Att E - Indicators for School Health Programs: Coordinated School Health Programs

Form Approved

OMB No.: 0920-0672

Expiration Date: xx/xx/xxxx

Coordinated School Health Programs (CSHPs) and

Physical Activity, Nutrition, and Tobacco Use (PANT)

Fiscal Year: March 1, 2011 – February 29, 2012

Division of Adolescent and School Health

Funding Opportunity Number: CDC-RFA-DP08-801:

Improving Health and Educational Outcomes of Young People

Instructions

This set of indicators describes the performance in nine areas of your project to support Coordinated School Health Programs (CSHP): (1) introduction; (2) joint activities of the State Education Agency and State Health Agency; (3) policy; (4) curricula and instruction; (5) health promotion and environmental approaches; (6) external collaboration; (7) reducing health disparities among populations of youth at disproportionate risk for chronic disease; and (8) other information and activities.

A glossary of terms is included at the end of the Indicators.

Activities to be reported are those for which any amount of DASH funds were used, or in which staff time to develop, implement, or evaluate activities was funded in any amount by DASH. These questions apply only to priority health risk behaviors addressed in Funding Opportunity Announcement DP08-801, excluding supplementary funding.

Please answer each question carefully and accurately. Not all items or activities may reflect the emphasis of your plan for the current fiscal year, and therefore you may report that you have not performed activities in those areas by entering zeros. Additionally, you may not currently collect information about some activities. If so, please leave the answer blank. Please be sure to include materials for those items requesting attachments.

Public reporting burden of this collection of information is estimated to average 10 hours per response, including the time 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 current 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, MS-D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0672).

F

Indicators for School Health Programs

or further questions or assistance with completing this report,

p

National Center for Chronic Disease Prevention and Health Promotion

lease contact your CDC project officer.

Division of Adolescent and School Health

I. INTRODUCTION

1. How many school districts do you have in your state? ______ TOTAL

2. How many schools do you have in your state? ______ TOTAL

3. How many regional support units do you have in your state? ______ TOTAL

4. During FY 2011, did your project have any funding other than DASH funding for state-level activities to support the coordination of school health programs? (May include federal, state, and/or private funding)

 YES

 NO

5. During FY 2011, did your project obtain any additional federal, state, or private funding for state-level CSHP activities to support the coordination of school health programs because of your DASH activities and plans?

 YES

 NO

II. JOINT ACTIVITIES OF THE STATE EDUCATION AGENCY (SEA)

AND STATE HEALTH AGENCY (SHA)

6. During FY 2011, did the SEA and SHA collaborate on the following activities?

		YES	NO
A.	Market or communicate about CSHP (i.e. create awareness or interest in new or on-going CSHP with the general public or partners)		
B.	Develop or implement CSHP activities		
C.	Develop or change CSHP policy (e.g., statute, model policy, etc.)		
D.	Share CSHP resources (e.g., databases, information, programs, etc.)		
E.	Provide CSHP professional development		
F.	Evaluate CSHP activities		
G.	Seek additional funding for CSHP activities		
H.	Develop or implement PANT activities		
I.	Develop or change PANT policy		
J.	Share PANT resources		
K.	Provide PANT professional development		
L.	Evaluate PANT activities		
M.	Seek additional funding for PANT activities		

III. POLICY

7. During FY 2011, which of the following activities did your project conduct to support district or school staff with regard to established or model policies, policy guidance, or other policy materials on the following topics? (Mark all that apply.)

	CSHP	PHYSICAL ACTIVITY	PHYSICAL EDUCATION	NUTRITION	TOBACCOUSE PREV.
A. DEVELOP (or revise or assist in developing) a model policy, policy guidance, or other policy materials					
B. DISTRIBUTE established or model policies, policy guidance, or other policy materials to inform policy direction					
C. Provide PROFESSIONAL DEVELOPMENT on established or model policies, policy guidance, or other policy materials to inform policy direction					
D. Provide TECHNICAL ASSISTANCE on established or model policies, policy, guidance, or other policy materials to inform policy direction					
E. None of the above					

8. During FY 2011, if your project provided professional development to district or school staff on established or model policies, policy guidance, or other policy materials, indicate the total across all topic areas:

1. Number of professional development events focusing on policy issues ____

2. Number of participants in professional development events focusing on policy issues _____

C. Number of professional development events focusing on policy issues for which you conducted follow-up support _______

9. During FY 2011, if your project provided PROFESSIONAL DEVELOPMENT or TECHNICAL ASSISTANCE to district or school staff on established or model policies, policy guidance, or other policy materials, provide the total:

1. Number of schools reached directly _____

2. Number of districts reached directly _____

3. Number of regional support units reached directly _____

10. During FY 2011, did your project assist district or school staff in policy development or policy implementation on the following topics? (Assistance to districts or schools may be through distributing materials on policy, professional development, or providing technical assistance.)

  

	Coordinated School Health Programs	YES	NO
1.	Developing coordinated school health policy		
2.	Integrating the school health objectives into the overall school improvement plan (CSH SLIM #9)		
3.	Creating, improving, or maintaining school health councils and school health teams ( CSH SLIM #2)		
4.	Developing policies regarding qualifications for and duties of local district CSHP coordinators		
5.	Implementing policies regarding qualifications for and duties of local district CSHP coordinators		
6.	Developing wellness policies		
7.	Implementing wellness policies		
	Health Education	YES	NO
1.	Implementing or revising time or graduation requirements for K-12 health education classes		
2.	Implementing or revising certification requirements for teachers of health education (CSH SLIM #5)		
3.	Providing nutrition education for students (Nutrition SLIM #5)		
4.	Incorporating physical activity as required content within health education (PE/PA SLIM #6)		
5.	Providing tobacco-use prevention education for students (Tobacco SLIM #3)		
6.	Providing health education teachers with goals, objectives, and expected outcomes for health education; a chart describing the annual scope and sequence of instruction; plans for how to assess student performance; written health education curricula (CSH SLIM #6)		
	Physical Education Policies	YES	NO
1.	Implementing or revising policies to increase the number of minutes dedicated to physical education for elementary and middle school students		
2.	Implementing or revising policies to increase the number of minutes dedicated to physical education for high school students		
3.	Implementing or revising policies to establish graduation requirements for physical education		
4.	Implementing or revising certification requirements for physical education teachers (PA/PE SLIM #2)		
5.	Prohibiting use of physical activity as a punishment during physical education class		
6.	Prohibiting exemptions or waivers for physical education participation for participation in other activities (PE/PA SLIM #4)		
7.	Establishing class size requirements for physical education		
8.	Implementing or revising physical education curriculum requirements to be based on national or state standards		
9.	Providing physical education teachers with goals, objectives, and expected outcomes for physical education; a chart describing the annual scope and sequence of instruction; plans for how to assess student performance; written physical education curricula (PE/PA SLIM #3)		

D.	Physical Activity Policies	YES	NO
1.	Providing daily recess for elementary school students		
2.	Increasing physical activity opportunities during school-day breaks		
3.	Prohibiting denying recess as a punishment		
4.	Providing opportunities for after-school physical activity and/or intramurals and/or interscholastic sports (PE/PA SLIM #5)		
5.	Allowing children or adolescents to use school indoor physical activity or athletic facilities for community-sponsored physical activity classes or lessons outside of school hours or when school is not in session (PE/PA SLIM #7)		
E.	Healthy Eating Policies	YES	NO
1.	Promoting access to and participation in school meals for all students		
2.	Regulating nutritional quality of all foods and beverages provided on school campuses		
3.	Limiting student access to unhealthy foods or beverages outside of the federally regulated school meals program (Nutrition SLIM #1)		
4.	Requiring nutrition standards for all foods or beverages provided outside of the federally regulated school meals program (Nutrition SLIM #1)		
5.	Promoting school fund-raising campaigns that consist of non-food items or healthful foods		
6.	Implementing or revising classroom guidelines that discourage the use of food as a reward or punishment		
7.	Actively promoting fruits and vegetables, whole grain foods, and low/non-fat dairy products to students		
8.	Prohibiting all forms of advertising and promotion (e.g., contests and coupons) of less nutritious foods and beverages on school property (Nutrition SLIM #6)		
9.	Promoting fruits or non-fried vegetables in vending machines, school stores, and during celebrations when foods and beverages are offered (Nutrition SLIM #2)		
F.	Tobacco Use Prevention Policies	YES	NO
1.	Prohibiting use of tobacco products by students, staff, parents, and visitors on school property, in school vehicles, and at school-sponsored functions away from school property, applicable 24 hours a day and seven days a week (Tobacco SLIM #1)		
2.	Prohibiting tobacco advertising in school buildings, at school functions, or in school publications		
3.	Providing tobacco-use cessation services to faculty, staff, and students through direct service at school or arrangements with providers not on school property (Tobacco SLIM #5)		
4.	Enforcing tobacco-use prevention policies (Tobacco SLIM #2)		
G.	Other	YES	NO
1.	Other policy topic		
	Specify _____________________________________

IV. CURRICULA & INSTRUCTION

11. During FY 2011, which of the following activities did your project conduct to support district or school staff with regard to standards, curriculum frameworks, instructional strategies, or other guidance on the following topics? (Mark all that apply.)

	PHYSICAL EDUCATION	HEALTH EDUCATION
		PHYSICAL ACTIVITY	NUTRITION	TOBACCO USE PREV.
A. DEVELOP (or revise or assist in developing) standards, curriculum frameworks, instructional strategies, or other guidance				
B. DISTRIBUTE standards, curriculum frameworks, instructional strategies, or other guidance				
C. Provide PROFESSIONAL DEVELOPMENT on standards, curriculum frameworks, instructional strategies, or other guidance			 Nutrition SLIM #4	 Tobacco SLIM #6
D. Provide TECHNICAL ASSISTANCE on standards, curriculum frameworks, instructional strategies, or other guidance				
E. None of the above				

12. During FY 2011, if your project provided PROFESSIONAL DEVELOPMENT to district or school staff on standards, curriculum frameworks, instructional strategies, or other guidance, indicate the total across all of the topic areas:

1. Number of professional development events focusing on curricula ____

2. Number of participants in professional development events focusing on curricula _____

C. Number of professional development events focusing on curricula for which you conducted follow-up support _______

13. During FY 2011, if your project provided PROFESSIONAL DEVELOPMENT or TECHNICAL ASSISTANCE to district or school staff on standards, curriculum frameworks, instructional strategies, or other guidance, provide the total:

1. Number of schools reached directly _____

2. Number of districts reached directly _____

3. Number of regional support units reached directly _____

14. During FY 2011, if your project provided PROFESSIONAL DEVELOPMENT to district or school staff on physical education or physical activity, did you address the following topics? (PE/PA SLIM #6)

		YES	NO
A.	Physical, psychological, or social benefits or physical activity		
B.	Health-related fitness (i.e., cardiorespiratory endurance, muscular endurance, muscular strength, flexibility, and body composition)		
C.	Phases of a workout (i.e., warm-up, workout, cool-down)		
D.	How much physical activity is enough (i.e., determining frequency, intensity, time, and type of physical activity)		
E.	Developing an individualized physical activity plan		
F.	Monitoring progress toward reaching goals in an individual physical activity plan		
G.	Overcoming barriers to physical activity		
H.	Decreasing sedentary activities (e.g., television viewing)		
I.	Opportunities for physical activity in the community		
J.	Preventing injury during physical activity		
K.	Weather-related safety (e.g., avoiding heat stroke, hypothermia, and sunburn while physically active)		
L.	Dangers of using performance-enhancing drugs (e.g., steroids)		

15. During FY 2011, if your project provided PROFESSIONAL DEVELOPMENT to district or school staff on health education focusing on nutrition, did you address the following topics? (Nutrition SLIM #5)

		YES	NO
A.	Benefits of healthy eating		
B.	Food guidance using MyPyramid		
C.	Using food labels		
D.	Balancing food intake and physical activity		
E.	Eating more fruits, vegetables, and whole grain products		
F.	Choosing foods that are low in fat, saturated fat, and cholesterol		
G.	Using sugars in moderation		
H.	Using salt and sodium in moderation		
I.	Eating more calcium-rich foods		
J.	Food safety		
K.	Preparing healthy meals and snacks		
L.	Risks of unhealthy weight control practices		
M.	Accepting body size differences		
N.	Signs, symptoms, and treatment for eating disorders		

16. During FY 2011, if your project provided PROFESSIONAL DEVELOPMENT to district or school staff on health education focusing on tobacco use prevention, did you address the following topics? (Tobacco SLIM #3)

		YES	NO
A.	Identifying tobacco products and the harmful substances they contain		
B.	Identifying short and long-term health consequences of tobacco use		
C.	Identifying legal, social, economic, and cosmetic consequences of tobacco use		
D.	Understanding the addictive nature of nicotine		
E.	Effects of tobacco use on athletic performance		
F.	Effects of second-hand smoke and benefits of a smoke-free environment		
G.	Understanding the social influences on tobacco use, including media, family, peers, and culture		
H.	Identifying reasons why students do and do not use tobacco		
I.	Making accurate assessments of how many peers use tobacco		
J.	Using interpersonal communication skills to avoid tobacco use (e.g., refusal skills, assertiveness)		
K.	Using goal-setting and decision-making skills related to not using tobacco		
L.	Finding valid information and services related to tobacco-use prevention and cessation		
M.	Supporting others who abstain from or want to quit using tobacco		
N.	Supporting school and community action to support a tobacco-free environment		
O.	Identifying harmful effects of tobacco use on fetal development		

17. During FY 2011, which of the following activities did your project conduct related to the Physical Education Curriculum Analysis Tool (PECAT) or the Health Education Curriculum Analysis Tool (HECAT)? (Mark all that apply.)

	PECAT	HECAT
A. DISTRIBUTE the tool		
B B. Provide PROFESSIONAL DEVELOPMENT on the tool		
C. Provide TECHNICAL ASSISTANCE on the tool		
D. None of the above		

18. During FY 2011, if your project provided PROFESSIONAL DEVELOPMENT to district or school staff on PECAT and/or HECAT, indicate the total across both tools:

1. Number of professional development events ______

2. Number of participants in professional development events _____

C. Number of professional development events focusing on curricula for which you conducted follow-up support ______

19. During FY 2011, if your project provided PROFESSIONAL DEVELOPMENT or TECHNICAL ASSISTANCE to district or school staff on PECAT and/or HECAT, provide the total:

1. Number of schools reached directly _____

2. Number of districts reached directly _____

3. Number of regional support units reached directly _____

20. During FY 2011, did your project provide guidance to district or school staff on following a written health education curriculum that addresses the following skills? (CSH SLIM #7)

		YES	NO
A.	Comprehending concepts related to health promotion and disease prevention to enhance health		
B.	Analyzing the influence of family, peers, culture, media, technology, and other factors on health behaviors		
C.	Accessing valid information and products and services to enhance health		
D.	Using interpersonal communication skills to enhance health and avoid or reduce health risks		
E.	Using decision-making skills to enhance health		
F.	Using goal-setting skills to enhance health		
G.	Practicing health-enhancing behaviors to avoid or reduce risks		
H.	Advocating for personal, family, and community health		

V. HEALTH PROMOTION AND ENVIRONMENTAL APPROACHES

21. During FY 2011, which of the following activities did your project conduct to support district or school staff with regard to model programs, guidance, implementation strategies, or other resource materials (not to include policy materials) to coordinate school health programs or promote PANT on the following topics? (Mark all that apply.)

	District- Level School Health Councils	School- Level School Health Councils	School Health Coordinators	Securing Administrative Support for CSHP	Collaborating with Community Partners
A. DEVELOP (or revise or assist in developing) model programs, guidance, implementation strategies, or other resource materials					
B. DISTRIBUTE model programs, guidance, implementation strategies, or other resource materials					
C. Provide PROFESSIONAL DEVELOPMENT on model programs, guidance, implementation strategies, or other resource materials					
D. Provide TECHNICAL ASSISTANCE on model programs, guidance, implementation strategies, or other resource materials					
E. None of the above					

22. During FY 2011, if your project provided PROFESSIONAL DEVELOPMENT to district or school staff on model programs, guidance, implementation strategies, or other resource materials (not to include policy materials) to coordinate school health programs or promote PANT, provide the total:

1. Number of professional development events ______

2. Number of participants in professional development events _____

3. Number of professional development events focusing on curricula for which you conducted follow-up support ______

23. During FY 2011, if your project provided PROFESSIONAL DEVELOPMENT or TECHNICAL ASSISTANCE activities you provided to district or school staff on model programs, guidance, implementation strategies, or other resource materials (not to include policy materials) to coordinate school health programs or promote PANT, provide the total:

1. Number of schools reached directly _____

2. Number of districts reached directly _____

3. Number of regional support units reached directly _____

24. During FY 2011, did your project conduct the following activities related to the School Health Index (SHI) tool to help schools assess, plan, or coordinate health programs? (Mark all that apply.) (CSH SLIM #3)

	YES	NO
A. DISTRIBUTE the SHI		
B. Provide PROFESSIONAL DEVELOPMENT on the SHI		
C. Provide TECHNICAL ASSISTANCE on the SHI		

25. During FY 2011, if your project provided PROFESSIONAL DEVELOPMENT to district or school staff on the School Health Index, provide the total:

1. Number of professional development events ______

2. Number of participants in professional development events _____

3. Number of professional development events focusing on curricula for which you conducted follow-up support ______

26. During FY 2011, if your project provided PROFESSIONAL DEVELOPMENT or TECHNICAL ASSISTANCE activities to district or school staff on the School Health Index, provide the total:

1. Number of schools reached directly _____

2. Number of districts reached directly _____

3. Number of regional support units reached directly _____

27. During FY 2011, did your project engage in any of the following activities to support district or school staff with regard to model programs, guidance, implementation strategies, or other resource materials (not to include policy materials) to promote physical activity through

• increasing physical activity opportunities during school-day breaks,

• adding daily recess to the school day in elementary schools,

• planning or implementing walk-to-school initiatives, or

• planning or implementing organized physical activity programs beyond physical education or competitive athletics (e.g., intramural or physical activity clubs, and other after school activities)?

		YES	NO
A.	DEVELOP model programs, guidance, implementation strategies, or other resource materials to promote physical activity		
B.	DISTRIBUTE model programs, guidance, implementation strategies, or other resource materials to promote physical activity		
C.	Provide PROFESSIONAL DEVELOPMENT on model programs, guidance, implementation strategies, or other resource materials to promote physical activity		
D.	Provide TECHNICAL ASSISTANCE model programs, guidance, implementation strategies, or other resource materials to promote physical activity		

28. During FY 2011, if your project provided PROFESSIONAL DEVELOPMENT to district or school staff on model programs, guidance, implementation strategies, or other resource materials (not to include policy materials) to promote physical activity, provide the total:

1. Number of professional development events ______

2. Number of participants in professional development events _____

3. Number of professional development events focusing on curricula for which you conducted follow-up support ______

29. During FY 2011, if your project provided PROFESSIONAL DEVELOPMENT or TECHNICAL ASSISTANCE to district or school staff on model programs, guidance, implementation strategies, or other resource materials (not to include policy materials) to promote physical activity, provide the total:

1. Number of schools reached directly _____

2. Number of districts reached directly _____

3. Number of regional support units reached directly _____

30. During FY 2011, did your project engage in any of the following activities to support district or school staff with regard to model programs, guidance, implementation strategies, or other resource materials (not to include policy materials) to promote healthy eating through

• improving nutritional quality of school meals,

• marketing healthy school meals, improving the nutritional quality of school food and beverages provided outside of school meals (e.g., vending machines and a la carte) (Nutrition SLIM #1), or

• marketing healthy school food and beverage choices provided outside of school meals (e.g., vending machines, classroom snacks, a la carte)?

		YES	NO
A.	DEVELOP model programs, guidance, implementation strategies, or other resource materials to promote healthy eating		
B.	DISTRIBUTE model programs, guidance, implementation strategies, or other resource materials to promote healthy eating		
C.	Provide PROFESSIONAL DEVELOPMENT on model programs, guidance, implementation strategies, or other resource materials to promote healthy eating		
D.	Provide TECHNICAL ASSISTANCE model programs, guidance, implementation strategies, or other resource materials to promote healthy eating		

31. During FY 2011, if your project provided PROFESSIONAL DEVELOPMENT to district or school staff on model programs, guidance, implementation strategies, or other resource materials (not to include policy materials) to promote healthy eating, provide the total:

1. Number of professional development events ______

2. Number of participants in professional development events _____

3. Number of professional development events focusing on curricula for which you conducted follow-up support ______

32. During FY 2011, if your project provided PROFESSIONAL DEVELOPMENT or TECHNICAL ASSISTANCE to district or school staff on model programs, guidance, implementation strategies, or other resource materials (not to include policy materials) to promote healthy eating, provide the total:

1. Number of schools reached directly _____

2. Number of districts reached directly _____

3. Number of regional support units reached directly _____

33. During FY 2011, did your project engage in any of the following activities to support district or school staff with regard to model programs, guidance, implementation strategies, or other resource materials (not to include policy materials) to promote tobacco use prevention?

		YES	NO
A.	DEVELOP model programs, guidance, implementation strategies, or other resource materials to promote tobacco use prevention		
B.	DISTRIBUTE model programs, guidance, implementation strategies, or other resource materials to promote tobacco use prevention		
C.	Provide PROFESSIONAL DEVELOPMENT on model programs, guidance, implementation strategies, or other resource materials to promote tobacco use prevention		
D.	Provide TECHNICAL ASSISTANCE model programs, guidance, implementation strategies, or other resource materials to promote tobacco use prevention		

34. During FY 2011, if your project provided PROFESSIONAL DEVELOPMENT to district or school staff on model programs, guidance, implementation strategies, or other resource materials (not to include policy materials) to promote tobacco use prevention, provide the total:

1. Number of professional development events ______

2. Number of participants in professional development events _____

3. Number of professional development events focusing on curricula for which you conducted follow-up support ______

35. During FY 2011, if your project provided PROFESSIONAL DEVELOPMENT or TECHNICAL ASSISTANCE to district or school staff on model programs, guidance, implementation strategies, or other resource materials (not to include policy materials) to promote tobacco use prevention, provide the total:

1. Number of schools reached directly _____

2. Number of districts reached directly _____

3. Number of regional support units reached directly _____

VI. EXTERNAL COLLABORATION

36. During FY 2011, in which of the following activities did your project COLLABORATE with external partners? (Mark all that apply.)

		CSHP	PHYSICAL ACTIVITY/ PHYSICAL EDUCATION	NUTRITION	TOBACCO USE PREV.
A.	Assessing policy				
B.	Developing (or revising, adapting, or assisting in developing) policy				
C.	Developing (or revising, adapting, or assisting in developing) exemplary curricula, health education standards, frameworks, instructional strategies, or other guidance				
D.	Developing a professional development infrastructure or designing, marketing, delivering, providing follow-up support, or evaluating professional development				
E.	Providing technical assistance				
F.	Identifying populations at disproportionate risk of acquiring HIV				
G.	Reaching populations at disproportionate risk of acquiring HIV				
H.	Strategic planning				
I.	Communicating and marketing programs				
J.	Sharing data				
K.	Evaluation				
L.	None of the above				

37. During FY2011, did your project play an active role in changing regulations, policies, or laws affecting coordinated school health, physical activity, physical education, nutrition, or tobacco use prevention?

� YES

� NO  Skip to 38

If YES, what activities did you conduct?

� Informing proposed regulations, policies, or laws

• Working to introduce new regulations, policies, or laws

• Assisting with the implementation of new regulations, policies, or laws

38. During FY 2011, did your project COLLABORATE with students’ families or community members to develop, communicate information about, or implement policies and programs on tobacco-use prevention, physical activity, and nutrition and healthy eating? (CSH SLIM #4)

 YES

 NO Skip to 39

If YES, in which topic areas did you collaborate? (Mark all that apply.)

	Physical activity/physical education
	Nutrition and healthy eating
	Tobacco use prevention

39. During FY 2011, did your project receive professional development or technical assistance from any Non-Governmental Organization (NGO) partners funded by CDC?

 YES

 NO Skip to 40

If YES, enter the partners from who you received professional development or technical assistance:

A.______________________

B.______________________

C.______________________

D.______________________

VII. REDUCING HEALTH DISPARITIES AMONG POPULATIONS OF

YOUTH AT DISPROPORTIONATE RISK FOR CHRONIC DISEASE

40. During FY 2011, what kinds of data did your project review to identify youth at disproportionate risk for chronic disease related to physical inactivity, unhealthy dietary patterns, and tobacco use?

		PHYSICAL INACTIVITY	UNHEALTHY DIETARY PATTERNS	TOBACCO USE
A.	Youth Risk Behavior Survey (YRBS) data			
B.	Adequate Yearly Progress (AYP) data			
C.	Youth Tobacco Survey (YTS) data			
D.	Free and reduced-price lunch data			
E.	Youth morbidity and mortality data			
F.	Other state data			
G.	Other Specify__________________________			
H.	None of the above			

41. During FY 2011, which populations of youth did your project identify as being at disproportionate risk for chronic disease? (Mark all that apply.)

		PHYSICAL INACTIVITY	UNHEALTHY DIETARY PATTERNS	TOBACCO USE PREVENTION
A.	African-American youth			
B.	Hispanic/Latino youth			
C.	Native American/Alaskan Native youth			
D.	Youth in data-driven, high-risk geographic areas (e.g., zip codes, districts, rural areas)			
E.	Youth in low performing schools			
F.	Youth receiving free or reduced lunch			
G.	Other Specify__________________________			
H.	None of the above			

(If your project did NOT identify any populations of youth at disproportionate risk for chronic disease, skip to 47.)

42. During FY 2011, which of the following activities did your project conduct to increase the capacity of districts and schools to reach populations of youth at disproportionate risk for chronic disease? (Mark all that apply.)

 Partnering with agencies to deliver programs within school settings

 Partnering with agencies to deliver programs outside school settings

 Partnering with health agencies to provide health services to youth in or out of school settings

 Promoting student organizations that reach youth at disproportionate risk for chronic disease

 Providing programs and services that reach youth at disproportionate risk for chronic disease

 Other

Specify______________________________________________________

 None of these

43. During FY 2011, for the activities your project conducted to increase the capacity of districts and schools to reach populations of youth at disproportionate risk for chronic disease, which topics were included? (Mark all that apply.)

 Identifying strategies to increase youth involvement in programs and services

 Providing culturally or linguistically competent educational programs or services

 Understanding the needs of youth at disproportionate risk for chronic disease

 Building the skill of school administrators, faculty, or staff to address youth at disproportionate risk for chronic disease

 Reaching families of youth at disproportionate risk for chronic disease

 Other

Specify______________________________________________________

 None of these

44. During FY 2011, did your project provide PROFESSIONAL DEVELOPMENT to district or school staff that focused on improving the quality of activities that reach populations of youth at disproportionate risk for chronic disease?

 YES

• NO Skip to 45

If YES, provide the total:

A. Number of professional development events that focused on improving the quality of activities for populations of youth at disproportionate risk ______

B. Number of participants in professional development events that focused on improving the quality of activities for populations of youth at disproportionate risk ____

C. Number of professional developments events that focused on improving the quality of activities for populations of youth at disproportionate risk for which you conducted follow-up support ______

45. During FY 2011, did your project provide TECHNICAL ASSISTANCE to district or school staff that focused on reaching populations of youth at disproportionate risk for chronic disease?

 YES

 NO

46. During FY 2011, if your project provided PROFESSIONAL DEVELOPMENT or TECHNICAL ASSISTANCE to district or school staff that focused on reaching populations of youth at disproportionate risk for chronic disease, provide the total:

1. Number of schools reached directly _____

2. Number of districts reached directly _____

3. Number of regional support units reached directly _____

VIII. OTHER INFORMATION & ACTIVITIES

47. During FY 2011, did your CSH project increase the capacity of districts and schools to provide parents and families health information to increase parent and family knowledge of tobacco-use prevention, physical activity, and nutrition and healthy eating? (CSH SLIM #8)

 YES

• NO

48. During FY 2011, did you provide PRE-SERVICE LEARNING events that focused on policy, curriculum, or environmental interventions related to physical activity, physical education, nutrition, tobacco-use prevention, health education, or CSHP?

 YES

• NO Skip to 49

If YES:

A. How many pre-service learning events did you provide focused on policy, curriculum, or environmental interventions related to physical activity, physical education, nutrition, tobacco-use prevention, health education, or CSHP? _____________

B. Mark all the topics on which you provided pre-service learning events in FY 2011:

___ Physical activity

___ Physical education

___ Nutrition

___ Tobacco-use prevention

___ Health education

___ CSHP

___ Other

Specify___________________________________________

49. Do you currently have a way to document the distribution of print materials and provision of professional development (PD) and technical assistance (TA)?

 Yes

 No

 Unsure

50. How confident are you that you accurately:

			Completely confident	Somewhat confident	Not at all confident
A.	Determined when an event participant represented a school, a district, or a regional support unit				
B.	Calculated schools, districts, and/or regional support units reached				
C.	Used data to identify populations at disproportionate risk for chronic disease related to physical inactivity, unhealthy dietary patterns, and tobacco use				

51. Please provide information about any additional activities not captured by the questions above. In particular, please report on any additional activities to improve physical activity, nutrition, or tobacco-use prevention policies, curriculum, instruction, collaborations, or CSH at the local level and any activities for which you could not collect information on participants or recipients of materials.

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

52. Please provide any additional general comments or information in the space below.

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

____________________________________________________________________________________

thank you for your responses. please return the indicators.

GLOSSARY

Please refer to the following definitions when answering the questions:

COLLABORATE – Two or more partners actively engage in planning, implementing, and evaluating programs, practices, and policy activities with defined roles and responsibilities.

COORDINATED SCHOOL HEALTH PROGRAM (CSHP) – A coordinated school health program is a planned and organized set of courses, services, policies, and interventions designed to meet the health and safety needs of K-12 students. Schools promote optimal physical, emotional, social, and educational development of students by providing health education; physical education; health services; nutrition services; counseling, psychological and social services; and a healthy and safe environment; and by promoting parent/community involvement and staff wellness. A successful and well-coordinated school health program is characterized by administrators, teachers, and school board members who view health protection and promotion as an essential part of the school’s mission; a school health council comprised of school, family, and community representatives to ensure a planning process for continuous improvement; a school health coordinator responsible for organizing and managing the school health program; and school staff who help plan and implement a full array of school health courses, services, policies, and interventions.

COORDINATION – the regulation of diverse elements into an integrated and harmonious operation.

CSHP STATE-WIDE COALITION – A confederation of organizations with similar goals that agree to work together toward a common goal. People who serve on coalitions, whether professional or volunteer, have obligations to the organization they represent as well as to the coalition.

CURRICULUM – An educational plan incorporating a structured, developmentally appropriate series of intended learning outcomes and associated learning experiences for students; generally organized as a related combination or series of school-based materials, content, and events.

DEVELOPMENT – The process of bringing into being, making active, available, or effective, CSHP-related materials, plans, policies, or activities.

DISTRIBUTE – Putting materials in the hands of appropriate personnel. Distribution may occur in response to requests for materials or through proactive sharing of information.

DISTRICT – An education agency at the local level that exists primarily to operate public schools or to contract for public school services. Synonyms include local basic administrative unit, local education agency, parish, independent school districts, etc.

ENVIRONMENTAL APPROACHES – Those policies and programs that are intended to affect physical surroundings and the psychosocial climate and culture of the school. Environmental approaches include policies, programs, and services that reinforce school health education and physical education curricula as well as contribute to health outcomes for students and staff.

EXTERNAL AGENCY PARTNERS – Agencies, organizations, and groups outside your own agency with which you collaborate or associate to further the goals of your CSHP project.

FISCAL YEAR (FY) – March 1, 2011 to February 29, 2012, the budget period for the cooperative agreement.

FOLLOW-UP SUPPORT – Assistance provided to enhance participants’ abilities to use skills, tools and techniques learned through professional development offerings. Follow-up support leads to a more sustained effect than training alone by addressing challenges and sharing successes through a variety of media (e.g., e-mail, conference calls, webcasts, site visits).

FRAMEWORK – An outline or plan that presents both the content (e.g., important concepts, skills, and generalizations) and the process for developing curricula, instruction, and assessment.

GUIDANCE – A set of strategies that apply frameworks to develop policies, curricula, and instruction.

HEALTH EDUCATION – Includes planned, sequential materials, instructions, and educational experiences delivered in the classroom setting that provide students with opportunities to acquire the knowledge and skills necessary for making health promoting decisions and achieving health literacy. Quality health education is based on sound theories of development and behavior change or empirically supportive practices that result in increased knowledge and positive behavior change.

HEALTH EDUCATION CURRICULUM ANALYSIS TOOL (HECAT) – An assessment tool for examining school health education curricula to determine how closely they align with the National Health Education Standards and CDC’s Characteristics of Effective Health Education Curricula. The HECAT helps school districts conduct a clear, complete, and consistent analysis of health education curricula. The HECAT results can help schools select or develop appropriate and effective health education curricula and improve the delivery of health education.

HEALTHY EATING – Eating behaviors that promote health, growth, and intellectual development; prevent immediate nutrition-related health problems; and reduce risks for long-term chronic disease (e.g., coronary heart disease, cancer, and stroke). Healthy eating behaviors include a diet consistent with recommendations from the Dietary Guidelines for Americans http://www.health.gov/dietaryguidelines/.

IMPLEMENTATION – To put into effect or accomplish plans, policies, or activities related to CSHP projects.

MATERIALS – Resources including written materials (e.g., curricula, training materials, and pamphlets); audio visual materials (e.g., motion pictures and video tapes); pictorials (e.g., posters and similar educational materials using photographs, slides, drawings, or paintings); and electronic resources (e.g., Web sites, PDF files, and PowerPoint files).

MODEL POLICY – Model policies provide a framework to assist school officials in developing their own state or local policies. They are written as statements of best practice which can be adapted to fit local circumstances. Model policies reflect state-of-the-art, scientifically reliable information on what constitutes effective school health programs and the expert opinions of many reviewers. Included in model policies are excerpts or references to actual national, state, and local policies; a purpose or goals; rationale; and definitions.

MODEL PROGRAM – A packaged, promising, evidence-based or science-based program that results in positive outcomes.

NUMBER OF DISTRICTS REACHED DIRECTLY – A district is reached directly when one or more district level staff receives materials, training, or assistance from personnel funded by your CSHP project. Each district reached is counted only once as being reached for a particular topic regardless of the number of district staff from that district are reached or the number of times district staff are reached.

NUMBER OF REGIONAL SUPPORT UNITS REACHED DIRECTLY – A regional support unit is reached directly when one or more regional support unit staff receives materials, training, or assistance from personnel funded by your CSHP project. Each regional support unit reached is counted only once as being reached for a particular topic regardless of the number of regional support unit staff from that regional support unit are reached or the number of times regional support unit staff are reached.

NUMBER OF SCHOOLS REACHED DIRECTLY – A school is reached directly when one or more school staff receives materials, training, or assistance from personnel funded by your CSHP project. Each school reached is counted only once as being reached for a particular topic regardless of the number of school staff from that school are reached or the number of times school staff are reached.

NUTRITION – The science or practice of taking in and utilizing foods.

PHYSICAL ACTIVITY – Any bodily movement produced by skeletal muscles which results in caloric expenditure.

PHYSICAL ACTIVITY, NUTRITION, AND TOBACCO-USE PREVENTION (PANT) PROJECT – Any activities or personnel that are funded in part or in whole, through funding opportunity announcement DP08-801 funds for improving health and education outcomes of young people through CSHP with a focus on physical activity, nutrition, and tobacco-use prevention. May include the work of contract staff.

PHYSICAL EDUCATION – An academic curricular area that implements physical education curricula and instruction that emphasizes enjoyable participation in physical activity and that helps students develop the knowledge, attitudes, motor skills, behavioral skills, and confidence needed to adopt and maintain physically active lifestyles.

PHYSICAL EDUCATION CURRICULUM ANALYSIS TOOL (PECAT) – A tool for analyzing written physical education curricula to determine how closely they align with national standards for high-quality physical education. The PECAT helps school districts conduct a clear, complete, and consistent analysis of physical education curricula. PECAT results can help users enhance, develop, or select appropriate and effective physical education curricula for the delivery of quality physical education, which will improve the ability of schools to positively influence motor skills and physical activity behaviors among school-age youth.

PHYSICAL INACTIVITY – Physical inactivity is categorized as sedentary or insufficient physical activity.

POLICY – Official mandates adopted by an authoritative governing body (e.g., school district boards of education, the state school board, state legislature, or other district or state agencies) that affects the environment in schools or throughout the state. These include policies developed by your agency or based on model policies developed elsewhere. Policies include legal codes, rules, standards, administrative orders, guidelines, mandates, or resolutions. Policies can be adopted at the school, state, or federal level but are implemented at the school level.

PRE-SERVICE LEARNING – Pre-service learning provides pre-professionals serving youth (e.g., educators, nurses, counselors) with an understanding of the central concepts, tools of inquiry, and structures of relevant disciplines.

process evaluation – Collecting and analyzing data to determine who, what, when, where, and how much of program activities have been conducted. Process evaluation allows staff to assess how well the program has been implemented.

PROFESSIONAL DEVELOPMENT – The systematic process used to strengthen the professional knowledge, skills and attitudes of those who serve youth to improve the health, education, and well-being of youth. Professional development is consciously designed to actively engage learners and includes the planning, design, marketing, delivery, evaluation, and follow-up of professional development offerings (events, information sessions, and technical assistance).

PROFESSIONAL DEVELOPMENT EVENT – A set of skill-building processes and activities designed to assist targeted groups of participants in mastering specific learning objectives. Such events are delivered in an adequate time span (at least 3 hours) and may include curriculum and other training, workshops, conferences, and on-line or distance learning courses.

PROGRAM – A multi-faceted approach to decrease health risk behaviors that may include a combination of strategies such as one-on-one interventions, policy and climate changes, advocacy, peer interventions, mentoring programs, youth asset development, and outreach.

REGIONAL SUPPORT UNITS – A state-recognized agency or organization (e.g., universities, regional education support agencies, regional offices of education, regional training centers, teacher centers, county superintendent’s offices, etc.) that provides professional development, technical assistance, and educational materials to school districts and schools within the state.

SCHOOL – A division of the public school system consisting of students in one or more grades or other identifiable groups organized to give instruction of a defined type. One school may share a building with another school or one school may be housed in several buildings. Each school usually has an identification number assigned by the state department of education for tracking purposes. Public schools include charter schools, magnet schools, vocational schools, and alternative schools.

SCHOOL HEALTH COORDINATOR – The professional at the district or school level who is responsible for the management and the coordination of all school health policies, activities, and resources.

SCHOOL HEALTH COUNCIL – A school health council (SHC) guides school programming and enables collaborations between the school and the community to improve students' health and learning. Ideally, the council is comprised of representatives from each of the eight components of a coordinated school health program, as well as parents, students, and other community representatives involved in the health and well-being of students. SHCs establish goals for the school health program and specific priority health issues; facilitate health programming and services in the school and between the school and community; and advocate for effective health policies, programs, and services.

SCHOOL HEALTH INDEX – The School Health Index is a self-assessment and planning tool that enables those who use it to identify the strengths and weaknesses of school health promotion policies and programs; develop an action plan for improving student health; and involve teachers, parents, students, and the community in improving school policies and programs. More information on the School Health Index is available at: http://www.cdc.gov/healthyyouth/shi.

SLIM – The purpose of the School Level Impact Measures (SLIMs) is to provide education agencies with a common set of measures for reporting progress on the implementation of CDC recommended practices and programs.

STANDARDS – An established set of written expectations that describe what a student should know (knowledge) and be able to do (skills) as a result of the instruction provided for a particular subject (content area). Standards provide a framework for curriculum development and selection, instruction, and assessment.

• Health Education Standards are written expectations for what students should know and be able to do by grades 2, 5, 8, and 12 to promote personal, family, and community health. An abbreviated version of the National Health Education Standards, Second Edition and Performance Indicators for specific grade level groupings can be found at http://www.cdc.gov/healthyyouth/sher/standards.

• Physical Education Standards are written expectations for what students should know and be able to do by grades 2, 5, 8, and 12 as a result of a quality physical education program. An abbreviated version of the National Standards for Physical Education, Second Edition, can be found at http://www.aahperd.org/naspe/publications-nationalstandards.html.

STATE HEALTH AGENCY (SHA) – The department of state or territorial government responsible for public health policy, funding, monitoring, and training within that state or territory.

STRATEGIC PLAN – A program planning tool that provides a blueprint to strengthen program activities, address areas for improvement, and move the program forward to new accomplishments.

TECHNICAL ASSISTANCE – Tailored guidance to meet the specific needs of a site or sites through collaborative communication between a specialist and the site(s). Assistance takes into account site-specific circumstances and culture and can be provided through phone, mail, e-mail, Internet, or in-person meetings.

TOBACCO USE – May be defined as the consumption of tobacco or tobacco-related products. Tobacco is predominantly consumed by inhalation of the smoke produced by items such as cigarettes, cigars, cigarillos, pipes, bidis, and kreteks. It is also consumed in the form of smokeless tobacco products, such as snuff or chewing tobacco. This smokeless consumption may occur by directly inhaling a prepared tobacco leaf product into the nostrils, or by sucking and/or chewing a prepared tobacco leaf product.

TOBACCO-USE PREVENTION – Interventions that prevent or delay the initiation of tobacco use or reduce the prevalence of tobacco use, including tobacco-use cessation. Interventions may target individuals or groups of youth, in terms of policy and/or environmental changes and may occur in schools or in partnership with community organizations. Tobacco-use prevention efforts may include activities designed to eliminate exposure to secondhand smoke.

UNHEALTHY DIETARY PATTERNS – Eating behaviors characterized by food intake that is typically high in fat, low in fiber, and low in fruits and vegetables, and are associated with increased risks for long-term chronic disease (e.g., coronary heart disease, cancer, and stroke).

YOUTH AT DISPROPORTIONATE RISK FOR CHRONIC DISEASE – Populations of youth for whom the incidence, prevalence, mortality, and burden of chronic disease and other related adverse health conditions, many of which result from health-related behaviors that are established during childhood and adolescence, are greater than in a comparison population. Populations can be defined by race or ethnicity, gender, education or income, disability, geographic location (i.e., rural or urban), or sexual orientation.