Form Approved OMB No: 0920-0445 Expiration Date: 10/31/2002 School Policy and Environment State Questionnaire School Policy and Environment State Questionnaire Questions Violence Prevention 1 - 8 Harassment Prevention 9 - 10 Tobacco Use Prevention 11 - 30 Alcohol Use Prevention 31 - 32 Illegal Drug Use Prevention 33 - 34 Accident and Injury Prevention 35 - 36 State Assistance to Districts and Schools 37 - 39 Public reporting burden for this collection of information is estimated to average 60 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 state practices and policies. 2. When we use the word “policy,” we mean any mandate issued by the state school board, state legislature, or other state agency that affects the environment in schools throughout your state. Please consider any policies officially adopted at the state level. These include policies developed by your state, or those based on model policies developed elsewhere. 3. We recognize that there may be some exceptions to the policies, but please answer the questions based on what is customary in your state. Please do not consider district or school practices or policies when answering the questions. (We will ask about district and school practices and policies when we collect information from districts and 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. Violence Prevention 1. Has your state adopted a policy prohibiting physical fighting by students? Yes 1 No 2 2. Does your state keep records on the number of times students are caught fighting? Yes 1 No 2 3. Has your state adopted a policy prohibiting weapon possession or use by students? Yes 1 No 2 ==> Skip to Question 5 4. Does that policy specifically prohibit weapon possession or use by students at offcampus, schoolsponsored events? Yes 1 No 2 5. Does your state keep records on the number of times students are caught using the following weapons? Yes No a. A handgun or other firearm 1 2 b. Any other weapon 1 2 6. Does your state keep records on the number of times students are caught possessing any weapon? Yes 1 No 2 7. Has your state adopted a policy prohibiting gang activities? Yes 1 No 2 8. Does your state keep records on the number of times students are caught breaking any rule on gang activities? Yes 1 No 2 Harassment Prevention 9. Has your state adopted a policy prohibiting harassment of students by other students? Yes 1 No 2 ==> Skip to Question 11 10. Does that policy specifically prohibit harassment of students by other students based on the following characteristics? Yes No a. Gender 1 2 b. Race or ethnicity 1 2 c. Religion 1 2 d. Sexual orientation 1 2 e. Physical or cognitive disability 1 2 Tobacco Use Prevention 11. Has your state adopted a policy prohibiting cigarette smoking by students? Yes 1 No 2 ==> Skip to Question 13 12. Does that policy specifically prohibit cigarette smoking by students in the following locations? Yes No a. In school buildings 1 2 b. Outside, on school grounds 1 2 c. In school buses or other vehicles used to transport students 1 2 d. At offcampus, schoolsponsored events 1 2 13. Does your state keep records on the number of times students are caught smoking cigarettes? Yes 1 No 2 14. Has your state adopted a policy prohibiting cigar or pipe smoking by students? Yes 1 No 2 15. Has your state adopted a policy prohibiting smokeless tobacco use by students? Yes 1 No 2 ==> Skip to Question 17 16. Does that policy specifically prohibit smokeless tobacco use by students in the following locations? Yes No a. In school buildings 1 2 b. Outside, on school grounds 1 2 c. In school buses or other vehicles used to transport students 1 2 d. At offcampus, schoolsponsored events 1 2 17. Does your state keep records on the number of times students are caught using smokeless tobacco? Yes 1 No 2 18. Has your state adopted a policy prohibiting tobacco advertisements in the following locations? Yes No a. In the school building 1 2 b. Outside, on school grounds, including on the outside of the school building, on playing fields, or other areas of the campus 1 2 c. On school buses 1 2 d. In school publications 1 2 19. Has your state adopted a policy prohibiting tobacco advertising through sponsorship of school events? Yes 1 No 2 20. Has your state adopted a policy that prohibits students from wearing tobacco brand-name apparel or carrying merchandise with tobacco company names, logos, or cartoon characters on it? Yes 1 No 2 21. Has your state adopted a policy prohibiting cigarette smoking by faculty and staff during any school-related activity? Yes 1 No 2 ==> Skip to Question 23 22. Does that policy specifically prohibit cigarette smoking by faculty and staff in the following locations? Yes No a. In school buildings 1 2 b. Outside, on school grounds 1 2 c. In school buses or other vehicles used to transport students 1 2 d. At offcampus, schoolsponsored events 1 2 23. Has your state adopted a policy prohibiting cigar or pipe smoking by faculty and staff during any school-related activity? Yes 1 No 2 24. Has your state adopted a policy prohibiting smokeless tobacco use by faculty and staff during any school-related activity? Yes 1 No 2 ==> Skip to Question 26 25. Does that policy specifically prohibit smokeless tobacco use by faculty and staff in the following locations? Yes No a. In school buildings 1 2 b. Outside, on school grounds 1 2 c. In school buses or other vehicles used to transport students 1 2 d. At offcampus, schoolsponsored events 1 2 26. Has your state adopted a policy prohibiting cigarette smoking by visitors to schools? Yes 1 No 2 ==> Skip to Question 28 27. Does that policy specifically prohibit cigarette smoking by visitors in the following locations? Yes No a. In school buildings 1 2 b. Outside, on school grounds 1 2 c. In school buses or other vehicles used to transport students 1 2 d. At offcampus, schoolsponsored events 1 2 28. Has your state adopted a policy prohibiting cigar or pipe smoking by visitors to schools? Yes 1 No 2 29. Has your state adopted a policy prohibiting smokeless tobacco use by visitors to schools? Yes 1 No 2 ==> Skip to Question 31 30. Does that policy specifically prohibit smokeless tobacco use by visitors in the following locations? Yes No a. In school buildings 1 2 b. Outside, on school grounds 1 2 c. In school buses or other vehicles used to transport students 1 2 d. At offcampus, schoolsponsored events 1 2 Alcohol Use Prevention 31. Has your state adopted a policy prohibiting alcohol use by students? Yes 1 No 2 32. Does your state keep records on the number of times students are caught drinking alcohol? Yes 1 No 2 Illegal Drug Use Prevention 33. Has your state adopted a policy prohibiting illegal drug possession or use by students? Yes 1 No 2 34. Does your state keep records on the number of times students are caught possessing or using illegal drugs? Yes 1 No 2 Accident and Injury Prevention 35. Has your state adopted a policy on each of the following topics? Yes No a. The inspection or maintenance of school buses or other vehicles used to transport students 1 2 b. The inspection or maintenance of playground facilities and equipment, such as playing surfaces, benches, monkey bars, and swings 1 2 c. The inspection or maintenance of indoor athletic facilities and equipment, such as playing surfaces, benches, tumbling mats, and weight lifting equipment 1 2 d. The inspection or maintenance of outdoor athletic facilities and equipment, such as playing fields and bleachers 1 2 e. The protection of students and staff from environmental hazards such as asbestos, pesticides, or chemicals in labs or workshops 1 2 f. The inspection or maintenance of the kitchen facilities and equipment 1 2 g. The inspection or maintenance of special classroom areas, such as chemistry labs, workshops, and art rooms 1 2 h. The inspection or maintenance of other school areas, such as halls, stairs, and regular classrooms 1 2 i. Smoke detectors 1 2 j. Fire extinguishers 1 2 k. Lighting inside school buildings 1 2 l. Lighting outside school buildings 1 2 36. Has your state adopted a policy requiring that students wear appropriate protective gear when engaged in the following activities? Yes No a. Classes such as wood shop or metal shop 1 2 b. Lab activities for photography, chemistry, biology, or other science classes 1 2 State Assistance to Districts and Schools 37. During the past 2 years, has your state provided model policies on the following topics to districts or schools? This might include policies developed by your state, or those based on model policies developed elsewhere. Yes No a. Violence prevention 1 2 b. Harassment prevention 1 2 c. Tobacco use prevention 1 2 d. Alcohol use prevention 1 2 e. Illegal drug use prevention 1 2 f. Accident and injury prevention 1 2 38. During the past 2 years, has your state provided any funding for or offered staff development to districts or schools on how to implement the following types of prevention policies and programs? This might include workshops, conferences, continuing education, graduate courses, or any other kind of in-service. Yes No a. Violence prevention policies or programs 1 2 b. Harassment prevention policies or programs 1 2 c. Tobacco use prevention policies or programs 1 2 d. Alcohol use prevention policies or programs 1 2 e. Illegal drug use prevention policies or programs 1 2 f. Accident and injury prevention policies or programs 1 2 39. During the past 2 years, has your state provided any funding or offered to help districts or schools establish a group to develop school policies or coordinate activities that address health issues (e.g., a school health council)? 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 School Policy and Environment State Questionnaire - Final Version — Revised: 10/26/99 6 School Policy and Environment State Questionnaire - Final Version — Revised: 10/26/99 Violence Prevention Tobacco Use Prevention 13 School Policy and Environment State Questionnaire - Final Version — Revised: 10/26/99