Student Health Survey

Appendix I. School Recruitment Script for the “Student Health Survey” Supplemental Documents

I1. School Letter of Invitation and Fact Sheet

I2. Letter to Agreeing Schools

Appendix I1. School Letter of Invitation and Fact Sheet

DATE

Dear [SCHOOL CONTACT]:

The purpose of this letter is to invite your school to participate in a methodological study of the Youth Risk Behavior Survey (YRBS). Only 80 schools nationwide will have the opportunity to participate in this voluntary study. [INSERT MENTIONING CONTACT FROM HIV EC, IF APPROPRIATE]

The YRBS is an ongoing survey of priority health-risk behaviors among high school students. The YRBS is designed to focus on those priority health-risk behaviors established during youth that result in the most significant mortality and morbidity during both youth and adulthood. The survey provides information on (1) behaviors that contribute to unintentional injuries and violence; (2) tobacco use; (3) alcohol and other drug use; (4) sexual behaviors that contribute to HIV infection, other sexually transmitted diseases, and unintended pregnancies; (5) unhealthy dietary behaviors; and (6) physical inactivity.

The YRBS has been conducted nationwide since 1990. In addition, your state conducts a YRBS of its own and many school districts conduct their own YRBS. The YRBS is sponsored by the Centers for Disease Control and Prevention (CDC), and was designed in cooperation with 19 Federal agencies, and over 100 state and local departments of education and health.

The purpose of the 2008 methodological study will be to look at the effects on prevalence estimates of completing the survey on paper in a classroom vs. via the Web in a computer lab. It will also look at whether it is possible to select students at school to complete a questionnaire and give them the responsibility to complete it on their own time via the Web.

Each student will be asked to complete a questionnaire either on a computer or on paper. The computer and paper questionnaires are virtually identical in content and ask about the six categories of behaviors described above as well as several methodological issues regarding the student’s perception of privacy and computer experience.

From your school, we would like to invite four classes of 9^th or 10^th grade students to participate. We estimate this to be between 100 and 120 students. After the four classes have been identified, we will randomly assign three classes to a “school-based” condition – that is, the students in those classes will complete the survey during a regular class period. Two of the three classes will complete the survey in a computer lab, while the third class will complete the survey in a regular classroom using a paper-and-pencil questionnaire. The fourth class will be randomly assigned to the “on your own” condition. That means the students from that classroom will be asked complete the survey via the web, on their own time, at a place of their choice. This could be anywhere the student chooses: at school, at home, at a library or community center with Internet access.

This study is conducted under the authority of the Public Health Service Act (42 USC 241). Parental permission forms will be provided for your school for distribution. The data collection period is between February and April 2008. We will send trained data collectors to administer the survey. Study procedures have been designed to protect student privacy. Counties, cities, school districts, schools, and students will not be identified in any published reports.

The YRBS has widespread support. The American Association for Health Education, the American Medical Association, the American School Health Association, the Association of State and Territorial Directors of Health Promotion and Public Health Education, the Association of State and Territorial Health Officials, the Council of Chief State School Officers, the National Association of State Boards of Education, the National Education Association, the National Network for Youth, the National PTA, the National School Boards Association, and the Society of State Directors of Health, Physical Education and Recreation support the YRBS.

As a symbol of appreciation for your time and support, the CDC will provide each participating school with $500. Schools will be encouraged to use the $500 to promote healthy student behavior. However, no restrictions will be placed on how schools can use these funds. Schools also will receive a copy of the published study report.

Enclosed are a copy of the questionnaire, a sample parental permission form, and a Fact Sheet about the survey. A representative from Macro International Inc., a nationally recognized survey research firm, will contact you to discuss participation in the study. If you have any immediate questions, please call Dr. Danice Eaton of my staff at (770) 488-6143. Your support for this study will help assess and improve efforts to reduce priority health-risk behaviors among adolescents throughout our Nation.

Sincerely yours,

Howell Wechsler, Ed.D., MPH

Director

Division of Adolescent and School Health

National Center for Chronic Disease

   Prevention and Health Promotion

Enclosures

cc:

FACT SHEET

The Youth Risk Behavior Survey (YRBS) is sponsored by the Centers for Disease Control and Prevention (CDC). The YRBS asks about a variety of health topics pertinent to today’s youth, including nutrition, physical activity, injuries, tobacco, alcohol, and other drug use. It also asks about sexual behaviors that cause AIDS, other sexually transmitted diseases, and pregnancy. This fact sheet answers commonly asked questions about the survey. Occasionally, CDC conducts special methodological studies of the YRBS. This fact sheet answers the most frequently asked questions about the YRBS and a methodological study CDC plans to conduct during the winter/spring semester, 2008.

Q. What is the focus of the YRBS?

A. The YRBS focuses on priority health risk behaviors established during youth that result in the most significant mortality and morbidity during both youth and adulthood. These include: behaviors that result in unintentional injuries and violence; tobacco use; alcohol and other drug use; sexual behaviors that contribute to HIV infection, other sexually transmitted diseases (STDs), and unintended pregnancies; unhealthy dietary behaviors; and physical inactivity. Nationwide, the YRBS is the most widely adopted survey of health risk behavior. Like nearly every other state, your State and/or school district conducts its own biennial YRBS.

Q. What has been the focus of previous methodological studies?

A. Three methodological studies have been conducted since 2000. The first study established the reliability of the YRBS questionnaire items (2000); the second examined the effects of differences in questionnaire wording and appeals for honesty on prevalence estimates (2002); and the third explored the effects of setting (school vs. home) and mode of administration (paper-and-pencil vs. laptop computer) and their interaction on prevalence estimates (2004).  

Q. What’s behind the 2008 methodological study?

Many school systems have begun to conduct Web-based student assessments. However, such efforts have not been without technological and other problems. In response to this trend, CDC wants to examine the feasibility, in a sample of volunteer schools, of conducting the YRBS via the Web using computer labs already in the schools.

Q. What is the main objective of the 2008 methodological study?

A. The main objective of the 2008 methodological study is to determine whether the kinds of answers students give (i.e., the prevalence estimates for various risk behaviors) are comparable between students who complete a Web-based YRBS in their school’s computer lab vs. those who complete a traditional paper-and-pencil YRBS in a classroom.

Q. Does the 2008 methodological study have other objectives?

A, We also are interested in whether students who are asked to complete the YRBS on their own time, using a computer of their choosing (e.g., at home, at a library) will follow through and, if so, whether their answers will be similar to those of other students. In addition, we are interested in finding out whether prevalence estimates of health risk behaviors in the Web-based administration in computer labs are affected by adding programmed skip patterns. The paper YRBS traditionally has not allowed skip patterns. In the Web-based administrations in computer labs, we plan to ask some students to use the version with skip patterns while other students use the more traditional version without skip patterns.

Q, Just to clarify, how many different “conditions” does the 2008 study involve?

A. There are four conditions: (1) paper-and-pencil administration in a classroom; (2) Web-based administration in a computer lab without programmed skip patterns; (3) Web-based administration in a computer lab with programmed skip patterns; and (4) Web-based administration to students “on their own,” using a computer of their own choosing.

Q. How many classrooms and how many students are you asking each school to provide? Who picks the classes? And can the students be from any grade?

A. Each school is being asked to use either 9^th or 10^th grade students, but not both. Having selected a grade, each school is being asked to select one required subject area from which we will select classrooms randomly to participate. For the selected subject area, the school is asked to provide us with a list of sections, including approximate enrollments for each section. Following a standard protocol, CDC’s contractor will randomly pick four classes to participate in the survey. We would like each class to contain 25 to 30 students. If class sizes tend to be small, we will want to pair up classes before selection so the net result is about 100 to 120 students combined.

Q. Is the school required to send home parental permission forms?

A. To comply with the No Child Left Behind law, parents need to be given the opportunity to opt out of having their child participate.

Q. Can parents see the questionnaire before deciding whether their children can participate?

A. Parents can see a copy of the questionnaire at the children’s school.

Q. How will results from the 2008 methodological study be used?

A. The results will help CDC to determine whether it is feasible to conduct a Web-based YRBS and, if so, whether the answers students give on a Web-based questionnaire are comparable to answers given on a paper-and-pencil questionnaire. If the answers are not comparable, then switching to a Web-based questionnaire could cause problems in analyzing trends over time, because all the earlier data were gathered using paper-and-pencil questionnaires.

Q. Does the YRBS have broad national support?

A. Yes. In addition to being conducted periodically by nearly every state, the YRBS is supported by many major national organizations interested in the health of youth. The American Academy of Pediatrics, the American Association for Health Education, the American Association of School Administrators, the American Cancer Society, the American Medical Association, the Association of State and Territorial Chronic Disease Directors, the Association of State and Territorial Health Officials, the Council of Chief State School Officers, the National Association of Chronic Disease Directors, the National Association of State Boards of Education, the National Education Association, the National PTA, the National School Boards Association, and the Society of State Directors of Health, Physical Education and Recreation have provided letters of support for the YRBS. People from over 100 state and local health and education agencies and 19 federal agencies assisted in the development of the YRBS.

Q. Are sensitive questions asked?

A. Some questions may be considered sensitive by some schools or school districts. AIDS, HIV infection, and other sexually transmitted diseases (STDs) are major health problems. Sexual intercourse and intravenous drug use are among the behaviors known to increase the risk of HIV or other STD. The only way to determine if adolescents are at risk of becoming infected with HIV or other STDs is to ask questions about these behaviors. Attempted suicide, tobacco use, alcohol and other drug use, and weapon-carrying also may be considered sensitive topics. Questions are presented in a straightforward and sensitive manner in recognition of these topics.

Q. How will students access the Web-based questionnaire?

A. Each student will be provided with the link (url) to get to the questionnaire and a unique, personal account number. After students get to the web site, they will be asked to enter their personal account number to access the questionnaire.

Q. How is student privacy protected? Will student names be used or linked to the surveys?

A. Survey administration procedures are designed to protect student privacy. The survey is administered by specially-trained field staff. Teachers at each school are asked to enter student’s names or ID numbers on a special roster to monitor parental permission form returns. This allows the data collector to make sure only students for whom permission has been obtained are asked to complete the YRBS. These lists are destroyed after the survey has been administered. Students do not put their names on the paper questionnaire nor will students be asked to enter their names on the computer. We do not record who received a particular personal account number Therefore, students’ names can never be connected to their answers.

Q. Are students tracked over time to see how their behavior changes?

A. No. Students who participate cannot be tracked because no identifying information is collected.

Q. What if some students assigned to the “on their own” condition do not have a home computer?

A. Students in the “on their own” condition may complete the questionnaire on any Web-linked computer in any location at any time of day during a two week period. Students who do not have a Web-linked home computer may use a computer at a community center, in a public library, at a friend’s house, or even on their own at school. Students should be informed that it is up to them when and where they complete the questionnaire.

Q. If we know that certain students do not have a home computer, should school personnel organize a special session for such students to take the survey?

A. No. It is important that students assigned to the “on their own” condition be reminded to complete the survey, but that the responsibility to find a time and place to do it remain with the student.

Q. If a student is physically unable to fill out a paper questionnaire due to disability or other limitations, can they complete a Web-based questionnaire? And vice versa, if they can’t complete a Web-based questionnaire?

A. If at all possible, students should be asked to complete the questionnaire under the conditions to which their randomly selected classroom was randomly assigned. However, exceptions can be made and should be discussed with the field staff person who comes to the school.

Q. What if school districts and schools decide not to participate?

A. Participation in the 2008 study is entirely voluntary. However, many school systems have expressed an interest in the study because they value the kinds of data gathered on the YRBS and think the purpose of the study is timely because of growing interest in Web-based student assessments and surveys.

Q. How many students will be involved in the 2008 study?

A. Nationwide, approximately 8,000 students from about 80 schools will be selected to participate in the 2008 study.

Q. How are schools being selected?

A. Candidate school districts are asked to identify candidate schools. In research terms, this is regarded as a “convenience sample.”

Q. How is the survey coordinated at each school?

A. It is preferable to have a single spokesperson in each school. This can be the principal, another administrator, the chair of the department through which classes will be selected, a teacher, the technology coordinator, or someone else designated by the principal. The spokesperson provides a list of class sections, distributes parental permission forms to teachers of the sampled classes, confirms availability and appropriate specifications of computer labs, helps to promote the survey in the school, and ensures a high participation rate.

Q. What is done to maximize student participation?

A. CDC provides information to school administrators explaining the importance of the study that can be shared with teachers, parents, and students. It is helpful if the school’s spokesperson for the YRBS is familiar with the survey and is willing to seek support from teachers, parents, and students. The school spokesperson may work through the school’s PTA to gain support for the survey. Many schools also notify parents of the survey in a paper or Web-based newsletter.

Q. How long does it take to complete the survey? Is there some sort of physical test?

A. One class period is needed. It takes approximately 10 minutes for the survey administrator to set up for the survey and read directions to the students. It then takes approximately 35 minutes for students to complete the YRBS. The questionnaire contains 80 multiple-choice questions. No physical test or exam is involved.

Q. Do students answer questions truthfully?

A. Research indicates data of this nature may be gathered as reliably from adolescents as from adults. Internal reliability checks help to identify the small percentage of students who falsify their answers. To obtain truthful answers, students must perceive the survey as important and know that procedures have been developed to protect their privacy and allow for anonymous participation.

Q. When is the survey conducted? When are results available?

A. Data collection occurs between February and April with schools closing earlier in the year completed first. Results are available the following year. All participating States, school districts, and schools receive a copy of the results.

Q. What do the schools receive for participating in the study?

A. As a symbol of appreciation for contributing their time and support and for being a significant partner in the study, the CDC will provide each participating school with a monetary school award. One option is to use these funds for prevention curriculum and educational materials. However, no restrictions will be placed on how schools can use these funds. Schools also will receive a copy of the published report on survey results and a variety of educational materials related to the health of young people.

Q. Who is the survey contractor?

A. Macro International Inc., a nationally recognized survey research company in Calverton, Maryland has received a contract from CDC to work with states, school districts, and schools to obtain agreements from school districts and schools, select a sample of students, schedule data collection, distribute survey materials, and collect student data.

Q. Where can additional information be obtained?

A. To obtain additional information about the YRBS, contact CDC or the HIV Education Project Director in your SEA or LEA. Inquiries to CDC should be directed to Dr. Danice Eaton, Centers for Disease Control and Prevention, Division of Adolescent and School Health, 4770 Buford Hwy., NE, Atlanta, GA 30341-3724; telephone 770-488-6143 or email at dhe0@cdc.gov

Appendix I2. Letter to Agreeing Schools

DATE

Dear [SCHOOL CONTACT]:

Thank you for agreeing to participate in a study of the student health survey, also referred to as the Youth Risk Behavior Survey (YRBS), sponsored by the Centers for Disease Control and Prevention (CDC). The YRBS is an important study that asks about a variety of health topics that are pertinent to today’s youth, including nutrition, physical activity, injuries, tobacco, alcohol, and other drug use. It also asks about sexual behaviors that cause AIDS, other sexually transmitted diseases, and pregnancy.

This year, the CDC is assessing the feasibility of administering the survey via the web vs. paper-and-pencil.

Thank you for assisting us in the selection of four classes from your school to participate in the study. We have randomly assigned the four classes to the settings and methods in which they will complete the survey. Specifically:

TEACHER NAME: Paper-and-pencil questionnaire in classroom

TEACHER NAME: Web-based questionnaire in computer lab Version 1

TEACHER NAME: Web-based questionnaire in computer lab Version 2

TEACHER NAME: Web-based questionnaire "on your own"

For the school-based computer survey administration, we have agreed to administer the survey in the designated computer lab to reduce disruption during the class period. For the school-based paper-and-pencil survey administration, we will administer the survey in the selected classroom during that class period.

Enclosed are a Summary of School Arrangements Form and the packets of materials for the participating teachers. The teacher packets contain (1) the Summary of School Arrangements Form, (2) a survey fact sheet, (3) a sample survey booklet, (4) instructions to be read when distributing permission forms, (5) parental permission forms, (6) reminder forms, and (7) a Data Collection Checklist. If requested, parental permission forms are provided in Spanish. We do not need to receive any returned parental permission forms. These remain at the school.

We request that each teacher complete a Data Collection Checklist for his or her class. Names or ID’s of all students in each selected class should be listed on this checklist, not just those participating in the survey. Names will be kept confidential and destroyed after the completion of data collection. The names are needed to take roll, make sure students not in the selected class

do not “slip in,” identify students eligible to complete the survey (i.e., returned parental permission form with “yes” response), develop make-up lists of eligible students who are absent, and determine the gender and grade of all nonparticipants.

Your support and encouragement will help to ensure a high rate of participation among your students. A high participation rate is needed to produce valid national data. We ask that you:

1. Distribute the packets to each participating teacher. Ask them to distribute the parental permission forms at least 7 days before survey administration and to encourage their students to return the forms.

2. Please check with teachers a few days prior to the survey administration to make sure parental permission forms have been distributed and student participation encouraged.

3. Identify someone within the school to whom participating teachers may refer students, in the unlikely event the survey raises questions about health risk behaviors. This person may be a guidance counselor, school nurse, or other person. Let the teachers know who this is, prior to the survey.

We appreciate your school’s graciousness in hosting the 2008 methodological study of the YRBS If you have any further questions, please call either of us at (800) 675-YRBS (9727) between 9:00 a.m. and 5:30 p.m. eastern time. Thank you again for your help.

Sincerely,

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