FSHP_District - public use Form Approved OMB No: 0920-0445 Expiration Date: 11/30/2008 Faculty and Staff Health Promotion District Questionnaire Faculty and Staff Health Promotion District Questionnaire Questions Health Insurance 1 - 3 Required Examinations and Screenings 4 - 10 Health Promotion Activities and Services 11 - 15 Employee Assistance Programs 16 Health Risk Appraisals 17 - 19 Off-site Health Promotion Activities 20 Planning and Coordination 21 - 28 Public reporting burden for this collection of information is estimated to average 20 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-74, Atlanta, GA 30333; Attention PRA (0920-0445). NOTE: THROUGHOUT THIS QUESTIONNAIRE, TEXT THAT APPEARS IN ALL CAPITAL LETTERS WILL NOT BE READ ALOUD TO RESPONDENTS. THIS QUESTIONNAIRE WILL BE ADMINISTERED USING COMPUTER-ASSISTED TELEPHONE INTERVIEWING TECHNOLOGY. THE INTERVIEWER WILL READ THE QUESTIONS ALOUD AND TYPE RESPONSES TO THE QUESTIONS INTO THE 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, AND 4) PERFORM OTHER USEFUL FUNCTIONS. THE PROGRAMMING SPECIFICATIONS FOR THE INTERVIEW ARE NOT INCLUDED IN THIS PRINTED VERSION OF THE QUESTIONNAIRE. 1. This questionnaire focuses on your district’s policies and practices regarding faculty and staff health promotion. 2. When I use the word “policy,” I mean any law, rule, regulation, administrative order, or similar kind of mandate issued by the local school board or other local agency with authority over schools in your district. I am most interested in what is required by the district, not what is recommended or contained in non-binding guidance documents, unless the question specifically asks about recommendations. 3. If a district policy is worded in such a way that it requires schools to develop and adopt their own policies on a given topic, for the purpose of this questionnaire please consider it the same as a district-wide requirement. 4. I recognize that the district may sometimes grant policy exceptions or waivers, but please answer each question based on what is considered the general policy and standard practice. 5. Please do not consider school practices or policies when answering the questions. We will ask about school practices and policies when we collect information from schools across the country. 6. Please include activities or services offered by your state, district, schools, or by anyone outside the school system. However, please consider only those activities or services that are offered to faculty and staff because they work in your district. The first question asks about health insurance that may be offered by your state. By offer, I mean that the state pays for some or all of the cost of the insurance or makes the insurance available to faculty and staff at their own expense. 1. Does your state offer health insurance to faculty and staff? Yes 1-->SKIP TO Q3A No 2 The next questions ask about health insurance that may be offered by your district. By offer, I mean that the district pays for some or all of the cost of the insurance or makes the insurance available to faculty and staff at their own expense. 2. Does your district offer health insurance to faculty and staff? Yes 1 No 2-->SKIP TO THE INTRODUCTION TO Q4 3. Does this health insurance cover all or part of the following for faculty and staff? Yes No a. Preventive health care, such as physicals 1 2 b. Vision care 1 2 c. Dental care 1 2 d. Immunizations 1 2 e. Mental health care 1 2 f. Alcohol or other drug use treatment 1 2 Next, I would like to ask about policies your district has adopted on health examinations and screenings that faculty and staff are required to receive prior to employment. 4. I’m going to read you four statements. Please tell me which one of the following statements best describes the requirement for physical health examinations of faculty and staff in your district. The district requires physical health examinations of all faculty and staff prior to employment, 1 The district requires physical health examinations prior to employment depending on the position the person will have, 2 The district requires physical health examinations prior to employment depending on something other than the person’s position, or 3 The district does not require physical health examinations of any faculty or staff prior to employment. 4 5. Now I’m going to read you four statements related to policies on illegal drug use screening. Please tell me which one of the following statements best describes the requirement for illegal drug use screening of faculty and staff in your district. The district requires drug screening of all faculty and staff prior to employment, 1 The district requires drug screening prior to employment depending on the position the person will have, 2 The district requires drug screening prior to employment depending on something other than the person’s position, or. 3 The district does not require drug screening of any school faculty or staff prior to employment 4 6. Now please tell me which of the following four statements best describes your district’s requirement for tuberculosis or TB testing for faculty and staff prior to employment. The district requires TB testing prior to employment for all faculty and staff, 1 The district requires TB testing prior to employment depending on the person’s position, 2 The district requires TB testing prior to employment only for faculty and staff meeting certain risk criteria, for example those born or recently living in other countries, or 3 The district does not require TB testing prior to school employment for any faculty or staff 4 These next questions ask about health examinations and screenings that the district requires faculty and staff to receive periodically while they are employed. 7. Please tell me which one of the following four statements best describes the requirement for physical health examinations of faculty and staff while they are employed. The district requires periodic physical health examinations of all faculty and staff while employed , 1 The district requires periodic physical health examinations depending on the person’s position, 2 The district requires periodic physical health examinations depending on something other than the person’s position, or. 3 The district does not require periodic physical health examinations of any faculty or staff while employed. 4 8. Now I’m going to read you four statements related to policies on illegal drug use screening. Please tell me which one of the following statements best describes the requirement for illegal drug use screening of faculty and staff in your district. The district requires periodic drug screening of all faculty and staff while employed,. 1 The district requires periodic drug screening depending on the person’s position,. 2 The district requires periodic drug screening depending on something other than the person’s position, or. 3 The district does not require periodic drug screening of any faculty or staff while employed. 4 9. Now please tell me which of the following four statements best describes your district’s requirement for routine TB testing for faculty and staff while they are employed. Please do not include TB testing that might be done during a school outbreak. The district requires periodic TB testing for all faculty and staff while employed, 1 The district requires periodic TB testing for faculty and staff depending on the person’s position, 2 The district requires periodic TB testing only for faculty and staff meeting certain risk criteria, for example those born or recently living in other countries, or 3 The district does not require periodic TB testing for any faculty and staff while employed 4 IF Q6 IS 4 AND Q9 IS 4, SKIP TO THE INTRODUCTION TO Q11. 10. Which method is required to be used when initially screening faculty and staff for TB? PPD skin test done by Mantoux method, 1 Skin test not otherwise specified, 2 Chest x-ray, or 3 Is no specific testing method required? 4 The remainder of the interview asks about faculty and staff health promotion activities or services. Faculty and staff health promotion activities or services focus on prevention of physical illnesses or injuries, promotion of physical fitness, promotion of mental health, or other activities or services designed to assist faculty and staff experiencing problems that can impact job performance, physical health, or overall well-being. We are interested in activities and services districts may provide to faculty and staff because they are employees, not because they take part in the state, district, or school health insurance. The next questions ask about health screenings for faculty and staff. 11. During the past 12 months, has your district provided funding for or offered the following screenings for faculty and staff? Yes No a. Oral health screening 1 2 b. Height and weight or body mass screening 1 2 c. Serum cholesterol screening 1 2 d. Blood pressure screening 1 2 e. Diabetes screening 1 2 f. Skin cancer screening 1 2 g. Breast cancer screening 1 2 h. Colorectal cancer screening 1 2 The next questions ask about health promotion activities for faculty and staff. These activities might include classes, workshops, distribution of materials, or individual or group counseling sessions. 12. During the past 12 months, has your district provided funding for or offered activities for faculty and staff related to the following? Yes No a. Nutrition education 1 2 b. Weight management 1 2 c. Worksite safety education 1 2 d. Emergency preparedness 1 2 e. Cardiopulmonary resuscitation or CPR education 1 2 f. Stress management education 1 2 g. Pre- or post-natal education 1 2 h. Conflict resolution education 1 2 i. Asthma management education 1 2 j. Diabetes management education 1 2 k. Tobacco use cessation 1 2 l. Physical activity and fitness counseling 1 2 m. Counseling for emotional disorders, such as anxiety or depression 1 2 n. Crisis intervention for personal problems 1 2 13. During the past 12 months, has your district provided funding for or offered the following services for faculty and staff? Yes No a. Referrals for child care or elder care 1 2 b. Referrals for oral health problems 1 2 c. Immunizations, not including those offered through health insurance, for example flu vaccines 1 2 d. Identification of or referrals for physical, sexual, or emotional abuse 1 2 14. During the past 12 months, has your district provided funding for or offered any physical activity programs for faculty and staff, such as aerobics classes, basketball leagues, or walking or jogging clubs? Yes 1 No 2 The next question asks about school facilities or equipment that could be used for physical activity and might be made available to faculty and staff. This would include any school facilities or equipment such as gyms, cafeterias, swimming pools, weight-lifting equipment, or cardiovascular exercise equipment. 15. Has your district adopted a policy stating that indoor or outdoor school facilities or equipment that could be used for physical activity will be made available for faculty and staff to use? Remember, we are talking about facilities or equipment that are available to faculty and staff because they work in your district’s schools. Do not consider facilities or equipment that are available to all residents of a community. Yes 1 No 2 Next I’d like to ask you about Employee Assistance Programs, or EAPs. EAPs provide services designed to assist employees experiencing personal or social problems that can impact work performance, physical health, or overall well-being. 16. During the past 12 months, has your district provided funding for or offered an Employee Assistance Program, or EAP, for faculty and staff? Yes 1 No 2 The next questions ask about health risk appraisals. A health risk appraisal is a questionnaire used to assess self-reported risk factors, such as smoking and physical inactivity. Some people may refer to this as a health risk survey. 17. During the past 12 months, has your district provided funding for or offered health risk appraisals for faculty and staff? Yes 1 No 2-->SKIP TO THE INTRODUCTION TO Q20 18. During the past 12 months, if the health risk appraisal identified individual problems, were follow-up services or referrals offered? Yes 1 No 2 Health risk appraisal did not identify any problems 3 19. During the past 12 months, was information from health risk appraisals used to develop health promotion activities and services such as health screenings, health education, or health counseling for faculty and staff? Yes 1 No 2 The next question asks about off-site health promotion activities. 20. Do this district’s faculty and staff receive any subsidies or discounts for off-site health promotion activities, such as health club memberships, weight loss programs, or tobacco use cessation programs? Yes 1 No 2 IF Q11A-H ARE “NO”, Q12A-N ARE “NO”, Q13A-D ARE “NO”, Q14 IS “NO”, Q16 IS “NO”, Q17 IS “NO”, AND Q20 IS “NO”, SKIP TO Q28. The next questions ask about objectives that are considered when planning health promotion activities or services for faculty and staff. 21. When planning activities or services for faculty and staff, is consideration given to… Yes No a. Reducing the number of sick days used? 1 2 b. Reducing the use or cost of health insurance benefits? 1 2 c. Reducing the number of faculty and staff injuries? 1 2 d. Improving faculty and staff morale? 1 2 e. Creating an environment in which faculty and staff serve as “healthy” role models for students? 1 2 f. Attracting and retaining good faculty and staff? 1 2 g. Improving job performance? 1 2 h. Addressing the health needs of faculty and staff? 1 2 i. Creating a positive image in the community? 1 2 22. During the past two years, has your district assessed faculty and staff satisfaction with health promotion activities or services? Yes 1 No 2 The next question asks about incentives faculty and staff might receive for participation in health promotion activities. 23. During the past 12 months, has your district provided funding for any of the following incentives for faculty and staff participation in health promotion programs? Yes No a. Monetary incentives 1 2 b. Gifts 1 2 c. Paid time off 1 2 d. Health insurance premium discounts 1 2 e. Certificates or awards 1 2 f. Public recognition 1 2 The next questions ask about organizations or agencies that have helped provide the health promotion activities or services for school faculty and staff. 24. During the past 12 months, did each of the following organizations or agencies help provide the health promotion activities or services for school faculty and staff offered or funded by your district? Yes No a. A local health department 1 2 b. A local hospital 1 2 c. A mental health or social services agency 1 2 d. A university or medical school 1 2 e. A managed care organization 1 2 f. A health organization, such as the American Heart Association or the American Cancer Society 1 2 g. A local health or fitness club 1 2 h. A local business 1 2 25. Does someone in your district oversee or coordinate health promotion activities or services for faculty and staff throughout the district? Yes 1 No 2-->SKIP TO Q28 26. Are you this person? Yes 1 No 2 27a. During the past 12 months, have you or others who oversee or coordinate health promotion activities or services for faculty and staff at the district level worked on those activities with district-level health education staff? Yes 1 No 2 District does not have district-level health education staff 3 27b. What about with district-level physical education staff? Yes 1 No 2 District does not have district-level physical education staff 3 27c. What about with district-level health services staff? Yes 1 No 2 District does not have district-level health services staff 3 27d. What about with district-level mental health or social services staff? Yes 1 No 2 District does not have district-level mental health or social services staff 3 27e. What about with district-level nutrition or food service staff? Yes 1 No 2 District does not have district-level nutrition or food service staff 3 28. Has your district adopted a policy stating that each school will have someone to oversee or coordinate health promotion activities or services for their faculty and staff? Yes 1 No 2 Thank you very much for taking the time to participate in this study. If you would like more information about this study or would like clarification of any questions in this survey, please call 800-287-1815. Planning and Coordination Faculty and Staff Health Promotion District Questionnaire – Public Use Version 2 Faculty and Staff Health Promotion District Questionnaire – Public Use Version 7 Faculty and Staff Health Promotion District Questionnaire – Public Use Version Planning and Coordination Special Instructions Health Insurance Health Insurance Faculty and Staff Health Promotion District Questionnaire – Public Use Version 8 Required Examinations and Screenings Required Examinations and Screenings Required Examinations and Screenings Required Examinations and Screenings Health Promotion Activities and Services Health Promotion Activities and Services Health Promotion Activities and Services Employee Assistance Programs Health Risk Appraisals Off-site Health Promotion Activities Planning and Coordination Planning and Coordination Planning and Coordination Planning and Coordination Planning and Coordination