M Survey

OMB #: 0925-0542

Expiration Date: 4-30-08

FORM M

Brain Power!

The NIDA Junior Scientists Program

Grades 4–5

Survey for Control Group Teachers

As part of your agreement to participate as a teacher in the control group of the Brain Power! curriculum intervention, please take a few minutes to fill out this brief questionnaire. Thank you.

This section includes questions about your background and experience.

1. Including this year, how long have you been teaching? (Please circle one response for each item.)

Number of years	0–5 years	6–11 years	12–17 years	18–23 years	24 years or more
a. Teaching	1	2	3	4	5
b. Teaching current grade	1	2	3	4	5
c. Teaching at this school	1	2	3	4	5

2. Have you ever used the Brain Power! The NIDA Junior Scientists curriculum in any of the following grades during the last 5 years of your teaching career (or during your entire teaching career, if less than 5 years)? (Please circle one response for each item.)

Yes No

a. Kindergarten 1 2

b. First grade 1 2

c. Second grade 1 2

d. Third grade 1 2

e. Fourth grade 1 2

f. Fifth grade 1 2

g. Sixth grade 1 2

h. Seventh grade 1 2

i. Eighth grade 1 2

3. What is your certification status? (Please circle one.)

Certified 1

Probationary (including those with temporary
teaching certification) 2 (Skip to Question 5)

Emergency 3 (Skip to Question 5)

Other (please specify) 4 (Skip to Question 5)

4. In what area(s) are you certified? (Please circle all that apply.)

a. Elementary education 1

b. Early childhood education 2

c. Reading 3

d. Special education 4

e. Bilingual education 5

f. Other (please specify) 6

5. Are you:

Male? 1

Female? 2

6. What is your age? (Please circle one.)

Less than 25 1

25–35 2

36–45 3

46–55 4

56–65 5

65 or older 6

7. What is the highest degree you’ve received? (Please circle one.)

Bachelor’s degree 1

Bachelor’s degree plus additional graduate course credit(s) 2

Master’s degree 3

Master’s degree plus additional graduate course credit(s) 4

Professional degree 5

This section includes questions about your classroom instruction and about your existing knowledge of neurobiology.

8. Have you taught or do you plan to teach the following topics during this school year (2005/2006)? (Please circle one on each line.)

Topic	No, have not taught and do not plan to teach	Yes, have already taught	Yes, plan to teach later
a. Differences between legal and illegal drugs	1	2	3
b. How drugs are presented in the media	1	2	3
c. The five major parts of the brain and their functions	1	2	3
d. Different techniques for studying the brain (e.g., PET scan, MRI)	1	2	3
e. Nerve cell communication (neurotransmission)	1	2	3
f. How stimulants like caffeine, nicotine, and Ritalin affect the brain and nervous system	1	2	3
g. How alcohol, marijuana, and inhalants affect the brain and nervous system………	1	2	3
h. Definition of addiction and how addiction relates to drug abuse………………………	1	2	3

9. If you answered Yes to any of the topics in Question 9 a–h, approximately how much time did

you spend (or do you plan to spend) teaching each over the course of this school year? (Please circle one.)

1–3 hours 1

4–6 hours 2

7–8 hours 3

More than 8 hours 4

10. How would you rate your current knowledge in each of the following topics? (Circle one on each line.)

Topic	Modest or very little amount	Fair or moderate amount	Significant or sizable amount
a. Names of major regions of the brain	1	2	3
b. Specific responsibilities of each brain region	1	2	3
c. The parts of a neuron and their individual functions	1	2	3
d. The process of neurotransmission	1	2	3
e. The role of neurotransmitters	1	2	3
f. The effect of drugs on neurotransmitters	1	2	3
g. The effects of stimulants such as caffeine, nicotine, and Ritalin on the brain and nervous system	1	2	3
h. The effects of alcohol on the brain and nervous system	1	2	3
i. The effects of marijuana on the brain and nervous system	1	2	3
j. The effects of inhalants on the brain and nervous system	1	2	3
k. Characteristics of and treatment for addiction	1	2	3

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