A middle school teacher asks his students to open their health textbooks. He says, "Read pages 111-119 on the physical effects of smoking. Answer the 6 questions at the end of the chapter and turn in your work by the end of the period."
And, the teacher expects that his students will now never use a tobacco product. Right.
This is how health education was taught to many of us. And, it's not effective. Sit and get, read and process, test and learn doesn't necessarily work when it comes to behavioral outcomes. Knowledge, skill gains and behavioral intentions come from a combination of increased knowledge, personal connection, skill-building with practice and repetition.
A middle school teacher uses CDCs Health Education Curriculum Analysis Tool (HECAT) to design a unit (or, better yet, they use a research-based middle school tobacco curriculum!). In order to design the unit, they start with the HECAT's Healthy Behavior Outcomes (HBOs) for tobacco:
A pre-K–12 tobacco-free curriculum should enable students to
- Avoid using (or experimenting with) any form of tobacco.
- Avoid second-hand smoke.
- Support a tobacco-free environment. Support others to be tobacco-free.
- Quit using tobacco, if already using.
Yup, that's it. So stick to the less is more theory. The unit includes the following concepts (what a student should know and quite possibly included in pages 111-119 of that textbook):
- Describe short- and long- term physical effects of using tobacco.
- Summarize the dangers of experimenting with tobacco products.
- Describe situations that could lead to the use of tobacco.
- Describe the relationship between using tobacco and alcohol or other drugs. (HBO 1) Summarize the benefits of being tobacco-free.
- Describe the social, economic, and cosmetic consequences of tobacco use.
- Explain reasons most individuals do not use tobacco products.
- Explain school policies and community laws related to the sale and use of tobacco products.
- Summarize that tobacco use is an addiction that can be treated.
- Summarize the effects of secondhand smoke.
- Describe ways to support family and friends who are trying to stop using tobacco.
- Summarize how addiction to tobacco use can be treated.
- Summarize how smoking cessation programs can be successful.
You can actually align each of these concepts to one or more of the HBO's, which means these concepts are truly what a student should know. We call this functional knowledge. Having students memorize the 1000's of chemicals in a cigarette or draw a detailed outline of the respiratory system does not fit into the functional knowledge category. Sorry teacher, body systems is science, not health. The entire 2 week curriculum isn't going to cover all of these concepts, hence why we advocate for health education every year. So concepts spread over the grade level spans and skills are reinforced.
The unit also includes skill building opportunities. In health education, we have 7 skill-building standards. The HECAT includes what a student should be able to do/demonstrate in each of these 7 skill standards. However, a unit will never touch upon all of these. That is why it's important for teachers to have professional development days to come up with a district scope and sequence to basically divide an conquer so that students are getting skill practice in different topic areas throughout a K-12 system.
Analyzing Influences (these are specifically for middle school, by the way. HECAT has grade level spans of PreK-2, 3-5, middle, high):
- Explain the influence of school rules and community laws on tobacco-related practices and behaviors.
- Explain how perceptions of norms influence behaviors related to tobacco-related practices and behaviors.
- Explain how social expectations influence behaviors related to tobacco-related practices and behaviors.
- Explain how personal values and beliefs influence tobacco-related practices and behaviors.
- Describe how some health risk behaviors, such as alcohol use, influence the likelihood of engaging in tobacco use.
- Analyze how relevant influences of family and culture affect tobacco-related practices and behaviors.
- Analyze how relevant influences of school and community affect tobacco-related practices and behaviors.
- Analyze how relevant influences of media (e.g., tobacco advertising) and technology affect tobacco-related practices and behaviors.
- Analyze how relevant influences of peers affect tobacco-related practices and behaviors.
- Analyze the validity and reliability of tobacco-related prevention information.
- Analyze the validity and reliability of tobacco-related cessation products.
- Analyze the validity and reliability of tobacco cessation services.
- Describe situations that call for professional tobacco cessation services.
- Determine the availability of valid and reliable tobacco cessation products.
- Access valid and reliable tobacco-related prevention and cessation information from home, school, or community.
- Locate valid and reliable tobacco cessation products. Locate valid and reliable tobacco cessation services.
Ok, ok, I'm not going to list the remaining 5 skill lists, but you get the point. And, just so you know, the remaining skills are: Interpersonal Communication, Decision Making, Goal Setting, Self Management and Advocacy. Overwhelmed yet? That's why I'm here... to help! :) But seriously, it's not that difficult. Unfortunately many organizations that are specialists (RDs, school garden advocates, sexual health experts) write K-12 curriculum and have no knowledge of curriculum pedagogy. Do you now see the paradigm shift that has occurred in health education?
And, one more thing! Long gone are the days when teachers give a multiple choice test on knowledge only. Now, at the end of the unit, a teacher gives the students a prompt to complete a performance assessment on the knowledge and skills gained during the 2 week time period. That performance assessment may be a pamphlet advocating for peers to quit using tobacco products (assessment for both concepts and advocacy). It may be role playing a scenario (interpersonal communication, decision making and self-management). Or, the assessment may be to write a letter to yourself establishing a health-related goal (goal-setting).
Once we have the knowledge of the paradigm shift in health education and the incredibly importance of the subject matter in our K-12 schools, we may be able to effectively advocate and communicate for the field of health education. We all need to talk to school boards and administrators and encourage them to hire health education specialists to teach health, those that are familiar with the tools and process I outlined above. Many of our decision makers in education remember answering those 6 questions on tobacco. Back when health was a joke.
Stay tuned for upcoming blog post, Eight Paradigm Shifts in Health Education.