National Standards for School Health Education.
by Summerfield, Liane M.
WHY HAVE HEALTH INSTRUCTION IN THE SCHOOLS?
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.
RESEARCH ON THE ABILITY OF HEALTH INSTRUCTION TO CHANGE CHILDREN'S
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.
NATIONAL STANDARDS FOR HEALTH EDUCATION
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
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
*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
*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
*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
*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.
HEALTH CURRICULUM CONTENT
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):
* consumer 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.
TEACHING PRACTICES THAT DEVELOP HEALTH KNOWLEDGE, ATTITUDES, AND
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
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).
IMPLICATIONS FOR TEACHER EDUCATION
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
*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
SOURCES OF ADDITIONAL INFORMATION ON HEALTH CURRICULA
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
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.