4 Paradigm Shifts in Health Education

Once in awhile, I have the opportunity to train K-12 teachers and health education specialists in secondary school. Many have not had accurate, effective professional development (PD) in years. That has to do mostly with budget cuts to schools and public perception that when teachers are not with their students, there are no benefits to the system. WRONG. I would much rather teachers have PD days than be teaching outdated, incorrect or even harmful information to our students. There have been many updates in the health education field. See below to learn about 4 of 8 of the paradigm shifts I'm going to be sharing over the next couple of days.

1. Scare tactics don't work.
Remember the "Don't do Drugs or else" campaigns? They don't work on the adolescent brain. Youth are risk- takers. Their brains are not as fully developed as an adult brain to think through decisions. For example, a teenager may have seen a YouTube video of a person who jumped off their roof onto a mattress. So they try it. And they break their leg. And the parent asks, "What were you thinking?" The teenager may say something like, "I wasn't thinking." or "If I just jumped a different way, everything would have been fine." And, that's how the adolescent brain works. Accept it.

What does work? Building student's skills in making decisions, communicating and advocating for their own health. If you look at the National Health Education Standards, 7 of the 8 content standards are skills; accessing (valid and reliable) information, interpersonal communication, advocacy, goal-setting, decision making, self-management and analyzing influences. If we had the appropriate amount of time to teach health education, students would have multiple times to practice their communication skills, performing tasks to demonstrate advocating for their health and other, setting clear and achievable goals, etc. 

The other issue surrounding scare tactics is that many times the information teachers are sharing isn't accurate. If a high school teacher shows a powerpoint that includes the worst photos of genitalia with STDs, they are actually sharing harmful information with them. Harmful in that most STD symptoms don't become that severe and many are asymptomatic. SO, the lesson? It has nothing to do with promoting abstinence, or using protection or practicing communication skills to say yes, I will, but only with a condom, or No, I choose abstinence. It's a group of students watching gross slides. And, of course they love it- it taps into a fear/gross factor and will probably always remember that one class (our brain remembers intense emotions). That doesn't mean it changes their behaviors or increases the likelihood they will be safe when sexually active. 

The drunk-driving crashed up car is another example. It's expensive and takes time and doesn't change behavior. Let's instead teach effective, research-based curriculum. If you need a list of what's out there, ask me. Happy to work with you on some really great curricula. Some are even free!

(See references below on why scare tactics don't work)

2. Teach Functional Knowledge
At one point in time, health educators thought it was a good idea to teach everything to students. The belief was that students needed all this information to make an informed choice. But, knowing all about the importance of wearing a helmet when riding a bike doesn't mean they are wearing a helmet or know how to properly fit it. Teachers LOVE to teach the body systems. That isn't health, it's science. However, what is health? Something with a behavior outcome. An educator teaches a piece of functional knowledge around the skeletal system. That means what the primary functions of the system is (protection of organs and structure) and then how to keep it safe (helmet, seatbelt, etc) and healthy (eat a nutrient-rich diet, exercise, etc). But memorizing the 206 bones in the body doesn't lead to any behavioral outcomes. Please don’t spend a lesson having kids build a heart out of clay or drawing their muscles. There is no behavioral outcome that leads to that. It might be art, it might be creative and fun, but with so little time to each health education, please spend a brief amount of time on what the system does, how to keep it safe and healthy. Set goals, make decision, advocate! Don’t draw and build things for days. Elementary students do not need to understand what a calorie is in order to basically, eat breakfast everyday, drink more water and eat fruits and veggies. What do our students REALLY need to know? What is the functional knowledge around a topic? And, it's a lot less than you think. Focus on skill-buidiing. That goes back to the National Health Education Content Standards.

3. Use a Research-Based curriculum, or Based in Best Practice
Know that programs out there aren't necessarily curricula. Curriculum should be developed with behavioral outcomes (preferably HECAT's HBO's- see blog post from January 30 for more information) in mind. It should be a sequential, progression of lessons (at least 8-15 per topic) based on the Health Education Standards. It may integrate with other subjects (ELA, Math, etc), but may not. Read who developed the curriculum. Was an evaluation done on increasing the knowledge, skills, attitudes and behavioral outcomes of the program? Please stop using programs out there that aren't effective. Some are gaining a lot of momentum but don't work. Use the Characteristics of an Effective Health Education Curriculum  here to select a curriculum that works for you. References listed below. Contact me if you have more questions.

4. Assemblies Don't Change Behavior
Sometimes I hear administrators trying to fulfill a curricula mandate by doing a one-time assembly on a topic in health education. It is important that schools do not make the assumption that one assembly for the entire school population on tobacco prevention is effective. It's not worth the time and the money. Again, let's spend the time having students demonstrate, practice, analyze, role play, advocate versus sit and get.

The other 4 paradigm shifts? Coming tomorrow! Stay tuned...


References for Scare Tactics Don't Work:

Beck, J. (1998) 100 Years of ‘just say no’ versus ‘just say know’: Re-Evaluating Drug Education Goals for the Coming Century. Evaluation Review 22 (1): 15-45

Bosworth and Sailes (1993), Center for Adolescent Studies, Indiana University 201 North Rose Street #3288 Bloomington, Indiana 47405

Brown, J. H., D’Emidio-Caston, M. and Pollard (1997). Evaluation Review. 19 (4) 451-492.

Golub, A, Johnson, B.D. (2001) Variation in youthful risks of progression from alcohol and tobacco to marijuana and to hard drugs across generations. American Journal of Public Health; 91:225-232

Hansen, W.B. (1997). Prevention Programs: Factors that individually focused programs must address. In Resource Papers for the Secretary's Youth Substance Abuse Initiative SAMSHA/CSAP Teleconference, Oct. 22, 1997. Pre-publication document.

Petrosino, A.J., Turpin-Petrosino, C. and Finkenauer, J.O. (2000). Well-meaning programs can have harmful effects: Lessons from the “Scared Straight” experiments. Crime and Delinquency, 46 (3), 354-379

Tobler, N.S. (1992) Drug Prevention Programs Can Work: Research Findings. Journal of Addictive Diseases 11(3) 1-36.

U.S. Department of Health and Human Services, National Institutes of Health, NIH Consensus Development Program, NIH News, October 15, 2004

U.S. Department of Health and Human Services. (2001). Youth Violence: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Injury Prevention and Control: Substance Abuse and Mental Health Services Administration, Center for Mental Health Services; and National Institutes of Health, National Institute of Mental Health. Government Printing Office


References for Characteristics of an Effective Health Education Curriculum:

Botvin GJ, Botvin EM, Ruchlin H. School-Based Approaches to Drug Abuse Prevention: Evidence for Effectiveness and Suggestions for Determining Cost-Effectiveness.  In: Bukoski WJ, editor. Cost-Benefit/Cost-Effectiveness Research of Drug Abuse Prevention: Implications for Programming and Policy. NIDA Research Monograph, Washington, DC: U.S. Department of Health and Human Services, 1998;176:59–82. 

Contento I, Balch GI, Bronner YL. Nutrition education for school-aged children. Journal of Nutrition Education 1995;27(6):298–311. 

Eisen M, Pallitto C, Bradner C, Bolshun N. Teen Risk-Taking: Promising Prevention Programs and Approaches. Washington, DC: Urban Institute; 2000. 

Gottfredson DC. School-Based Crime Prevention. In: Sherman LW, Gottfredson D, MacKenzie D, Eck J, Reuter P, Bushway S, editors.  Preventing Crime: What Works, What Doesn’t, What’s Promising. National Institute of Justice; 1998. 

Kirby D. Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy. Washington, DC: National Campaign to Prevent Teen Pregnancy; 2001. 

Kirby D, Coyle K, Alton F, Rolleri L, Robin L. Reducing Adolescent Sexual Risk: A Theoretical Guide for Developing and Adapting Curriculum-Based Programs. Scotts Valley, CA: ETR Associates; 2011. 

Lohrmann DK, Wooley SF. Comprehensive School Health Education. In: Marx E, Wooley S, Northrop D, editors. Health Is Academic: A Guide to Coordinated School Health Programs. New York: Teachers College Press; 1998:43–45.  

Lytle L, Achterberg C. Changing the diet of America’s children: what works and why? Journal of Nutrition Education 1995;27(5):250–60. 

Nation M, Crusto C, Wandersman A, Kumpfer KL, Seybolt D, Morrissey-Kane, E, Davino K. What works: principles of effective prevention programs. American Psychologist 2003;58(6/7):449–456. 

Stone EJ, McKenzie TL, Welk GJ, Booth ML. Effects of physical activity interventions in youth. Review and synthesis. American Journal of Preventive Medicine 1998;15(4):298–315. 

Sussman, S. Risk factors for and prevention of tobacco use. Review. Pediatric Blood and Cancer2005;44:614–619. 

Tobler NS, Stratton HH. Effectiveness of school-based drug prevention programs: a meta-analysis of the research. Journal of Primary Prevention 1997;18(1):71–128. 

U.S. Department of Health and Human Services. Preventing Tobacco Use Among Young People–An Update: A Report of the Surgeon General. Atlanta (GA): U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2011: 6-22–6-45. 

Weed SE, Ericksen I. A Model for Influencing Adolescent Sexual Behavior. Salt Lake City, UT: Institute for Research and Evaluation; 2005. Unpublished manuscript.