Form 24 Health Education Classroom Questionnaire

School Health Policies and Practices Study 2012

Appendix G-21 Health Education_Classroom

Classroom Data Collection

OMB: 0920-0445

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General Course Characteristics and Content

Form Approved

OMB No: 0920-0445

Expiration Date: xx/xx/xxxx

Health Education
Classroom Questionnaire

6 January 2011

Frame1 §





Public reporting burden for this collection of information is estimated to average 50 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
Classroom Questionnaire

Questions

General Course Characteristics and Content 1–4

Alcohol or Other Drug Use Prevention 5–8

Tobacco Use Prevention 9–12

Nutrition and Dietary Behavior 13–17

Physical Activity and Fitness 18–21

Human Sexuality 22–35

Emotional and Mental Health 36–39

Suicide Prevention 40–42

Violence Prevention 43–46

Injury Prevention and Safety 47–50

Personal Health and Wellness 51–52

Teaching Techniques 53–63

Respondent Background 64–79

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 INTERVIEW 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.

NOTE: PRIOR TO THE INTERVIEW, HEALTH EDUCATION COURSES, TEACHERS, AND SECTIONS WERE RANDOMLY SELECTED AT EACH SCHOOL. IN ELEMENTARY SCHOOLS, THE SCHOOL CONTACT PROVIDED A LIST OF ALL GRADES IN WHICH REQUIRED HEALTH EDUCATION IS TAUGHT. TWO GRADES WERE RANDOMLY SELECTED FROM THIS LIST (UNLESS THERE WERE ONLY TWO OR FEWER GRADES, IN WHICH CASE ALL WERE SELECTED). FOR EACH SELECTED GRADE, ONE TEACHER WAS RANDOMLY SELECTED TO BE INTERVIEWED. WHEN NECESSARY, A SECTION (E.G. MORNING KINDERGARTEN CLASS) WAS RANDOMLY SELECTED FOR THE TEACHER TO FOCUS ON THROUGHOUT THE INTERVIEW. IN MIDDLE AND HIGH SCHOOLS, THE SCHOOL CONTACT PROVIDED A LIST OF ALL REQUIRED HEALTH EDUCATION COURSES FOR THE 2011–12 SCHOOL YEAR WITH A CORRESPONDING LIST OF TEACHERS FOR EACH COURSE. IF THE NUMBER OF REQUIRED HEALTH EDUCATION COURSES WAS EIGHT OR FEWER, ALL THE COURSES WERE SELECTED. IF THE NUMBER OF REQUIRED HEALTH EDUCATION COURSES EXCEEDED EIGHT, EIGHT COURSES WERE RANDOMLY SELECTED. FOR EACH SELECTED COURSE, ONE TEACHER WAS RANDOMLY SELECTED TO BE INTERVIEWED AND ONE SECTION OF THAT TEACHER’S COURSE (E.G. 2ND PERIOD HEALTH 101) WAS RANDOMLY SELECTED FOR HIM/HER TO FOCUS ON THROUGHOUT THE INTERVIEW.

The first questions I am going to ask you are about the general characteristics and content of a required health education course or class that you teach. Throughout this interview, please think about what took place when you taught ______________ section of this course.

ANSWER Q1 FOR MIDDLE AND HIGH SCHOOL ONLY. OTHERWISE, SKIP TO Q2.

SHOW CARD 1

Please use this card for your reference during my next question.

  1. Which one of the statements listed on this card best describes the class? Was this class...

Devoted to health topics, such as alcohol
or other drug use prevention? 1

A combined health education
and physical education class? 2

Mainly about some subject other than
health education, such as science,
social studies, or English? 3

  1. At the end of the class, how many students were enrolled in the class?

_____ Students

SHOW CARD 2

As I read the list of topics on this card, please tell me if you taught about each one in the class. By “teach,” I mean some advanced planning on your part was involved; the subject was not just brought up in class.

  1. Did you 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. HIV or human immunodeficiency virus prevention? 1 2

  7. Other STD or sexually transmitted disease 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, including
    foodborne illness and flu prevention? 1 2

  1. When planning to teach or teaching the class, did you use...

Yes No

  1. Internet resources? 1 2

  2. Any state-, district- or school-developed
    curricula for health education? 1 2

  3. Any commercially-developed curricula? 1 2

  4. A commercially-developed student textbook? 1 2

  5. A commercially-developed teacher's guide? 1 2

  6. Health education performance assessment materials? 1 2

  7. Any materials from health organizations,
    such as the American Heart Association
    or the American Cancer Society? 1 2

IF ALCOHOL OR OTHER DRUG USE PREVENTION WAS TAUGHT IN THIS CLASS (Q3A IS “YES”), ANSWER Q5–Q8. OTHERWISE, SKIP TO THE INSTRUCTIONS BEFORE Q9.

Now I’m going to ask you about instruction on alcohol or other drug use prevention in this class.

SHOW CARD 3

As I read the topics listed on this card, please tell me if you taught about each one in the class.

  1. When you taught about alcohol or other drug use prevention, did you teach about...

Yes No

  1. Short-term health consequences
    of alcohol use and addiction? 1 2

  2. Long-term health consequences
    of alcohol use and addiction? 1 2

  3. Benefits of not using alcohol? 1 2

  4. Drink equivalents and blood alcohol content? 1 2

  5. Legal consequences of underage drinking? 1 2

  6. Short-term health consequences
    of illegal drug use and addiction? 1 2

  7. Long-term health consequences
    of illegal drug use and addiction? 1 2

  8. Benefits of not using illegal drugs? 1 2

  9. Distinguishing between medicinal
    and non-medicinal drug use? 1 2

  10. Consequences of using prescription drugs
    without a doctor’s prescription? 1 2

  11. Consequences of using inhalants,
    such as paints or sprays, to get high? 1 2

  12. Effects of alcohol or other drug use
    on decision-making? 1 2

SHOW CARD 4

As I read the areas of instruction listed on this card, please tell me if you taught about each one.

  1. Did you teach about...

Yes No

  1. How many young people use alcohol
    or other drugs? 1 2

  2. The influence of families on alcohol
    or other drug use? 1 2

  3. The influence of the media on alcohol
    or other drug use? 1 2

  4. Social or cultural influences on alcohol
    or other drug use? 1 2

  5. The influence of peers on alcohol or other drug use? 1 2

  6. How to find valid information or services related
    to alcohol or other drug use prevention or cessation? 1 2

  7. Resisting peer pressure to use alcohol or other drugs? 1 2

  8. Making a personal commitment not to use
    alcohol or other drugs? 1 2

  9. How students can influence, support, or advocate
    for others in efforts to prevent alcohol
    or other drug use? 1 2

  10. How students can influence or support others
    in efforts to quit using alcohol or other drugs? 1 2

  1. Did you provide students with the opportunity to practice communication, decision‑making, goal-setting, or refusal skills related to alcohol or other drug use prevention, for example through role playing?

Yes 1

No 2

  1. How many hours did you spend teaching about alcohol or other drug use prevention?

Less than 1 hour 0

1 Hour 1

2 Hours 2

3 Hours 3

4 Hours 4

5 Hours 5

6 Hours 6

7 Hours 7

8 Hours 8

9 Hours 9

10 Hours 10

11 or more hours 11

IF TOBACCO USE PREVENTION WAS TAUGHT IN THIS CLASS (Q3B IS “YES”), ANSWER Q9–Q12. OTHERWISE, SKIP TO THE INSTRUCTIONS BEFORE Q13.

The next questions ask about instruction on tobacco use prevention in this class.

SHOW CARD 5

As I read the topics listed on this card, please tell me if you taught about each one in the class.

  1. When you taught about tobacco use prevention, did you teach about...

Yes No

  1. Short-term health consequences of cigarette smoking? 1 2

  2. Long-term health consequences of cigarette smoking? 1 2

  3. Benefits of not smoking cigarettes? 1 2

  4. Short-term health consequences of cigar smoking? 1 2

  5. Long-term health consequences of cigar smoking? 1 2

  6. Benefits of not smoking cigars? 1 2

  7. Short-term health consequences of using
    smokeless tobacco? 1 2

  8. Long-term health consequences of using
    smokeless tobacco? 1 2

  9. Benefits of not using smokeless tobacco? 1 2

  10. Risks of using other tobacco and tobacco-like
    products, such as pipes, kreteks, or bidis? 1 2

  11. Importance of quitting tobacco use? 1 2

  12. Addictive effects of nicotine in tobacco products? 1 2

  13. Health effects of environmental tobacco smoke (ETS)
    or second-hand smoke? 1 2

SHOW CARD 6

As I read the areas of instruction listed on this card, please tell me if you taught about each one.

  1. Did you teach about...

Yes No

  1. How many young people use tobacco? 1 2

  2. The influence of families on tobacco use? 1 2

  3. The influence of the media on tobacco use? 1 2

  4. Social or cultural influences on tobacco use? 1 2

  5. The influence of peers on tobacco use? 1 2

  6. How to find valid information or services related
    to tobacco use prevention or cessation? 1 2

  7. Resisting peer pressure to use tobacco? 1 2

  8. Making a personal commitment not to use tobacco? 1 2

  9. Supporting school and community action to support
    a tobacco-free environment? 1 2

  10. How students can influence, support, or advocate for others
    to prevent tobacco use? 1 2

  11. How students can influence or support others
    in efforts to quit using tobacco? 1 2

  12. How to avoid environmental tobacco smoke (ETS)
    or second-hand smoke? 1 2

  1. Did you provide students with the opportunity to practice communication, decision‑making, goal-setting, or refusal skills related to tobacco prevention, for example through role playing?

Yes 1

No 2

  1. How many hours did you spend teaching about tobacco use prevention?

Less than 1 hour 0

1 Hour 1

2 Hours 2

3 Hours 3

4 Hours 4

5 Hours 5

6 Hours 6

7 Hours 7

8 Hours 8

9 Hours 9

10 Hours 10

11 or more hours 11

IF NUTRITION AND DIETARY BEHAVIOR WAS TAUGHT IN THIS CLASS (Q3C IS “YES”), ANSWER Q13–Q17. OTHERWISE, SKIP TO THE INSTRUCTIONS BEFORE Q18.

The next questions ask about instruction on nutrition and dietary behavior in this class.

SHOW CARD 7

As I read the topics listed on this card, please tell me if you taught about each one in the class.

  1. When you taught about nutrition and dietary behavior, did you teach about...

Yes No

  1. The relationship between healthy eating and
    personal health and disease prevention? 1 2

  2. Food guidance using MyPyramid? 1 2

  3. Reading and using food labels? 1 2

  4. Eating a variety of foods? 1 2

  5. Balancing food intake and physical activity? 1 2

  6. Eating more fruits, vegetables, and
    whole grain products? 1 2

  7. Choosing foods that are low in fat, saturated fat,
    and cholesterol and do not contain trans fat? 1 2

  8. Choosing foods and beverages with little
    added sugars? 1 2

  9. Eating more calcium-rich foods? 1 2

  10. Preparing healthy meals and snacks? 1 2

  11. Risks of unhealthy weight control practices? 1 2


ANSWER L FOR MIDDLE SCHOOL AND HIGH SCHOOL ONLY.

OTHERWISE, SKIP TO M.


  1. Eating disorders? 1 2

  2. Accepting body size differences? 1 2

  3. Food safety? 1 2

  4. The importance of water consumption? 1 2

  5. The importance of eating breakfast? 1 2

  6. Making healthy choices when eating at restaurants? 1 2

(Q13 continued)

ANSWER R AND S FOR MIDDLE AND HIGH SCHOOL ONLY. OTHERWISE, SKIP TO Q14.

Yes No

  1. The Dietary Guidelines for Americans? 1 2

  2. Using salt and sodium in moderation? 1 2

  1. When you taught about nutrition and dietary behavior, did students have opportunities to taste new, healthful foods, such as fruits, vegetables, and whole grain foods, as part of a lesson?

Yes 1

No 2

SHOW CARD 8

As I read the areas of instruction listed on this card, please tell me if you taught about each one.

  1. Did you teach about...

Yes No

  1. The influence of families on dietary behavior? 1 2

  2. The influence of the media on dietary behavior? 1 2

  3. Social or cultural influences on dietary behavior? 1 2

  4. The influence of peers on dietary behavior? 1 2

  5. How to find valid information or services
    related to nutrition and dietary behavior? 1 2

  6. Resisting peer pressure related to unhealthy
    dietary behavior? 1 2

  7. How students can influence, support,
    or advocate for others’ healthy dietary behavior? 1 2

  1. Did you provide students with the opportunity to practice communication, decision‑making, goal-setting, or refusal skills related to nutrition and dietary behavior, for example through role playing?

Yes 1

No 2

  1. How many hours did you spend teaching about nutrition and dietary behavior?

Less than 1 hour 0

1 Hour 1

2 Hours 2

3 Hours 3

4 Hours 4

5 Hours 5

6 Hours 6

7 Hours 7

8 Hours 8

9 Hours 9

10 Hours 10

11 or more hours 11

IF PHYSICAL ACTIVITY AND FITNESS TOPICS WERE TAUGHT IN THIS CLASS (Q3D IS “YES”), ANSWER Q18–Q21. OTHERWISE, SKIP TO THE INSTRUCTIONS BEFORE Q22.

Now I’m going to ask you about instruction on physical activity and fitness in this class.

SHOW CARD 9

As I read the topics listed on this card, please tell me if you taught about each one in the class.

  1. When you taught about physical activity and fitness, did you teach about...

Yes No

  1. The physical, psychological, or social benefits
    of physical activity? 1 2

  2. How physical activity can contribute to a healthy weight? 1 2

  3. How an inactive lifestyle contributes to chronic disease? 1 2

  4. Health-related fitness, that is, cardiovascular endurance,
    muscular endurance, muscular strength, flexibility,
    and body composition? 1 2

  5. The difference between physical activity, exercise,
    and fitness? 1 2

  6. Phases of an exercise session, that is, warmup, workout,
    and cool down? 1 2

  7. Overcoming barriers to physical activity? 1 2

  8. Decreasing sedentary activities, such as TV watching? 1 2

  9. Opportunities for physical activity in the community? 1 2

  10. Preventing injury during physical activity? 1 2

  11. Weather-related safety, for example avoiding heat stroke,
    hypothermia, and sunburn while physically active? 1 2

(Q18 continued)

ANSWER L, M, N, AND O FOR MIDDLE AND HIGH SCHOOL ONLY. OTHERWISE, SKIP TO THE INTRODUCTION TO Q19.

Yes No

  1. How much physical activity is enough, that is,
    determining frequency, intensity, time, and type
    of physical activity? 1 2

  2. Developing an individualized physical activity plan? 1 2

  3. Monitoring progress toward reaching goals
    in an individualized physical activity plan? 1 2

  4. Dangers of using performance-enhancing drugs,
    such as steroids? 1 2

SHOW CARD 10

As I read the list of areas of instruction on this card, please tell me if you taught about each one.

  1. Did you teach about...

Yes No

  1. The influence of families on physical activity? 1 2

  2. The influence of the media on physical activity? 1 2

  3. Social or cultural influences on physical activity? 1 2

  4. The influence of peers on physical activity? 1 2

  5. How to find valid information or services
    related to physical activity and fitness? 1 2

  6. Resisting peer pressure that discourages physical activity? 1 2

  7. How students can influence, support, or advocate
    for others to engage in physical activity? 1 2

  1. Did you provide students with the opportunity to practice communication, decision‑making, or goal-setting skills related to physical activity, for example through role playing?

Yes 1

No 2

  1. How many hours did you spend in the classroom teaching about physical activity? Please do not include time students spent actually being active.

Less than 1 hour 0

1 Hour 1

2 Hours 2

3 Hours 3

4 Hours 4

5 Hours 5

6 Hours 6

7 Hours 7

8 Hours 8

9 Hours 9

10 Hours 10

11 or more hours 11

IF HUMAN SEXUALITY WAS TAUGHT IN THIS CLASS (Q3E, Q3F, Q3G, OR Q3H IS “YES”), ANSWER Q22–Q24. OTHERWISE, SKIP TO THE INSTRUCTIONS BEFORE Q25.

The next section asks about instruction on human sexuality in this class.

SHOW CARD 11

You mentioned that when you taught the class, you taught about human sexuality topics. As I read the topics listed on this card, please tell me if you taught about each one.

  1. When you taught about human sexuality, did you teach about...

Yes No

  1. Abstinence as the most effective method to avoid
    pregnancy, HIV, and other STDs? 1 2

  2. The relationship among HIV, other STDs,
    and pregnancy? 1 2

  3. Dating and healthy relationships? 1 2

  4. Marriage and commitment? 1 2

  5. Human development issues, such as reproductive
    anatomy and puberty? 1 2

ANSWER F–L FOR MIDDLE AND HIGH SCHOOL ONLY. OTHERWISE, SKIP TO THE INRODUCTION TO Q23.

  1. Risks associated with having multiple sexual partners? 1 2

  2. Condom efficacy, that is, how well condoms work
    and do not work? 1 2

  3. How to correctly use a condom? 1 2

  4. How to obtain condoms? 1 2

  5. The importance of using condoms consistently
    and correctly? 1 2

  6. The importance of using a condom at the same time
    as another form of contraception to prevent both
    STDs and pregnancy? 1 2

  7. Sexual identity and sexual orientation? 1 2

SHOW CARD 12

As I read the areas of instruction listed on this card, please tell me if you taught about each one.

  1. Did you teach about...

Yes No

  1. The influence of families on sexual behavior? 1 2

  2. The influence of the media on sexual behavior? 1 2

  3. Social or cultural influences on sexual behavior? 1 2

  4. The influence of peers on sexual behavior? 1 2

  5. Resisting peer pressure to engage in sexual behavior? 1 2

  6. How students can influence, support, or advocate
    for others to make healthy decisions related to
    sexual behaviors? 1 2

  7. The relationship between alcohol or other drug use
    and risk for HIV, other STDs, and pregnancy? 1 2

  1. Did you provide students with the opportunity to practice communication, decision‑making, goal-setting, or refusal skills related to human sexuality, for example through role playing?

Yes 1

No 2

IF PREGNANCY PREVENTION WAS TAUGHT IN THIS CLASS (Q3E IS “YES”) ANSWER Q25–Q26. OTHERWISE, SKIP TO THE INSTRUCTIONS BEFORE Q27.

  1. When you taught about pregnancy prevention, did you teach about...

Yes No

  1. How to prevent pregnancy? 1 2

  2. Risks associated with teen pregnancy? 1 2

  3. The educational and social impact of teen pregnancy? 1 2

  4. How to find valid information or services related to

Pregnancy or pregnancy testing? 1 2



ANSWER E, F, G, AND H FOR MIDDLE SCHOOL AND HIGH SCHOOL ONLY.


  1. Methods of contraception? 1 2

  2. The importance of using contraception consistently
    and correctly? 1 2

  3. How to obtain contraception? 1 2

  4. Contraception efficacy, that is, how well contraception
    works and does not work? 1 2

  1. How many hours did you spend teaching about pregnancy prevention?

Less than 1 hour 0

1 Hour 1

2 Hours 2

3 Hours 3

4 Hours 4

5 Hours 5

6 Hours 6

7 Hours 7

8 Hours 8

9 Hours 9

10 Hours 10

11 or more hours 11

IF HIV PREVENTION WAS TAUGHT IN THIS CLASS (Q3F IS “YES”), ANSWER
Q27–Q28. OTHERWISE, SKIP TO THE INSTRUCTIONS BEFORE Q29.

  1. When you taught about HIV prevention, did you teach about...

Yes No

  1. How to prevent HIV infection? 1 2

  2. Signs and symptoms of HIV and AIDS? 1 2

  3. How HIV is transmitted? 1 2

  4. How HIV affects the human body? 1 2

  5. Long-term health consequences of HIV and AIDS? 1 2

  6. Compassion for persons living with HIV or AIDS? 1 2

  7. How to find valid information or services related to
    HIV or HIV counseling and testing? 1 2

  8. How HIV is diagnosed and treated? 1 2

  1. How many hours did you spend teaching about HIV prevention?

Less than 1 hour 0

1 Hour 1

2 Hours 2

3 Hours 3

4 Hours 4

5 Hours 5

6 Hours 6

7 Hours 7

8 Hours 8

9 Hours 9

10 Hours 10

11 or more hours 11

IF STD PREVENTION WAS TAUGHT IN THIS CLASS (Q3G IS “YES”), ANSWER
Q29–Q31. OTHERWISE, SKIP TO INTRODUCTION TO Q32.

  1. When you taught about STD prevention, did you teach about...

Yes No

  1. How to prevent STDs? 1 2

  2. How STDs, other than HIV, are transmitted? 1 2

  3. Signs and symptoms of STDs? 1 2

  4. How to find valid information or services related
    to STDs or STD screening? 1 2

  5. How STDs are diagnosed and treated? 1 2

  6. Long-term health consequences of STDs? 1 2

  1. How many hours did you spend teaching about STD prevention? Please do not include hours spent teaching about HIV prevention.

Less than 1 hour 0

1 Hour 1

2 Hours 2

3 Hours 3

4 Hours 4

5 Hours 5

6 Hours 6

7 Hours 7

8 Hours 8

9 Hours 9

10 Hours 10

11 or more hours 11

  1. You said you spent [FILL NUMBER OF HOURS] hours teaching about pregnancy prevention, HIV prevention, and STD prevention, but there is often overlap among these topics. Taking this overlap into account, how many hours did you spend teaching all three human sexuality topics?

Less than 1 hour 0

1 Hour 1

2 Hours 2

3 Hours 3

4 Hours 4

5 Hours 5

6 Hours 6

7 Hours 7

8 Hours 8

9 Hours 9

10 Hours 10

11 or more hours 11

IF PREGNANCY PREVENTION, HIV PREVENTION, STD PREVENTION, AND HUMAN SEXUALITY WERE NOT TAUGHT (Q3E, Q3F, Q3G, Q3H ARE “NO”) THEN SKIP TO THE INSTRUCTIONS BEFORE Q36.

  1. Which of the following statements best describes your use of a curriculum related to human sexuality, pregnancy prevention, HIV prevention, or other STD prevention?

I do not use a specific curriculum
for teaching these topics. 1

I use a curriculum that is required
by the state, district, or school 2

I use a curriculum that is recommended
by the state, district, or school 3

I use a curriculum chosen from some
other source 4

I use a curriculum that I developed myself 5

  1. Were any students excused by a parent’s or guardian’s request from attending the class when topics related to pregnancy prevention, HIV prevention, other STD prevention, or human sexuality were presented?

Yes 1

No 2 SKIP TO THE INSTRUCTIONS BEFORE Q39

  1. How many students were excused by a parent’s or guardian’s request from attending class when topics related to pregnancy prevention, HIV prevention, other STD prevention, or human sexuality were presented?

_____ Students

  1. When excused from class when topics related to pregnancy prevention, HIV prevention, other STD prevention, or human sexuality were presented, did these students participate in…

Yes No

  1. Study hall? 1 2

  2. An assignment or project related to sex education? 1 2



(Q35 Continued)

  1. An assignment or project related to another health
    education topic? 1 2

  2. Additional time in physical education? 1 2

  3. Another activity? 1 2

IF EMOTIONAL AND MENTAL HEALTH WAS TAUGHT IN THIS CLASS (Q3I IS “YES”), ANSWER Q36–Q39. OTHERWISE, SKIP TO THE INSTRUCTIONS BEFORE Q40.

The next section asks about instruction on emotional and mental health in this class.

SHOW CARD 13

As I read the topics listed on this card, please tell me if you taught about each one in the class.

  1. When you taught about emotional and mental health, did you teach about...

Yes No

  1. Feelings and emotions associated with loss and grief? 1 2

ANSWER B FOR MIDDLE AND HIGH SCHOOL ONLY. OTHERWISE, SKIP TO C.

  1. How emotions change during adolescence? 1 2

  2. Appropriate ways to express and deal
    with emotions and feelings? 1 2

  3. The relationship between feelings and behaviors? 1 2

  4. The importance of talking with trusted adults
    about emotions and feelings? 1 2

  5. Causes, signs, and effects of stress? 1 2

  6. Positive and negative ways of dealing with stress? 1 2

  7. Causes, signs, and effects of depression? 1 2

  8. When to seek help for mental health problems? 1 2

  9. Interrelationship of physical, mental, emotional,
    social, and spiritual health? 1 2

  10. Strategies for controlling impulsive behaviors? 1 2

  11. Strategies for controlling anger? 1 2

  12. Strategies for coping with loss and grief? 1 2

  13. Being sensitive to the feelings of others? 1 2

  14. Establishing and maintaining healthy relationships? 1 2

  15. Healthy ways to express affection, love, friendship,
    and concern? 1 2

  16. How mental illness is diagnosed and treated? 1 2

SHOW CARD 14

As I read the areas of instruction listed on this card, please tell me if you taught about each one.

  1. Did you teach about...

Yes No

  1. The influence of families on emotional
    and mental health? 1 2

  2. The influence of the media on emotional
    and mental health? 1 2

  3. Social or cultural influences on emotional
    and mental health? 1 2

  4. The influence of peers on emotional
    and mental health? 1 2

  5. How to find valid information or services related to
    emotional and mental health? 1 2

  6. How students can influence, support, or advocate
    for others to promote emotional and mental health? 1 2

  7. The relationship between alcohol or other drug use
    and emotional and mental health? 1 2

  1. Did you provide students with the opportunity to practice communication, decision-making, or goal-setting skills related to emotional and mental health, for example through role playing?

Yes 1

No 2

  1. How many hours did you spend teaching about emotional and mental health?

Less than 1 hour 0

1 Hour 1

2 Hours 2

3 Hours 3

4 Hours 4

5 Hours 5

6 Hours 6

7 Hours 7

8 Hours 8

9 Hours 9

10 Hours 10

11 or more hours 11

IF EMOTIONAL AND MENTAL HEALTH OR SUICIDE PREVENTION WERE TAUGHT IN THE CLASS (Q3I OR Q3J IS “YES”), ANSWER Q40–Q42. OTHERWISE, SKIP TO THE INSTRUCTIONS BEFORE Q43.

Now I’m going to ask you about instruction on suicide prevention in this class.

SHOW CARD 15

As I read the topics listed on this card, please tell me if you taught about each one in the class.

  1. When you taught about suicide prevention, did you teach about...

Yes No

  1. Recognizing signs and symptoms of people
    who are in danger of hurting themselves? 1 2

  2. What to do if someone is thinking about hurting
    himself or herself? 1 2

  3. The relationship between suicide and other types
    of violence? 1 2

  4. The relationship between suicide and emotional
    and mental health? 1 2

  5. When to seek help for suicidal thoughts? 1 2

SHOW CARD 16

As I read the areas of instruction listed on this card, please tell me if you taught about each one.

  1. Did you teach about...

Yes No

  1. The influence of families on suicidal behaviors? 1 2

  2. The influence of the media on suicidal behaviors? 1 2

  3. Social or cultural influences on suicidal behaviors? 1 2

  4. The influence of peers on suicidal behaviors? 1 2

  5. How to find valid information or services to prevent
    suicidal behaviors? 1 2

  6. Resisting peer pressure that would increase risk
    of suicidal behaviors? 1 2

  7. How students can influence, support, or advocate
    for others to prevent suicidal behaviors? 1 2

  8. The relationship between alcohol or other drug use
    and suicidal behaviors? 1 2

  1. How many hours did you spend teaching about suicide prevention?

Less than 1 hour 0

1 Hour 1

2 Hours 2

3 Hours 3

4 Hours 4

5 Hours 5

6 Hours 6

7 Hours 7

8 Hours 8

9 Hours 9

10 Hours 10

11 or more hours 11

IF VIOLENCE PREVENTION WAS TAUGHT IN THE CLASS (Q3K IS “YES”), ANSWER Q43–Q46. OTHERWISE, SKIP TO THE INSTRUCTIONS BEFORE Q47.

SHOW CARD 17

The next several questions are about instruction on the prevention of violence and intentional injuries, including topics such as bullying, fighting, or dating violence. As I read the topics listed on this card, please tell me if you taught about each one in the class.

  1. When you taught about the prevention of violence and intentional injuries, did you teach about...

Yes No

  1. Anger management? 1 2

  2. Bullying? 1 2

  3. What to do if someone is being bullied? 1 2

ANSWER D, E AND F FOR ELEMENTARY SCHOOL ONLY. OTHERWISE, SKIP TO G.

  1. Teasing? 1 2

  2. Personal safety, for example, dealing with strangers? 1 2

  3. Inappropriate touching? 1 2

  4. Techniques to resolve interpersonal conflicts
    without fighting? 1 2

  5. Prosocial behaviors such as cooperation, praise,
    or showing support for others? 1 2

ANSWER I–M FOR MIDDLE AND HIGH SCHOOL ONLY. OTHERWISE, SKIP TO N.

  1. Personal safety, for example avoiding becoming
    a victim of a crime? 1 2

  2. Sexual harassment? 1 2

  3. Dating violence? 1 2

  4. Sexual assault and rape? 1 2

  5. Gangs? 1 2

  6. Recognizing signs and symptoms of people
    who are in danger of hurting others? 1 2

(Q43 continued)

Yes No

  1. What to do if someone is thinking about hurting others? 1 2

  2. Prejudice, discrimination, and bias? 1 2

  3. Empathy, that is, identification with and understanding
    of another person’s feelings, situation, or motives? 1 2

  4. Perspective-taking, that is, taking another person’s
    point of view? 1 2

  5. Short-term consequences of violence? 1 2

  6. Long-term consequences of violence? 1 2

SHOW CARD 18

As I read the areas of instruction listed on this card, please tell me if you taught about each one.

  1. Did you teach about...

Yes No

  1. The influence of families on behaviors related
    to violence? 1 2

  2. The influence of the media on behaviors related
    to violence? 1 2

  3. Social or cultural influences on behaviors related
    to violence? 1 2

  4. The influence of peers on behaviors related
    to violence? 1 2

  5. How to find valid information or services
    to prevent violence? 1 2

  6. Resisting peer pressure to engage in violent behaviors? 1 2

  7. How students can influence, support, or advocate
    for others to prevent violence? 1 2

  8. The relationship between alcohol or other drug use
    and violence? 1 2

  9. The relationship between anger and violence? 1 2

  1. Did you provide students with the opportunity to practice communication, decision‑making, goal-setting, or refusal skills related to violence prevention, for example through role playing?

Yes 1

No 2

  1. How many hours did you spend teaching about violence prevention? Please do not include hours spent teaching about suicide prevention.

Less than 1 hour 0

1 Hour 1

2 Hours 2

3 Hours 3

4 Hours 4

5 Hours 5

6 Hours 6

7 Hours 7

8 Hours 8

9 Hours 9

10 Hours 10

11 or more hours 11

IF INJURY PREVENTION AND SAFETY WERE TAUGHT IN THE CLASS (Q3L IS “YES”), ANSWER Q47–Q50. OTHERWISE, SKIP TO THE INTRODUCTION TO Q51.

SHOW CARD 19

Next, I am going to ask about instruction on ways to prevent unintentional injuries like those from car crashes, fires, or drownings. As I read the topics listed on this card, please tell me if you taught about each one in the class.

  1. When you taught about injury prevention and safety, did you teach about...

Yes No

  1. Fire safety? 1 2

  2. Water safety? 1 2

  3. Emergency preparedness? 1 2

  4. Pedestrian safety? 1 2

  5. Motor vehicle occupant safety such as seatbelt use? 1 2

ASK F FOR MIDDLE AND HIGH SCHOOLS ONLY

  1. State laws related to teen driving? 1 2

  2. Use of protective equipment for biking, skating,
    or other sports? 1 2

  3. First aid? 1 2

  4. Cardiopulmonary resuscitation, or CPR? 1 2

  5. Poisoning prevention? 1 2

ANSWER K FOR ELEMENTARY SCHOOL ONLY. OTHERWISE, SKIP TO THE INTRODUCTION TO Q48.

  1. Playground safety? 1 2

SHOW CARD 20

As I read the areas of instruction listed on this card, please tell me if you taught about each one.

  1. Did you teach about...

Yes No

  1. The influence of families on behaviors related
    to safety? 1 2

  2. The influence of the media on behaviors related
    to safety? 1 2

  3. The influence of technology on behaviors related
    to safety? 1 2

  4. Social or cultural influences on behaviors related
    to safety? 1 2

  5. The influence of peers on behaviors related
    to safety? 1 2

  6. How to find valid information or services
    to prevent injuries? 1 2

  7. Resisting peer pressure that would increase risk
    of injuries? 1 2

  8. How students can influence, support, or advocate
    for others to prevent injuries? 1 2

  9. The relationship between alcohol or other drug use
    and injuries? 1 2

  1. Did you provide students with the opportunity to practice communication, decision‑making, goal-setting, or refual skills related to injury prevention and safety, for example through role playing?

Yes 1

No 2

  1. How many hours did you spend teaching about injury prevention and safety?

Less than 1 hour 0

1 Hour 1

2 Hours 2

3 Hours 3

4 Hours 4

5 Hours 5

6 Hours 6

7 Hours 7

8 Hours 8

9 Hours 9

10 Hours 10

11 or more hours 11

Now I’d like to ask you a few questions about instruction on personal health and wellness in this class.

SHOW CARD 21

As I read the topics listed on this card, please tell me if you taught about each one in the class.

  1. Did you teach about...

Yes No

  1. Hand washing or hand hygiene? 1 2

  2. Dental and oral health? 1 2

  3. Consumer health, such as choosing sources of
    health-related information, products, and services wisely? 1 2

  4. Environmental health, such as how air
    and water quality can affect health? 1 2

  5. Growth and development? 1 2

  6. Immunizations? 1 2

  7. Sun safety or skin cancer prevention? 1 2

  8. The difference between infectious and chronic diseases? 1 2

  9. How common infectious illnesses like the flu
    are transmitted? 1 2

  10. How to cover your mouth or nose when coughing
    or sneezing? 1 2

  11. The importance of staying at home when sick? 1 2

  12. Benefits of rest and sleep? 1 2

  13. Ways to prevent vision and hearing loss? 1 2

  14. The importance of health screenings and checkups? 1 2

  15. How positive health behaviors can benefit people
    throughout the life span? 1 2

  16. Potential health and social consequences of popular fads
    and trends? 1 2

SHOW CARD 22

  1. Did you teach about…

Yes No

  1. The influence of families on behaviors related
    to personal health and wellness? 1 2

  2. The influence of the media on behaviors related
    to personal health and wellness? 1 2

  3. Social or cultural influences on behaviors related
    to personal health and wellness? 1 2

  4. The influence of peers on behaviors related
    to personal health and wellness? 1 2

  5. How to find valid information or services to promote
    personal health and wellness? 1 2

  6. How students can influence, support, or advocate
    for others to promote personal health and wellness? 1 2

Now, I would like to ask a few more general questions about the class. Please remember to answer these questions about this class only. The next questions ask about the use of various teaching methods.

IF THIS IS AN ONLINE HEALTH EDUCATION CLASS, SKIP TO Q54.

  1. How often did you use...

Almost
Some- Always or
Never Rarely times Always

  1. Audiovisual media, such as DVDs? 1 2 3 4

  2. Group discussions? 1 2 3 4

  3. Cooperative group activities? 1 2 3 4

  4. Role play, simulations, or practice? 1 2 3 4

  5. Visual, performing, or language arts? 1 2 3 4

  6. Pledges or contracts for changing
    behavior or abstaining from a behavior? 1 2 3 4

  7. Guest speakers? 1 2 3 4

  8. Peer teaching? 1 2 3 4

  9. The Internet? 1 2 3 4

  10. Health education programs available
    through videoconferencing
    or other distance learning methods? 1 2 3 4

  11. Student logs or journals? 1 2 3 4

  12. Games to reinforce concepts? 1 2 3 4

  13. Field trips as a method of instruction? 1 2 3 4


SKIP TO THE INTRODUCTION TO Q55

  1. How often did you use...

Almost
Some- Always or
Never Rarely times Always

  1. Group discussions? 1 2 3 4

  2. Cooperative group activities? 1 2 3 4

  3. Role play, simulations, or practice? 1 2 3 4

  4. Visual, performing, or language arts? 1 2 3 4

  5. Pledges or contracts for changing
    behavior or abstaining from a behavior? 1 2 3 4

  6. Guest speakers? 1 2 3 4

  7. Peer teaching? 1 2 3 4

  8. Student logs or journals? 1 2 3 4

  9. Games to reinforce concepts? 1 2 3 4

The next questions ask about the use of methods to highlight diversity or the values of various cultures.

  1. When teaching the class did you...

Yes No N/A

  1. Use textbooks or curricular materials
    reflective of various cultures? 1 2

  2. Use textbooks, curricular materials, or
    other teaching techniques designed for
    students with limited English proficiency? 1 2 3

  3. Ask students or families to share
    their own cultural experiences related
    to health topics? 1 2

  4. Teach about cultural differences
    and similarities? 1 2

  5. Modify teaching methods to match
    students’ learning styles, health beliefs,
    or cultural values? 1 2

  1. Did you ask students to...

Yes No

  1. Perform volunteer work at a hospital,
    a local health department, or any other local
    organization that addresses health issues? 1 2

  2. Participate in or attend a community health fair? 1 2

  3. Gather information about health services
    that are available in the community,
    such as health screenings? 1 2

  4. Visit a store to compare prices of health products? 1 2

  5. Identify potential injury sites at school, home,
    or in the community? 1 2

  6. Identify advertising in the community designed
    to influence health behaviors? 1 2

  7. Advocate for a health-related issue? 1 2

  1. Did you...

Yes No

  1. Provide families of all students in the class
    with information on the class? 1 2

  2. Give students homework or projects
    that involve family members? 1 2

  3. Invite families of all students in the class to attend
    the class or other health education activities,
    such as a health fair or field trip? 1 2

  4. Provide strategies to help students promote
    the health of family members? 1 2

  5. Collect suggestions from students about the class? 1 2

  6. Collect suggestions from students’ families
    about the class? 1 2

The next question asks about student assessment in this class.

  1. Did you assess students based on…

Yes No

  1. Their attendance? 1 2

  2. Their level of participation? 1 2

  3. Their attitude? 1 2

  4. Their performance on knowledge tests? 1 2

  5. Their final scores on skills performance tests? 1 2

  6. Their improvement in skills performance tests? 1 2

  7. Their scores on a portfolio? 1 2

  8. Their demonstration of self-management skills,
    such as goal-setting or self-assessment? 1 2

ANSWER Q59, Q60, AND Q61 FOR ELEMENTARY SCHOOL ONLY. OTHERWISE, SKIP TO THE INTRODUCTION TO Q62.

  1. Did you make time for students to wash their hands using a bathroom or classroom sink..

Yes No

  1. Before lunch? 1 2

  2. Before snacks? 1 2

  3. After recess? 1 2

  1. Did you make time for students to use hand sanitizers...

Students do not
have access to
Yes No hand sanitizers

  1. Before lunch? 1 2 3

  2. Before snacks? 1 2 3

  3. After recess? 1 2 3

  1. Does the classroom supply list for students include hand cleaning products?

Yes 1

No 2

My next questions ask about teaching students with long-term physical, medical, or cognitive disabilities. Examples of such disabilities include Down syndrome, learning disabilities, and conditions that require permanent use of a wheelchair.

  1. Were there any students with long-term physical, medical, or cognitive disabilities in the class?

Yes 1

No 2 SKIP TO THE INTRODUCTION TO Q64

  1. Was there...

Yes No

  1. A special education teacher with whom you
    coordinated assignments for students with disabilities? 1 2

  2. A teacher or aide who came in to assist
    with the students with disabilities? 1 2

  3. Assigned note takers or readers for class work? 1 2

  4. Simplified instructional content or variations
    in the amount or difficulty of material taught? 1 2

  5. More skill modeling, practicing, or repetition? 1 2

  6. Preferential seating for the students with disabilities? 1 2

  7. Modified assessment? 1 2

My last set of questions asks about your teaching experience and educational background.

  1. Counting this year as a full year and including years spent teaching health education topics or courses at any other schools, how many years of experience do you have teaching health education topics or courses?

_____ Years

IF THIS IS AN ONLINE HEALTH EDUCATION CLASS, SKIP TO Q66.

  1. Have you ever taught an online or distance health education class for any of grades K-12?

Yes 1

No 2

  1. Do you coach an interscholastic sport?

Yes 1

No 2

  1. Do you have an undergraduate degree?

Yes 1

No 2 SKIP TO Q73

  1. 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

  1. Did you have an undergraduate minor?

Yes 1

No 2 SKIP TO Q71

  1. 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

  1. Do you have a graduate degree?

Yes 1

No 2 SKIP TO Q73

  1. In what area or areas?
    MARK ALL THAT APPLY

Health education 1

Physical education 2

Other education 3

Nursing 4

Biology or other science 5

Other (Specify) 6

  1. Currently, are you certified, endorsed, or licensed by the state to teach health education in...

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

  1. Elementary school? 1 2 3

  2. Middle school? 1 2 3

  3. High school? 1 2 3

ANSWER Q74 FOR MIDDLE AND HIGH SCHOOL ONLY. OTHERWISE, SKIP TO THE INTRODUCTION TO Q75.

  1. Are you a Certified Health Education Specialist, or CHES?

Yes 1

No 2

Now I’d like to ask you about professional development you may have received or would like to receive. Professional development might include workshops, conferences, continuing education, graduate courses, or any other kind of in-service.

SHOW CARD 23

As I read the list of topics on this card, please tell me if you received any professional development on each topic.

  1. During the past two years, did you receive any professional development 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. HIV, or human immunodeficiency virus, prevention? 1 2

  7. Other STD, or sexually transmitted disease, 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, including foodborne
    illness and flu prevention? 1 2

  1. Which of these topics would you like to receive further professional development on?
    MARK ALL THAT APPLY

Alcohol or other drug use prevention 1

Tobacco use prevention 2

Nutrition and dietary behavior 3

Physical activity and fitness 4

Pregnancy prevention 5

HIV, or human immunodeficiency
virus, prevention 6

Other STD, or sexually transmitted
disease, prevention 7

Human sexuality 8

Emotional and mental health 9

Suicide prevention 10

Violence prevention, for example bullying,
fighting, or dating violence prevention 11

Injury prevention and safety 12

Asthma 13

Infectious disease prevention, including
foodborne illness and flu prevention 14

None of these 15

SHOW CARD 24

As I read the list of topics on this card, please tell me if you received any professional development on each one during the past two years.

  1. During the past two years, did you receive any professional development 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. Encouraging family or community involvement? 1 2

  7. Teaching skills for behavior change? 1 2

  8. Classroom management techniques, such as social skills
    training, environmental modification, conflict resolution
    and mediation, and behavior management? 1 2

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

  10. Health education standards? 1 2

  11. Teaching online or distance education courses? 1 2

  12. Transforming traditional face-to-face courses
    into an online format? 1 2

  13. Using technology such as computers for health education? 1 2

  1. Which of these topics would you like to receive further professional development on?
    MARK ALL THAT APPLY

Teaching students with physical, medical,
or cognitive disabilities 1

Teaching students of various
cultural backgrounds 2

Teaching students with limited
English proficiency 3

Using interactive teaching methods,
such as role plays or cooperative
group activities 4

Using peer educators for health education 5

Encouraging family
or community involvement 6

Teaching skills for behavior change 7

Classroom management techniques, such as
social skills training, environmental
modification, conflict resolution
and mediation, and behavior management 8

Assessing or evaluating students
in health education 9

Health education standards 10

Teaching online or distance education courses 11

Transforming traditional face-to-face courses
into an online format 12

Using technology such as computers
for health education 13

None of these 14

  1. 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.

Health Education Classroom Questionnaire—National Review Version 0

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File TitleForm Approved
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Last Modified Byarp5
File Modified2011-03-09
File Created2011-03-03

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