying, fighting, or homicide? 1 2 l. Injury prevention and safety? 1 2 m. Asthma awareness? 1 2 n. Foodborne illness prevention? 1 2 IF STUDENTS ARE NOT REQUIRED TO RECEIVE INSTRUCTION ON ANY OF THE TOPICS LISTED ABOVE (Q7A – N IS “NO”), SKIP TO Q22. IF STUDENTS RECEIVE INSTRUCTION ON HUMAN SEXUALITY TOPICS (Q7E, Q7F, Q7G, OR Q7H IS “YES”), ANSWER Q8 AND Q9. OTHERWISE, SKIP TO THE INTRODUCTION TO Q10. 8. Does this school notify parents or guardians before students receive instruction on pregnancy prevention, HIV prevention, other STD prevention, or human sexuality? Yes 1 No 2 9. Does this school allow parents or guardians to exclude their children from receiving instruction on pregnancy prevention, HIV prevention, other STD prevention, or human sexuality? Yes 1 No 2 The next questions ask about required health education. By health education, I mean any instruction on health topics, including instruction that occurs outside of health education courses. I’m going to read you three statements that describe requirements for instruction on health topics. Instruction on health topics is not limited to instruction that occurs in health education courses. Please listen to all three statements before giving your answer. You may choose more than one option. 10. How would you describe the requirements for instruction on health topics at your school? MARK ALL THAT APPLY Health education is required, but not in a specific grade 1-->SKIP TO THE INTRODUCTION TO Q16 Health education is required in specific grades 2-->SKIP TO Q12, AFTER Q15, SKIP TO Q22 Health education is not required 3 IF Q10 IS 3, ANSWER Q11. OTHERWISE, SKIP TO Q12. 11. Earlier you indicated that students at this school are required to receive instruction on [FILL WITH ANSWERS FROM Q7]. Is health education required at your school? Yes 1-->RETURN TO Q10 No 2-->RETURN TO Q7 AND THEN SKIP TO Q22 12. 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 ANSWER Q13-Q15 FOR EACH GRADE LISTED ABOVE. 13. How many weeks during the school year are ____ graders scheduled to take health education? _____ Weeks 14. 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 15. On average, how many minutes is each session of health education scheduled to last? _____ Minutes SKIP TO Q22 IF Q10 IS 2 ONLY. I am going to ask you about required courses. These courses might cover the same content for all students or they might be composed of units that the students choose from to form the required course; these are sometimes called “required electives.” 16. Are students at this school required to take any courses that include instruction on health topics? Yes 1 No 2-->SKIP TO Q22 17. Please tell me the names of these specific courses that include instruction on health topics that are required for students at this school. ________________________ Course 1 ________________________ Course 17 ________________________ Course 2 ________________________ Course 18 ________________________ Course 3 ________________________ Course 19 ________________________ Course 4 ________________________ Course 20 ________________________ Course 5 ________________________ Course 21 ________________________ Course 6 ________________________ Course 22 ________________________ Course 7 ________________________ Course 23 ________________________ Course 8 ________________________ Course 24 ________________________ Course 9 ________________________ Course 25 ________________________ Course 10 ________________________ Course 26 ________________________ Course 11 ________________________ Course 27 ________________________ Course 12 ________________________ Course 28 ________________________ Course 13 ________________________ Course 29 ________________________ Course 14 ________________________ Course 30 ________________________ Course 15 ________________________ Course 31 ________________________ Course 16 ________________________ Course 32 ANSWER Q18-Q21 FOR EACH COURSE NAMED IN Q17. 18. In what grade do students usually take _____________? 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 No usual grade 13 19. How many weeks is the course scheduled to last? _____ Weeks 20. 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 21. On average, how many minutes is each class period scheduled to last? _____ Minutes 22. Does your school use school assemblies to provide information to students about health topics? Yes 1 No 2 The next question asks about health education centers. Health education centers can be independent, non-profit organizations or affiliated with other public institutions, such as hospitals, science museums, or universities. They offer instruction on health topics in place of or to enhance health education provided by schools. 23. Does your school use health education centers to provide information to students about health topics? Yes 1 No 2 24. Does your school use health fairs to provide information to students about health topics? Yes 1 No 2 25. Does your school provide information to students about health topics through any other means? Yes 1 No 2 IF YES: Specify:____________________________ ANSWER Q26 FOR ELEMENTARY SCHOOL ONLY. OTHERWISE, SKIP TO THE INSTRUCTIONS BEFORE Q27. SHOW CARD 2 26. 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) or specialist(s) 1 Physical education teacher(s) or specialist(s) 2 Regular classroom teacher(s) 3 School nurse(s) 4 School counselor(s) 5 Other(s) 6 ANSWER Q27 FOR MIDDLE/JUNIOR HIGH AND SENIOR HIGH SCHOOL ONLY. OTHERWISE, SKIP TO THE INSTRUCTIONS BEFORE Q28. SHOW CARD 3 27. 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 THE INSTRUCTIONS BEFORE Q31. OTHERWISE, CONTINUE WITH Q28. These next questions ask about grading students in required health education. 28. What type of grade do students receive 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 THE INSTRUCTIONS TO Q31 29. 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 School does not calculate grade point averages or have any other indicators of academic standing 3 30. If students fail required health education, are they required to repeat it? Yes 1 No 2 ANSWER Q31 FOR MIDDLE/JUNIOR HIGH AND SENIOR HIGH SCHOOL ONLY. OTHERWISE, SKIP TO Q32. 31. Are there any elective courses at this school that include instruction on health topics? Yes 1 No 2 32. Currently, are there any students with long-term physical, medical, or cognitive disabilities enrolled at this school? Yes 1 No 2-->SKIP TO THE INTRODUCTION TO Q34 33. Is health education ever included in Individualized Education Programs (IEPs) or 504 plans for students with long-term physical, medical, or cognitive disabilities? Yes 1 No 2 Now I’m going to ask you several questions about staffing and staff development at your school. 34. Are newly hired staff who teach health topics required to have undergraduate or graduate training in health education? Yes 1 No 2 35. 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 State does not offer certification, licensure, or endorsement in health education 3 36. Are newly hired staff who teach health topics required to earn continuing education credits on health education topics? Yes 1 No 2 ANSWER Q37 FOR MIDDLE/JUNIOR HIGH AND SENIOR HIGH SCHOOL ONLY. OTHERWISE, SKIP TO THE INTRODUCTION TO Q38A. 37. Are newly hired staff who teach health topics required to be Certified Health Education Specialists or CHES? Yes 1 No 2 Now I’m going to ask you about collaboration among health education staff and other school and local agency staff. 38a. During the past 12 months, have the health education staff worked on health education activities with physical education staff from this school? Yes 1 No 2 School does not have physical education staff 3 38b. What about with health services staff from this school? Yes 1 No 2 School does not have health services staff 3 38c. What about with mental health or social services staff from this school? Yes 1 No 2 School does not have mental health or social services staff 3 38d. What about with nutrition or food service staff from this school? Yes 1 No 2 School does not have nutrition or food service staff 3 39. During the past 12 months, have the school health education staff worked on health education activities with staff or members from... Yes No N/A a. A local health department? 1 2 3 b. A local hospital? 1 2 3 c. A local mental health or social services agency? 1 2 3 d. A local law enforcement agency? 1 2 3 e. Local fire or emergency medical services? 1 2 3 f. A health organization, such as the American Heart Association or the American Cancer Society? 1 2 3 g. A local service club, such as the Rotary Club? 1 2 3 h. A local college or university? 1 2 3 i. A local business? 1 2 The next question asks about health education promotion that might occur at your school. 40. During the past 12 months, has this school... Yes No a. Met with a parents’ organization, such as the PTA, to discuss school health education? 1 2 b. Provided families with information on school health education? 1 2 c. Discussed student performance in health education as part of parent-teacher conferences? 1 2 d. Invited family members to attend health education classes? 1 2 e. Offered any health education for families? 1 2 f. Collected suggestions from family members of students about school health education? 1 2 g. Collected suggestions from students about school health education? 1 2 41. Currently, does someone at this school oversee or coordinate health education? Yes 1 No 2-->SKIP TO Q53 42. Are you this person? Yes 1 No 2-->SKIP TO Q53 My last set of questions asks about your teaching experience and educational background. 43. Counting this year as a full year and including years spent teaching health education topics or courses at any other schools, how many years of experience do you have teaching health education topics or courses? _____ Years 44. Do you coach an interscholastic sport? Yes 1 No 2 45. Do you have an undergraduate degree? Yes 1 No 2-->SKIP TO Q51 46. What did you major in? MARK ALL THAT APPLY Health education 1 Physical education 2 Other education 3 Kinesiology, exercise physiology, or exercise science 4 Nursing 5 Nutrition 6 Public health 7 Biology or other science 8 Home economics or family and consumer science 9 Other 10 47. Did you have an undergraduate minor? Yes 1 No 2-->SKIP TO Q49 48. What did you minor in? MARK ALL THAT APPLY Health education 1 Physical education 2 Other education 3 Kinesiology, exercise physiology, or exercise science 4 Nursing 5 Nutrition 6 Public health 7 Biology or other science 8 Home economics or family and consumer science 9 Other 10 49. Do you have a graduate degree? Yes 1 No 2-->SKIP TO Q51 50. In what area or areas? MARK ALL THAT APPLY Health education 1 Physical education 2 Other education 3 Kinesiology, exercise physiology, or exercise science 4 Nursing 5 Nutrition 6 Public health 7 Biology or other science 8 Home economics or family and consumer science 9 Other 10 51. Currently, are you certified, endorsed, or licensed by the state to teach health education in... Yes No N/A a. Elementary school? 1 2 3 b. Middle or junior high school? 1 2 3 c. Senior high school? 1 2 3 52. Are you a Certified Health Education Specialist or CHES? Yes 1 No 2 53. 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. If you would like more information about this study or would like clarification of any questions in this questionnaire, please call Tonja Kyle or Lori Gross at (800) 287-1815.