District Health Education

Health Education Coordinator

Form Approved

OMB No: 0920-0445

Expiration Date: xx/xx/xxxx

Health Education
District Questionnaire

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Public reporting burden for this collection of information is estimated to average 30 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).

Health Education
District Questionnaire

Questions

MODULE 1

Standards 1–3

MODULE 2

Elementary School Instruction 4–13

MODULE 3

Middle School Instruction 14–24

MODULE 4

High School Instruction 25–35

MODULE 5

Staffing and Professional Development 36–39

Collaboration and Promotion 40–42

Evaluation 43

MODULE 6

Health Education Coordinator 44–53

THIS QUESTIONNAIRE WILL BE ADMINISTERED USING WEB-BASED INTERVIEW TECHNOLOGY. AS THE RESPONDENT TYPES 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. COMMENTS APPEARING IN THE MARGIN REPRESENT ADDITIONAL CLARIFICATION ON THE QUESTION OR THE SPECIFIC TERMINOLOGY USED. THIS TEXT WILL APPEAR ON-SCREEN UNDER THE MAIN QUESTION TEXT. 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 health education.

2. For the purposes of this questionnaire, “policy” means 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. SHPPS is 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. For the purposes of this questionnaire, “adopted a policy” means either that the district has its own policy or that the district follows a policy established at the state level, including any law, rule, regulation, administrative order, or similar kind of mandate.

4. 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 purposes of this questionnaire please consider it the same as a district-wide requirement.

5. Districts may sometimes grant policy exceptions or waivers, but please answer each question based on what is considered the general policy and standard practice in your district.

6. Please do not consider school practices or policies when answering the questions. This information is gathered during data collection from schools across the country.

7. For the purposes of this questionnaire, “elementary school” refers to a school that contains any of grades K–5. “Middle school” refers to a school that contains any of grades 6–8. Some jurisdictions may refer to these schools as “junior high schools.” “High school” refers to a school that contains any of grades 10–12. Some jurisdictions may refer to these schools as “senior high schools.”

The first questions ask about health education standards adopted or used by your district. These standards might cover student expectations and performance outcomes for health education.

1. Has your district adopted a policy stating that schools will follow any national, state, or district health education standards?

Yes 1 SKIP TO Q3

No 2

2. Has your district adopted a policy encouraging schools to follow any national, state, or district health education standards?

Yes 1

No 2 SKIP TO THE INTRODUCTION TO Q4

3. Are these health education standards based on the 2007 National Health Education Standards?

Yes 1

No 2

The next questions ask about elementary school instruction.

4. Does your district follow standards for elementary school health education?

Yes 1

No 2 SKIP TO THE INTRODUCTION TO Q6

5. Do the standards followed by your district for elementary school health education specifically address…

Yes No

1. Comprehending concepts related to health promotion
   and disease prevention to enhance health? 1 2

2. Analyzing the influence of family, peers, culture, media,
   technology, and other factors on health behaviors? 1 2

3. Accessing valid information, products, and services
   to enhance health? 1 2

4. Using interpersonal communication skills to enhance
   health and avoid or reduce health risks? 1 2

5. Using decision-making skills to enhance health? 1 2

6. Using goal-setting skills to enhance health? 1 2

7. Practicing health-enhancing behaviors to avoid
   or reduce health risks? 1 2

8. Advocating for personal, family, and community health? 1 2

The next questions ask about specific health topics.

6. Has your district adopted a policy stating that elementary schools will teach about…

Yes No

1. Alcohol or other drug use prevention? 1 2

2. Tobacco use prevention? 1 2

3. Nutrition and dietary behavior? 1 2

4. Physical activity and fitness, that is, classroom instruction,
   not a physical education class? 1 2

5. Pregnancy prevention? 1 2

6. Human immunodeficiency virus (HIV) prevention? 1 2

7. Other sexually transmitted disease (STD) prevention? 1 2

8. Human sexuality? 1 2

9. Emotional and mental health? 1 2

10. Suicide prevention? 1 2

11. Violence prevention, for example bullying, fighting, or
    dating violence prevention? 1 2

12. Injury prevention and safety? 1 2

13. Asthma? 1 2

14. Infectious disease prevention, for example influenza (flu)
    prevention? 1 2

15. Foodborne illness prevention? 1 2

IF STUDENTS DO RECEIVE INSTRUCTION ON HUMAN SEXUALITY TOPICS (Q6E, Q6F, Q6G, OR Q6H IS “YES”), ANSWER Q7 AND Q8. OTHERWISE, SKIP TO THE INTRODUCTION TO Q9.

7. Has your district adopted a policy stating that elementary schools will notify parents or guardians before students receive instruction on pregnancy prevention, HIV prevention, other STD prevention, or human sexuality?

Yes 1

No 2

8. Has your district adopted a policy stating that elementary schools will allow parents or guardians to exclude their children from receiving instruction on pregnancy prevention, HIV prevention, other STD prevention, or human sexuality?

Yes 1

No 2

The next questions ask about resources that your district might have provided for elementary school health education.

9. During the past two years, has your district provided…

Yes No

1. A list of one or more recommended elementary
   school health education curricula? 1 2

2. Lesson plans or learning activities for elementary
   school health education? 1 2

3. Plans or strategies for assessing or evaluating students
   in elementary school health education? 1 2

4. A list of one or more recommended elementary
   school health education textbooks? 1 2

10. Has your district ever used a curriculum analysis tool such as the Health Education Curriculum Analysis Tool (HECAT) to assess one or more health education curricula for elementary schools?

Yes 1

No 2

11. Districts use many ways to describe how much health education students are required to receive while in elementary school. For example, districts might describe these requirements in terms of minutes per week, hours per quarter, or hours per year. In your district, are there specified time requirements for health education at the elementary school level?

Yes 1

No 2

The next questions ask about staffing for elementary school health education in your district.

12. Has your district adopted a policy stating that newly hired staff who teach health education at the elementary school level will have undergraduate or graduate training in health education?

Yes 1

No 2

13. Has your district adopted a policy stating that newly hired staff who teach health education at the elementary school level will be certified, licensed, or endorsed by the state to teach health education?

Yes 1

No 2

State does not offer certification, licensure, or
endorsement to teach health education at the
elementary school level 3

The next questions ask about middle school instruction.

14. Does your district follow standards for middle school health education?

Yes 1

No 2 SKIP TO THE INTRODUCTION TO Q16

15. Do the standards followed by your district for middle school health education specifically address…

Yes No

1. Comprehending concepts related to health promotion
   and disease prevention to enhance health? 1 2

2. Analyzing the influence of family, peers, culture, media,
   technology, and other factors on health behaviors? 1 2

3. Accessing valid information, products, and services to
   enhance health? 1 2

4. Using interpersonal communication skills to enhance
   health and avoid or reduce health risks? 1 2

5. Using decision-making skills to enhance health? 1 2

6. Using goal-setting skills to enhance health? 1 2

7. Practicing health-enhancing behaviors to avoid or
   reduce health risks? 1 2

8. Advocating for personal, family, and community health? 1 2

The next questions ask about specific health topics.

16. Has your district adopted a policy stating that middle schools will teach about…

Yes No

1. Alcohol or other drug use prevention? 1 2

2. Tobacco use prevention? 1 2

3. Nutrition and dietary behavior? 1 2

4. Physical activity and fitness, that is, classroom instruction,
   not a physical education class? 1 2

5. Pregnancy prevention? 1 2

6. Human immunodeficiency virus (HIV) prevention? 1 2

7. Other sexually transmitted disease (STD) prevention? 1 2

8. Human sexuality? 1 2

9. Emotional and mental health? 1 2

10. Suicide prevention? 1 2

11. Violence prevention, for example bullying, fighting, or
    dating violence prevention? 1 2

12. Injury prevention and safety? 1 2

13. Asthma? 1 2

14. Infectious disease prevention, for example influenza (flu)
    prevention? 1 2

15. Foodborne illness prevention? 1 2

IF STUDENTS RECEIVE INSTRUCTION ON HUMAN SEXUALITY TOPICS (Q16E, Q16F, Q16G, OR Q16H IS “YES”), ANSWER Q17 AND Q18. OTHERWISE, SKIP TO THE INTRODUCTION TO Q19.

17. Has your district adopted a policy stating that middle schools will notify parents or guardians before students receive instruction on pregnancy prevention, HIV prevention, other STD prevention, or human sexuality?

Yes 1

No 2

18. Has your district adopted a policy stating that middle schools will allow parents or guardians to exclude their children from receiving instruction on pregnancy prevention, HIV prevention, other STD prevention, or human sexuality?

Yes 1

No 2

The next questions ask about resources that your district might have provided for middle school health education.

19. During the past two years, has your district provided…

Yes No

1. A list of one or more recommended middle school
   health education curricula? 1 2

2. Lesson plans or learning activities for middle school
   health education? 1 2

3. Plans or strategies for assessing or evaluating students in
   middle school health education? 1 2

4. A list of one or more recommended middle school
   health education textbooks? 1 2

20. Has your district ever used a curriculum analysis tool such as the Health Education Curriculum Analysis Tool (HECAT) to assess one or more health education curricula for middle schools?

Yes 1

No 2

21. Districts use many ways to describe how much health education students are required to receive while in middle school. For example, districts might describe these requirements in terms of minutes per week, hours per quarter, or hours per year. In your district, are there specified time requirements for health education at the middle school level?

Yes 1

No 2

The next questions ask about staffing for middle school health education in your district.

22. Has your district adopted a policy stating that newly hired staff who teach health education at the middle school level will have undergraduate or graduate training in health education?

Yes 1

No 2

23. Has your district adopted a policy stating that newly hired staff who teach health education at the middle school level will be certified, licensed, or endorsed by the state to teach health education?

Yes 1

No 2

State does not offer certification, licensure, or
endorsement to teach health education at the
middle school level 3

24. Has your district adopted a policy stating that newly hired staff who teach health education at the middle school level will be Certified Health Education Specialists (CHES)?

Yes 1

No 2

The next questions ask about high school instruction.

25. Does your district follow standards for high school health education?

Yes 1

No 2 SKIP TO THE INTRODUCTION TO Q27

26. Do the standards followed by your district for high school health education specifically address…

Yes No

1. Comprehending concepts related to health promotion
   and disease prevention to enhance health? 1 2

2. Analyzing the influence of family, peers, culture, media,
   technology, and other factors on health behaviors? 1 2

3. Accessing valid information, products, and services to
   enhance health? 1 2

4. Using interpersonal communication skills to enhance
   health and avoid or reduce health risks? 1 2

5. Using decision-making skills to enhance health? 1 2

6. Using goal-setting skills to enhance health? 1 2

7. Practicing health-enhancing behaviors to avoid or
   reduce health risks? 1 2

8. Advocating for personal, family, and community health? 1 2

The next questions ask about specific health topics.

27. Has your district adopted a policy stating that high schools will teach about…

Yes No

1. Alcohol or other drug use prevention? 1 2

2. Tobacco use prevention? 1 2

3. Nutrition and dietary behavior? 1 2

4. Physical activity and fitness, that is, classroom instruction,
   not a physical education class? 1 2

5. Pregnancy prevention? 1 2

6. Human immunodeficiency virus (HIV) prevention? 1 2

7. Other sexually transmitted disease (STD) prevention? 1 2

8. Human sexuality? 1 2

9. Emotional and mental health? 1 2

10. Suicide prevention? 1 2

11. Violence prevention, for example bullying, fighting, or
    dating violence prevention? 1 2

12. Injury prevention and safety? 1 2

13. Asthma? 1 2

14. Infectious disease prevention, for example influenza (flu)
    prevention? 1 2

15. Foodborne illness prevention? 1 2

IF STUDENTS RECEIVE INSTRUCTION ON HUMAN SEXUALITY TOPICS (Q27E, Q27F, Q27G, OR Q27H IS “YES”), ANSWER Q28 AND Q29. OTHERWISE, SKIP TO THE INTRODUCTION TO Q30.

28. Has your district adopted a policy stating that high schools will notify parents or guardians before students receive instruction on pregnancy prevention, HIV prevention, other STD prevention, or human sexuality?

Yes 1

No 2

29. Has your district adopted a policy stating that high schools will allow parents or guardians to exclude their children from receiving instruction on pregnancy prevention, HIV prevention, other STD prevention, or human sexuality?

Yes 1

No 2

The next questions ask about resources that your district might have provided for high school health education.

30. During the past two years, has your district provided…

Yes No

1. A list of one or more recommended high school
   health education curricula? 1 2

2. Lesson plans or learning activities for high school
   health education? 1 2

3. Plans or strategies for assessing or evaluating students
   in high school health education? 1 2

4. A list of one or more recommended high school
   health education textbooks? 1 2

31. Has your district ever used a curriculum analysis tool such as the Health Education Curriculum Analysis Tool (HECAT) to assess one or more health education curricula for high schools?

Yes 1

No 2

32. Districts use many ways to describe how much health education students are required to receive while in high school. For example, districts might describe these requirements in terms of minutes per week, hours per quarter, or hours per year. In your district, are there specified time requirements for health education at the high school level?

Yes 1

No 2

The next questions ask about staffing for high school health education in your district.

33. Has your district adopted a policy stating that newly hired staff who teach health education at the high school level will have undergraduate or graduate training in health education?

Yes 1

No 2

34. Has your district adopted a policy stating that newly hired staff who teach health education at the high school level will be certified, licensed, or endorsed by the state to teach health education?

Yes 1

No 2

State does not offer certification, licensure or
endorsement to teach health education at the
high school level 3

35. Has your district adopted a policy stating that newly hired staff who teach health education at the high school level will be Certified Health Education Specialists (CHES)?

Yes 1

No 2

36. Has your district adopted a policy stating that those who teach health education are required to earn continuing education credits on health education topics or instructional strategies?

Yes 1

No 2

37. Has your district adopted a policy stating that each school will have someone to oversee or coordinate health education at the school, for example, a lead health education teacher?

Yes 1

No 2

The next questions are about professional development for those who teach health education. This might include workshops, conferences, continuing education, graduate courses, or any other kind of in-service.

38. During the past two years, has your district provided funding for or offered professional development to those who teach health education on…

Yes No

1. Alcohol or other drug use prevention? 1 2

2. Tobacco use prevention? 1 2

3. Nutrition and dietary behavior? 1 2

4. Physical activity and fitness? 1 2

5. Pregnancy prevention? 1 2

6. Human immunodeficiency virus (HIV) prevention? 1 2

7. Other sexually transmitted disease (STD) prevention? 1 2

8. Human sexuality? 1 2

9. Emotional and mental health? 1 2

10. Suicide prevention? 1 2

11. Violence prevention, for example bullying, fighting, or
    dating violence prevention? 1 2

12. Injury prevention and safety? 1 2

13. Asthma? 1 2

14. Infectious disease prevention, for example influenza (flu)
    prevention? 1 2

15. Foodborne illness prevention? 1 2

39. During the past two years, has your district provided funding for or offered professional development to those who teach health education on…

Yes No

1. Teaching students with long-term physical, medical,
   or cognitive disabilities? 1 2

2. Teaching students of various cultural backgrounds? 1 2

3. Teaching students with limited English proficiency? 1 2

4. Using interactive teaching methods, such as role plays
   or cooperative group activities? 1 2

5. Using peer educators for health education? 1 2

6. How to involve students’ families in health education? 1 2

7. How to involve the community in students’
   health education? 1 2

8. Teaching skills for behavior change? 1 2

9. Using classroom management techniques, such as social
   skills training, environmental modification, conflict
   resolution and mediation, or behavior management? 1 2

10. Assessing or evaluating students in health education? 1 2

11. Aligning health education standards to curriculum,
    instruction, or student assessment? 1 2

12. Teaching online or distance education courses? 1 2

13. Using technology such as computers in the classroom? 1 2

14. Using the Health Education Curriculum Analysis Tool
    (HECAT) to help assess health education curricula? 1 2

15. Using data to plan or evaluate health education
    policies or practices? 1 2

The next questions ask about collaboration with other district-level staff and outside organizations.

40. During the past 12 months, have district-level health education staff worked on health education activities with district-level…

No district-
level staff
Yes No in this area

1. Physical education staff? 1 2 3

2. Health services staff? 1 2 3

3. Mental health or social services staff? 1 2 3

4. Nutrition or food service staff? 1 2 3

5. General curriculum coordinators or
   supervisors? 1 2 3

41. During the past 12 months, have district-level health education staff worked on health education activities with staff or members from…

Yes No

1. Alliance for a Healthier Generation? 1 2

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

3. A local health department? 1 2

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

5. A local juvenile justice department? 1 2

6. A local college or university? 1 2

7. A local business? 1 2

8. Action for Healthy Kids? 1 2

9. A local hospital? 1 2

10. A local law enforcement agency? 1 2

11. A local service club, such as the Rotary Club? 1 2

12. Local fire or emergency medical services? 1 2

13. A local youth organization, such as the
    Boys and Girls Clubs? 1 2

42. During the past 12 months, has anyone from your district…

Yes No

1. Provided families of all students with information on
   school health education? 1 2

2. Offered any health education to families of all students? 1 2

3. Provided district or school personnel—for example
   classroom teachers, administrators, or school board
   members—with information on school health education? 1 2

4. Sought positive media attention for school
   health education? 1 2

The next question asks about different aspects of school health education that might have been evaluated during the past two years.

43. During the past two years, have the following aspects of health education in your district been evaluated?

Yes No N/A

1. Health education policies 1 2 3

2. Health education curricula 1 2 3

3. Health education professional
   development or in-service programs 1 2 3

4. Health education teachers 1 2 3

44. Currently, does someone in your district oversee or coordinate health education?

Yes 1

No 2 That is the last question.
Thank you very much for taking the time to complete this questionnaire.

45. Are you this person?

Yes 1

No 2 That is the last question.
Thank you very much for taking the time to complete this questionnaire.

The last questions ask about your educational background.

46. Do you have an undergraduate degree?

Yes 1

No 2 SKIP TO Q52

47. What did you major in?
    MARK ALL THAT APPLY

Health education 1

Physical education 2

Other education 3

Nursing 4

Biology or other science 5

Other (Specify) 6

48. Did you have an undergraduate minor?

Yes 1

No 2 SKIP TO Q50

49. What did you minor in?
    MARK ALL THAT APPLY

Health education 1

Physical education 2

Other education 3

Nursing 4

Biology or other science 5

Other (Specify) 6

50. Do you have a graduate degree?

Yes 1

No 2 SKIP TO Q52

51. In what area or areas was your graduate work?
    MARK ALL THAT APPLY

Health education 1

Physical education 2

Other education 3

Nursing 4

Biology or other science 5

Other (Specify) 6

52. Are you certified, licensed, or endorsed by the state to teach health education at the…

State does not
offer certification,
licensure,
or endorsement
to teach
health education
Yes No at this level

1. Elementary school level? 1 2 3

2. Middle school level? 1 2 3

3. High school level? 1 2 3

53. Are you a Certified Health Education Specialist (CHES)?

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 questionnaire, please call 800-287-1815.

Health Education District Questionnaire—Public Use Version 0