23 Faculty and Staff Health Promotion School Questionnaire

Form Approved

OMB No: 0920-0445

Expiration Date: xx/xx/xxxx

Faculty and Staff Health Promotion
School Questionnaire

10 January 2011

§

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).

Faculty and Staff Health Promotion
School Questionnaire

Questions

Health Insurance 1–4

Required Examinations and Screenings 5–13

Health Promotion Activities and Services 14–19

Employee Assistance Programs 20

Health Risk Appraisals 21

Off-site Health Promotion Activities 22

Planning and Coordination 23–32

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 PERSONAL INTERVIEWING TECHNOLOGY. 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, AND 4) PERFORM OTHER USEFUL FUNCTIONS. THE PROGRAMMING SPECIFICATIONS FOR THE INTERVIEW ARE NOT INCLUDED IN THIS PRINTED VERSION OF THE QUESTIONNAIRE.

1. What is your job title at the school? (In which role do you spend more time?)

1) Principal 2) Asst. Principal/Other School Administrator 3) School Secretary 4) Physical Ed Teacher 5) Athletic Director 6) Health Ed Teacher 7) Other Teacher 8) Food Service Manager 9) Commercial Food Service Provider 10) Other School Food Service Staff

11) School Counselor 12) Social Worker 13) Psychologist 14) Other Mental Health/ Social Services Provider 15) Nurse 16) Health Aide 17) Physician 18) Other Health Services Provider 19) SBHC Health Services Staff 20) SBHC Mental Health/ Social Services Staff 50) Other Staff

During this interview, I will ask about health promotion activities or services that are offered to your school’s faculty and staff because they work for your school. 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 school faculty and staff experiencing problems that can impact job performance, physical health, or overall well-being.

Please include those activities or services offered by your state, district, school, or anyone outside the school system. If I ask you about things that do not apply to your school or that your school does not do, please bear with me.

IF THIS SCHOOL IS A PUBLIC SCHOOL, SKIP TO THE INTRODUCTION TO Q14. IF THIS SCHOOL IS A PRIVATE SCHOOL, CONTINUE TO THE INTRODUCTION TO Q2.

The first questions ask about health insurance that may be offered by your school. By “offer,” I mean that the school pays for some or all of the cost of the insurance or makes the insurance available to faculty and staff at a discounted group rate.

2. Does your school offer health insurance to faculty and staff?

Yes 1

No 2 SKIP TO THE INTRODUCTION TO Q5

3. Does this health insurance cover the following for faculty and staff?

Yes No

1. Preventive healthcare, such as physicals 1 2

2. Prescription drugs 1 2

3. Vision care 1 2

4. Dental care 1 2

5. Immunizations 1 2

6. Mental health care 1 2

7. Tobacco use cessation 1 2

8. Alcohol or other drug use treatment 1 2

The next question asks about sick leave.

4. Does your school allow faculty and staff to use sick leave to care for their own children when they are sick?

Yes 1

No 2

Next, I would like to ask about health examinations and screenings that faculty and staff are required to receive prior to employment.

SHOW CARD 1

5. Please tell me which of the statements on this card best describes the requirement for a physical health examination of faculty and staff prior to employment.

Physical health examinations are required
of all faculty and staff prior to employment 1

Physical health examinations are required
prior to employment depending
on the position the person will have 2

Physical health examinations are required
prior to employment depending on
something other than the person’s position 3

Physical health examinations are not
required of any faculty or staff
prior to employment 4

SHOW CARD 2

6. Which of the statements on this card best describes the requirement for illegal drug use screening of faculty and staff prior to employment at your school?

Drug screening is required of all faculty
and staff prior to employment 1

Drug screening is required prior to
employment depending on the position
the person will have 2

Drug screening is required prior to employment
depending on something other than
the person’s position 3

Drug screening is not required of any faculty
or staff prior to employment 4

SHOW CARD 3

The next questions ask about examinations and screenings that your school’s faculty and staff are required to receive periodically while they are employed at your school.

7. Which of the statements on this card best describes the requirement for physical health examinations of faculty and staff while they are employed at your school?

Physical health examinations are
periodically required of all faculty
and staff while employed 1

Physical health examinations are
periodically required depending on
the person’s position 2

Physical health examinations are
periodically required depending on
something other than the person’s position 3

Physical health examinations are
not required of any faculty or staff
while employed 4

SHOW CARD 4

8. Which of the statements on this card best describes the requirement for illegal drug use screening of faculty and staff while they are employed at your school?

Drug screening is periodically required
of all faculty and staff while employed 1

Drug screening is periodically required
depending on the person’s position 2

Drug screening is periodically required
depending on something other than
the person’s position 3

Drug screening is not required of any
faculty or staff while employed 4

The next question asks about requirements for tuberculosis, or TB, screening for faculty and staff prior to employment. By “screening,” I mean the identification of staff meeting certain risk criteria, for example those born or recently living in other countries. Faculty and staff meeting these criteria would then be referred for TB testing or required to provide evidence of medical clearance.

9. Please tell me which one of the following three statements best describes the requirement for tuberculosis, or TB, screening of faculty and staff prior to employment.

TB screening is required prior
to employment for all faculty and staff 1

TB screening is required prior
to employment depending on the
person’s position 2

TB screening is not required prior
to employment for any faculty or staff 3

Now I’m going to ask about the requirements for tuberculosis, or TB, testing for faculty and staff prior to employment. By “testing,” I mean a clinical test for TB.

10. Please tell me which one of the following statements best describes the requirement for tuberculosis, or TB, testing of faculty and staff prior to employment.

DO NOT DISPLAY OPTION 1 IF Q9 = 3

TB testing is required prior to employment
based on the results of TB screening 1

TB testing is required prior to employment
depending on the person’s position 2

TB testing is required prior to employment
for all faculty and staff 3

TB testing is not required prior
to employment for any faculty or staff 4

SHOW CARD 5

11. Which of the statements on this card best describes your school’s requirement for periodic TB testing of faculty and staff while they are employed at your school? Please do not include TB testing that might be done after exposure to TB at school or a school-sponsored event. For the purposes of this question, “periodic” means that the test is repeated at regular intervals (e.g., annually) or at a specific time (e.g., at the beginning of each school year).

Periodic TB testing is required for all
faculty and staff while employed 1

Periodic TB testing is required for faculty and
staff depending on the person’s position 2

Periodic TB testing is required only for
faculty and staff previously identified
through screening 3

Periodic TB testing is not required for any
faculty and staff while employed 4

IF Q10 IS 4, AND Q11 IS 4, SKIP TO Q13.

12. Which method is required to be used to provide evidence of a negative TB test?

PPD skin test done by Mantoux method 1

Skin test not otherwise specified 2

Chest x-ray 3

Blood test (i.e., interferon-gamma
release assays) 4

No specific testing method is required 5

13. Please tell me which one of the following four statements best describes the requirement for annual influenza vaccinations for faculty and staff while they are employed.

The school requires annual influenza
vaccinations of all faculty and staff
while employed 1

The school requires annual influenza
vaccinations depending on the
person’s position 2

The school requires annual influenza
vaccinations depending on something
other than the person’s position 3

The school does not require annual influenza
vaccinations of any faculty or staff
while employed 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 schools may provide to all faculty and staff regardless of what is provided through their health insurance.

The next questions ask about health screenings for faculty and staff.

14. During the past 12 months, has your school offered the following screenings for faculty and staff?

Yes No

1. Oral health screening 1 2

2. Weight status screening using body mass index, or BMI 1 2

3. Serum cholesterol screening 1 2

4. Blood pressure level screening 1 2

5. Diabetes screening 1 2

6. Skin cancer screening 1 2

7. Breast cancer screening 1 2

8. 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.

15. During the past 12 months, has your school offered activities for faculty and staff related to the following?

Yes No

1. Nutrition education 1 2

2. Weight management 1 2

3. Worksite safety education 1 2

4. Emergency preparedness 1 2

5. Infectious disease prevention 1 2

6. Cardiopulmonary resuscitation, or CPR, education 1 2

7. Stress management education 1 2

8. Pre- or post-natal education 1 2

9. Conflict resolution education 1 2

10. Asthma management education 1 2

11. Diabetes management education 1 2

12. Tobacco use cessation 1 2

13. Physical activity and fitness counseling 1 2

14. Counseling for emotional disorders,
    such as anxiety or depression 1 2

15. Crisis intervention for personal problems 1 2

16. During the past 12 months, has your school offered the following services for faculty and staff?

Yes No

1. Referrals for child care or elder care 1 2

2. Referrals for oral health problems 1 2

3. Immunizations, not including those covered
   through health insurance, for example flu vaccines 1 2

4. Identification of or referrals for physical, sexual,
   or emotional abuse 1 2

17. During the past 12 months has your school offered health-related sessions as part of professional development for faculty and staff? These sessions might include motivational speakers, health assessments accompanied by resources to prevent or address health risks, or opportunities to engage in health promoting behaviors such as physical activity and healthy eating.

Yes 1

No 2

18. During the past 12 months, have any physical activity programs, such as aerobics classes, basketball leagues, or walking or jogging clubs been offered to your school’s faculty and staff?

Yes 1

No 2

I’d like to ask about the use of school facilities or equipment that could be used for physical activity, such as a gym, cafeteria, swimming pool, weight-lifting equipment, and cardiovascular exercise equipment.

19. Are any indoor or outdoor school facilities or equipment that could be used for physical activity made available for your school’s faculty or staff to use? Remember, we are talking about facilities or equipment that are available to faculty and staff only because they work at your school. 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 faculty and staff experiencing personal or social problems that can impact work performance, physical health, or overall well-being.

20. During the past 12 months, has an EAP been offered to your school’s faculty and staff?

Yes 1

No 2

The next question asks 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.

21. During the past 12 months, has your school provided health risk appraisals for faculty and staff?

Yes 1

No 2

The next question asks about off-site health promotion activities.

22. Do your school’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 Q14A–H ARE “NO,” Q15A–O ARE “NO,” Q16A–D ARE “NO,” Q18 IS “NO,” Q20 IS “NO,” Q21 IS “NO,” AND Q22 IS “NO,” SKIP TO Q26.

The next questions ask about objectives that are taken into account when planning health promotion activities or services for faculty and staff.

23. How much does your school take into account the following factors when planning activities or services for faculty and staff?

Not at all A little A lot

1. Reducing the number of sick days used 1 2 3

2. Reducing the use or cost of health
   insurance benefits 1 2 3

3. Reducing the number of faculty
   and staff injuries 1 2 3

4. Improving faculty and staff morale 1 2 3

5. Creating an environment in which
   faculty and staff serve as “healthy”
   role models for students 1 2 3

6. Attracting and retaining good faculty
   and staff 1 2 3

7. Improving job performance 1 2 3

8. Addressing the health needs of faculty
   and staff 1 2 3

9. Creating a positive image
   in the community 1 2 3

The next question asks about needs assessments that collect information that can be used to plan your school’s health promotion activities or services for faculty and staff. For example, such a needs assessment might collect information about your school’s healthcare costs, faculty and staff health concerns and interests, or health promotion activities and services already being offered.

24. Has your school conducted a needs assessment of the health promotion activities or services for faculty and staff?

Yes 1

No 2

25. During the past two years, has your school 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.

26. During the past 12 months, has your school provided any of the following incentives for faculty and staff participation in health promotion programs?

Yes No

1. Monetary incentives 1 2

2. Gifts 1 2

3. Paid time off 1 2

4. Health insurance premium discounts 1 2

5. Certificates or awards 1 2

6. Public recognition 1 2

The next questions ask about organizations or agencies that have helped provide the health promotion activities or services for faculty and staff.

SHOW CARD 6

27. During the past 12 months, have any activities or services been offered to your school’s faculty and staff by the following organizations or agencies?

Yes No N/A

1. Your school district 1 2 3

2. A local health department 1 2 3

3. A local hospital 1 2 3

4. A local mental health or social
   services agency 1 2 3

5. A university or medical school 1 2 3

6. A managed care organization 1 2 3

7. A health organization, such as
   the American Heart Association
   or the American Cancer Society 1 2

8. A local health or fitness club 1 2 3

9. A local business 1 2

The next questions ask about ways to promote health programs for faculty and staff.

28. During the past 12 months, were the following actions taken to publicize the health promotion activities or services offered to faculty and staff?

Yes No

1. Notices included with paychecks or sent with pay stubs 1 2

2. Fliers or bulletins posted at the school 1 2

3. Letters mailed directly to faculty and staff 1 2

4. Announcements made at staff meetings 1 2

5. Special assemblies or presentations offered 1 2

6. Emails sent to faculty and staff 1 2

7. Notices posted on the school Web site 1 2

8. Notices or articles appeared in school newsletters
   or newspapers 1 2

29. During the past 12 months...

Yes No

1. Has release time been given for participation in health
   promotion activities? 1 2

2. Have competitions between groups of faculty
   and staff been held, for example, a contest between
   teachers from different grades or departments? 1 2

30. Currently, does someone at your school oversee or coordinate health promotion activities or services for your school’s faculty and staff?

Yes 1

No 2 SKIP TO Q32

31a. During the past 12 months, has this person worked on health promotion activities or services for faculty and staff with health education staff?

Yes 1

No 2

School does not have health education staff 3

31b. What about with physical education staff?

Yes 1

No 2

School does not have physical education staff 3

31c. What about with health services staff?

Yes 1

No 2

School does not have health services staff 3

31d. What about with mental health or social services staff?

Yes 1

No 2

School does not have mental health
or social services staff 3

31e. What about with nutrition or food service staff?

Yes 1

No 2

School does not have nutrition
or food service staff 3

32. 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.

Faculty and Staff Health Promotion School Questionnaire—Public Use Version