2008 SCHOOL HEALTH PROFILES
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: _________________________________________________________________

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2008 SCHOOL HEALTH PROFILES
LEAD HEALTH EDUCATION TEACHER QUESTIONNAIRE

REQUIRED HEALTH EDUCATION
(Definition: Required health education is defined as instruction about health education topics such as injuries and violence, alcohol and other drug use, tobacco use, nutrition, HIV infection, and physical activity that students must receive for graduation or promotion from this school.)

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

a	Yes
b	No 	Skip to Question 5

2.	How many required health education courses do students take in grades 6 through 12 in this school? (Mark one response.)

a	0 courses        Skip to Question 5
b	1 course 
c	2 courses 
d	3 courses  
e	4 or more courses 

3.	Is a required health education course taught in each of the following grades in this school?  (Mark yes, no, or not applicable for each grade.)

	Not 
	Applicable
	(e.g., grade not 
	Grade	Yes	No	taught in this school.)
a.	6	0	0	0
b.	7	0	0	0 
c.	8	0	0	0
d.	9	0	0	0
e.	10	0	0	0
f.	11	0	0	0
g.	12	0	0	0

4. 	If students fail a required health education course, are they required to repeat it? (Mark one response.)

a.	Yes
b.	No

5.	Are those who teach health education at this school provided with the following materials? (Mark yes or no for each material.)

	Material	Yes	No
a.	Goals, objectives, and expected outcomes for health education	0	0
b.	A chart describing the annual scope and sequence of instruction 
	for health education	0	0
c.	Plans for how to assess student performance in health education	0	0
d.	A written health education curriculum	0	0

6.	Does your health education curriculum address each of the following? (Mark yes or no for each skill; or mark NA for each skill if your school does not have a health education curriculum.)

	Skill	Yes	No	NA
a.	Comprehending concepts related to health promotion 
	and disease prevention to enhance health	0	0	0
b.	Analyzing the influence of family, peers, culture, media, 
	technology, and other factors on health behaviors	0	0	0
c.	Accessing valid information and products and services to
	enhance health	0	0	0
d.	Using interpersonal communication skills to enhance 
	health and avoid or reduce health risks	0	0	0
e.	Using decision-making skills to enhance health	0	0	0
f.	Using goal-setting skills to enhance health	0	0	0
g.	Practicing health-enhancing behaviors to avoid or reduce 
	risks	0	0	0
h.	Advocating for personal, family, and community health	0	0	0

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

	Topic	Yes	No
a.	Alcohol or other drug use prevention	0	0
b.	Asthma awareness	0	0
c.	Emotional and mental health	0	0
d.	Foodborne illness prevention	0	0
e.	HIV (human immunodeficiency virus) prevention	0	0
f.	Human sexuality	0	0
g.	Injury prevention and safety	0	0
h.	Nutrition and dietary behavior	0	0
i.	Physical activity and fitness	0	0
j.	Pregnancy prevention	0	0
k.	STD (sexually transmitted disease) prevention	0	0
l.	Suicide prevention	0	0
m.	Tobacco-use prevention	0	0
n.	Violence prevention, such as bullying, fighting, or 
	homicide	0	0

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

	Topic	Yes	No
a.	Identifying tobacco products and the harmful substances they 
	contain	0	0  
b.	Identifying short and long-term health consequences of tobacco 
	use	0	0
c.	Identifying legal, social, economic, and cosmetic consequences 
	of tobacco use	0	0
d.	Understanding the addictive nature of nicotine	0	0
e.	Effects of tobacco use on athletic performance	0	0
f.	Effects of second-hand smoke and benefits of a smoke-free 
	environment	0	0
g.	Understanding the social influences on tobacco use, including 
	media, family, peers, and culture	0	0
h.	Identifying reasons why students do and do not use tobacco	0	0
i.	Making accurate assessments of how many peers use tobacco	0	0
j.	Using interpersonal communication skills to avoid tobacco 
	use (e.g., refusal skills, assertiveness)	0	0
k.	Using goal-setting and decision-making skills related to not using 
	tobacco	0	0
l.	Finding valid information and services related to tobacco-use 
	prevention and cessation	0	0
m.	Supporting others who abstain from or want to quit using tobacco	0	0
n.	Supporting school and community action to support a tobacco-free 
	environment	0	0
o.	Identifying harmful effects of tobacco use on fetal development	0	0

9.	During this school year, did teachers in this school teach each of the following HIV, STD, or pregnancy prevention topics in a required course for students in any of grades 6, 7, or 8? (Mark yes or no for each topic; or mark NA for each topic if your school does not contain grades 6, 7, or 8.)

	Topic	Yes	No	NA
a.	The differences between HIV and AIDS	0	0	0
b.	How HIV and other STDs are transmitted	0	0	0
c.	How HIV and other STDs are diagnosed and treated	0	0	0
d.	Health consequences of HIV, other STDs, and pregnancy	0	0	0
e.	The benefits of being sexually abstinent	0	0	0
f.	How to prevent HIV, other STDs, and pregnancy	0	0	0
g.	How to access valid and reliable health information, products, 
	and services related to HIV, other STDs, and pregnancy	0	0	0
h.	The influences of media, family, and social and cultural 
	norms on sexual behavior	0	0	0
i.	Communication and negotiation skills related to eliminating 
	or reducing risk for HIV, other STDs, and pregnancy	0	0	0
j.	Goal-setting and decision-making skills related to eliminating 
	or reducing risk for HIV, other STDs, and pregnancy	0	0	0 
k.	Compassion for persons living with HIV or AIDS	0	0	0

10.	During this school year, did teachers in this school teach each of the following HIV, STD, or pregnancy prevention topics in a required course for students in any of grades 9, 10, 11, or 12? (Mark yes or no for each topic; or mark NA for each topic if your school does not contain grades 9, 10, 11, or 12.)
	
	Topic	Yes	No	NA
a.	The relationship among HIV, other STDs, and pregnancy	0	0	0
b.	The relationship between alcohol and other drug use and 
	risk for HIV, other STDs, and pregnancy	0	0	0
c.	The benefits of being sexually abstinent	0	0	0
d.	How to prevent HIV, other STDs, and pregnancy	0	0	0
e.	How to access valid and reliable health information, products, 
	and services related to HIV, other STDs, and pregnancy	0	0	0
f.	The influences of media, family, and social and cultural 
	norms on sexual behavior	0	0	0
g.	Communication and negotiation skills related to eliminating 
	or reducing risk for HIV, other STDs, and pregnancy	0	0	0
h.	Goal-setting and decision-making skills related to eliminating 
	or reducing risk for HIV, other STDs, and pregnancy	0	0	0
i.	Efficacy of condoms, that is, how well condoms work and do 
	not work	0	0	0
j.	The importance of using condoms consistently and correctly	0	0	0
k.	How to obtain condoms	0	0	0

11.	During this school year, did teachers in this school teach each of the following nutrition and dietary behavior topics in a required course for students in any of grades 6 through 12? (Mark yes or no for each topic.)
	
		Topic	Yes	No
a.	Benefits of healthy eating	0	0
b.	Food guidance using MyPyramid	0	0 
c.	Using food labels	0	0
d.	Balancing food intake and physical activity	0	0
e.	Eating more fruits, vegetables, and whole grain products	0	0
f.	Choosing foods that are low in fat, saturated fat, and cholesterol	0	0
g.	Using sugars in moderation	0	0
h.	Using salt and sodium in moderation	0	0
i.	Eating more calcium-rich foods	0	0
j.	Food safety	0	0
k.	Preparing healthy meals and snacks	0	0
l.	Risks of unhealthy weight control practices	0	0
m.	Accepting body size differences	0	0
n.	Signs, symptoms, and treatment for eating disorders	0	0

12.	During this school year, did teachers in this school teach each of the following physical activity topics in a required course for students in any of grades 6 through 12? (Mark yes or no for each topic.)
	
		Topic	Yes	No
a.	Physical, psychological, or social benefits of physical activity	0	0
b.	Health-related fitness (i.e., cardiorespiratory endurance, muscular 
	endurance, muscular strength, flexibility, and body composition)	0	0
c.	Phases of a workout (i.e., warm-up, workout, cool down)	0	0
d.	How much physical activity is enough (i.e., determining 
	frequency, intensity, time, and type of physical activity)	0	0
e.	Developing an individualized physical activity plan	0	0
f.	Monitoring progress toward reaching goals in an individualized 
	physical activity plan	0	0
g.	Overcoming barriers to physical activity	0	0
h.	Decreasing sedentary activities such as television viewing	0	0
i.	Opportunities for physical activity in the community	0	0
j.	Preventing injury during physical activity	0	0
k.	Weather-related safety (e.g., avoiding heat stroke, hypothermia, 
	and sunburn while physically active)	0	0
l.	Dangers of using performance-enhancing drugs such as steroids	0	0

HIV PREVENTION

13.	During this school year, did your school provide any HIV, STD, or pregnancy prevention programs for ethnic/racial minority youth at high risk (e.g. black, Hispanic, or American Indian youth), including after-school or supplemental programs, that did each of the following? (Mark yes or no for each activity.)
	
		Activity	Yes	No
a.	Provided curricula or supplementary materials that include 
	pictures, information, and learning experiences that reflect the 
	life experiences of these youth in their communities	0	0
b.	Provided curricula or supplementary materials in the primary 
	languages of the youth and families	0	0
c.	Facilitated access to direct health services or arrangements with 
	providers not on school property who have experience in serving 
	these youth in the community	0	0
d.	Facilitated access to direct social services and psychological 
	services or arrangements with providers not on school property 
	who have experience in serving these youth in the community	0	0

COLLABORATION

14.	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.)
	
	Group	Yes	No
a.	Physical education staff	0	0
b.	School health services staff (e.g., nurses)	0	0
c.	School mental health or social services staff 
	(e.g., psychologists, counselors, and social workers)	0	0
d.	Nutrition or food service staff	0	0

15.	During this school year, did your school provide parents and families with health information designed to increase parent and family knowledge of the following topics? (Mark yes or no for each topic.)
	
	Topic	Yes	No
a.	HIV prevention, STD prevention, or teen pregnancy 
	prevention	0	0
b.	Tobacco-use prevention	0	0
c.	Physical activity	0	0
d.	Nutrition and healthy eating	0	0
e.	Asthma	0	0

PROFESSIONAL DEVELOPMENT

16.	During the past two years, did you receive professional 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 topic.)

	Topic	Yes	No
a.	Alcohol or other drug use prevention	0	0
b.	Asthma awareness	0	0
c.	Emotional and mental health	0	0
d.	Foodborne illness prevention	0	0
e.	HIV (human immunodeficiency virus) prevention	0	0
f.	Human sexuality	0	0
g.	Injury prevention and safety	0	0
h.	Nutrition and dietary behavior	0	0
i.	Physical activity and fitness	0	0
j.	Pregnancy prevention	0	0
k.	STD (sexually transmitted disease) prevention	0	0
l.	Suicide prevention	0	0
m.	Tobacco-use prevention	0	0
n.	Violence prevention, such as bullying, fighting, or homicide	0	0

17.	During the past two years, did you receive professional 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 topic.)
	
		Topic	Yes	No
a.	Describing how widespread HIV and other STD infections 
	are and the consequences of these infections	0	0
b.	Understanding the modes of transmission and effective 
	prevention strategies for HIV and other STDs	0	0
c.	Identifying populations of youth who are at high risk of being 
	infected with HIV and other STDs	0	0
d.	Implementing health education strategies using prevention 
	messages that are likely to be effective in reaching youth	0	0
e.	Teaching HIV prevention education to students with 
	physical, medical, or cognitive disabilities	0	0
f.	Teaching HIV prevention education to students of various 
	cultural backgrounds	0	0
g.	Using interactive teaching methods for HIV prevention 
	education, such as role plays or cooperative group activities	0	0
h.	Teaching essential skills for health behavior change related to 
	HIV prevention and guiding student practice of these skills	0	0
i.	Teaching about health-promoting social norms and beliefs 
	related to HIV prevention	0	0
j.	Strategies for involving parents, families, and others in student 
	learning of HIV prevention education	0	0
k.	Assessing students’ performance in HIV prevention education	0	0
l.	Implementing standards-based HIV prevention education 
	curriculum and student assessment	0	0
m.	Using technology to improve HIV prevention education 
	instruction	0	0
n.	Teaching HIV prevention education to students with limited 
	English proficiency	0	0
o.	Addressing community concerns and challenges related to HIV 
	prevention education	0	0 

18.	Would you like to receive professional development on each of these health education topics? (Mark yes or no for each topic.)

	Topic	Yes	No
a.	Alcohol or other drug use prevention	0	0
b.	Asthma awareness	0	0
c.	Emotional and mental health	0	0
d.	Foodborne illness prevention	0	0
e.	HIV (human immunodeficiency virus) prevention	0	0
f.	Human sexuality	0	0
g.	Injury prevention and safety	0	0
h.	Nutrition and dietary behavior	0	0
i.	Physical activity and fitness	0	0
j.	Pregnancy prevention	0	0
k.	STD (sexually transmitted disease) prevention	0	0
l.	Suicide prevention	0	0
m.	Tobacco-use prevention	0	0
n.	Violence prevention, such as bullying, fighting, 
	or homicide	0	0

19.	During the past two years, did you receive professional 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.) 
		
		Topic	Yes	No
a.	Teaching students with physical, medical, or cognitive 
	disabilities	0	0
b.	Teaching students of various cultural backgrounds	0	0
c.	Teaching students with limited English proficiency	0	0
d.	Using interactive teaching methods, such as role plays or 
	cooperative group activities	0	0
e.	Encouraging family or community involvement	0	0
f.	Teaching skills for behavior change	0	0
g.	Classroom management techniques, such as social skills training, 
	environmental modification, conflict resolution and mediation, 
	and behavior management	0	0
h.	Assessing or evaluating students in health education	0	0

20.	Would you like to receive professional development on each of these topics? (Mark yes or no for each teaching topic.)
	
		Topic	Yes	No
a.	Teaching students with physical, medical, or cognitive 
	disabilities	0	0
b.	Teaching students of various cultural backgrounds	0	0
c.	Teaching students with limited English proficiency	0	0
d.	Using interactive teaching methods, such as role plays or 
	cooperative group activities	0	0
e.	Encouraging family or community involvement	0	0
f.	Teaching skills for behavior change	0	0
g.	Classroom management techniques, such as social skills training, 
	environmental modification, conflict resolution and mediation, 
	and behavior management	0	0
h.	Assessing or evaluating students in health education	0	0

PROFESSIONAL PREPARATION

21.	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

22.	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
	
23.	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.