Form 17 PE Instructor Protocol

SSA Attachment 17

HEALTHY COMMUNITIES STUDY

HEALTHY COMMUNITIES STUDY

SCHOOL PHYSICAL ACTIVITY ENVIRONMENTAL ASSESSMENT

PROTOCOL FOR SCHOOL PHYSICAL EDUCATION INSTRUCTORS

The following document contains the school physical activity environmental assessment protocol for the the physical education instructors. In addition to the school physical activity environmental assessment instruments provided in SSA Attachment 15, physical education instructors in all 279 communities will be asked to participate in providing information on the school’s physical activity environment.

Baseline observational assessments of the physical activity environment will be conducted in up to four randomly selected schools (two elementary and two middle schools) per community. The Battelle community liaison will interview a member of the physical education staff at the school. The physical education interview will gather data about physical activity resources and facilities on school campuses, the provision of physical education, recess, and other physical activity opportunities at schools, the community partnerships established for providing physical activity opportunities, and the norms and culture for physical activity at the schools. These assessments will be conducted in all 279 communities during the initial visit to the community, and again in the RIPA communities, three years later.

HEALTHY COMMUNITIES STUDY PHYSICAL ACTIVITY OBSERVATIONS
PHYSICAL EDUCATION PERSONNEL INTERVIEW
Public reporting burden of this collection of information is 15 minutes, including the time for verbal consent, searching existing data sources, gathering and maintaining 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 S. Sonia Arteaga, Ph.D., project officer at [email protected]
		/ / mm dd yyyy
		Today’s Date					School ID
		___________________ Position of Person Being Interviewed					Liaison ID (Observer)
(VERBAL CONSENT SCRIPT): We are asking you to complete this interview because you are a part of the Physical Education staff in one of the schools within a community in the Healthy Communities Study. This study aims to study community policies and programs and how they relate to children’s growth and health over time. The information we get from you will be used in this research study to try to understand how physical education practices and policies impact children’s health. We will not collect any personally identifying information from you.
Do you understand and agree to participate in this interview?								YES……(proceed with interview) 1 NO……..(mark as refusal) 2
This interview will address physical education and physical activity policies and practices at your school. The first questions are about physical education practices.
PHYSICAL EDUCATION PRACTICES
A1.	How many weeks during the school year are (3rd / 7th) grade students scheduled to take physical education?							# of weeks RF 97 DK 98
A2.	On average how many days per week are (3rd / 7th) grade students scheduled to take physical education?							# of days RF 7 DK 8
A3.	On average how many minutes is each session of physical education for (3rd / 7th) graders scheduled to last?							# of minutes RF 997 DK 998
A4.	Does your school’s standards for physical education specifically address…
								YES		NO		RF		DK
	a. Competence in motor skills and movement patterns needed to perform a variety of physical activities?							1		2		7		8
	b. Understanding of movement concepts, principles, strategies, and tactics as they apply to the learning and performance of physical activities?							1		2		7		8
								YES		NO		RF		DK
	c. Understanding of movement concepts, principles, strategies, and tactics as they apply to the learning and performance of physical activities?							1		2		7		8
	d. Regular participation in physical activity?							1		2		7		8
	e. Achievement and maintenance of a health-enhancing level of physical fitness?							1		2		7		8
	f. Responsible personal and social behavior that respects self and others in physical activity settings?							1		2		7		8
	g. Value for physical activity for health, enjoyment, challenge, self-expression, and/or social interaction?							1		2		7		8
A5.	Does your school require or recommend that you use…
			Require	Recommend					Neither		RF		DK
	a. Fitnessgram		1	2					3		7		8
	b. The President’s Challenge		1	2					3		7		8
	c. Other fitness test? Specify:___________________		1	2					3		7		8
The next questions are about physical activity practices at your school, including recess, intramurals, physical activity clubs, and interscholastic sports.
RECESS
A6.	Does your school require or recommend that students be provided with regularly scheduled recess?							Require 1 Recommend 2 Neither 3 RF 7 DK 8
A7.	How many minutes per day of recess are required or recommended for students?							Less than 10 minutes per day 1 10-19 minutes per day 2 20-29 minutes per day 3 30 or more minutes per day 4 No specified time requirements or recommendations 5 RF 7 DK 8
INTRAMURALS, PHYSICAL ACTIVITY CLUBS AND INTERSCHOLASTIC SPORTS
A8.	Does your school offer opportunities for students to participate in intramural sports or physical activity clubs?							YES 1 NO……(SKIP TO A10) 2 RF……(SKIP TO A10) 7 DK……(SKIP TO A10) 8
A9.	Please list the intramural activities or physical activity clubs offered? (INCLUDE PROMPTS ABOUT SPECIFIC ACTIVITIES OR COMMON ONES THAT MAY NOT BE LISTED: GOTR, STEP TEAM, DOUBLE DUTCH, ETC.)							ACTIVITY 1: _______________ ACTIVITY 2: _______________ ACTIVITY 3: _______________ ACTIVITY 4: _______________ ACTIVITY 5: _______________
A10.	Does your school offer interscholastic sports programs?							YES 1 NO……(SKIP TO A12) 2 RF……(SKIP TO A12) 7 DK……(SKIP TO A12) 8
A11.	List the programs and grade levels for each.							Program 1 ______________ Program 1 grades ______________ Program 2 ______________ Program 2 grades ______________ Program 3 ______________ Program 3 grades ______________ Program 4 ______________ Program 4 grades ______________
In these next questions, I’ll ask about the facilities that your school might have or have access to for physical education and/or physical activity programs.
FACILITIES
A12.	Does your school have or have access to the following?
								YES		NO		RF		DK
	a. A gymnasium							1		2		7		8
	b. An indoor track							1		2		7		8
	c. An indoor pool							1		2		7		8
	d. A weight room							1		2		7		8
	e. A cardiovascular fitness center							1		2		7		8
	f. A dance studio							1		2		7		8
	g. A track for walking, jogging or running							1		2		7		8
	h. An outdoor pool							1		2		7		8
	i. An outdoor volleyball court							1		2		7		8
	j. An outdoor basketball court							1		2		7		8
	k. An outdoor tennis court							1		2		7		8
	l. A baseball or softball field							1		2		7		8
	m. A soccer or football field							1		2		7		8
	n. A general use field							1		2		7		8
	o. Physical activity or fitness stations							1		2		7		8
	p. Other outdoor facility: __________________							1		2		7		8

A13.	Does your school, either directly or through the district, have a joint use agreement for shared facility use with…
				YES	NO	RF	DK
	a. A local parks or recreation department			1	2	7	8
	b. A local youth organization, such as the YMCA, Boys or Girls Clubs, or Boy Scouts or Girl Scouts			1	2	7	8
				YES	NO	RF	DK
	c. A local faith-based organization			1	2	7	8
	d. A local health club			1	2	7	8
	e. Any other public or private entity			1	2	7	8
A14.	Outside of school hours or when not in session, do children or adolescents use any of your school’s physical activity or athletic facilities for….
				YES	NO	RF	DK
	a. Community-sponsored sports teams?			1	2	7	8
	b. Community-sponsored classes or lessons, such as tennis or gymnastics?			1	2	7	8
	c. Community-sponsored supervised “open-gym” or “free-play”?			1	2	7	8
A15.	Outside of school hours or when school is not in session, do adults who are not school employees use any of this school’s physical activity or athletic facilities for…
				YES	NO	RF	DK
	a. Community-sponsored sports teams?			1	2	7	8
	b. Community-sponsored classes or lessons, such as tennis or aerobics?			1	2	7	8
	c. Community-sponsored supervised “open-gym”?			1	2	7	8
The last questions ask about professional development for physical educators at your school.
PROFESSIONAL DEVELOPMENT
A16.	During the past two years has your school provided funding or offered professional development to those who teach physical education on…
				YES	NO	RF	DK
	a. Methods to increase the amount of class time students are engaged in moderate to vigorous physical activity?			1	2	7	8
	b. Using physical activity monitoring devices, such as pedometers or heart rate monitors for physical education			1	2	7	8
				YES	NO	RF	DK
	c. Administering or using fitness tests			1	2	7	8
	d. Helping students develop individualized physical activity plans			1	2	7	8
	e. Developing and using student portfolios for physical education			1	2	7	8
	f. Teaching methods to promote inclusion and active participation of overweight children during physical education			1	2	7	8
	g. Methods for developing, implementing, and evaluating intramural or physical activity clubs			1	2	7	8
	h. Developing, implementing, and evaluating comprehensive school physical activity programs			1	2	7	8
	i. Establishing walking or biking to school programs			1	2	7	8
	j. Assessing student weight status using body mass index (BMI), skinfolds, or bioelectrical impedance			1	2	7	8

PHYSICAL PHYSICAL EDUCATION PERSONNEL INTERVIEW

Sources and References

1. Centers for Disease Control and Prevention. School Health Policies and Programs Study 2006. Atlanta: U.S. Department of Health and Human Services; 2007

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