2012 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

1.       This questionnaire should be completed by the lead health education teacher (or the person acting in that capacity) and concerns only activities that occur in the school listed below.  Please consult with other people if you are not sure of an answer.

2.       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.

3.       Follow the instructions for each question.

4.       Write any additional comments you wish to make at the end of this questionnaire.

5.       Return the questionnaire in the envelope provided.

 

 

Person completing this questionnaire

 

Name: _______________________________________________________________________

Title: ________________________________________________________________________

School name: _________________________________________________________________

District: _____________________________________________________________________

Telephone number: ___________________________________________________________

 

To be completed by the SEA or LEA 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


2012 SCHOOL HEALTH PROFILES

LEAD HEALTH EDUCATION TEACHER QUESTIONNAIRE

 

 

REQUIRED HEALTH EDUCATION COURSES

(Definition: A required health education course is defined as 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

 

The following questions apply to any instruction on health topics such as those listed 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.)

 

       Material                                                      Yes    No

a.     Goals, objectives, and expected outcomes for health education. 0.... 0

b.     A chart describing the annual scope and sequence of instruction

              for health education.......................................... 0.... 0

c.     Plans for how to assess student performance in health

       education..................................................... 0.... 0

d.     A written health education curriculum......................... 0.... 0

                                               

 

5.     Does your health education curriculum address each of the following? (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

 

 

REQUIRED HEALTH EDUCATION

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

 

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

 

a.     Yes

       b.     No

 

 

7.     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.     Emotional and mental health................................... 0.... 0

d.     Foodborne illness prevention.................................. 0.... 0

e.     Human immunodeficiency virus (HIV) prevention................. 0.... 0

f.     Human sexuality............................................... 0.... 0

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

       prevention)................................................... 0.... 0

h.     Injury prevention and safety.................................. 0.... 0

i.     Nutrition and dietary behavior................................ 0.... 0

j.     Physical activity and fitness................................. 0.... 0

k.     Pregnancy prevention.......................................... 0.... 0

l.     Sexually transmitted disease (STD) prevention................. 0.... 0

m.     Suicide prevention............................................ 0.... 0

n.     Tobacco-use prevention........................................ 0.... 0

o.     Violence prevention (e.g., bullying, fighting, or

       dating violence prevention)................................... 0.... 0

 

 

8.     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

       use........................................................... 0.... 0

c.     Identifying legal, social, economic, and cosmetic consequences

       of tobacco use................................................ 0.... 0

d.     Understanding the addictive nature of nicotine................ 0.... 0

e.     Effects of tobacco use on athletic performance................ 0.... 0

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

       environment................................................... 0.... 0

g.     Understanding the social influences on tobacco use, including

       media, family, peers, and culture............................. 0.... 0

h.     Identifying reasons why students do and do not use tobacco.... 0.... 0

i.     Making accurate assessments of how many peers use tobacco..... 0.... 0

j.     Using interpersonal communication skills to avoid tobacco

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

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

       tobacco....................................................... 0.... 0

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

       prevention and cessation...................................... 0.... 0

m.     Supporting others who abstain from or want to quit using

       tobacco....................................................... 0.... 0

n.     Supporting school and community action to support a tobacco-free

       environment................................................... 0.... 0

o.     Identifying harmful effects of tobacco use on fetal

       development................................................... 0.... 0

 

 

9. During this school year, did teachers in your school teach each of the following HIV, STD, or pregnancy prevention 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. The differences between HIV and AIDS............... 0... 0... 0........ 0... 0... 0

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

c. How HIV and other STDs are diagnosed and treated... 0... 0... 0........ 0... 0... 0

d. Health consequences of HIV, other STDs, and

   pregnancy  ........................................ 0... 0... 0........ 0... 0... 0

e. The relationship among HIV, other STDs,

   and pregnancy...................................... 0... 0... 0........ 0... 0... 0

f. The relationship between alcohol and other drug

   use and risk for HIV, other STDs, and pregnancy.... 0... 0... 0........ 0... 0... 0

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

h. How to prevent HIV, other STDs, and pregnancy...... 0... 0... 0........ 0... 0... 0

i. How to access valid and reliable health information,

   products, and services related to HIV, other STDs,

   and pregnancy...................................... 0... 0... 0........ 0... 0... 0

j. The influences of media, family, and social and

   cultural norms on sexual behavior.................. 0... 0... 0........ 0... 0... 0

k. Communication and negotiation skills related to

   eliminating or reducing risk for HIV, other STDs,

   and pregnancy...................................... 0... 0... 0........ 0... 0... 0

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

   eliminating or reducing risk for HIV, other STDs,

   and pregnancy...................................... 0... 0... 0........ 0... 0... 0

m. Compassion for persons living with HIV or AIDS..... 0... 0... 0........ 0... 0... 0

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

   work and do not work............................... 0... 0... 0........ 0... 0... 0

o. The importance of using condoms consistently

   and correctly...................................... 0... 0... 0........ 0... 0... 0

p. How to obtain condoms.............................. 0... 0... 0........ 0... 0... 0

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

r. How to obtain contraceptives, other than condoms... 0... 0... 0........ 0... 0... 0

s. How to correctly use contraceptives, other than

   condoms    ........................................ 0... 0... 0........ 0... 0... 0

t. The importance of using contraceptive methods,

   other than condoms, consistently and correctly..... 0... 0... 0........ 0... 0... 0

u. The importance of using a condom at the same time

   as another form of contraception to prevent both

   sexually transmitted diseases (STDs) and pregnancy. 0... 0... 0........ 0... 0... 0

v. How to create and sustain healthy and respectful

   relationships...................................... 0... 0... 0........ 0... 0... 0

 

 

10.    During this school year, did teachers in your school teach about the following contraceptives in a required course for students in any of grades 9 through 12? (Mark yes or no for each contraceptive, or mark NA for each one if your school does not contain grades 9, 10, 11, or 12.)

 

       Contraceptive                                             Yes    No     NA

a.     Birth control pill (e.g., OrthoTri-cyclen) ................ 0..... 0..... 0

b.     Birth control patch (e.g., Ortho Evra) .................... 0..... 0..... 0

c.     Birth control ring (e.g., NuvaRing)........................ 0..... 0..... 0

d.     Birth control shot (e.g., Depo-Provera).................... 0..... 0..... 0

e.     Implants (e.g., Implanon).................................. 0..... 0..... 0

f.     Intrauterine device (IUD; e.g., Mirena, ParaGard).......... 0..... 0..... 0

g.     Emergency contraception (e.g., Plan B)..................... 0..... 0..... 0

 

 

11.    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.     Food guidance using the current Dietary Guidelines for Americans

       (e.g., MyPlate or MyPyramid).................................. 0.... 0

c.     Using food labels............................................. 0.... 0

d.     Balancing food intake and physical activity................... 0.... 0

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

f.     Choosing foods that are low in fat, saturated fat, and

       cholesterol................................................... 0.... 0

g.     Using sugars in moderation.................................... 0.... 0

h.     Using salt and sodium in moderation........................... 0.... 0

i.     Eating more calcium-rich foods................................ 0.... 0

j.     Food safety................................................... 0.... 0

k.     Preparing healthy meals and snacks............................ 0.... 0

l.     Risks of unhealthy weight control practices................... 0.... 0

m.     Accepting body size differences............................... 0.... 0

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

 

 

12.    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.       Physical, psychological, or social benefits of physical

activity...................................................... 0.... 0

b.       Health-related fitness (i.e., cardiorespiratory endurance,

muscular endurance, muscular strength, flexibility, and

body composition)............................................. 0.... 0

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

d.     How much physical activity is enough (i.e., determining

       frequency, intensity, time, and type of physical activity).... 0.... 0

e.     Developing an individualized physical activity plan........... 0.... 0

f.     Monitoring progress toward reaching goals in an individualized

       physical activity plan........................................ 0.... 0

g.     Overcoming barriers to physical activity...................... 0.... 0

h.     Decreasing sedentary activities (e.g., television viewing).... 0.... 0

i.     Opportunities for physical activity in the community.......... 0.... 0

j.     Preventing injury during physical activity.................... 0.... 0

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

       and sunburn while physically active).......................... 0.... 0

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

 

 

HIV PREVENTION

 

13.    During this school year, did your school provide any HIV, STD, or pregnancy prevention programs for ethnic/racial minority youth at high risk (e.g., black, Hispanic, or American Indian youth), including after-school or supplemental programs, that did each of the following? (Mark yes or no for each activity.)

      

              Activity                                                      Yes    No

a.     Provided curricula or supplementary materials that include

       pictures, information, and learning experiences that reflect the

       life experiences of these youth in their communities.......... 0.... 0

b.     Provided curricula or supplementary materials in the primary

       languages of the youth and families........................... 0.... 0

c.     Facilitated access to direct health services or arrangements with

       providers not on school property who have experience in serving

       these youth in the community.................................. 0.... 0

d.     Facilitated access to direct social services and psychological

       services or arrangements with providers not on school property

       who have experience in serving these youth in the community... 0.... 0

 

 

14.    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

 

COLLABORATION

 

15.    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.)

      

              Group                                                         Yes    No

a.     Physical education staff...................................... 0.... 0

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

c.     Mental health or social services staff

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

d.     Nutrition or food service staff............................... 0.... 0

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

 

 

16.    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 prevention, STD prevention, or teen pregnancy

       prevention.................................................... 0.... 0

b.     Tobacco-use prevention........................................ 0.... 0

c.     Physical activity............................................. 0.... 0

d.     Nutrition and healthy eating.................................. 0.... 0

e.     Asthma........................................................ 0.... 0

 

 

PROFESSIONAL DEVELOPMENT

 

17.    During the past two years, did you receive professional development (e.g., workshops, conferences, continuing education, or 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.     Emotional and mental health................................... 0.... 0

d.     Foodborne illness prevention.................................. 0.... 0

e.     HIV prevention................................................ 0.... 0

f.     Human sexuality............................................... 0.... 0

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

h.     Injury prevention and safety.................................. 0.... 0

i.     Nutrition and dietary behavior................................ 0.... 0

j.     Physical activity and fitness................................. 0.... 0

k.     Pregnancy prevention.......................................... 0.... 0

l.     STD prevention................................................ 0.... 0

m.     Suicide prevention............................................ 0.... 0

n.     Tobacco-use prevention........................................ 0.... 0

o.     Violence prevention (e.g., bullying, fighting, or dating

       violence prevention).......................................... 0.... 0

 

 

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

      

              Topic                                                         Yes    No

a.     Describing how widespread HIV and other STD infections

       are and the consequences of these infections.................. 0.... 0

b.     Understanding the modes of transmission and effective

       prevention strategies for HIV and other STDs.................. 0.... 0

c.     Identifying populations of youth who are at high risk of being

       infected with HIV and other STDs.............................. 0.... 0

d.     Implementing health education strategies using prevention

       messages that are likely to be effective in reaching youth.... 0.... 0

e.     Teaching HIV prevention education to students with 
       physical, medical, or cognitive disabilities.................. 0.... 0
f.     Teaching HIV prevention education to students of various 
       cultural backgrounds.......................................... 0.... 0
g.     Using interactive teaching methods for HIV prevention 
       education (e.g., role plays or cooperative group activities).. 0.... 0
h.     Teaching essential skills for health behavior change related to 
       HIV prevention and guiding student practice of these skills... 0.... 0
i.     Teaching about health-promoting social norms and beliefs 
       related to HIV prevention..................................... 0.... 0
j.     Strategies for involving parents, families, and others in student 
       learning of HIV prevention education.......................... 0.... 0
k.     Assessing students’ performance in HIV prevention education... 0.... 0
l.     Implementing standards-based HIV prevention education 
       curricula and student assessment.............................. 0.... 0
m.     Using technology to improve HIV prevention education 
       instruction................................................... 0.... 0
n.     Teaching HIV prevention education to students with limited 
       English proficiency........................................... 0.... 0
o.     Addressing community concerns and challenges related to HIV 
       prevention education.......................................... 0.... 0 
p.     Describing the prevalence and potential effects of 
       teen pregnancy................................................ 0.... 0
q.     Identifying populations of youth who are at high risk of becoming
       pregnant...................................................... 0.... 0

 

 

19.    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.     Emotional and mental health................................... 0.... 0

d.     Foodborne illness prevention.................................. 0.... 0

e.     HIV prevention................................................ 0.... 0

f.     Human sexuality............................................... 0.... 0

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

h.     Injury prevention and safety.................................. 0.... 0

i.     Nutrition and dietary behavior................................ 0.... 0

j.     Physical activity and fitness................................. 0.... 0

k.     Pregnancy prevention.......................................... 0.... 0

l.     STD prevention................................................ 0.... 0

m.     Suicide prevention............................................ 0.... 0

n.     Tobacco-use prevention........................................ 0.... 0

o.     Violence prevention (e.g., bullying, fighting,

       or dating violence prevention)................................ 0.... 0

 

 

20.    During the past two years, did you receive professional development (e.g., workshops, conferences, continuing education, or 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.     Teaching students of different sexual orientations or gender

       identities.................................................... 0.... 0

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

       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,

       and behavior management)...................................... 0.... 0

i.     Assessing or evaluating students in health education.......... 0.... 0

 

 

21.    Would you like to receive professional development on each of these 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.     Teaching students of different sexual orientations or gender

       identities.................................................... 0.... 0

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

       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,

       and behavior management)...................................... 0.... 0

i.     Assessing or evaluating students in health education.......... 0.... 0

 

 

PROFESSIONAL PREPARATION

 

22.    What was the major emphasis of your professional preparation? (Mark one response.)

 

a. Health and physical education combined

b. Health education

c. Physical education

d. Other education degree

e. Kinesiology, exercise science, or exercise physiology

f. Home economics or family and consumer science

g. Biology or other science

h. Nursing

i. Counseling

j. Public health

k. Nutrition

l. Other

 

 

23.    Currently, are you certified, licensed, or endorsed by the state to teach health education in middle school or high school? (Mark one response.)

 

a. Yes

b. No

      

 

24.    Including this school year, how many years of experience do you have teaching health education courses or topics? (Mark one response.)

 

a. 1 year

b. 2 to 5 years

c. 6 to 9 years

d. 10 to 14 years

e. 15 years or more

 

 

Thank you for your responses.  Please return this questionnaire.