2006 SCHOOL HEALTH PROFILE
LEAD HEALTH EDUCATION TEACHER QUESTIONNAIRE

This questionnaire will be used to assess school health education across your state or school 
district.  Your cooperation is essential for making the results of this survey comprehensive, 
accurate, and timely.  Your answers will be kept confidential.

INSTRUCTIONS

1.  This questionnaire should be completed by the lead health education teacher (or the 
    person acting in that capacity) and concerns only activities that occur in the school listed 
    below.  Please consult with other people if you are not sure of an answer.
2.  Please use a #2 pencil to fill in the answer circles completely.  Do not fold, bend, or 
    staple this questionnaire or mark outside the answer circles.
3.  Follow the instructions for each question.
4.  Write any additional comments you wish to make at the end of this questionnaire.
5.  Return the questionnaire in the envelope provided.

Person completing this questionnaire

Name: 
Title: 
School name: 
District: 
Telephone number: 

To be completed by the SEA or LEA conducting the survey

School name: 
Survey ID: 

REQUIRED HEALTH EDUCATION COURSES

(Definition:  A required health education course is taught as a separate semester-, quarter-, 
or year-long unit of instruction for which the student receives credit.  It is not health 
education units or lessons integrated into other subjects.)

1.  Is a required health education course taught for students in any of grades 6 through 
    12 in this school? (Mark one response.)

a.	Yes 
b.	No        If no, skip to Question 12

2.  Are teachers in this school required to use each of the following materials in a 
    required health education course for students in any of grades 6 through 12? (Mark 
    yes or no for each type of material.)

a.  The National Health Education Standards			Yes/No
b.  The Health Education Curriculum Analysis Tool (HECAT) 
    from the Centers for Disease Control and Prevention		Yes/No
c.  Any state-, district-, or school-developed curriculum	Yes/No
d.  A commercially-developed curriculum				Yes/No
e.  A commercially-developed student textbook			Yes/No
f.  A commercially-developed teacher's guide			Yes/No
g.  Health education performance assessment materials		Yes/No
h.  Any materials from health organizations, such as the 
    American Heart Association or the American Cancer Society	Yes/No

3.  During this school year, have teachers in this school tried to increase student 
    knowledge on each of the following topics in a required health education course in 
    any of grades 6 through 12? (Mark yes or no for each topic.)

a.  Alcohol or other drug use prevention			Yes/No
b.  Asthma awareness						Yes/No
c.  Consumer health, such as choosing sources of health-related 
    information, products, and services wisely			Yes/No
d.  Cardiopulmonary resuscitation (CPR)				Yes/No
e.  Dental and oral health					Yes/No
f.  Emotional and mental health					Yes/No
g.  Environmental health, such as how air and water quality 
    can affect health						Yes/No
h.  First aid							Yes/No
i.  Foodborne illness prevention				Yes/No
j.  Growth and development					Yes/No
k.  HIV (human immunodeficiency virus) prevention		Yes/No
l.  Human sexuality						Yes/No
m.  Immunizations						Yes/No
n.  Injury prevention and safety				Yes/No
o.  Nutrition and dietary behavior				Yes/No
p.  Physical activity and fitness				Yes/No
q.  Pregnancy prevention					Yes/No
r.  STD (sexually transmitted disease) prevention		Yes/No
s.  Suicide prevention						Yes/No
t.  Sun safety or skin cancer prevention			Yes/No
u.  Tobacco-use prevention					Yes/No
v.  Violence prevention (such as bullying, fighting, 
    or homicide)						Yes/No

4.  During this school year, have teachers in this school tried to improve each of the
    following student skills in a required health education course in any of grades 6
    through 12? (Mark yes or no for each skill.)

a.  How to find valid information or services related to
    personal health and wellness				Yes/No
b.  Influence of media on personal health and wellness		Yes/No
c.  Communication skills, such as how to ask for assistance 
    with a health-related problem				Yes/No
d.  Decision-making skills, such as deciding to get appropriate 
    health screenings and exams 				Yes/No
e.  Goal-setting skills, such as setting a goal for improving 
    personal health habits					Yes/No
f.  Conflict resolution skills, such as techniques to resolve 
    interpersonal conflicts without fighting			Yes/No
g.  Resisting peer pressure to engage in unhealthy behavior
    related to personal health and wellness 			Yes/No	
	
5.  During this school year, how often have teachers in this school used each of the 
    following teaching methods in a required health education course in any of grades 6 
    through 12? (Mark yes or no for each teaching method.)

a.   Audio-visual media, such as videos    			Never/Rarely/Sometimes/Almost always or always
b.   Group discussions    					Never/Rarely/Sometimes/Almost always or always
c.   Cooperative group activities    				Never/Rarely/Sometimes/Almost always or always
d.   Role play, simulations, or practice    			Never/Rarely/Sometimes/Almost always or always
e.   Language, performing, or visual arts    			Never/Rarely/Sometimes/Almost always or always
f.   Pledges or contracts for changing behavior
     or abstaining from a behavior    				Never/Rarely/Sometimes/Almost always or always
g.   Peer teaching    						Never/Rarely/Sometimes/Almost always or always
h.   The Internet    						Never/Rarely/Sometimes/Almost always or always
i.   Computer-assisted instruction    				Never/Rarely/Sometimes/Almost always or always
j.   Guest speakers    						Never/Rarely/Sometimes/Almost always or always
k.   Health education programs available through 
     videoconferencing or other distance learning methods  	Never/Rarely/Sometimes/Almost always or always

6.  During this school year, have teachers in this school used each of the following 
    teaching methods to highlight diversity or the values of various cultures in a required 
    health education course in any of grades 6 through 12? (Mark yes or no for each 
    teaching method.)

a.  Use textbooks or curricular materials reflective of various		
    cultures								Yes/No
b.  Use textbooks or curricular materials designed for students
    with limited English proficiency					Yes/No
c.  Ask students or families to share their own cultural 
    experiences related to health topics				Yes/No
d.  Teach about cultural differences and similarities			Yes/No
e.  Modify teaching methods to match students' learning styles,
    health beliefs, or cultural values					Yes/No

7.  During this school year, have teachers in this school asked students to participate in 
    each of the following activities as part of a required health education course in any 
    of grades 6 through 12? (Mark yes or no for each activity.)

a.  Perform volunteer work at a hospital, a local health
    department, or any other local organization that 
    addresses health issues						Yes/No
b.  Participate in or attend a community health fair			Yes/No
c.  Gather information about health services that are
    available in the community, such as health screenings		Yes/No
d.  Visit a store to compare prices of health products			Yes/No
e.  Identify potential injury sites at school, home, or 
    in the community							Yes/No
f.  Identify advertising in the community designed to 
    influence health behaviors 						Yes/No
g.  Advocate for a health-related issue					Yes/No
h.  Complete homework or projects that involve family 
    members 								Yes/No

8.  During this school year, did teachers in this school teach each of the following 
    tobacco-use prevention topics in a required health education course for students in 
    any of grades 6 through 12?  (Mark yes or no for each topic.)

a.  Short- and long-term health consequences of cigarette smoking (such as 
    stained teeth, bad breath, heart disease, and cancer)			Yes/No
b.  Benefits of not smoking cigarettes (including long- and short-term 
    health benefits, social benefits, environmental benefits, and 
    financial benefits)								Yes/No
c.  Short- and long-term health consequences of cigar smoking			Yes/No
d.  Short- and long-term health consequences of using smokeless 
    tobacco									Yes/No
e.  Benefits of not using smokeless tobacco					Yes/No
f.  Addictive effects of nicotine in tobacco products				Yes/No
g.  How many young people use tobacco						Yes/No
h.  Influence of families on tobacco use					Yes/No
i.  Influence of the media on tobacco use					Yes/No
j.  Social or cultural influences on tobacco use				Yes/No
k.  How to find valid information or services related to
    tobacco-use prevention or cessation						Yes/No
l.  Making a personal commitment not to use tobacco				Yes/No
m.  How students can influence or support others to prevent tobacco use 	Yes/No
n.  How students can influence or support others in efforts to quit 
    using tobacco								Yes/No
o.  Resisting peer pressure to use tobacco					Yes/No
p.  The health effects of environmental tobacco smoke (ETS) or 
    second-hand smoke								Yes/No

9.  During this school year, did teachers in this school teach each of the following 
    pregnancy, HIV, or STD prevention topics in a required health education course for 
    students in any of grades 6 through 12? (Mark yes or no for each topic.)

a.  Abstinence as the most effective method to avoid 
    pregnancy, HIV, and STDs					Yes/No
b.  How to correctly use a condom				Yes/No
c.  Condom efficacy, that is, how well condoms work 
    and do not work						Yes/No
d.  Risks associated with having multiple sexual partners	Yes/No
e.  Social or cultural influences on sexual behavior		Yes/No
f.  How to prevent HIV infection				Yes/No
g.  How HIV is transmitted					Yes/No
h.  How HIV affects the human body				Yes/No
i.  Influence of alcohol and other drugs on HIV-related 
    risk behaviors						Yes/No
j.  How to find valid information or services related to  
    HIV or HIV testing						Yes/No
k.  Compassion for persons living with HIV or AIDS		Yes/No

10. During this school year, did teachers in this school teach each of the following 
    nutrition and dietary topics in a required health education course for students in 
    any of grades 6 through 12? (Mark yes or no for each topic.)

a.  The benefits of healthy eating				Yes/No
b.  Food guidance using MyPyramid 				Yes/No
c.  Using food labels						Yes/No
d.  Balancing food intake and physical activity			Yes/No
e.  Eating more fruits, vegetables, and grain products		Yes/No
f.  Choosing foods that are low in fat, saturated fat, and 
    cholesterol 						Yes/No
g.  Using sugars in moderation					Yes/No
h.  Using salt and sodium in moderation				Yes/No
i.  Eating more calcium-rich foods				Yes/No
j.  Food safety							Yes/No
k.  Preparing healthy meals and snacks				Yes/No
l.  Risks of unhealthy weight control practices			Yes/No
m.  Accepting body size differences				Yes/No
n.  Eating disorders						Yes/No

11.  During this school year, did teachers in this school teach each of the following 
     physical activity topics in a required health education course for students in any of 
     grades 6 through 12? (Mark yes or no for each topic.)

a.  The physical, psychological, or social benefits of physical activity    	Yes/No
b.  Health-related fitness (i.e., cardiovascular endurance, muscular 
    endurance, muscular strength, flexibility, and body composition)    			Yes/No
c.  The difference between physical activity, exercise, and fitness    		Yes/No
d.  Phases of a workout (i.e., warm-up, workout, and cool down)    		Yes/No
e.  How much physical activity is enough (i.e., determining frequency, 
    intensity, time, and type of physical activity)    				Yes/No
f.  Developing an individualized physical activity plan    			Yes/No
g.  Monitoring progress toward reaching goals in an individualized 
    physical activity plan    							Yes/No
h.  Overcoming barriers to physical activity    				Yes/No
i.  Decreasing sedentary activities such as television watching    		Yes/No
j.  Opportunities for physical activity in the community    			Yes/No
k.  Preventing injury during physical activity    				Yes/No
l.  Weather-related safety (e.g., avoiding heat stroke, hypothermia, 
    and sunburn while physically active)    					Yes/No
m.  Dangers of using performance-enhancing drugs, such as steroids    		Yes/No

HIV PREVENTION

12.  Are required HIV prevention units or lessons taught in each of the following courses
     in this school?  (Mark yes or no for each course.)

a.  Science    						Yes/No
b.  Home economics or family and consumer education	Yes/no
c.  Physical education					Yes/No
d.  Family life education or life skills		Yes/No
e.  Special education					Yes/No
f.  Social studies					Yes/No

COLLABORATION

13.  During this school year, have any health education staff worked with each of the 
     following groups on health education activities?  (Mark yes or no for each group.)

a.  Physical education staff					Yes/No
b.  School health services staff (e.g., nurses)			Yes/No
c.  School mental health or social services staff 
    (e.g., psychologists, counselors, and social workers)	Yes/No
d.  Nutrition or food service staff				Yes/No

14.  During this school year, has this school done each of the following activities?  (Mark 
     yes or no for each activity.)

a.  Provided families with information on school health 
    education 							Yes/No
b.  Met with a parents' organization such as the PTA to 
    discuss school health education 				Yes/No
c.  Invited family members to attend health education 
    classes							Yes/No

STAFF DEVELOPMENT

15.  During the past two years, did you receive staff development (such as workshops, 
     conferences, continuing education, or any other kind of in-service) on each of the 
     following health education topics? (Mark yes or no for each topic.) 

a.  Alcohol or other drug use prevention			Yes/No
b.  Asthma awareness						Yes/No
c.  Consumer health, such as choosing sources of 
    health-related information, products, and services wisely	Yes/No
d.  Cardiopulmonary resuscitation (CPR)				Yes/No
e.  Dental and oral health					Yes/No
f.  Emotional and mental health					Yes/No
g.  Environmental health, such as how air and water quality 
    can affect health						Yes/No
h.  First aid							Yes/No
i.  Foodborne illness prevention				Yes/No
j.  Growth and development					Yes/No
k.  HIV (human immunodeficiency virus) prevention		Yes/No
l.  Human sexuality						Yes/No
m.  Immunizations						Yes/No
n.  Injury prevention and safety				Yes/No
o.  Nutrition and dietary behavior				Yes/No
p.  Physical activity and fitness				Yes/No
q.  Pregnancy prevention					Yes/No
r.  STD (sexually transmitted disease) prevention		Yes/No
s.  Suicide prevention						Yes/No
t.  Sun safety or skin cancer prevention			Yes/No
u.  Tobacco-use prevention					Yes/No
v.  Violence prevention (such as bullying, fighting, 
    or homicide)						Yes/No
      
16. Would you like to receive staff development on each of these health education 
    topics? (Mark yes or no for each topic.) 

a.  Alcohol or other drug use prevention			Yes/No
b.  Asthma awareness						Yes/No
c.  Consumer health, such as choosing sources of health-related 
    information, products, and services wisely			Yes/No
d.  Cardiopulmonary resuscitation (CPR)				Yes/No
e.  Dental and oral health					Yes/No
f.  Emotional and mental health					Yes/No
g.  Environmental health, such as how air and water quality 
    can affect health						Yes/No
h.  First aid							Yes/No
i.  Foodborne illness prevention				Yes/No
j.  Growth and development					Yes/No
k.  HIV (human immunodeficiency virus) prevention		Yes/No
l.  Human sexuality						Yes/No
m.  Immunizations						Yes/No
n.  Injury prevention and safety				Yes/No
o.  Nutrition and dietary behavior				Yes/No
p.  Physical activity and fitness				Yes/No
q.  Pregnancy prevention					Yes/No
r.  STD (sexually transmitted disease) prevention		Yes/No
s.  Suicide prevention						Yes/No
t.  Sun safety or skin cancer prevention			Yes/No
u.  Tobacco-use prevention					Yes/No
v.  Violence prevention (such as bullying, fighting, 
    or homicide)						Yes/No

17. During the past two years, did you receive staff development (such as workshops, 
    conferences, continuing education, or any other kind of in-service) on each of the 
    following topics? (Mark yes or no for each teaching topic.) 
			
a.  Teaching students with physical, medical, or 
    cognitive disabilities					Yes/No
b.  Teaching students of various cultural 
    backgrounds							Yes/No 
c.  Teaching students with limited English 
    proficiency							Yes/No
d.  Using interactive teaching methods 
    such as role plays or cooperative 
    group activities 						Yes/No
e.  Encouraging family or community
    involvement  						Yes/No
f.  Teaching skills for behavior change 			Yes/No
g.  Classroom management techniques, such as social 
    skills training, environmental modification, conflict 
    resolution and mediation, and behavior management		Yes/No
h.  Assessing or evaluating students in health education	Yes/No

18. Would you like to receive staff development on each of these topics? (Mark yes or no 
    for each teaching topic.)
								
a.  Teaching students with physical, medical, or cognitive 
    disabilities    						Yes/No
b.  Teaching students of various cultural backgrounds    	Yes/No
c.  Teaching students with limited English proficiency    	Yes/No
d.  Using interactive teaching methods such as role plays
    or cooperative group activities    				Yes/No
e.  Encouraging family or community involvement    		Yes/No
f.  Teaching skills for behavior change    			Yes/No
g.  Classroom management techniques, such as social 
    skills training, environmental modification, conflict 
    resolution and mediation, and behavior management    	Yes/No
h.  Assessing or evaluating students in health education    	Yes/No

      
PROFESSIONAL PREPARATION

19. What was the major emphasis of your professional preparation? (Mark one 
    response.)

a.  Health and physical education combined 
b.  Health education 
c.  Physical education 
d.  Other education degree 
e.  Kinesiology, exercise science, or exercise physiology 
f.  Home economics or family and consumer science
g.  Biology or other science 
h.  Nursing 
i.  Counseling
j.  Public health
k.  Nutrition
l.  Other

20. Currently, are you certified, licensed, or endorsed by the state to teach health 
    education in middle/junior high school or senior high school?

a.	Yes
b.	No
	
21. Including this school year, how many years of experience do you have teaching 
    health education classes or topics? (Mark one response.)

a.	1 year 
b.	2 to 5 years 
c.	6 to 9 years 
d.	10 to 14 years 
e.	15 years or more 

Thank you for your responses.  Please return this questionnaire.

COMMENTS