Form Approved OMB No: 0920-0445 Expiration Date: 10/31/2002 Health Education District Questionnaire Health Education District Questionnaire Questions Standards and Guidelines 1 - 4 Elementary School Instruction 5 - 11 Middle/Junior High School Instruction 12 - 18 Senior High School Instruction 19 - 25 Staffing and Staff Development 26 - 31 Health Education Collaboration 32 - 33 Health Education Promotion 34 Health Education Evaluation 35 Health Education Coordinator 36 - 45 Public reporting burden for this collection of information is estimated to average 40 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 1. This questionnaire focuses on your district practices and policies. 2. When we use the word “policy,” we mean any mandate issued by the local school board or other local agency that affects health education in schools throughout your district. Please consider any policies officially adopted at the district level. These include policies developed by your district, or those based on model policies developed by your state or elsewhere. 3. We recognize that there may be some exceptions, but please answer the questions based on what is customary in your district. Please do not consider school practices or policies when answering the questions. (We will ask about school practices and policies when we collect information from schools across the country.) 4. If you would like more information about this study or would like clarification of any questions in this survey, please call Tim Smith at 1-800-647-9664, extension 6095. Standards and Guidelines 1. Has your district adopted a policy stating that schools will follow any national, state, or district health education standards or guidelines? These might cover topics such as the goals and objectives of health education or expected student outcomes. Yes 1 ==> Skip to Question 3 No 2 2. Has your district adopted a policy encouraging (e.g., in memoranda or guidelines) schools to follow any national, state, or district health education standards or guidelines? Yes 1 No 2 ==> Skip to Question 5 3. Are these health education standards or guidelines based on the National Health Education Standards? HED013 Yes 1 No 2 Don’t Know 3 4. Which of the following methods does your district use to improve school compliance with these health education standards or guidelines? HED010 Yes No a. Staff development for health education teachers 1 2 b. Monitoring student achievement 1 2 c. Submission of written reports by schools 1 2 d. Teacher evaluations or classroom monitoring 1 2 e. Teachers mentoring other teachers 1 2 Elementary School Instruction 5. Has your district adopted goals, objectives, or expected outcomes for elementary school health education? If your district does not include any elementary schools, mark this box ? and skip to Question 12. Yes 1 No 2 ==> Skip to Question 7 6. Do these goals or objectives for elementary school health education specifically address each of the following student outcomes? HED018 Yes No a. Comprehension of concepts related to health promotion and disease prevention 1 2 b. Ability to access valid health information and health promoting products and services 1 2 c. Ability to analyze the influence of culture, media, technology, and other factors on health 1 2 d. Ability to practice health-enhancing behaviors and reduce health risks 1 2 e. Ability to use interpersonal communication skills to enhance health 1 2 f. Ability to use goal-setting and decision-making skills to enhance health 1 2 g. Ability to advocate for personal, family, and community health 1 2 7. Has your district adopted a policy stating that elementary schools will teach each of the following health topics? HED024 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 - 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. Human immunodeficiency virus (HIV) prevention 1 2 i. Sexually transmitted disease (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. Cardiopulmonary resuscitation (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 8. Has your district adopted a policy stating that elementary schools will notify students’ parents or guardians before the students receive instruction on any aspect of human sexuality? HED026 If your district does not provide instruction on human sexuality in elementary schools, mark this box ? and skip to Question 9. Yes 1 No 2 9. Has your district developed its own curricula for elementary school health education? HED029 Yes 1 No 2 10. During the past 2 years, has your district provided the following information or materials for elementary school health education? HED034 Yes No a. A list of one or more recommended elementary school health education curricula 1 2 b. Elementary school health education curricula 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 11. Based on policies adopted by your district, how much health education are students required to receive while in elementary school? Districts use many ways to describe these requirements, such as minutes per week, hours per quarter, or hours per year. If it is more convenient for you, please mark the “Requirements enclosed” box and include a copy of your requirements when you return this questionnaire. If your district does not have specified time requirements for elementary school students, mark this box ? and skip to Question 12. Requirements enclosed ? ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Middle/Junior High School Instruction 12. Has your district adopted goals, objectives, or expected outcomes for middle/junior high school health education? If your district does not include any middle/junior high schools, mark this box ? and skip to Question 19. Yes 1 No 2 ==> Skip to Question 14 13. Do these goals or objectives for middle/junior high school health education specifically address each of the following? HED018 Yes No a. Comprehension of concepts related to health promotion and disease prevention 1 2 b. Ability to access valid health information and health promoting products and services 1 2 c. Ability to analyze the influence of culture, media, technology, and other factors on health 1 2 d. Ability to practice health-enhancing behaviors and reduce health risks 1 2 e. Ability to use interpersonal communication skills to enhance health 1 2 f. Ability to use goal-setting and decision-making skills to enhance health 1 2 g. Ability to advocate for personal, family, and community health 1 2 14. Has your district adopted a policy stating that middle/junior high schools will teach each of the following health topics? HED024 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 - 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 15. Has your district adopted a policy stating that middle/junior high schools will notify students’ parents or guardians before the students receive instruction on any aspect of human HED026sexuality? If your district does not provide instruction on human sexuality in middle/junior high schools, mark this box ? and skip to Question 16. Yes 1 No 2 16. Has your district developed its own curricula for middle/junior high school health education? HED029 Yes 1 No 2 17. During the past 2 years, has your district provided the following information or materials for middle/junior high school health education? HED034 Yes No a. A list of one or more recommended middle/junior high school health education curricula 1 2 b. Middle/junior high school health education curricula 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 18. Based on policies adopted by your district, how much health education are students required to receive while in middle/junior high school? Districts use many ways to describe these requirements, such as minutes per week, hours per quarter, or hours per year. If it is more convenient for you, please mark the “Requirements enclosed” box and include a copy of your requirements when you return this questionnaire. If your district does not have specified time requirements for middle/junior high school students, mark this box ? and skip to Question 19. Requirements enclosed ? ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Senior High School Instruction 19. Has your district adopted goals, objectives, or expected outcomes for senior high school health education? If your district does not include any senior high schools, mark this box ? and skip to Question 26. Yes 1 No 2 ==> Skip to Question 21 20. Do these goals or objectives for senior high school health education specifically address each of the following student outcomes? HED018 Yes No a. Comprehension of concepts related to health promotion and disease prevention 1 2 b. Ability to access valid health information and health promoting products and services 1 2 c. Ability to analyze the influence of culture, media, technology, and other factors on health 1 2 d. Ability to practice health-enhancing behaviors and reduce health risks 1 2 e. Ability to use interpersonal communication skills to enhance health 1 2 f. Ability to use goal-setting and decision-making skills to enhance health 1 2 g. Ability to advocate for personal, family, and community health 1 2 21. Has your district adopted a policy stating that senior high schools will teach each of the following health topics? HED024 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 - 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 22. Has your district adopted a policy stating that senior high schools will notify students’ parents or guardians before the students receive instruction on any aspect of human sexuality? HED026 If your district does not provide instruction on human sexuality in senior high schools, mark this box ? and skip to Question 23. Yes 1 No 2 23. Has your district developed its own curricula for senior high school health education? HED029 Yes 1 No 2 24. During the past 2 years, has your district provided the following information or materials for senior high school health education? HED034 Yes No a. A list of one or more recommended senior high school health education curricula 1 2 b. Senior high school health education curricula 1 2 c. A chart describing the scope and sequence of instruction for health education 1 2 b. Lesson plans or learning activities for health education 1 2 d. Plans for how to assess or evaluate students in health education 1 2 25. Based on policies adopted by your district, how much health education are students required to receive while in senior high school? Districts use many ways to describe these requirements, such as minutes per week, hours per quarter, or hours per year. If it is more convenient for you, please mark the “Requirements enclosed” box and include a copy of your requirements when you return this questionnaire. If your district does not have specified time requirements for senior high school students, mark this box ? and skip to Question 26. Requirements enclosed ? ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Staffing and Staff Development 26. Has your district adopted a policy stating that newly-hired staff who teach health education at each of the following levels will have undergraduate or graduate training in health education? HED074 No schools Yes No at this level a. Elementary school 1 2 3 b. Middle/junior high school 1 2 3 c. Senior high school 1 2 3 27. Has your district adopted a policy stating that newly-hired staff who teach health education at each of the following levels will be Certified Health Education Specialists (CHES)? No schools Yes No at this level a. Elementary school 1 2 3 b. Middle/junior high school 1 2 3 c. Senior high school 1 2 3 28. Has your district adopted a policy stating that newly-hired staff who teach health education at each of the following levels will be certified, licensed, or endorsed by the state to teach health education? HED075 If your state does not offer certification, licensure, or endorsement in health education at a level, please mark the box labeled “Not offered.” Not No schools Yes No offered at this Level a. Elementary school 1 2 3 4 b. Middle/junior high school 1 2 3 4 c. Senior high school 1 2 3 4 29. Has your district adopted a policy stating that each school will have someone to oversee or coordinate health education at the school (e.g., a lead health education teacher)? Yes 1 No 2 30. During the past 2 years, has your district provided any funding for or offered staff development on each of the following topics to those who teach health education? HED076 This might include workshops, conferences, continuing education, graduate courses, or any other kind of in-service. 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 - 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 31. During the past 2 years, has your district provided any funding for or offered staff development on each of the following teaching methods to those who teach health education? 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 Health Education Collaboration 32. During the past 12 months, have district health education staff worked on health education activities with each of the following groups? Yes No a. District physical education staff 1 2 b. District health services staff 1 2 c. District mental health or social services staff 1 2 d. District food service staff 1 2 33. During the past 12 months, have district health education staff worked on health education activities with staff or members from each of these organizations? Yes No a. Local health department 1 2 b. Local hospital 1 2 c. Local mental health or social services agency 1 2 d. Health organization, such as the American Heart Association or the American Cancer Society 1 2 e. Local colleges or universities 1 2 f. Local businesses 1 2 Health Education Promotion 34. During the past 12 months, has your district done each of the following activities to promote school health education programs? 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 Health Education Evaluation 35. During the past 2 years, have the following aspects of your district health education program been evaluated? Yes No a. Student satisfaction with the health education program 1 2 b. Family satisfaction with the health education program 1 2 c. Health education policies 1 2 d. Health education curricula 1 2 e. Health education staff development or in-service programs 1 2 Health Education Coordinator 36. Currently, does someone in your district oversee or coordinate health education? HEB003 Yes 1 No 2 ==> That is the last question. Thank you very much for taking the time to complete this questionnaire. 37. Are you this person? Yes 1 No 2 ==> That is the last question. Thank you very much for taking the time to complete this questionnaire. 38. Do you have an undergraduate degree? Yes 1 No 2 ==> Skip to Question 44 39. 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 40. Do you have an undergraduate minor?HEC059 Yes 1 No 2 ==> Skip to Question 42 41. 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 42. Do you have a graduate degree? Yes 1 No 2 ==> Skip to Question 44 43. In what area or areas? HEC064 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 44. Are you certified, licensed, or endorsed by the state to teach health education at each of the following grade levels? If your state does not offer certification, licensure, or endorsement in health education at a level, please mark the box labeled “Not offered.” Not Yes No offered a. Elementary school 1 2 3 b. Middle/Junior high school 1 2 3 c. Senior high school 1 2 3 45. Are you a Certified Health Education Specialist or CHES? Yes 1 No 2 If you would like to provide any additional comments, please use the space below. Thank you very much for taking the time to participate in this study. Additional Comments Please return this questionnaire to: Don Evers Research Triangle Institute P.O. Box 12194 Research Triangle Park, NC 27709 Health Education District Questionnaire - Final Version — Revised: 10/26/99 Health Education District Questionnaire - Final Version — Revised: 10/26/99 12 Health Education District Questionnaire - Final Version — Revised: 10/26/99 Elementary School Instruction Middle/Junior High School Instruction Senior High School Instruction Staffing and Staff Development 13 Health Education District Questionnaire - Final Version — Revised: 10/26/99 21 Health Education District Questionnaire - Final Version — Revised: 10/26/99 Health Education Coordinator