National Standards for School Health Education. ERIC Digest. 

by Summerfield, Liane M.


The Centers for Disease Control and Prevention (CDC) finds that most major health problems in the United States today are caused by six categories of behavior: behaviors that lead to intentional and unintentional injuries; smoking; alcohol and other drug use; sexual behaviors leading to sexually transmitted diseases, HIV infection, and unintended pregnancy; poor nutrition; and lack of physical activity (Kolbe, 1993a). According to Kolbe (1993a), behaviors and attitudes about health that are initiated during childhood are responsible for most of the leading causes of death, illness, and disability in the Uunited States today. Comprehensive school health education programs represent one effective way of providing students with the knowledge and skills to prevent health-impairing behaviors.


Health education works. Hundreds of studies have evaluated health education and concluded that it is effective in reducing the number of teenage pregnancies, decreasing smoking rates among young people, and preventing the adoption of many high-risk behaviors. But its effectiveness depends upon factors such as teacher training, comprehensiveness of the health program, time available for instruction, family involvement, and community support (Gold, 1994; Seffrin, 1990). And, sequential school health education programs for K-12 students have been found to be more effective in changing health behaviors than occasional programs on single health topics (Kolbe, 1993b).

The Louis Harris survey of over 4,700 students in grades 3 through 12 who were attending 199 public schools found that health knowledge, attitudes, and behaviors improved with increasing years of health instruction (Louis Harris, 1989). The School Health Education Evaluation (Connell, Turner, & Mason, 1985), which looked at four different health curricula for 30,000 4th through 7th graders in 20 states, found:

*Students receiving health instruction had higher knowledge scores than students with no health instruction, with the greatest differences seen in knowledge of substance use and abuse;

*Knowledge, attitudes, and skills improved even with minimal instruction, but gains were most apparent when students received at least 50 hours of health instruction per school year; and

*More hours were needed to improve attitudes than to enhance health knowledge and practices.


To assist schools in developing and evaluating comprehensive health education programs, the Joint Committee for National School Health Education Standards (1995) has developed guidelines for school health standards. The committee was made up of representatives from the Association for the Advancement of Health Education, the American Public Health Association, the American School Health Association, and the Society of State Directors of Health, Physical Education and Recreation and was sponsored by the American Cancer Society.

The committee's goal was to emphasize the need for school health education and create a framework for local school boards to use in determining content of the health curriculum in their communities. There are seven broad standards that promote health literacy, which is the capacity of individuals to obtain, interpret, and understand basic health information and services and the competence to use such information and services in ways which enhance health (Joint Committee, 1995, p. 5). For each standard there are performance indicators to help educators determine the knowledge and skills that students should possess by the end of grades 4, 8, and 11.

*Standard 1: Students will comprehend concepts related to health promotion and disease prevention. Performance indicators for this standard center around identifying what good health is, recognizing health problems, and ways in which lifestyle, the environment, and public policies can promote health.

*Standard 2: Students will demonstrate the ability to access valid health information and health-promoting products and services. Performance indicators focus on identification of valid health information, products, and services including advertisements, health insurance and treatment options, and food labels.

*Standard 3: Students will demonstrate the ability to practice health-enhancing behaviors and reduce health risks. Performance indicators include identifying responsible and harmful behaviors, developing health-enhancing strategies, and managing stress.

*Standard 4: Students will analyze the influence of culture, media, technology, and other factors on health. Performance indicators are related to describing and analyzing how one's cultural background, messages from the media, technology, and one's friends influence health.

*Standard 5: Students will demonstrate the ability to use interpersonal communication skills to enhance health. Performance indicators relate to interpersonal communication, refusal and negotiation skills, and conflict resolution.

*Standard 6: Students will demonstrate the ability to use goal-setting and decision-making skills to enhance health. Performance indicators focus on setting reasonable and attainable goals and developing positive decision-making skills.

*Standard 7: Students will demonstrate the ability to advocate for personal, family, and community health. Performance indicators relate to identifying community resources, accurately communicating health information and ideas, and working cooperatively to promote health.


The school health education program should be based upon local needs--the health behaviors and problems within the school population--and national data suggesting the health status of children and youth. Experts have identified 10 content areas as necessary for a comprehensive school health education program (American School Health Association, 1994):

*community health

* consumer health

*environmental health

*personal health and fitness

*family life education

*nutrition and healthy eating

*disease prevention and control

*safety and injury prevention

*prevention of substance use and abuse (alcohol, tobacco, drugs)

*growth and development

The objective is to offer an ongoing, sequenced, and developmentally appropriate program that is consistent with community needs and providing at least 50 hours per year of health instruction. Some references for identifying curricula are listed at the end of this Digest.


At the elementary and middle school level, the classroom teacher is expected to teach health as a curricular area like math, reading, and social studies. At the high school level, 39 states require that health be taught by a teacher who is certified in health education (Allensworth, 1993). Many teachers avoid health subjects because of inadequate undergraduate training.

The most effective methods of instruction in health are student-centered approaches: hands-on activities, cooperative learning techniques, and activities that include problem-solving and peer instruction to help students develop skills in decision-making, communication, setting goals, resistance to peer pressure, and stress management (Kane, 1993; Seffrin, 1990). As with other instructional areas, the teacher should promote parental involvement by sending materials home, involving parents in classroom activities, and creating assignments that involve parents.

Because of time limitations in the school day, some teachers find it helpful to infuse health topics into other subject areas. For example, a unit on smoking might include (Allensworth, 1993):

*investigating the effects of smoking on body systems (science);

*developing, administering, and analyzing a survey on student attitudes about smoking (math);

*writing an antismoking advertisement (language arts);

*examining the economics of smoking in states where tobacco is a significant crop (social studies).


Teacher preparation is critical to successful school health education programs. If children and youth are to achieve health literacy, teacher preparation programs will need to support preservice health education that addresses:

*health content

*teaching methods for teacher education

*including health content across the curriculum

*cultural diversity of teachers and students

*assessment of student achievement of National Health Education Standards


Choosing the tools: A review of selected K-12 health education curricula. (1995). Newton, MA: Educational Development Center (1-800-225-4276).

Lloyd-Kolkin, D., & Hunter, L. (1990). The comprehensive school health sourcebook. Menlo Park, CA: Health & Education Communication Consultants.

Mahoney, B. S., & Olsen, L. K. (Eds.). (1993). Health education teacher resource handbook. A practical guide for K-12 health education. Millwood, NY: Kraus International Publications. ED 365 653

U.S. Public Health Service. (1993). School health: Findings from evaluated programs. Rockville, MD: Office of Disease Prevention and Health Promotion. ED 370 938


References identified with an EJ or ED number have been abstracted and are in the ERIC database. Documents (ED) are available in ERIC microfiche collections at more than 900 locations. Documents can also be ordered through the ERIC Document Reproduction Service:(800) 443-ERIC. Journal articles (EJ) should be available at most research libraries.

Allensworth, D. D. (1993). Health education: State of the art. Journal of School Health, 63(1), 14-20. EJ 469 777

American School Health Association. (1994). Guidelines for comprehensive school health programs, 2nd edition. Kent, OH: Author.

Connell, D. R., Turner, R. R., & Mason, E. F. (1985). Summary of findings of the school health education evaluation: Health promotion effectiveness, implementation, and costs. Journal of School Health, 55(8), 316-321.

Gold, R. S. (1994). The science base for comprehensive school health education. In: P. Cortese & K. Middleton (Eds.), The comprehensive school health challenge: Promoting health through education (Vol. 2) (pp. 545-573). Santa Cruz: ETR Associates.

Joint Committee on National Health Education Standards. (1995). National health education standards. Available from the American School Health Association (P.O. Box 708, 7263 State Route 43, Kent, OH 44240; the Association for the Advancement of Health Education, 1900 Association Drive, Reston, VA 22091; or the American Cancer Society at 1-800-ACS-2345).

Kane, W. M. (1993). Step-by-step to comprehensive school health: The program planning guide. Santa Cruz, CA: ETR Associates. ED 360 304

Kolbe, L. J. (1993a). An essential strategy to improve the health and education of Americans. Preventive Medicine, 22(4) 1-17.

Kolbe, L. J. (1993b). Developing a plan of action to institutionalize comprehensive school health education programs in the United States. Journal of School Health, 63(1), 12-13.

Lavin, A. T. (1993). Comprehensive school health education: Barriers and opportunities. Journal of School Health, 63(1), 24-27.

Louis Harris & Associates. (1989). Health--You've got to be taught: An evaluation of comprehensive health education in American public schools. New York: Metropolitan Life Foundation.

Seffrin, J. R. (1990). The comprehensive school health curriculum: Closing the gap between state-of-the-art and state-of-the-practice. Journal of School Health, 60(4), 151-156.

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