Lead Health Education Teacher Questionnaire

School Health Profiles Test-Retest Reliability Study

AttD-Lead Health Edu Teacher Ques 4-1-20

OMB: 0920-1320

Document [docx]

Download: docx | pdf

Form Approved

OMB No. 0920-XXXX

Exp. Date XX/XX/XXXX

Public reporting burden of 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, MS D-74, Atlanta, Georgia 30333; Attn: OMB-PRA (0920-New)

Attachment D

Lead Health Education Teacher Questionnaire

2020 SCHOOL HEALTH PROFILES

LEAD HEALTH EDUCATION TEACHER QUESTIONNAIRE

This questionnaire will be used to assess school health education across your state or school district. Your cooperation is essential for making the results of this survey comprehensive, accurate, and timely. Your answers will be kept confidential.

INSTRUCTIONS

This questionnaire should be completed by the lead health education teacher (or the person most knowledgeable about health education at your school) and concerns only activities that occur in the school listed below. Please consult with other people if you are not sure of an answer.
Please use a #2 pencil to fill in the answer circles completely. Do not fold, bend, or staple this questionnaire or mark outside the answer circles.
Follow the instructions for each question.
Write any additional comments you wish to make at the end of this questionnaire.
Return the questionnaire in the envelope provided.

Person completing this questionnaire

Name: ____________________________________________________________

Title: _____________________________________________________________

School name: ______________________________________________________

District: ___________________________________________________________

Telephone number: __________________________________________________

To be completed by the agency conducting the survey

School name: _________________________________________________________

Survey ID

0	0	0	0
1	1	1	1
2	2	2	2
3	3	3	3
4	4	4	4
5	5	5	5
6	6	6	6
7	7	7	7
8	8	8	8
9	9	9	9

2020 SCHOOL HEALTH PROFILES

LEAD HEALTH EDUCATION TEACHER QUESTIONNAIRE

REQUIRED HEALTH EDUCATION COURSES

(Definition: A required health education course is one that students must take for graduation or promotion from your school and includes instruction about health topics such as injuries and violence, alcohol and other drug use, tobacco use, nutrition, HIV infection, and physical activity.)

1. How many required health education courses do students take in grades 6 through 12 in your school? (Mark one response.)

a 0 courses Skip to Question 4

b 1 course

c 2 courses

d 3 courses

e 4 or more courses

2. Is a required health education course taught in each of the following grades in your school? (For each grade, mark yes or no, or if your school does not have that grade, mark “grade not taught in your school.”)

Grade not taught

Grade Yes No in your school

a. 6 0 0 0

b. 7 0 0 0

c. 8 0 0 0

d. 9 0 0 0

e. 10 0 0 0

f. 11 0 0 0

g. 12 0 0 0

3. If students fail a required health education course, are they required to repeat it? (Mark one response.)

a Yes

b No

HEALTH EDUCATION MATERIALS

The following questions apply to any instruction on health topics such as those listed in the definition above Question 1, including instruction that is not required and instruction that occurs outside of health education courses.

4. Are those who teach health education at your school provided with each of the following materials? (Mark yes or no for each material, or mark NA for each material if no one in your school teaches health education.)

Material Yes No NA

a. Goals, objectives, and expected outcomes for health

education 0 0 0

b. A chart describing the annual scope and sequence of

instruction for health education 0 0 0

c. Plans for how to assess student performance in health

education 0 0 0

d. A written health education curriculum 0 0 0

5. Does your health education curriculum address each of the following skills? (Mark yes or no for each skill, or mark NA for each skill if your school does not have a health education curriculum.)

Skill Yes No NA

a. Comprehending concepts related to health promotion

and disease prevention to enhance health 0 0 0

b. Analyzing the influence of family, peers, culture, media,

technology, and other factors on health behaviors 0 0 0

c. Accessing valid information and products and services to

enhance health 0 0 0

d. Using interpersonal communication skills to enhance

health and avoid or reduce health risks 0 0 0

e. Using decision-making skills to enhance health 0 0 0

f. Using goal-setting skills to enhance health 0 0 0

g. Practicing health-enhancing behaviors to avoid or reduce

risks 0 0 0

h. Advocating for personal, family, and community health 0 0 0

SEXUAL HEALTH EDUCATION

(Definition: Sexual health education is a systematic approach that uses medically accurate, developmentally appropriate, and culturally inclusive content to equip students with the essential knowledge and skills needed to avoid HIV, other STDs, and unintended pregnancy.)

6. Are those who teach sexual health education at your school provided with each of the following materials? (Mark yes or no for each material, or mark NA for each material if no one in your school teaches sexual health education.)

Material Yes No NA

a. An approved health education scope and sequence that

includes learning objectives, outcomes, and content to

guide sexual health education instruction 0 0 0

b. A written health education curriculum that includes

objectives and content addressing sexual health education 0 0 0

c. Teacher pacing guides for sexual health education

(i.e., schedules that regulate a teacher’s pace of the unit

or curriculum) 0 0 0

d. Teaching resources (e.g., lesson plans, handouts) to support

sexual health education instruction 0 0 0

e. Strategies that are age-appropriate, relevant, and actively

engage students in learning 0 0 0

f. Methods to assess student knowledge and skills related to

sexual health education 0 0 0

7. Does your school provide curricula or supplementary materials that include HIV, STD, or pregnancy prevention information that is relevant to lesbian, gay, bisexual, transgender, and questioning youth (e.g., curricula or materials that use inclusive language or terminology)? (Mark one response.)

a Yes

b No

REQUIRED HEALTH EDUCATION

(Definition: Required health education means any classroom instruction on health topics such as those listed in the definition above Question 1, including instruction that occurs outside of health education courses that students must receive for graduation or promotion from your school.)

8. Is health education instruction required for students in any of grades 6 through 12 in your school? (Mark one response.)

a Yes

b No

9. During this school year, have teachers in your school tried to increase student knowledge on each of the following topics in a required course in any of grades 6 through 12? (Mark yes or no for each topic.)

Topic Yes No

a. Alcohol- or other drug-use prevention 0 0

b. Asthma 0 0

c. Chronic disease prevention (e.g., diabetes, obesity prevention) 0 0

d. Emotional and mental health 0 0

e. Epilepsy or seizure disorder 0 0

f. Food allergies 0 0

g. Foodborne illness prevention 0 0

h. Human immunodeficiency virus (HIV) prevention 0 0

i. Human sexuality 0 0

j. Infectious disease prevention (e.g., influenza [flu] prevention) 0 0

k. Injury prevention and safety 0 0

l. Nutrition and dietary behavior 0 0

m. Physical activity and fitness 0 0

n. Pregnancy prevention 0 0

o. Sexually transmitted disease (STD) prevention 0 0

p. Suicide prevention 0 0

q. Tobacco-use prevention 0 0

r. Violence prevention (e.g., bullying, fighting, dating violence

prevention) 0 0

10. During this school year, did teachers in your school teach each of the following tobacco-use prevention topics in a required course for students in any of grades 6 through 12? (Mark yes or no for each topic.)

Topic Yes No

a. Identifying tobacco products and the harmful substances they

contain 0 0

b. Identifying short- and long-term health consequences of

tobacco product use 0 0

c. Identifying social, economic, and cosmetic consequences

of tobacco product use 0 0

d. Understanding the addictive nature of nicotine 0 0

e. Effects of nicotine on the adolescent brain 0 0

f. Effects of tobacco product use on athletic performance 0 0

g. Effects of second-hand smoke and benefits of a smoke-free

environment 0 0

h. Understanding the social influences on tobacco product use,

including media, family, peers, and culture 0 0

i. Identifying reasons why students do and do not use tobacco

products 0 0

j. Making accurate assessments of how many peers use

tobacco products 0 0

k. Using interpersonal communication skills to avoid tobacco product

use (e.g., refusal skills, assertiveness) 0 0

l. Using goal-setting and decision-making skills related to not using

tobacco products 0 0

m. Finding valid information and services related to tobacco-use

prevention and cessation 0 0

n. Supporting others who abstain from or want to quit using tobacco

products 0 0

o. Identifying harmful effects of tobacco product use on

fetal development 0 0

p. Relationship between using tobacco products and alcohol

or other drugs 0 0

q. How addiction to tobacco products can be treated 0 0

r. Understanding school policies and community laws related to

the sale and use of tobacco products 0 0

s. Benefits of tobacco product cessation programs 0 0

11. During this school year, did teachers in your school teach about the following tobacco products in a required course for students in any of grades 6 through 12? (Mark yes or no for each product.)

Product Yes No

a. Cigarettes 0 0

b. Smokeless tobacco (e.g., chewing tobacco, snuff, dip, snus,

dissolvable tobacco) 0 0

c. Cigars, little cigars, or cigarillos 0 0

d. Pipes 0 0

e. Electronic vapor products (e.g., e-cigarettes, vapes,

vape pens, e-hookahs, mods, or brands such as JUUL) 0 0

12. During this school year, did teachers in your school teach each of the following alcohol- and other drug-use prevention topics in a required course for students in any of grades 6 through 12? (Mark yes or no for each topic.)

Topic Yes No

a. Differences between proper use and abuse of over-the-counter

medicines and prescription medicines 0 0

b. Harmful short- and long-term physical, psychological, and social

effects of using alcohol and other drugs 0 0

c. Situations that lead to the use of alcohol and other drugs 0 0

d. Alcohol and other drug use as an unhealthy way to manage weight 0 0

e. Identifying reasons why individuals choose to use or not to use

alcohol and other drugs 0 0

f. Using interpersonal communication skills to avoid alcohol and other

drug use (e.g., refusal skills, assertiveness) 0 0

g. Supporting others who abstain from or want to quit using alcohol

and other drugs 0 0

h. Understanding the social influences on alcohol and other drug use,

including media, family, peers, and culture 0 0

i. How to persuade and support others to be alcohol

and other drug free 0 0

13. During this school year, did teachers in your school teach each of the following sexual health topics in a required course for students in each of the grade spans below? (Mark yes or no for each topic for each grade span, or mark NA for each topic if your school does not contain grades in that grade span.)

Grades Grades

6, 7, or 8 9, 10, 11, or 12

Topic Yes No NA Yes No NA

a. How HIV and other STDs are transmitted 0 0 0 0 0 0

b. Health consequences of HIV, other STDs, and

pregnancy 0 0 0 0 0 0

c. The benefits of being sexually abstinent 0 0 0 0 0 0

d. How to access valid and reliable health

information, products, and services related to

HIV, other STDs, and pregnancy 0 0 0 0 0 0

e. The influences of family, peers, media, technology

and other factors on sexual risk behaviors 0 0 0 0 0 0

f. Communication and negotiation skills related to

eliminating or reducing risk for HIV, other

STDs, and pregnancy 0 0 0 0 0 0

g. Goal-setting and decision-making skills related to

eliminating or reducing risk for HIV, other

STDs, and pregnancy 0 0 0 0 0 0

h. Influencing and supporting others to avoid or

reduce sexual risk behaviors 0 0 0 0 0 0

i. Efficacy of condoms, that is, how well condoms

work and do not work 0 0 0 0 0 0

j. The importance of using condoms consistently

and correctly 0 0 0 0 0 0

k. How to obtain condoms 0 0 0 0 0 0

l. How to correctly use a condom 0 0 0 0 0 0

m. Methods of contraception other than condoms 0 0 0 0 0 0

n. The importance of using a condom at the same

time as another form of contraception to prevent

both STDs and pregnancy 0 0 0 0 0 0

o. How to create and sustain healthy and respectful

relationships 0 0 0 0 0 0

p. The importance of limiting the number of sexual

partners 0 0 0 0 0 0

q. Preventive care (such as screenings and

immunizations) that is necessary to maintain

reproductive and sexual health 0 0 0 0 0 0

r. How to communicate sexual consent between

partners 0 0 0 0 0 0

s. Recognizing and responding to sexual victimization

and violence 0 0 0 0 0 0

Question 13, continued

Grades Grades

6, 7, or 8 9, 10, 11, or 12

Topic Yes No NA Yes No NA

t. Diversity of sexual orientations and

gender identities 0 0 0 0 0 0

u. How gender roles and stereotypes affect goals,

decision making, and relationships 0 0 0 0 0 0

v. The relationship between alcohol and other drug

use and sexual risk behaviors 0 0 0 0 0 0

14. During this school year, did teachers in your school assess the ability of students to do each of the following in a required course for students in each of the grade spans below? (Mark yes or no for each topic for each grade span, or mark NA for each topic if your school does not contain grades in that grade span.)

Grades Grades

6, 7, or 8 9, 10, 11, or 12

Topic Yes No NA Yes No NA

a. Comprehend concepts important to prevent

HIV, other STDs, and pregnancy 0 0 0 0 0 0

b. Analyze the influence of family, peers, culture,

media, technology, and other factors on sexual

risk behaviors 0 0 0 0 0 0

c. Access valid information, products, and services

to prevent HIV, other STDs, and pregnancy 0 0 0 0 0 0

d. Use interpersonal communication skills to avoid

or reduce sexual risk behaviors 0 0 0 0 0 0

e. Use decision-making skills to prevent HIV, other

STDs, and pregnancy 0 0 0 0 0 0

f. Set personal goals that enhance health, take

steps to achieve these goals, and monitor

progress in achieving them 0 0 0 0 0 0

g. Influence and support others to avoid or reduce

sexual risk behaviors 0 0 0 0 0 0

15. During this school year, did teachers in your school provide students with the opportunity to practice the following skills in a required course for students in any of grades 6 through 12? (Mark yes or no for each skill.)

Skill Yes No

a. Communication, decision-making, goal-setting, or refusal skills

related to sexual health (e.g., through role playing) 0 0

b. Analyzing the influence of family, media, and culture on

sexual health 0 0

c. Accessing valid sexual health information, products, and services 0 0

16. During this school year, did teachers in your school implement the following inclusive practices when providing sexual health education in a required course for students in grades 6 through 12? (Mark yes or no for each practice, or mark NA for each practice if no one in your school teaches sexual health education.)

Practice Yes No NA

a. Encouraged use of gender-neutral pronouns such as

“they/them” during instruction to recognize gender diversity

among students 0 0 0

b. Provided positive examples of lesbian, gay, bisexual,

or transgender (LGBT) people and same-sex relationships 0 0 0

c. Encouraged students to respect others’ sexual and

gender identities 0 0 0

d. Provided students with information about LGBT resources

within the school (e.g., counseling services, student support

groups like Gay/Straight Alliances or Genders and Sexualities

Alliances) 0 0 0

e. Identified additional LGBT resources available in the community

or online 0 0 0

17. During this school year, did teachers in your school teach each of the following nutrition and dietary behavior topics in a required course for students in any of grades 6 through 12? (Mark yes or no for each topic.)

Topic Yes No

a. Benefits of healthy eating 0 0

b. Benefits of drinking plenty of water 0 0

c. Benefits of eating breakfast every day 0 0

d. Food guidance using the current Dietary Guidelines for Americans

(e.g., MyPlate) 0 0

e. Using food labels 0 0

f. Differentiating between nutritious and non-nutritious beverages 0 0

g. Balancing food intake and physical activity 0 0

h. Eating more fruits, vegetables, and whole grain products 0 0

i. Choosing foods and snacks that are low in solid fat (i.e., saturated

and trans fat) 0 0

j. Choosing foods, snacks, and beverages that are low in added

sugars 0 0

k. Choosing foods and snacks that are low in sodium 0 0

l. Eating a variety of foods that are high in calcium 0 0

m. Eating a variety of foods that are high in iron 0 0

n. Food safety 0 0

o. Preparing healthy meals and snacks 0 0

p. Risks of unhealthy weight control practices 0 0

q. Accepting body size differences 0 0

r. Signs, symptoms, and treatment for eating disorders 0 0

s. Relationship between diet and chronic diseases 0 0

t. Assessing body mass index (BMI) 0 0

u. The influence of the media on dietary behaviors 0 0

v. Food production, including how food is grown, harvested,

processed, packaged, and transported 0 0

18. During this school year, did teachers in your school teach each of the following physical activity topics in a required course for students in any of grades 6 through 12? (Mark yes or no for each topic.)

Topic Yes No

a. Short-term and long-term benefits of physical activity, including

reducing the risks for chronic disease 0 0

b. Mental and social benefits of physical activity 0 0

c. Health-related fitness (i.e., cardiorespiratory endurance, muscular

endurance, muscular strength, flexibility, and body composition) 0 0

d. Phases of a workout (i.e., warm-up, workout, and cool down) 0 0

e. Recommended amounts and types of moderate, vigorous, muscle-

strengthening, and bone-strengthening physical activity 0 0

f. Decreasing sedentary activities (e.g., television viewing,

using video games) 0 0

g. Preventing injury during physical activity 0 0

h. Weather-related safety (e.g., avoiding heat stroke, hypothermia,

and sunburn while physically active) 0 0

i. Dangers of using performance-enhancing drugs (e.g., steroids) 0 0

j. Increasing daily physical activity 0 0

k. Incorporating physical activity into daily life (without relying on

a structured exercise plan or special equipment) 0 0

l. Using safety equipment for specific physical activities 0 0

m. Benefits of drinking water before, during, and after physical

activity 0 0

COLLABORATION

19. During this school year, have any health education staff worked with each of the following groups on health education activities? (Mark yes or no for each group, or mark NA for each group if your school does not have any health education staff.)

Group Yes No NA

a. Physical education staff 0 0 0

b. Health services staff (e.g., nurses) 0 0 0

c. Mental health or social services staff

(e.g., psychologists, counselors, social workers) 0 0 0

d. Nutrition or food service staff 0 0 0

e. School health council, committee, or team 0 0 0

20. During this school year, did your school provide parents and families with health information designed to increase parent and family knowledge of each of the following topics? (Mark yes or no for each topic.)

Topic Yes No

a. HIV, other STD, or pregnancy prevention 0 0

b. Tobacco-use prevention 0 0

c. Alcohol- or other drug-use prevention 0 0

d. Physical activity 0 0

e. Nutrition and healthy eating 0 0

f. Asthma 0 0

g. Food allergies 0 0

h. Diabetes 0 0

i. Preventing student bullying and sexual harassment, including

electronic aggression (i.e., cyber-bullying) 0 0

21. During this school year, have teachers in this school given students health education homework assignments or activities to do at home with their parents? (Mark one response.)

a Yes

b No

PROFESSIONAL DEVELOPMENT

22. During the past two years, did you receive professional development (e.g., workshops, conferences, continuing education, any other kind of in-service) on each of the following topics? (Mark yes or no for each topic.)

Topic Yes No

a. Alcohol- or other drug-use prevention 0 0

b. Asthma 0 0

c. Chronic disease prevention (e.g., diabetes, obesity prevention) 0 0

d. Emotional and mental health 0 0

e. Epilepsy or seizure disorder 0 0

f. Food allergies 0 0

g. Foodborne illness prevention 0 0

h. HIV prevention 0 0

i. Human sexuality 0 0

j. Infectious disease prevention (e.g., flu prevention) 0 0

k. Injury prevention and safety 0 0

l. Nutrition and dietary behavior 0 0

m. Physical activity and fitness 0 0

n. Pregnancy prevention 0 0

o. STD prevention 0 0

p. Suicide prevention 0 0

q. Tobacco-use prevention 0 0

r. Violence prevention (e.g., bullying, fighting, dating

violence prevention) 0 0

23. During the past two years, did you receive professional development (e.g., workshops, conferences, continuing education, any other kind of in-service) on each of the following topics? (Mark yes or no for each topic.)

Topic Yes No

a. Teaching students with physical, medical, or cognitive

disabilities 0 0

b. Teaching students of various cultural backgrounds 0 0

c. Teaching students with limited English proficiency 0 0

d. How to support lesbian, gay, bisexual, and transgender students

(e.g., bystander intervention skills, implementing safe spaces,

use of inclusive language, providing students with information

about LGBT resources within the school) 0 0

e. Using interactive teaching methods (e.g., role plays,

cooperative group activities) 0 0

f. Encouraging family or community involvement 0 0

g. Teaching skills for behavior change 0 0

h. Classroom management techniques (e.g., social skills training,

environmental modification, conflict resolution and mediation,

behavior management) 0 0

i. Assessing or evaluating students in health education 0 0

24. During the past two years, did you receive professional development (e.g., workshops, conferences, continuing education, any other kind of in-service) on each of the following topics related to teaching sexual health education? (Mark yes or no for each topic. If you did not receive professional development on sexual health education, mark no for each topic.)

Topic Yes No

Aligning lessons and materials with the district scope and

sequence for sexual health education 0 0

b. Creating a comfortable and safe learning environment for students

receiving sexual health education 0 0

c. Connecting students to on-site or community-based sexual

health services 0 0

d. Using a variety of effective instructional strategies to deliver

sexual health education 0 0

e. Building student skills in HIV, other STD, and pregnancy

prevention 0 0

f. Assessing student knowledge and skills in sexual health education 0 0

g. Understanding current district or school board policies or

curriculum guidance regarding sexual health education 0 0

h. Identifying appropriate modifications to the sexual health curriculum

to meet the needs of all students 0 0

i. Engaging parents in sexual health education 0 0

25. Would you like to receive professional development on each of the following topics? (Mark yes or no for each topic.)

Topic Yes No

a. Alcohol- or other drug-use prevention 0 0

b. Asthma 0 0

c. Chronic disease prevention (e.g., diabetes, obesity prevention) 0 0

d. Emotional and mental health 0 0

e. Epilepsy or seizure disorder 0 0

f. Food allergies 0 0

g. Foodborne illness prevention 0 0

h. HIV prevention 0 0

i. Human sexuality 0 0

j. Infectious disease prevention (e.g., flu prevention) 0 0

k. Injury prevention and safety 0 0

l. Nutrition and dietary behavior 0 0

m. Physical activity and fitness 0 0

n. Pregnancy prevention 0 0

o. STD prevention 0 0

p. Suicide prevention 0 0

q. Tobacco-use prevention 0 0

r. Violence prevention (e.g., bullying, fighting, dating

violence prevention) 0 0

26. Would you like to receive professional development on each of the following topics? (Mark yes or no for each topic.)

Topic Yes No

a. Teaching students with physical, medical, or cognitive

disabilities 0 0

b. Teaching students of various cultural backgrounds 0 0

c. Teaching students with limited English proficiency 0 0

d. Supporting lesbian, gay, bisexual, and transgender students

(e.g., bystander intervention skills, implementing safe spaces,

use of inclusive language, providing students with information

about LGBT resources within the school) 0 0

e. Using interactive teaching methods (e.g., role plays,

cooperative group activities) 0 0

f. Encouraging family or community involvement 0 0

g. Teaching skills for behavior change 0 0

h. Classroom management techniques (e.g., social skills training,

environmental modification, conflict resolution and mediation,

behavior management) 0 0

i. Assessing or evaluating students in health education 0 0

27. Would you like to receive professional development on each of the following topics related to teaching sexual health education? (Mark yes or no for each topic.)

Topic Yes No