A r c h i v e d  I n f o r m a t i o n

The Safe and Drug-Free Schools and Communities Act
Reporting Form for State Educational Agencies (Part 2 of 2)

36. Section 4117 of SDFSCA requires that states report "data on the prevalence of drug use and violence by youth in schools and communities." As a way to collect this information, states can conduct a drug use and violence prevalence survey at least once every three years for a sample of students in the eighth, tenth, and twelfth grades (with the eighth grade being optional).

During the 1995-1996, 1996-1997, or 1997-1998 school years, did your state conduct student prevalence surveys? The Youth Risk Behavior Survey (YRBS) is one example; data from that survey will satisfy this request.

Yes_____ 1--> CONTINUE WITH QUESTION 37

No_____ 2--> SKIP TO QUESTION 60

37. The next questions ask about how these prevalence surveys were conducted and about the results that were obtained. First, we are interested in the latest survey of eighth graders. When was your latest survey of eighth graders conducted? Please check one box.

Fall, 1995	___1	--> CONTINUE WITH QUESTION 38
Spring, 1996	___2
Fall, 1996	___3
Spring, 1997	___4
Fall, 1997	___5
Spring, 1998	___6
Eighth graders not surveyed	___7	--> SKIP TO QUESTION 42



38. For your latest eighth grade student prevalence survey, which survey instrument was used?

Youth Risk Behavior Survey (YRBS)	____1
A state or locally-developed survey	____2
Some other survey	____3 -> PLEASE SPECIFY: _____________________________ _____________________________

39. For your latest eighth grade survey, what type of sample did your state draw to select student respondents?

A census of all eighth graders was done	___1 -> SKIP TO QUESTION 42
A random or probability-based sample (e.g., a stratified or cluster sample)	___2
A non-random sample was used	___3

40. For your latest eighth grade survey, please provide the number of LEAs, schools, and eighth graders selected for the survey. If any LEAs are part of a consortium, please include each LEA separately in your count.

		Number Selected
a.	LEAs	_______________
b.	Schools	_______________
c.	Eighth graders	_______________

41. Of the eighth graders selected (Question 40c), how many completed the survey?

______ Participants

42. Next, we are interested in the latest survey of tenth graders. When was your latest survey of tenth graders conducted? Please check one box.

Fall, 1995	____1
Spring, 1996	____2
Fall, 1996	____3
Spring, 1997	____4
Fall, 1997	____5
Spring, 1998	____6

43. For your latest tenth grade student prevalence survey, which survey instrument was used?

Youth Risk Behavior Survey (YRBS)	_____
A state or locally-developed survey	_____
Some other survey	_____ -> PLEASE SPECIFY: _____________________________ _____________________________

44. For your latest tenth grade survey, what type of sample did your state draw to select student respondents?

A census of all tenth graders was done	_____ -> SKIP TO QUESTION 47
A random or probability-based sample (e.g., a stratified or cluster sample)	_____
A non-random sample was used	_____

45. For your latest tenth grade survey, please provide the number of LEAs, schools, and tenth graders selected for the survey. If any LEAs are part of a consortium, please include each LEA separately in your count.

		Number Selected
a.	LEAs	_______________
b.	Schools	_______________
c.	Tenth graders	_______________

46. Of the tenth graders selected (Question 45c) how many completed the survey?

    _______Participants

47. Now, we are interested in the latest survey of twelfth graders. When was your latest survey of twelfth graders conducted? Please check one box.

Fall, 1995	_____
Spring, 1996	_____
Fall, 1996	_____
Spring, 1997	_____
Fall, 1997	_____
Spring, 1998	_____

48. For your latest twelfth grade student prevalence survey, which survey instrument was used?

Youth Risk Behavior Survey (YRBS)	____1
A state or locally-developed survey	____2
Some other survey	____3 -> PLEASE SPECIFY: _____________________________ _____________________________

49. For your latest twelfth grade survey, what type of sample did your state draw to select student respondents?

A census of all twelfth graders was done	____1 -> SKIP TO QUESTION 52
A random or probability-based sample (e.g., a stratified or cluster sample)	____2
A non-random sample was used	____3

50. For your latest twelfth grade survey, please provide the number of LEAs, schools, and twelfth graders selected for the survey. If any LEAs are part of a consortium, please include each LEA separately in your count.

		Number Selected
a.	LEAs	_______________
b.	Schools	_______________
c.	Twelfth graders	_______________

51. Of the twelfth graders selected (Question 50c), how many completed the survey?

_________ Participants

NOTE TO STATES USING THE 1997 YRBS: Questions 52 to 59 ask for the results of your state's student prevalence survey. Items that match questions on the YRBS standard form for 1997 are shaded for your information. If you used the YRBS as your prevalence survey you may attach copies of the relevant pages from your YRBS report that provide the data as requested in lieu of completing those items. Attachment B contains a list of the YRBS standard high school form (1997) items that correspond to Questions 52-59 on this reporting form. Data obtained from other prevalence surveys or items not included in the YRBS 1997 must be reported on this form.

52. Using the results of your state's latest student prevalence survey, please provide the following information on the lifetime use of alcohol and various types of other drugs among the students in your state's eighth, tenth, and twelfth grades.

For each substance, please record the percentage of students in each grade who reported never using, and the percentage who reported using at least once in his or her lifetime. Note that the sum of these two numbers should equal 100%.

Substance	GRADE
	Eighth	Tenth	Twelfth
*Cigarettes
Never used	_______%	_______%	_______%
Used at least once	_______ %	_______ %	_______ %
Total	100 %	100 %	100%
Alcohol
Never used	_______%	_______%	_______%
Used at least once	_______ %	_______ %	_______ %
Total	100 %	100 %	100 %
Marijuana or hashish
Never used	_______%	_______%	_______%
Used at least once	_______ %	_______ %	_______ %
Total	100 %	100 %	100 %
Cocaine (crack, powder, or freebase)
Never used	_______%	_______%	_______%
Used at least once	_______ %	_______ %	_______ %
Total	100 %	100 %	100 %
Inhalants (for example, glues, aerosols, paint)
Never used	_______%	_______%	_______%
Used at least once	_______ %	_______ %	_______ %
Total	100 %	100 %	100 %
Other illegal drugs (for example LSD, PCP, mushrooms, heroin, etc.)
Never used	_______%	_______%	_______%
Used at least once	_______ %	_______ %	_______ %
Total	100 %	100 %	100 %

*Note: Please include data on cigarette use only. Do not include data on other forms of smoking tobacco or data on smokeless tobacco. If data are not available for cigarettes only, please enter "MD".

53. Using the results of your state's latest student prevalence survey, please provide the following information on the use within the last 30 days of alcohol and various types of other drugs among the students in your state's eighth, tenth, and twelfth grades.

1. For cigarettes and alcohol, please record the percentages of students in each grade who reported not using, using occasionally, using weekly, and using daily. The sum of these reported percentages should equal 100%. Note that the reported use is measured in days and includes use at any location, not just on school property.

Substance	GRADE
	Eighth	Tenth	Twelfth
*Cigarettes
Not used	______%	______ %	______ %
Occasional use (1-5 days in past 30)	______ %	______ %	______ %
Weekly use (6-19 days in past 30)	______ %	______ %	______ %
Daily use (20 or more days in past 30)	______ %	______ %	______ %
Total	100 %	100 %	100 %
Alcohol
Not used	______ %	______ %	______ %
Occasional use (1-5 days in past 30)	______ %	______ %	______ %
Weekly use (6-19 days in past 30)	______ %	______ %	______ %
Daily use (20 or more days in past 30)	______ %	______ %	______ %
Total	100 %	100 %	100 %

2. For marijuana, cocaine, inhalants, and other illegal drugs, please record the percentages of students in each grade who reported not using or using one or more times. The sum of these reported percentages should equal 100%. Note that the reported use is measured in occasions (times) and includes use at any location, not just on school property.

Substance	GRADE
	Eighth	Tenth	Twelfth
Marijuana or hashish
Not used	______ %	______ %	______ %
1 - 9 times	______ %	______ %	______ %
10 - 39 times	______ %	______ %	______ %
40 or more times	______ %	______ %	______ %
Total	100 %	100 %	100 %

* Note: Please include data on cigarette use only. Do not include data on other forms of smoking tobacco or data on smokeless tobacco. If data are not available for cigarettes only, please enter "MD".

Substance	GRADE
	Eighth	Tenth	Twelfth
Cocaine (crack, powder, or freebase)
Not used	______%	______ %	______ %
1 - 9 times	______ %	______ %	______ %
10 - 39 times	______ %	______ %	______ %
40 or more times	______ %	______ %	______ %
Total	100 %	100 %	100 %
Inhalants (for example, glues, aerosols, paint)
Not used	______%	______%	______%
1 - 9 times	______ %	______ %	______ %
10 - 39 times	______ %	______ %	______ %
40 or more times	______ %	______ %	______ %
Total	100 %	100 %	100 %
Other illegal drugs (for example, LSD, PCP, mushrooms, heroin, etc.)
Not used	______%	______%	______%
1 - 9 times	______ %	______ %	______ %
10 - 39 times	______ %	______ %	______ %
40 or more times	______ %	______ %	______ %
Total	100 %	100 %	100 %

54. Using the results of your state's latest student prevalence survey, please provide the following information on the age of first use among eighth, tenth, and twelfth graders in your state for each of the following substances.

For each substance, please record the percentage of students in each grade who reported never using and the percentages of students in each grade who reported first use at 8 years or younger, between 9 and 10 years, between 11 and 12 years, between 13 and 14 years, between 15 and 16 years, and 17 years old or older. The sum of these percentages should equal 100%.

Substance	GRADE
	Eighth	Tenth	Twelfth
*Cigarettes
Not used	______%	______%	______%
8 years or younger	______ %	______ %	______ %
9 to 10 years	______ %	______ %	______ %
11 to 12 years	______ %	______ %	______ %
13 to 14 years	______ %	______ %	______ %
15 to 16 years	______ %	______ %	______ %
17 years or older	______ %	______ %	______ %
Total	100 %	100 %	100 %
Alcohol
Not used	______%	______%	______%
8 years or younger	______ %	______ %	______ %
9 to 10 years	______ %	______ %	______ %
11 to 12 years	______ %	______ %	______ %
13 to 14 years	______ %	______ %	______ %
15 to 16 years	______ %	______ %	______ %
17 years or older	______ %	______ %	______ %
Total	100 %	100 %	100 %
Marijuana or hashish
Not used	______%	______%	______%
8 years or younger	______ %	______ %	______ %
9 to 10 years	______ %	______ %	______ %
11 to 12 years	______ %	______ %	______ %
13 to 14 years	______ %	______ %	______ %
15 to 16 years	______ %	______ %	______ %
17 years or older	______ %	______ %	______ %
Total	100 %	100 %	100 %
*Note: Please include data on cigarette use only. Do not include data on other forms of smoking tobacco or data on smokeless tobacco. If data are not available for cigarettes only, please enter "MD".
Cocaine (crack, powder, or free base)
Not used	______%	______%	______%
8 years or younger	______ %	______ %	______ %
9 to 10 years	______ %	______ %	______ %
11 to 12 years	______ %	______ %	______ %
13 to 14 years	______ %	______ %	______ %
15 to 16 years	______ %	______ %	______ %
17 years or older	______ %	______ %	______ %
Total	100 %	100 %	100 %
Inhalants (for example, glues, aerosols, paint)
Not used	______%	______%	______%
8 years or younger	______ %	______ %	______ %
9 to 10 years	______ %	______ %	______ %
11 to 12 years	______ %	______ %	______ %
13 to 14 years	______ %	______ %	______ %
15 to 16 years	______ %	______ %	______ %
17 years or older	______ %	______ %	______ %
Total	100 %	100 %	100 %
Other illegal drugs (for example, LSD, PCP, mushrooms, heroin, etc.)
Not used	______%	______%	______%
8 years or younger	______ %	______ %	______ %
9 to 10 years	______ %	______ %	______ %
11 to 12 years	______ %	______ %	______ %
13 to 14 years	______ %	______ %	______ %
15 to 16 years	______ %	______ %	______ %
17 years or older	______ %	______ %	______ %
Total	100 %	100 %	100 %

55. Using the results of your state's student prevalence survey, please complete the following table on the frequency with which students brought weapons, such as guns, knives, and clubs, to school during the 30 days before completing the survey.

For each grade level, record the percentage of students who, during the 30 days before the survey:

Weapons incident		GRADE
		Eighth	Tenth	Twelfth
a.	brought no weapon to school	______ %	______ %	______ %
b.	brought weapon for 1 day	______ %	______ %	______ %
c.	brought weapon for 2 or 3 days	______ %	______ %	______ %
d.	brought weapon for 4 or 5 days	______ %	______ %	______ %
e.	brought weapon for 6 or more days	______ %	______ %	______ %
Total		100 %	100 %	100 %

56. Using the results of your state's student prevalence survey, please complete the following table on the frequency with which students did not attend school because they felt unsafe either at or on the way to school during the 30 days before completing the survey.

For each grade level, record the percentage of students who, during the 30 days before the survey:

School days missed		GRADE
		Eighth	Tenth	Twelfth
a.	did not miss school for this reason	______ %	______ %	______ %
b.	missed school for 1 day	______ %	______ %	______ %
c.	missed school for 2 or 3 days	______ %	______ %	______ %
d.	missed school for 4 or 5 days	______ %	______ %	______ %
e.	missed school for 6 or more days	______ %	______ %	______ %
Total		100 %	100 %	100 %

57. Using the results of your state's student prevalence survey, please complete the following table on the frequency with which students were threatened or injured with a weapon on school property during the 12 months before completing the survey.

For each grade level, record the percentage of students who, during the 12 months before the survey:

Incident		GRADE
		Eighth	Tenth	Twelfth
a.	were not threatened or injured	______ %	______ %	______ %
b.	were threatened or injured 1 time	______ %	______ %	______ %
c.	2 or 3 times	______ %	______ %	______ %
d.	4 or 5 times	______ %	______ %	______ %
e.	6 or 7 times	______ %	______ %	______ %
f.	8 or 9 times	______ %	______ %	______ %
g.	10 or 11 times	______ %	______ %	______ %
h.	12 or more times	______ %	______ %	______ %
Total		100 %	100 %	100 %

58. Using the results of your state's student prevalence survey, please complete the following table on the frequency with which student property (for example, a car, clothing, or books) was stolen or deliberately damaged on school grounds during the 12 months before completing the survey.

For each grade level, record the percentage of students who, during the 12 months before the survey:

Incident		GRADE
		Eighth	Tenth	Twelfth
a.	did not report any property stolen or damaged	______ %	______ %	______ %
b.	reported property stolen or damaged 1 time	______ %	______ %	______ %
c.	2 or 3 times	______ %	______ %	______ %
d.	4 or 5 times	______ %	______ %	______ %
e.	6 or 7 times	______ %	______ %	______ %
f.	8 or 9 times	______ %	______ %	______ %
g.	10 or 11 times	______ %	______ %	______ %
h.	12 or more times	______ %	______ %	______ %
Total		100 %	100 %	100 %

59. Using the results of your state's student prevalence survey, please complete the following table on the frequency with which students reported being in a physical fight on school grounds during the 12 months before completing the survey.

For each grade level, record the percentage of students who, during the 12 months before the survey:

Incident		GRADE
		Eighth	Tenth	Twelfth
a.	reported not being in a fight on school grounds	______ %	______ %	______ %
b.	reported being in a fight 1 time on school grounds	______ %	______ %	______ %
c.	2 or 3 times	______ %	______ %	______ %
d.	4 or 5 times	______ %	______ %	______ %
e.	6 or 7 times	______ %	______ %	______ %
f.	8 or 9 times	______ %	______ %	______ %
g.	10 or 11 times	______ %	______ %	______ %
h.	12 or more times	______ %	______ %	______ %
Total		100 %	100 %	100 %

60. The next set of questions ask about implementing the Principles of Effectiveness.
1. With regard to LEA implementation of the Principles, what has occurred in your state between July 1, 1998 and ___________(date)?(please check all that apply)

_____ No LEAs have had difficulties with implementing the Principles.

_____ Some LEAs have had difficulties with implementing the Principles.

_____ Some LEAs have requested technical assistance with implementing the Principles from my office or other sources.

_____ Many LEAs have requested technical assistance with implementing the Principles from my office or other sources.

_____ Even with technical assistance, some LEAs have had significant difficulties with implementing the Principles.

_____ Even with technical assistance, many LEAs have had significant difficulties with implementing the Principles.

_____ My office has had to work with one or more LEAs to resolve issues related to their compliance with the Principles.

 

2. What have been the most serious concerns or difficulties for LEAs in implementing the Principles? (PLEASE ATTACH ADDITIONAL SHEETS IF NECESSARY)

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

 

3. How many LEAs are still experiencing these serious concerns or difficulties, as of ___________(date)?

 

4. Please briefly describe the types of technical assistance your office has provided (or arranged for other sources to provide) to LEAs in implementing the Principles, and any other activities your agency has conducted related to implementation of the Principles.

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

 

The next set of questions (60e - 60g) is optional; however, your response will help us to provide better technical assistance to SEAs and LEAs.

 

5. Please describe any difficulties your office has had in providing technical assistance to LEAs in implementing the Principles, or in arranging for others sources to provide this technical assistance.

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

 

6. What types of technical assistance would you like from the U.S. Department of Education with regard to implementation of the Principles?

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

 

7. Please list one or more districts in your state whose efforts to implement the Principles of Effectiveness have been particularly well designed and executed, and that you believe can serve as a model for other LEAs. Please provide the district name and contact information.

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

 

61. Please provide the name, position, and telephone numbers of the individual who completed this report.

Name:_______________________

Position:_______________________

Telephone Number:_______________________

Fax Number:_______________________

Email:_______________________

 

62. What is the name and mailing address of your agency?

Agency Name:_______________________

Mailing Address

Street Address:_______________________

City:______________________

State:______________________

Zip Code:______________________

THANK YOU FOR COMPLETING THIS FORM PROMPTLY AND COMPLETELY.

AUTHORIZATION FOR DATA COLLECTION Section 4117 of the Safe and Drug-Free Schools and Communities Act (SDFSCA) requires the Secretary to collect certain information about State and local implementation of SDFSCA on a triennial basis. Specifically, States are required to submit to the Secretary information on the State and local programs conducted with assistance furnished under SDFSCA that must include: a report on the implementation and outcomes of State programs (state educational agency (SEA) and governors' programs); an assessment of the effectiveness of state educational agency and governors' programs; a report on the State's progress toward attaining its goals for drug and violence prevention; data on the prevalence of drug use and violence by youth in schools and communities. Section 4117 requires the Secretary to report to Congress, including reporting on the frequency, seriousness, and incidence of violence in elementary and secondary schools in the States.

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[SDFSCA Reporting Form for State Educational Agencies (Part 1 of 2)]

[Attachment A. Glossary of Terms, SDFSCA Reporting Form For State Educational Agencies]

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