Form Approved OMB No: 0920-0445 Expiration Date: 10/31/2002 Health Education Classroom Questionnaire Health Education Classroom Questionnaire Questions General Course Characteristics and Content 1 - 13 Accident or Injury Prevention 14 - 16 Violence Prevention 17 - 19 Tobacco Use Prevention 20 - 23 Alcohol and Other Drug Use Prevention 24 - 27 Nutrition and Dietary Behavior 28 - 31 Physical Activity 32 - 34 Human Sexuality 35 - 44 Teaching and Evaluation Techniques 45 - 52 Respondent Background 53 - 65 Public reporting burden for 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, Mailstop D-24, Atlanta, GA 30333; Attention PRA (0920-0445). Special Instructions This questionnaire will be administered using Computer Assisted Personal Interviewing. The interviewer will read the questions aloud and type responses to the questions into the laptop computer. The interview program will 1) display the correct tense of verbs, 2) provide alternate answers to questions (e.g., not applicable, “I don’t know”), 3) navigate complex skip patterns, 4) access information that was provided in previous contact with a school, and 5) perform other useful functions. The programming specifications for the interview are not included in this printed version of the questionnaire. If you would like more information about this study or would like clarification of any questions in this questionnaire, please call Tim Smith at 1-800-647-9664, extension 6095. General Course Characteristics and Content If this is an elementary school, answer Q1-Q3. If this is a middle, junior, or senior high school, skip to Q4. 1. I would like to talk with you about teaching health topics in ______________ grade. Are you currently teaching health topics to a group of _____________ graders? Yes. 1 No 2 ==> Thank you for your time and patience. That is the end of the interview. 2. How many different groups of _______________ graders are you teaching health topics to? _____ Groups If only one group, skip to Q10. Otherwise, continue with Q3. 3. For this interview, I need to ask about one specific group. If you would name each group, for example your “morning class” or your “afternoon class,” I will type the names into the computer. The computer will then select the group that I will ask about during the interview. Please tell me the names of all the groups. Group 1 ______________________ Group 2 ______________________ Group 3 ______________________ Group 4 ______________________ Group 5 ______________________ Group 6 ______________________ Group 7 ______________________ Group 8 ______________________ Group 9 ______________________ Group 10 ______________________ Group 11 ______________________ Group 12 ______________________ The computer has selected ______________. Throughout this interview, please think about what will take place by the time you finish teaching this group of ______________ graders. Skip to Q10. 4. During this interview, I would like to talk about teaching ______________. In what month and year did you last finish teaching a section of the class? _____ Month _____ Year 5. In what month and year did you begin teaching that section of the class? _____ Month _____ Year 6. Are you currently teaching a section of the class? Yes. 1 No 2 7. At that time, how many sections of the class were you teaching? HEC003 _____ Sections If only one section, skip to Q9. Otherwise, continue with Q8. 8. For this interview, I need to ask about one specific class section. If you would name each section, for example your “first period class” or your “afternoon period,” I will type the names into the computer. The computer will then select the section that I will ask about during the interview. Please tell me the names of all the sections. Section 1 _______________________ Section 2 _______________________ Section 3 _______________________ Section 4 _______________________ Section 5 _______________________ Section 6 _______________________ Section 7 _______________________ Section 8 _______________________ Section 9 _______________________ Section 10 _______________________ Section 11 _______________________ Section 12 _______________________ . The computer has selected ______________. Throughout this interview, please think about what took place when you taught this class section. SHOW CARD 1 9. Which one of the statements listed on this card best describes the class? Was this class... Devoted to health topics, such as alcohol or other drug use prevention? 1 A combined health education and physical education class? 2 Mainly about some subject other than health education, such as science, social studies, or English? 3 10. At the end of the class, how many students were enrolled in the class? _____ Students SHOW CARD 2 11. Please look over this list to see what health topics I am including in health education. As I read the topics listed on the card, please tell me if you taught about each one in the class. By teach, I mean some advanced planning on your part was involved; the subject was not just brought up in class. Did you teach about... 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, that is 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 (human immunodeficiency virus) prevention? 1 2 i. STD (sexually transmitted disease) 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 (cardiopulmonary resuscitation)? 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 12. When planning to teach or teaching the class, did you use... HEC013 Yes No a. The National Health Education Standards? 1 2 b. Any state, district, or school curriculum or guidelines for health education? 1 2 c. Any materials from health organizations, such as the American Heart Association or the American Cancer Society? 1 2 d. A commercially-developed student textbook? 1 2 e. A commercially-developed teacher's guide? 1 2 13. Did students use a textbook for the class? Yes 1 No 2 Accident or Injury Prevention If you have taught about accident or injury prevention in the class (Q11p is Yes), answer Q14-Q16. Otherwise, skip to Q17. SHOW CARD 3 14. Next, I am going to ask about instruction on ways to prevent unintentional injuries or accidents like car crashes, fires, or drownings. As I read the topics listed on this card, please tell me if you taught about each one in the class. When you taught about accident or injury prevention, did you teach about... Yes No a. Fire safety? 1 2 b. Water safety? 1 2 c. Road or transportation safety? 1 2 d. Use of protective equipment for biking, skating, or other sports ? 1 2 e. First aid or CPR ? 1 2 SHOW CARD 4 15. As I read the topics listed on this card, please tell me if you taught about each one. Did you teach about... Yes No a. How many young people do things that cause accidents like drinking and driving? 1 2 b. The number of injuries and deaths from accidents such as the number of people who die from fires or drownings? 1 2 c. The influence of families on risk behaviors related to accidents? 1 2 d. The influence of the media on risk behaviors related to accidents? 1 2 e. Social or cultural influences on risk behaviors related to accidents? 1 2 f. How to find valid information or services to prevent accidents? 1 2 g. Communication skills to avoid accidents such as convincing friends not to drink and drive? 1 2 h. Decision-making skills to avoid accidents such as deciding to wear a bike helmet? 1 2 i. Goal-setting skills to protect oneself from accidents such as learning to swim before going boating? 1 2 j. Resisting peer pressure that would increase risk of accidents? 1 2 k. How students can influence or support others to prevent accidents? 1 2 16. How many hours did you spend teaching about accident or injury prevention? Less than 1 hour 0 1 Hour 1 2 Hours 2 3 Hours 3 4 Hours 4 5 Hours 5 6 Hours 6 7 Hours 7 8 Hours 8 9 Hours 9 10 Hours 10 11 or more hours 11 Violence Prevention If you taught about violence prevention in the class (Q11o is Yes), answer Q17-Q19. Otherwise, skip to Q20. SHOW CARD 5 17. The next several questions are about instruction on violence prevention and intentional injuries, including topics such as bullying, fighting, or homicide. As I read the topics listed on this card, please tell me if you taught about each one in the class. When you taught about violence prevention and intentional injuries, did you teach about... Yes No a. Personal safety, for example, dealing with strangers? 1 2 b. Anger management? 1 2 c. Bullying? 1 2 d. Risks associated with physical fighting? 1 2 e. Techniques to avoid interpersonal conflicts and fights? 1 2 f. Prosocial behaviors such as cooperation, praise, or showing support for others? 1 2 g. Gun safety? 1 2 h. Sexual harassment? 1 2 Answer i and j if this is a middle, junior, or senior high school. i. Dating violence? 1 2 j. Sexual assault? 1 2 Answer k if this is an elementary school. k. Inappropriate touching? 1 2 l. How to handle stress in healthy ways? 1 2 m. Recognizing stressors and signs of depression that might be associated with suicide? 1 2 n. What to do if someone is thinking about suicide? 1 2 SHOW CARD 6 18. As I read the topics listed on this card, please tell me if you taught about each one. Did you teach about... Yes No a. How many young people do things that can lead to violence or suicide, like carrying a weapon? 1 2 b. The number of injuries or deaths from violence or suicide, such as the number of people who commit suicide? 1 2 c. The influence of families on suicidal behaviors or violence? 1 2 d. The influence of the media on suicidal behaviors or violence? 1 2 e. Social or cultural influences on suicidal behaviors or violence? 1 2. f. How to find valid information or services to prevent suicidal behaviors or violence? 1 2 g. Communication skills to avoid violence, such as talking out problems? 1 2 h. Decision-making skills to avoid violence, such as deciding to walk away from conflicts? 1 2 i. Goal-setting skills to avoid violence, such as handling conflicts without violence? 1 2 j. Resisting peer pressure that would increase risk of suicidal behaviors or violence? 1 2 k. How students can influence or support others to prevent suicidal behaviors or violence? 1 2 19. How many hours did you spend teaching about violence prevention? Less than 1 hour 0 1 Hour 1 2 Hours 2 3 Hours 3 4 Hours 4 5 Hours 5 6 Hours 6 7 Hours 7 8 Hours 8 9 Hours 9 10 Hours 10 11 or more hours 11 Tobacco Use Prevention If you taught tobacco use prevention in this class (Q11m is Yes), answer Q20-Q23. Otherwise, skip to Q24. SHOW CARD 7 20. As I read the topics listed on this card, please tell me if you taught about each one in the class. When you taught about tobacco use prevention, did you teach about... Yes No a. Short-term health consequences of cigarette smoking? 1 2 b. Long-term health consequences of cigarette smoking? 1 2 c. Benefits of not smoking cigarettes ? 1 2 d. Short-term health consequences of using smokeless tobacco? 1 2 e. Long-term health consequences of using smokeless tobacco? 1 2 f. Benefits of not using smokeless tobacco? 1 2 g. Risks of cigar or pipe smoking? 1 2 h. Addictive effects of nicotine in tobacco products? 1 2 SHOW CARD 8 21. As I read the topics listed on this card, please tell me if you taught about each one. Did you teach about... Yes No a. How many young people use tobacco? 1 2 b. The number of illnesses and deaths related to tobacco use? 1 2 c. The influence of families on tobacco use? 1 2 d. The influence of the media on tobacco use? 1 2 e. Social or cultural influences on tobacco use? 1 2 f. How to find valid information or services related to tobacco use prevention or cessation? 1 2 g. Communication skills to avoid tobacco use, such as expressing your decision not to smoke? 1 2 h. Decision-making skills to avoid tobacco use, such as deciding not to use tobacco? 1 2 i. Goal-setting skills to avoid tobacco use, such as setting a quit date? 1 2 j. Resisting peer pressure to use tobacco? 1 2 k. Making a personal commitment not to use tobacco? 1 2 l. How students can influence or support others to prevent tobacco use? 1 2 m. How students can influence or support others in efforts to quit using tobacco? 1 2 22. Students sometimes say that using tobacco helps them achieve personal goals such as reducing stress, losing weight, or “fitting in” with peers. Did you teach about alternative ways to achieve such goals? Yes 1 No 2 23. How many hours did you spend teaching about tobacco use prevention? Less than 1 hour 0 1 Hour 1 2 Hours 2 3 Hours 3 4 Hours 4 5 Hours 5 6 Hours 6 7 Hours 7 8 Hours 8 9 Hours 9 10 Hours 10 11 or more hours 11 Alcohol and Other Drug Use Prevention If you taught about alcohol or other drug use prevention in this class (Q11n is Yes), answer Q24-Q27. Otherwise, skip to Q28. SHOW CARD 9 24. As I read the topics listed on this card, please tell me if you taught about each one in the class. When you taught about alcohol and other drug use prevention, did you teach about... Yes No a. Short-term health consequences of alcohol use? 1 2 b. Long-term health consequences of alcohol use and addiction? 1 2 c. Benefits of not using alcohol? 1 2 d. Drink equivalents and blood alcohol content? 1 2 e. Short-term health consequences of illegal drug use, such as marijuana? 1 2 f. Long-term health consequences of illegal drug use? 1 2 g. Benefits of not using illegal drugs? 1 2 h. Distinguishing between medicinal and non-medicinal drug use? 1 2 i. Risks associated with illegal steroid use? 1 2 j. Effects of alcohol or other drug use on decision-making? 1 2 SHOW CARD 10 25. As I read the topics listed on this card, please tell me if you taught about each one. Did you teach about... Yes No a. How many young people use alcohol or other drugs? 1 2 b. The number of illnesses and deaths related to alcohol or other drug use? 1 2 c. The influence of families on alcohol or other drug use? 1 2 d. The influence of the media on alcohol or other drug use? 1 2 e. Social or cultural influences on alcohol or other drug use? 1 2 f. How to find valid information or services related to alcohol or other drug use prevention or cessation? 1 2 g. Communication skills to avoid alcohol and other drug use, such as telling a friend why you do not use drugs? 1 2 h. Decision-making skills to avoid alcohol and other drug use, such as deciding not to drink alcohol? 1 2 i. Goal-setting skills to avoid alcohol and other drug use, such as not attending parties where alcohol is served? 1 2 j. Resisting peer pressure to use alcohol and other drugs? 1 2 k. Making a personal commitment not to use alcohol and other drugs? 1 2 l. How students can influence or support others in efforts to prevent alcohol and other drug use? 1 2 m. How students can influence or support others in efforts to quit using alcohol and other drugs? 1 2 26. Students sometimes say that using alcohol or other drugs helps them achieve personal goals such as reducing stress or “fitting in” with peers. Did you teach about alternative ways to achieve such goals? Yes 1 No 2 27. How many hours did you spend teaching about alcohol or other drug use prevention? Less than 1 hour 0 1 Hour 1 2 Hours 2 3 Hours 3 4 Hours 4 5 Hours 5 6 Hours 6 7 Hours 7 8 Hours 8 9 Hours 9 10 Hours 10 11 or more hours 11 Nutrition and Dietary Behavior If you taught about nutrition and dietary behavior in this class (Q11c is Yes), answer Q28-Q31. Otherwise, skip to Q32. SHOW CARD 11 28. As I read the topics listed on this card, please tell me if you taught about each one in the class. When you taught about nutrition and dietary behavior, did you teach about... Yes No a. The benefits of healthy eating? 1 2 b. The Food Guide Pyramid? 1 2 c. The Dietary Guidelines for Americans? 1 2 d. Using food labels? 1 2 e. Eating a variety of foods? 1 2 f. Balancing food intake and physical activity? 1 2 g. Eating more fruits, vegetables, and grain products? 1 2 h. Choosing foods that are low in fat, saturated fat, and cholesterol? 1 2 i. Using salt and sodium in moderation? 1 2 j. Using sugars in moderation? 1 2 k. Eating more calcium-rich foods? 1 2 l. Preparing healthy meals and snacks ? 1 2 m. Risks of unhealthy weight control practices ? 1 2 n. Accepting body size differences? 1 2 o. Eating disorders? 1 2 p. Foods from different cultures? 1 2 q. Food safety? 1 2 29. When you taught about nutrition and dietary behavior, did students have opportunities to taste new foods as part of a lesson? Yes 1 No 2 SHOW CARD 12 30. As I read the topics listed on this card, please tell me if you taught about each one. Did you teach about... Yes No a. The number of illnesses or deaths related to poor nutrition or unhealthy dietary behavior? 1 2 b. The influence of families on dietary behavior? 1 2 c. The influence of the media on dietary behavior? 1 2 d. Social or cultural influences on dietary behavior? 1 2 e. How to find valid information or services related to nutrition and dietary behavior? 1 2 f. Communication skills for healthy eating, such as how to ask parents to buy more fresh fruit? 1 2 g. Decision-making skills for healthy eating, such as choosing healthy snacks? 1 2 h. Goal-setting skills for healthy eating, such as eating five fruits or vegetables every day? 1 2 i. Resisting peer pressure related to unhealthy dietary behavior? 1 2 j. How students can influence or support others’ healthy dietary behavior? 1 2 31. How many hours did you spend teaching about nutrition and dietary behavior? Less than 1 hour 0 1 Hour 1 2 Hours 2 3 Hours 3 4 Hours 4 5 Hours 5 6 Hours 6 7 Hours 7 8 Hours 8 9 Hours 9 10 Hours 10 11 or more hours 11 Physical Activity If you taught physical activity and fitness topics in this class (Q11d is Yes), answer Q32-Q34. Otherwise, skip to Q35. SHOW CARD 13 32. As I read the topics listed on this card, please tell me if you taught about each one in the class. When you taught about physical activity, did you teach about... Yes No a. The physical, psychological, or social benefits of physical activity ? 1 2 b. Health-related fitness, that is cardiovascular endurance, muscular endurance, muscular strength, flexibility, and body composition? 1 2 c. Basic anatomy? 1 2 d. Phases of a workout, that is warmup, workout, and cool down? 1 2 e. How much physical activity is enough, that is determining frequency, intensity, time and type of physical activity? 1 2 f. Developing an individualized physical activity plan? 1 2 g. Monitoring progress toward reaching goals in an individualized physical activity plan? 1 2 h. Overcoming barriers to physical activity? 1 2 i. Decreasing sedentary activities, such as TV watching? 1 2 j. Opportunities for physical activity in the community? 1 2 k. Preventing injury during physical activity? 1 2 l. Weather-related safety, for example avoiding heat stroke, hypothermia, and sunburn while physically active? 1 2 m. Dangers of using performance-enhancing drugs, such as steroids? 1 2 SHOW CARD 14 33. As I read the list of topics on this card, please tell me if you taught about each one. Did you teach about... Yes No a. The number of illnesses and deaths related to a lack of physical activity? 1 2 b. The influence of families on physical activity? 1 2 c. The influence of the media on physical activity? 1 2 d. Social or cultural influences on physical activity? 1 2 e. How to find valid information or services related to physical activity and fitness? 1 2 f. Communication skills to encourage physical activity, such as how to explain to others that physical activity is important to you? 1 2 g. Decision-making skills for physical activity, such as deciding to take the stairs? 1 2 h. Goal-setting skills for physical activity, such as developing an individualized physical activity plan? 1 2 i. Resisting peer pressure that discourages physical activity? 1 2 j. How students can influence or support others to engage in physical activity? 1 2 34. How many hours did you spend in the classroom teaching about physical activity? Please do not include time students spent actually being active. Less than 1 hour 0 1 Hour 1 2 Hours 2 3 Hours 3 4 Hours 4 5 Hours 5 6 Hours 6 7 Hours 7 8 Hours 8 9 Hours 9 10 Hours 10 11 or more hours 11 Human Sexuality If you taught human sexuality in this class (Q11 f, g, h, or i is Yes), answer Q35. Otherwise, skip to Q36. SHOW CARD 15 35. You mentioned that when you taught the class, you taught about human sexuality topics. As I read the topics listed on this card, please tell me if you taught about each one. When you taught about human sexuality, did you teach about... Yes No a. Abstinence as the most effective method to avoid pregnancy, HIV, or STDs? 1 2 b. Dating and relationships? 1 2 c. Marriage and commitments? 1 2 d. Human development issues, such as reproductive anatomy and puberty? 1 2 Answer e, f, g, and h if this is a middle, junior, or senior high school. e. Risks associated with having multiple sexual partners? 1 2 f. Condom efficacy, that is, how well condoms work and don’t work? 1 2 g. How to correctly use a condom? 1 2 h. Sexual identity and sexual orientation? 1 2 If you taught about HIV prevention in this class (Q11h is Yes), answer Q36-Q37. Otherwise, skip to Q38. 36. When you taught about HIV prevention, did you teach about... Yes No a. How HIV is transmitted? 1 2 b. How HIV affects the human body? 1 2 c. Compassion for persons living with HIV or AIDS (acquired immunodeficiency syndrome)? 1 2 d. How to find valid information or services related to HIV or HIV testing? 1 2 37. How many hours did you spend teaching about HIV prevention? Less than 1 hour 0 1 Hour 1 2 Hours 2 3 Hours 3 4 Hours 4 5 Hours 5 6 Hours 6 7 Hours 7 8 Hours 8 9 Hours 9 10 Hours 10 11 or more hours 11 If you taught about STD prevention in this class (Q11i is Yes), answer Q38-Q39. Otherwise, skip to Q40. 38. When you taught about STD prevention, did you teach about... Yes No a. How STDs, other than HIV, are transmitted? 1 2 b. Signs and symptoms of STDs? 1 2 c. How to find valid information or services related to STDs or STD testing? 1 2 39. How many hours did you spend teaching about STD prevention? Please do not include hours teaching about HIV prevention. Less than 1 hour 0 1 Hour 1 2 Hours 2 3 Hours 3 4 Hours 4 5 Hours 5 6 Hours 6 7 Hours 7 8 Hours 8 9 Hours 9 10 Hours 10 11 or more hours 11 If you taught about pregnancy prevention in this class (Q11g is Yes), answer Q40-Q41. Otherwise, skip to Q42. 40. When you taught about pregnancy prevention, did you teach about... Yes No Answer a if this is a middle, junior, or senior high school. a. Methods of contraception? 1 2 b. Risks associated with teen pregnancy? 1 2 c. How to find valid information or services related to pregnancy or pregnancy testing? 1 2 41. How many hours did you spend teaching about pregnancy prevention? Less than 1 hour 0 1 Hour 1 2 Hours 2 3 Hours 3 4 Hours 4 5 Hours 5 6 Hours 6 7 Hours 7 8 Hours 8 9 Hours 9 10 Hours 10 11 or more hours 11 SHOW CARD 16 42. As I read the topics listed on this card, please tell me if you taught about each one. Did you teach about... Yes No a. How many young people are sexually active? 1 2 b. The number of teenage pregnancies? 1 2 c. The number of young people who get STDs or HIV? 1 2 d. The influence of families on sexual behavior? 1 2 e. The influence of the media on sexual behavior? 1 2 f. Social or cultural influences on sexual behavior? 1 2 g. Communication skills related to sexual behaviors, such as telling your date you do not want to have sex? 1 2 h. Decision-making skills related to sexual behaviors, such as deciding when to start dating? 1 2 i. Goal-setting skills related to sexual behaviors, such as waiting until marriage to have sex? 1 2 j. Resisting peer pressure to engage in sexual behavior? 1 2 k. How students can influence or support others to make healthy decisions related to sexual behaviors? 1 2 43. Were any students excused by parental request from attending the class when specific topics related to human sexuality were presented? HEC040 Yes 1 No 2 ==> Skip to Q45 44. How many students were excused by parental request from attending class when topics related to human sexuality were presented? _____ Students Teaching and Evaluation Techniques Now, I would like to ask a few more general questions about the class. Please remember to answer these questions about this class only. 45. The next questions ask about the use of various teaching methods. Did you use... Yes No a. Group discussions? 1 2 b. Cooperative group activities? 1 2 c. Role play, simulations, or practice? 1 2 d. Visual, performing, or language arts? 1 2 e. Pledges or contracts for behavior change? 1 2 f. Guest speakers? 1 2 g. Peer teaching? 1 2 h. The Internet? 1 2 i. Computer-assisted instruction? 1 2 46. The next questions ask about the use of methods to highlight diversity or the values of various cultures. When teaching the class did you... Yes No a. Use textbooks or curricular materials reflective of various cultures? 1 2 b. Use textbooks or curricular materials designed for students with limited English proficiency? 1 2 c. Ask students to share their own cultural experiences related to health topics? 1 2 d. Teach about cultural differences and similarities? 1 2 e. Modify teaching methods to match students’ learning styles, health beliefs, or cultural values? 1 2 47. Did you ask students to... Yes No a. Perform volunteer work at a hospital, a local health department, or any other local organization that addresses health issues? 1 2 b. Participate in or attend a community health fair? 1 2 c. Gather information about health services that are available in the community, such as health screenings? 1 2 d. Visit a store to compare prices of health products? 1 2 e. Identify potential injury sites at school, home, or in the community? 1 2 f. Identify advertising in the community designed to influence health behaviors? 1 2 g. Advocate for a health-related issue? 1 2 48. Did you... Yes No a. Provide families with information on the class? 1 2 b. Give students homework or projects that involve family members? 1 2 c. Invite family members to attend the class? 1 2 If you are an elementary school classroom teacher, answer Q49. Otherwise, skip to Q50. 49. Did you make time for students to wash their hands using instant hand sanitizers or a bathroom or classroom sink ... Yes No a. Before lunch? 1 2 b. Before snacks? 1 2 c. After recess? 1 2 50. To assess or evaluate students, did you use... Yes No a. Written examinations? 1 2 b. Oral presentations or oral reports? 1 2 c. Journal writing? 1 2 d. Student portfolios? 1 2 e. Homework assignments? 1 2 f. Group projects? 1 2 g. Student self-assessment? 1 2 My next questions ask about teaching students with permanent physical or cognitive disabilities. Examples of such disabilities include blindness, Down’s Syndrome, learning disabilities, and conditions that require permanent use of a wheelchair. 51. Were there any students with permanent physical or cognitive disabilities in the class? Yes 1 No 2 ==> Skip to Q53 52. Was there... HEC017 Yes No a. A special education teacher with whom you coordinated assignments for students with permanent disabilities? 1 2 b. A teacher or aide who came in to assist with the students with permanent disabilities? 1 2 c. Assigned note takers or readers for class work? 1 2 d. Simplified instructional content or variations in the amount or difficulty of material taught? 1 2 e. More skill modeling, practicing, or repetition? 1 2 f. Preferential seating for the students with permanent disabilities? 1 2 Respondent Background My last set of questions asks about your educational background and teaching experience. 53. Counting this year as a full year and including years spent teaching health education topics or classes at any other schools, how many years of experience do you have teaching health education topics or classes? _____ Years 54. Do you have an undergraduate degree? Yes 1 No 2 ==> Skip to Q60 55. 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 56. Do you have an undergraduate minor?HEC059 Yes 1 No 2 ==> Skip to Q58 57. 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 58. Do you have a graduate degree? Yes 1 No 2 ==> Skip to Q60 59. In what area or areas? MARK ALL THAT APPLY. HEC064 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 60. Currently, are you certified, endorsed, or licensed by the state to teach health education in... Yes No a. Elementary school? 1 2 b. Middle or junior high school? 1 2 c. Senior high school? 1 2 61. Are you a Certified Health education Specialist or CHES? Yes 1 No 2 SHOW CARD 17 62. As I read the list of topics on this card, please tell me if you received any staff development on each topic during the past 2 years. This might include workshops, conferences, continuing education, graduate courses, or any other kind of in-service. During the past 2 years, did you receive any staff development on... 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, that is 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 63. Which of these topics would you like to receive further staff development on? MARK ALL THAT APPLY. Personal hygiene 1 Dental and oral health 2 Nutrition and dietary behavior 3 Physical activity and fitness, that is classroom instruction, not a physical activity period 4 Growth and development 5 Human sexuality 6 Pregnancy prevention 7 HIV prevention 8 STD prevention 9 Emotional and mental health 10 Suicide prevention 11 Death and dying 12 Tobacco use prevention 13 Alcohol or other drug use prevention 14 Violence prevention, such as bullying, fighting, or homicide 15 Accident or injury prevention 16 CPR 17 First aid 18 Immunizations or vaccinations 19 Sun safety or skin cancer prevention 20 Consumer health, such as choosing sources of health- related information, products, and services wisely 21 Environmental health, such as how air and water quality can affect health 22 None 23 SHOW CARD 18 64. As I read the list of teaching methods on this card, please tell me if you received any staff development on each one during the past 2 years. During the past 2 years, did you receive any staff development on... 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 65. Which of these teaching methods would you like to receive further staff development on? MARK ALL THAT APPLY. a. Teaching students with permanent physical or cognitive disabilities 1 b. Teaching students of various cultural backgrounds 2 c. Teaching students with limited English proficiency 3 d. Using interactive teaching methods, such as role plays or cooperative group activities 4 e. Encouraging family or community involvement 5 f. Teaching skills for behavior change 6 g. None 7 66. My supervisor may wish to call you to ask about how I conducted this interview. Would you please tell me a telephone number where we might reach you starting with the area code? ( ) - 1) Daytime or 2) Evening/Weekend Thank you very much for taking the time to complete this interview. Health Education Classroom Questionnaire - Final Version — Revised: 10/26/99 32 Health Education Classroom Questionnaire - Final Version — Revised: 10/26/99 General Course Characteristics and Content Accident or Injury Prevention Violence Prevention Tobacco Use Prevention Alcohol and Other Drug Use Prevention Nutrition and Dietary Behavior Physical Activity Human Sexuality Teaching and Evaluation Techniques Respondent Background