Form Approved
OMB No: 0920-0445
Expiration Date: 10/31/2002












Health Education
Classroom Questionnaire

Health Education
Classroom Questionnaire



                                                                 Questions 

General Course Characteristics and Content	1 - 13

Accident or Injury Prevention	14 - 16

Violence Prevention	17 - 19

Tobacco Use Prevention	20 - 23

Alcohol and Other Drug Use Prevention	24 - 27

Nutrition and Dietary Behavior	28 - 31

Physical Activity	32 - 34

Human Sexuality	35 - 44

Teaching and Evaluation Techniques	45 - 52

Respondent Background	53 - 65






Public reporting burden for this collection of information is estimated to average 45 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-24, Atlanta, GA  30333; Attention PRA (0920-0445).


Special Instructions




This questionnaire will be administered using Computer Assisted Personal Interviewing.  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 dont know), 3) navigate complex skip patterns,   4) access information that was provided in previous contact with a school, and 5) perform other useful functions. The programming specifications for the interview are not included in this printed version of the questionnaire.

If you would like more information about this study or would like clarification of any questions in this questionnaire, please call Tim Smith at 1-800-647-9664, extension 6095.




General Course Characteristics and Content



If this is an elementary school, answer Q1-Q3.  If this is a middle, junior, or senior high school, skip to Q4.


1. I would like to talk with you about teaching health topics in  ______________ grade.  Are you currently teaching health topics to a group of _____________ graders?

     Yes.	1
No	2	==>	Thank you for your time and patience.  That is the end of the interview.


2. How many different groups of _______________ graders are you teaching health topics to?

_____	Groups


If only one group, skip to Q10.  Otherwise, continue with Q3.


3. For this interview, I need to ask about one specific group.  If you would name each group, for example your morning class or your afternoon class, I will type the names into the computer.  The computer will then select the group that I will ask about during the interview.  Please tell me the names of all the groups.

Group 1	______________________ 
Group 2	______________________ 
Group 3	______________________ 
Group 4	______________________ 
Group 5	______________________ 
Group 6	______________________ 
Group 7	______________________ 
Group 8	______________________ 
Group 9	______________________ 
Group 10	______________________ 
Group 11	______________________ 
Group 12	______________________ 

The computer has selected ______________.  Throughout this interview, please think about what will take place by the time you finish teaching this group of ______________ graders.


     Skip to Q10.


4. During this interview, I would like to talk about teaching ______________.  In what month and year did you last finish teaching a section of the class?

_____	Month
_____	Year


5. In what month and year did you begin teaching that section of the class?

_____	Month
_____	Year


6. Are you currently teaching a section of the class?

     Yes.	1 
No		2	


7. At that time, how many sections of the class were you teaching?	HEC003

_____	Sections


     If only one section, skip to Q9.  Otherwise, continue with Q8.

8. For this interview, I need to ask about one specific class section.  If you would name each section, for example your first period class or your afternoon period, I will type the names into the computer.  The computer will then select the section that I will ask about during the interview.  Please tell me the names of all the sections.

Section 1	_______________________ 
Section 2	_______________________ 
Section 3	_______________________ 
Section 4	_______________________ 
Section 5	_______________________ 
Section 6	_______________________ 
Section 7	_______________________ 
Section 8	_______________________ 
Section 9	_______________________ 
Section 10	_______________________ 
Section 11	_______________________ 
Section 12	_______________________ 

.
The computer has selected ______________.  Throughout this interview, please think about what took place when you taught this class section.


SHOW CARD 1


9. 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


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

_____	Students



SHOW CARD 2


11. Please look over this list to see what health topics I am including in health education.  As I read the topics listed on the 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.  Did you teach about...

     	Yes	No

a. Personal hygiene?	1	2
b. Dental and oral health?	1	2
c. Nutrition and dietary behavior?	1	2
d. Physical activity and fitness, that is classroom 
        instruction, not a physical activity period?	1	2
e. Growth and development?	1	2
f. Human sexuality?	1	2
g. Pregnancy prevention?	1	2
h. HIV (human immunodeficiency virus) prevention?	1	2
i. STD (sexually transmitted disease) prevention?	1	2
j. Emotional and mental health?	1	2
k. Suicide prevention?	1	2
l. Death and dying?	1	2
m. Tobacco use prevention?	1	2
n. Alcohol or other drug use prevention?	1	2
o. Violence prevention, for example bullying, fighting, or
        homicide?	1	2
p. Accident or injury prevention?	1	2
q. CPR (cardiopulmonary resuscitation)?	1	2
r. First aid?	1	2
s. Immunizations or vaccinations?	1	2
t. Sun safety or skin cancer prevention?	1	2
u. Consumer health, such as choosing sources of health- 
        related information, products, and services wisely?	1	2
v. Environmental health, such as how air and water quality 
        can affect health?	1	2



12. When planning to teach or teaching the class, did you use... HEC013

        	Yes	No

a. The National Health Education Standards?	1	2
b. Any state, district, or school curriculum or guidelines 
        for health education?	1	2
c. Any materials from health organizations, such as the
        American Heart Association or the American Cancer
        Society?	1	2
d. A commercially-developed student textbook?	1	2
e. A commercially-developed teacher's guide?	1	2


13. Did students use a textbook for the class?

Yes		1
No		2


Accident or Injury Prevention



If you have taught about accident or injury prevention in the class (Q11p is Yes), answer Q14-Q16.  Otherwise, skip to Q17.


SHOW CARD 3


14. Next, I am going to ask about instruction on ways to prevent unintentional injuries or accidents like 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.  When you taught about accident or injury prevention, did you teach about...

        	Yes	No

a. Fire safety? 	1	2
b. Water safety?	1	2
c. Road or transportation safety? 	1	2
d. Use of protective equipment for biking, skating, or 
        other sports ?	1	2
e. First aid or CPR ?	1	2



SHOW CARD 4


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

        	Yes	No

a. How many young people do things that cause 
        accidents like drinking and driving?	1	2
b. The number of  injuries and deaths from accidents such
        as the number of people who die from fires or 
        drownings?	1	2
c. The influence of families on risk behaviors related to 
        accidents?	1	2
d. The influence of the media on risk behaviors related
        to accidents?	1	2
e. Social or cultural influences on risk behaviors related
        to accidents?	1	2
f. How to find valid information or services to prevent 
        accidents?	1	2
g. Communication skills to avoid accidents such as 
        convincing friends not to drink and drive?	1	2
h. Decision-making skills to avoid accidents such as 
        deciding to wear a bike helmet?	1	2
i. Goal-setting skills to protect oneself from accidents 
        such as learning to swim before going boating?	1	2
j. Resisting peer pressure that would increase risk of 
        accidents?	1	2
k. How students can influence or support others to prevent 
        accidents?	1	2



16. How many hours did you spend teaching about accident or injury 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



Violence Prevention



If you taught about violence prevention in the class (Q11o is Yes), answer Q17-Q19.  Otherwise, skip to Q20.


SHOW CARD 5


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

        	Yes	No

a. Personal safety, for example, dealing with strangers?	1	2
b. Anger management?	1	2
c. Bullying?	1	2
d. Risks associated with physical fighting?	1	2
e. Techniques to avoid interpersonal conflicts and fights?	1	2
f. Prosocial behaviors such as cooperation, praise, or 
        showing support for others?	1	2
g. Gun safety?	1	2
h. Sexual harassment?	1	2
     Answer i and j if this is a middle, junior, or senior high school.
i. Dating violence?	1	2
j. Sexual assault?	1	2
     Answer k if this is an elementary school.
k. Inappropriate touching?	1	2
l. How to handle stress in healthy ways?	1	2
m. Recognizing stressors and signs of depression that
        might be associated with suicide?	1	2
n. What to do if someone is thinking about suicide?	1	2

SHOW CARD 6


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

        	Yes	No

a. How many young people do things that can lead to 
        violence or suicide, like carrying a weapon?	1	2
b. The number of injuries or deaths from violence or
        suicide, such as the number of people who commit
        suicide?	1	2
c. The influence of families on suicidal behaviors or 
        violence?	1	2
d. The influence of the media on suicidal behaviors or
        violence?	1	2
e. Social or cultural influences on suicidal behaviors or
        violence?	1	2.
f. How to find valid information or services to prevent 
        suicidal behaviors or violence?	1	2
g. Communication skills to avoid violence, such as talking
        out problems?	1	2
h. Decision-making skills to avoid violence, such as 
        deciding to walk away from conflicts?	1	2
i. Goal-setting skills to avoid violence, such as handling 
        conflicts without violence?	1	2
j. Resisting peer pressure that would increase risk of
        suicidal behaviors or violence?	1	2
k. How students can influence or support others to prevent 
        suicidal behaviors or violence?	1	2



19. How many hours did you spend teaching about violence 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



Tobacco Use Prevention



If you taught tobacco use prevention in this class (Q11m is Yes), answer Q20-Q23.  Otherwise, skip to Q24.


SHOW CARD 7


20. As I read the topics listed on this card, please tell me if you taught about each one in the class.  When you taught about tobacco use prevention, did you teach about...

        	Yes	No

a. Short-term health consequences of cigarette smoking? 	1	2
b. Long-term health consequences of cigarette smoking? 	1	2
c. Benefits of not smoking cigarettes ?	1	2
d. Short-term health consequences of using smokeless 
        tobacco?	1	2
e. Long-term health consequences of using smokeless 
        tobacco?	1	2
f. Benefits of not using smokeless tobacco?	1	2
g. Risks of cigar or pipe smoking?	1	2
h. Addictive effects of nicotine in tobacco products?	1	2



SHOW CARD 8


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

        	Yes	No

a. How many young people use tobacco?	1	2
b. The number of illnesses and deaths related to tobacco 
        use?	1	2
c. The influence of families on tobacco use?	1	2
d. The influence of the media on tobacco use?	1	2
e. Social or cultural influences on tobacco use?	1	2
f. How to find valid information or services related to 
        tobacco use prevention or cessation?	1	2
g. Communication skills to avoid tobacco use, such as
        expressing your decision not to smoke?	1	2
h. Decision-making skills to avoid tobacco use, such as
        deciding not to use tobacco?	1	2
i. Goal-setting skills to avoid tobacco use, such as setting
        a quit date?	1	2
j. Resisting peer pressure to use tobacco?	1	2
k. Making a personal commitment not to use tobacco?	1	2
l. How students can influence or support others to 
        prevent tobacco use?	1	2
m. How students can influence or support others in efforts
        to quit using tobacco?	1	2


22. Students sometimes say that using tobacco helps them achieve personal goals such as reducing stress, losing weight, or fitting in with peers.  Did you teach about alternative ways to achieve such goals?

     Yes		1
No		2



23. 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
     


Alcohol and Other Drug Use Prevention



If you taught about alcohol or other drug use prevention in this class (Q11n is Yes), answer Q24-Q27.  Otherwise, skip to Q28.


SHOW CARD 9


24. As I read the topics listed on this card, please tell me if you taught about each one in the class.  When you taught about alcohol and other drug use prevention, did you teach about...

        	Yes	No

a. Short-term health consequences of alcohol use? 	1	2
b. Long-term health consequences of alcohol use and 
        addiction?	1	2
c. Benefits of not using alcohol?	1	2
d. Drink equivalents and blood alcohol content?	1	2
e. Short-term health consequences of illegal drug use, 
        such as marijuana?	1	2
f. Long-term health consequences of illegal drug use?	1	2
g. Benefits of not using illegal drugs?	1	2
h. Distinguishing between medicinal and non-medicinal 
        drug use?	1	2
i. Risks associated with illegal steroid use?	1	2
j. Effects of alcohol or other drug use on decision-making?	1	2


SHOW CARD 10


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

        	Yes	No

a. How many young people use alcohol or other drugs?	1	2
b. The number of  illnesses and deaths related to alcohol
        or other drug use?	1	2
c. The influence of families on alcohol or other drug use?	1	2
d. The influence of the media on alcohol or other drug
        use?	1	2
e. Social or cultural influences on alcohol or other drug 
        use?	1	2
f. How to find valid information or services related to 
        alcohol or other drug use prevention or cessation?	1	2
g. Communication skills to avoid alcohol and other drug 
        use, such as telling a friend why you do not use drugs?	1	2
h. Decision-making skills to avoid alcohol and other drug
        use, such as deciding not to drink alcohol?	1	2
i. Goal-setting skills to avoid alcohol and other drug use, 
        such as not attending parties where alcohol is served?	1	2
j. Resisting peer pressure to use alcohol and other drugs?	1	2
k. Making a personal commitment not to use alcohol and
        other drugs?	1	2
l. How students can influence or support others in efforts
        to prevent alcohol and other drug use?	1	2
m. How students can influence or support others in efforts
        to quit using alcohol and other drugs?	1	2


26. Students sometimes say that using alcohol or other drugs helps them achieve personal goals such as reducing stress or fitting in with peers.  Did you teach about alternative ways to achieve such goals?

     Yes		1
No		2



27. 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
     


Nutrition and Dietary Behavior



If you taught about nutrition and dietary behavior in this class (Q11c is Yes), 
     answer Q28-Q31.  Otherwise, skip to Q32.


SHOW CARD 11


28. As I read the topics listed on this card, please tell me if you taught about each one in the class.  When you taught about nutrition and dietary behavior, did you teach about...

        	Yes	No

a. The benefits of healthy eating?	1	2
b. The Food Guide Pyramid?	1	2
c. The Dietary Guidelines for Americans?	1	2
d. Using food labels?	1	2
e. Eating a variety of foods?	1	2
f. Balancing food intake and physical activity?	1	2
g. Eating more fruits, vegetables, and grain products?	1	2
h. Choosing foods that are low in fat, saturated fat, and
        cholesterol?	1	2
i. Using salt and sodium in moderation?	1	2
j. Using sugars in moderation?	1	2
k. Eating more calcium-rich foods?	1	2
l. Preparing healthy meals and snacks ?	1	2
m. Risks of unhealthy weight control practices ?	1	2
n. Accepting body size differences?	1	2
o. Eating disorders?	1	2
p. Foods from different cultures?	1	2
q. Food safety?	1	2


29. When you taught about nutrition and dietary behavior, did students have opportunities to taste new foods as part of a lesson?

     Yes		1
No		2
     
     
SHOW CARD 12


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

        	Yes	No

a. The number of  illnesses or deaths related to poor 
        nutrition or unhealthy dietary behavior?	1	2
b. The influence of families on dietary behavior?	1	2
c. The influence of the media on dietary behavior?	1	2
d. Social or cultural influences on dietary behavior?	1	2
e. How to find valid information or services related to 
        nutrition and dietary behavior?	1	2
f. Communication skills for healthy eating, such as how to
        ask parents to buy more fresh fruit?	1	2
g. Decision-making skills for healthy eating, such as
        choosing healthy snacks?	1	2
h. Goal-setting skills for healthy eating, such as eating
        five fruits or vegetables every day?	1	2
i. Resisting peer pressure related to unhealthy dietary 
        behavior?	1	2
j. How students can influence or support others healthy
        dietary behavior?	1	2


31. 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
     

Physical Activity



If you taught physical activity and fitness topics in this class (Q11d is Yes), 
     answer Q32-Q34.  Otherwise, skip to Q35.


SHOW CARD 13


32. As I read the topics listed on this card, please tell me if you taught about each one in the class.  When you taught about physical activity, did you teach about...

        	Yes	No

a. The physical, psychological, or social benefits of
        physical activity ?	1	2
b. Health-related fitness, that is cardiovascular endurance,
        muscular endurance, muscular strength, flexibility, and 
        body composition?	1	2
c. Basic anatomy?	1	2
d. Phases of a workout, that is warmup, workout, and cool
        down?	1	2
e. How much physical activity is enough, that is
        determining frequency, intensity, time and type of 
        physical activity?	1	2
f. Developing an individualized physical activity plan?	1	2
g. Monitoring progress toward reaching goals in an 
        individualized physical activity plan?	1	2
h. Overcoming barriers to physical activity?	1	2
i. Decreasing sedentary activities, such as TV watching?	1	2
j. Opportunities for physical activity in the community?	1	2
k. Preventing injury during physical activity?	1	2
l. Weather-related safety, for example avoiding heat stroke,
        hypothermia, and sunburn while physically active?	1	2
m. Dangers of using performance-enhancing drugs, such
        as steroids?	1	2
        
SHOW CARD 14


33. As I read the list of topics on this card, please tell me if you taught about each one.  Did you teach about...

        	Yes	No

a. The number of illnesses and deaths related to a lack of
        physical activity?	1	2
b. The influence of families on physical activity?	1	2
c. The influence of the media on physical activity?	1	2
d. Social or cultural influences on physical activity?	1	2
e. How to find valid information or services related to 
        physical activity and fitness?	1	2
f. Communication skills to encourage physical activity, 
        such as how to explain to others that physical activity
        is important to you?	1	2
g. Decision-making skills for physical activity, such as
        deciding to take the stairs?	1	2
h. Goal-setting skills for physical activity, such as
        developing an individualized physical activity plan?	1	2
i. Resisting peer pressure that discourages physical 
        activity?	1	2
j. How students can influence or support others to engage
        in physical activity?	1	2


34. 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
     

Human Sexuality



If you taught human sexuality in this class (Q11 f, g, h, or i is Yes), answer Q35.  Otherwise, skip to Q36.


SHOW CARD 15


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

        	Yes	No

a. Abstinence as the most effective method to avoid
        pregnancy, HIV, or STDs?	1	2
b. Dating and relationships?	1	2
c. Marriage and commitments?	1	2
d. Human development issues, such as reproductive 
        anatomy and puberty?	1	2
     Answer e, f, g, and h if this is a middle, junior, or senior high school.
e. Risks associated with having multiple sexual 
        partners?	1	2
f. Condom efficacy, that is, how well condoms work 
        and dont work?	1	2
g. How to correctly use a condom?	1	2
h. Sexual identity and sexual orientation?	1	2



If you taught about HIV prevention in this class (Q11h is Yes), answer Q36-Q37.  Otherwise, skip to Q38.


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

        	Yes	No

a. How HIV is transmitted?	1	2
b. How HIV affects the human body?	1	2
c. Compassion for persons living with HIV or AIDS
        (acquired immunodeficiency syndrome)?	1	2
d. How to find valid information or services related to 
        HIV or HIV testing?	1	2


37. 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 you taught about STD prevention in this class (Q11i is Yes), answer Q38-Q39.  Otherwise, skip to Q40.


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

        	Yes	No

a. How STDs, other than HIV, are transmitted? 	1	2
b. Signs and symptoms of STDs?	1	2
c. How to find valid information or services related to 
        STDs or STD testing?	1	2


39. How many hours did you spend teaching about STD prevention?  Please do not include hours 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 you taught about pregnancy prevention in this class (Q11g is Yes), answer Q40-Q41.  Otherwise, skip to Q42.


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

        	Yes	No

     Answer a if this is a middle, junior, or senior high school.
a. Methods of contraception?	1	2
b. Risks associated with teen pregnancy?	1	2
c. How to find valid information or services related to 
        pregnancy or pregnancy testing?	1	2


41. 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



SHOW CARD 16


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

        	Yes	No

a. How many young people are sexually active?	1	2
b. The number of teenage pregnancies?	1	2
c. The number of young people who get STDs or HIV?	1	2
d. The influence of families on sexual behavior?	1	2
e. The influence of the media on sexual behavior?	1	2
f. Social or cultural influences on sexual behavior?	1	2
g. Communication skills related to sexual behaviors, such
        as telling your date you do not want to have sex?	1	2
h. Decision-making skills related to sexual behaviors,
        such as deciding when to start dating?	1	2
i. Goal-setting skills related to sexual behaviors, such as
        waiting until marriage to have sex?	1	2
j. Resisting peer pressure to engage in sexual behavior?	1	2
k. How students can influence or support others to make 
        healthy decisions related to sexual behaviors?	1	2


43. Were any students excused by parental request from attending the class when specific topics related to human sexuality were presented?	HEC040

     Yes		1
No		2	==>	Skip to Q45


44. How many students were excused by parental request from attending class when topics related to human sexuality were presented?
     
_____	Students


Teaching and Evaluation Techniques



Now, I would like to ask a few more general questions about the class.  Please remember to answer these questions about this class only.


45. The next questions ask about the use of various teaching methods.  Did you use...

        	Yes	No

a. Group discussions?	1	2
b. Cooperative group activities?	1	2
c. Role play, simulations, or practice?	1	2
d. Visual, performing, or language arts?	1	2
e. Pledges or contracts for behavior change?	1	2
f. Guest speakers?	1	2
g. Peer teaching?	1	2
h. The Internet?	1	2
i. Computer-assisted instruction?	1	2


46. The next questions ask about the use of methods to highlight diversity or the values of various cultures.  When teaching the class did you...

        	Yes	No

a. Use textbooks or curricular materials reflective of
        various cultures?	1	2
b. Use textbooks or curricular materials designed for
        students with limited English proficiency?	1	2
c. Ask students to share their own cultural experiences 
        related to health topics?	1	2
d. Teach about cultural differences and similarities?	1	2
e. Modify teaching methods to match students learning 
        styles, health beliefs, or cultural values?	1	2


47. Did you ask students to...

        	Yes	No

a.	Perform volunteer work at a hospital, a local health 
        department, or any other local organization that 
        addresses health issues?	1	2
b. Participate in or attend a community health fair?	1	2
c. Gather information about health services that are 
        available in the community, such as health screenings?	1	2
d. Visit a store to compare prices of health products?	1	2
e. Identify potential injury sites at school, home, or in 
        the community?	1	2
f. Identify advertising in the community designed to 
        influence health behaviors?	1	2
g. Advocate for a health-related issue?	1	2


48. Did you...

        	Yes	No

a. Provide families with information on the class?	1	2
b. Give students homework or projects that involve 
        family members?	1	2
c. Invite family members to attend the class?	1	2


If you are an elementary school classroom teacher, answer Q49.  Otherwise, skip to Q50.


49. Did you make time for students to wash their hands using instant hand sanitizers or a bathroom or classroom sink ...

        	Yes	No

a. Before lunch?	1	2
b. Before snacks?	1	2
c. After recess?	1	2



50. To assess or evaluate students, did you use...

        	Yes	No

a. Written examinations?	1	2
b. Oral presentations or oral reports?	1	2
c. Journal writing?	1	2
d. Student portfolios?	1	2
e. Homework assignments?	1	2
f. Group projects?	1	2
g. Student self-assessment?	1	2


My next questions ask about teaching students with permanent physical or cognitive disabilities.  Examples of such disabilities include blindness, Downs Syndrome, learning disabilities, and conditions that require permanent use of a wheelchair.


51. Were there any students with permanent physical or cognitive disabilities in the class?

Yes		1
No		2	==> 	Skip to Q53


52. Was there...	HEC017

        	Yes	No

a. A special education teacher with whom you coordinated
        assignments for students with permanent disabilities?	1	2
b. A teacher or aide who came in to assist with the
        students with permanent disabilities?	1	2
c. Assigned note takers or readers for class work?	1	2
d. Simplified instructional content or variations in the
        amount or difficulty of material taught?	1	2
e. More skill modeling, practicing, or repetition?	1	2
f. Preferential seating for the students with permanent 
        disabilities?	1	2



Respondent Background



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


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

_____	Years


54. Do you have an undergraduate degree?

     Yes		1
     No		2	==>	Skip to Q60


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

     Health education and physical education combined	1
     Health education	2
     Physical education	3
     Other education	4
     Kinesiology	5
     Exercise physiology	6
     Exercise science	7
     Nursing	8
     Nutrition	9
     Public health	10
     Biology or other science	11
     Home economics	12
     Other	13


56. Do you have an undergraduate minor?HEC059

     Yes		1
No		2	==>	Skip to Q58

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

     Health education and physical education combined	1
     Health education	2
     Physical education	3
     Other education	4
     Kinesiology	5
     Exercise physiology	6
     Exercise science	7
     Nursing	8
     Nutrition	9
     Public health	10
     Biology or other science	11
     Home economics	12
     Other	13


58. Do you have a graduate degree?

Yes		1
No		2	==>	Skip to Q60


59. In what area or areas?
     MARK ALL THAT APPLY.	HEC064

     Health education and physical education combined	1
     Health education	2
     Physical education	3
     Other education	4
     Kinesiology	5
     Exercise physiology	6
     Exercise science	7
     Nursing	8
     Nutrition	9
     Public health	10
     Biology or other science	11
     Home economics	12
     Other	13


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

        	Yes	No

a. Elementary school?	1	2
b. Middle or junior high school?	1	2
c. Senior high school?	1	2


61. Are you a Certified Health education Specialist or CHES?

Yes		1
     No		2

SHOW CARD 17


62. As I read the list of topics on this card, please tell me if you received any staff development on each topic during the past 2 years.  This might include workshops, conferences, continuing education, graduate courses, or any other kind of in-service.  During the past 2 years, did you receive any staff development on...

        	Yes	No

a. Personal hygiene?	1	2
b. Dental and oral health?	1	2
c. Nutrition and dietary behavior?	1	2
d. Physical activity and fitness, that is classroom 
        instruction, not a physical activity period?	1	2
e. Growth and development?	1	2
f. Human sexuality?	1	2
g. Pregnancy prevention?	1	2
h. HIV prevention?	1	2
i. STD prevention?	1	2
j. Emotional and mental health?	1	2
k. Suicide prevention?	1	2
l. Death and dying?	1	2
m. Tobacco use prevention?	1	2
n. Alcohol or Other drug use prevention?	1	2
o. Violence prevention, for example bullying, fighting,
        or homicide?	1	2
p. Accident or injury prevention?	1	2
q. CPR?	1	2
r. First aid?	1	2
s. Immunizations or vaccinations?	1	2
t. Sun safety or skin cancer prevention?	1	2
u. Consumer health, such as choosing sources of health- 
        related information, products, and services wisely?	1	2
v. Environmental health, such as how air and water 
        quality can affect health?	1	2



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

     Personal hygiene	1
     Dental and oral health	2
     Nutrition and dietary behavior	3
     Physical activity and fitness, that is classroom instruction, 
        not a physical activity period	4
     Growth and development	5
     Human sexuality	6
     Pregnancy prevention	7
     HIV prevention	8
     STD prevention	9
     Emotional and mental health	10
     Suicide prevention	11
     Death and dying	12
     Tobacco use prevention	13
     Alcohol or other drug use prevention	14
     Violence prevention, such as bullying, fighting, or
        homicide	15
     Accident or injury  prevention	16
     CPR	17
     First aid	18
     Immunizations or vaccinations	19
     Sun safety or skin cancer prevention	20
Consumer health, such as choosing sources of health-
related information, products, and services wisely	21
     Environmental health, such as how air and water quality
        can affect health	22
      None	23

SHOW CARD 18


64.	As I read the list of teaching methods on this card, please tell me if you received any staff development on each one during the past 2 years.  During the past 2 years, did you receive any staff development on...

        	Yes	No

a. Teaching students with permanent physical or 
        cognitive disabilities?	1	2
b. Teaching students of various cultural backgrounds?	1	2
c. Teaching students with limited English proficiency?	1	2
d. Using interactive teaching methods, such as role plays 
        or cooperative group activities?	1	2
e. Encouraging family or community involvement?	1	2
f. Teaching skills for behavior change?	1	2


65.	Which of these teaching methods would you like to receive further staff development on?
     MARK ALL THAT APPLY.

a. Teaching students with permanent physical or
        cognitive disabilities	1
b. Teaching students of various cultural backgrounds	2
c.	Teaching students with limited English proficiency	3
d. Using interactive teaching methods, such as role plays
        or cooperative group activities	4
e.	Encouraging family or community involvement	5
f. Teaching skills for behavior change	6
g.	None	7


66. 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 - Final Version   Revised: 10/26/99


32
Health Education Classroom Questionnaire - Final Version   Revised: 10/26/99

General Course Characteristics and Content





Accident or Injury Prevention





Violence Prevention





Tobacco Use Prevention





Alcohol and Other Drug Use Prevention





Nutrition and Dietary Behavior





Physical Activity





Human Sexuality





 Teaching and Evaluation Techniques





Respondent Background