When Authentic Learning Doesn't Align to Assessment

A few weeks ago, I worked with a large school district on the east coast. They loved my activities on the health education, my pitch on the Whole School, Whole Community, Whole Child model and how as health teachers they play a role in a bigger health system. They loved my effective practices in health education activity and the energizers I was incorporating in. I had them enthused! Motivated! 

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Using Health Education Standards & Assessment in the Classroom

I'm incredibly excited to be facilitating this Standards and Assessment training in western Kentucky next week for about 10 health teachers. In fact, two are grade level teachers from the elementary level! It's the first time I've offered this workshop in about 4 years and it's been completely overhauled. 

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Foundations of Health Education

I knew I was working with a great group of teachers when they were asked by their District Coordinator, Tempe Beall, to introduce themselves and share which National Health Education Standard they enjoyed teaching the most. I loved hearing things like, "I have my students role plays to practice interpersonal communication and self-management." "I love teaching students accessing information; accessing valid and reliable sources to promote health."

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What Have We Been Up To?

Here is an update about what Cairn Guidance has been up to recently. We are so excited to be working in school health, community health and within the content areas of: tele-medicine, after-school programming for youth, school health policies, facilitation, keynoting, bicycle and pedestrian-friendly streets, sustainability, curriculum, systems thinking, suicide prevention, mental health promotion, and obesity prevention! 

Foundation for a Healthy Kentucky- Jess is a part time project officer for the Foundation, overseeing sub-grantee projects around Kentucky. These projects are funded through the federal Social Innovation Fund (SIF) and focus on a variety of community health issues. Through the Foundation, Jess was invited to the White House this upcoming Friday for a SIF reception displaying some of the innovative projects being implemented around the country. She is honored to have been invited to participate in this great event!

Prince Georges County Public Schools (PGCPS)- We have just completed a review of PGCPS District Wellness Policy and all other related school health policies, including Bullying/Harassment, Crisis, Recess, Competitive Foods and HIV policies. We are also helping to facilitate a Health and Wellness Team Conference on September 27 for over 100 participants across their school system, representing school nurses, health education teachers, physical education teachers, cafeteria managers and school administrators. I will be keynoting the day to energize participants and helping facilitate school health related information, best practices and sustainability of their school health work. Both the Alliance for a Healthier Generation and ASCD will be present to help support the district’s commitment to being “Great By Choice” and choosing to invest more in health promotion, disease prevention, quality health care while in school for their students, health screenings for their staff and increased family engagement in school health and wellness committees in order to improve academic achievement for ALL students attending their public schools.

American School Health Association (ASHA)- ASHA is in Portland Oct 9-11! Jess will be facilitating the first-timer’s session at ASHA this year, on Friday morning. She is also presenting a workshop on “Creating Lasting School Health Programs,” focused on how to create sustainable school health initiatives. 

Alaska Department of Education- Jess will be traveling up to Anchorage in October to facilitate the Systems Thinking; Systems Changing Simulation for districts in Alaska working on chronic disease and school health, some CDC 1305/Quad Grant-selected districts.  Jess is excited that this trip falls right after ASHA’s conference in Portland and will allow a couple of days in Seward AK to ‘play’!

Alta Planning/Grand Rapids MI Transportation Project- Cairn Guidance is working with Alta Planning to create a safer, healthier city. We are working on a project funded by the transportation to create a more bicycle/pedestrian friendly city. Cairn’s role will be to create adult-learning modules to promote safe bicycling and walking around the city, during all times throughout the year. We are mentioned in this article on the project.

EVEN- EVEN is an initiative Cairn is helping launch around mental health. The project includes a High School suicide prevention project and will be expanding to address mental health within communities, specifically military and their families, K-12 schools and in work settings addressing employee wellness. More to come on this project!

HYPE Project- Eat Smart, Move More South Carolina partnered with the University of South Carolina Arnold School of Public Health and South Carolina Department of Health and Environmental Control to create the Healthy Young People Empowerment (HYPE) Project. It was created through funding from the Federal Community Transformation Grant Program as a part of the Healthy South Carolina Initiative.

The purpose of the HYPE Project is to motivate and engage youth in policy, systems, and environmental obesity change efforts throughout South Carolina. The HYPE Project will build the skills of youth so that they can become a greater voice in their communities. The HYPE Project activities focus on healthy eating and active living; however, youth are encouraged to use the skills they learn to be lifelong champions of positive change.

Cairn Guidance is reviewing HYPE’s student and facilitator guides in order to strengthen the program. Using their pilot and evaluation feedback and reviewing the program through the lens of the Health Education Analysis Tool, we will provide additions and revisions as needed.

Southern Obesity Summit- Jess will be keynoting this conference on Tuesday, October 7 in Louisville. Her “Do Something Extraordinary” keynote will motivate and energize participants to continue to fight obesity in their communities and set personal wellness goals to take care of their own health. 


Resources to Support K-12 School Health Education

I have had a folder on my computer for over ten years now that is called "Much-Used Documents." I'm not sure that is an accurate way to use the English language, however, the folder name has stuck. In it, I have my go-to favorite resources, tools, documents, materials. It's a quick way to access what I need when I need it. Today, I'll list the tools that I refer to often for Health Education. Tomorrow, I'll list those tools I use for broader school health work. My hope is that you, the reader have an opportunity to read through this list, check these things out and utilize them! Some of these documents are things I developed. So, I'll list them and if you are interested in any of them, contact me. I'm happy to share. 

You should be developing a scope and sequence or unit or lessons based on these 4 things:

  • National or State level K-12 Health Education Standards
  • Characteristics of Effective Health Education Curricula
  • YRBS or other data sources
  • Local/State Laws and Policies related to what you are required to teach


National Health Education Standards- Let's start here. I was fortunate enough to be selected to be on the panel for revision of this second edition, 2007 document. There is discussion within the field now, that I am a part of, to create another document that may be supplemental to this one. It would include a more classroom teacher-friendly tool and include more information for the 21st Century learner/teacher, as well as have a focus on health literacy. I have mixed feelings about a new document, but understand that the second edition is not really a classroom-friendly tool. Although, if you had a strong higher ed health education experience, it should be a tool most health education specialists can use. The problem is that most teachers teaching health education aren't health ed specialists and would love a tool that is aligned to 21st Century Skills, Common Core and has a focus on health literacy. So, I'm excited to be a part of the discussion and really appreciate being asked! 

Health Education Curriculum Analysis Tool (HECAT)- This is the second place to start. The NHES focuses on the content standards, but without much mention of the health issues. The HECAT is an overwhelming tool, yes, however, it is a tool that can guide a state to develop state standards, a district to create a K-12 health education scope and sequence and individual teacher to do lesson planning. I refer to it quite often. I'm planning on doing a webinar on the tool (or a series of them) very soon. One of the most useful tools within the document is on page 4, Characteristics of an Effective Health Education Curricula.

MMWR's School Health Guidelines to Promote Healthy Eating and Physical Activity- Here's the Executive Summary. For full resource, go here. This tool is very public-healthy. However, Guideline 5 is, 'Implement Health Education that Provides Students with the Knowledge, Attitudes, Skills, and Experiences Needed for Healthy Eating and Physical Activity.' And Guideline 4 is 'Implement a Comprehensive Physical Activity Program with Quality Physical Education as the Cornerstone.' So, check it out. It goes over some of the best practices in health and physical education.

CDCs Youth Risk Behavior Survey- Use data to drive curricular decisions! If you are health ed specialist, you should have been taught how to do this in school. However, if not, dig into any local, state, national data you can find to actually see what risk and health behaviors your students are participating in. 2 week unit on prescription drug abuse? Why if most of your students are drinking alcohol. Know the numbers and develop a curricula based on them.

Don't Do It! Scare Tactics Don't Work- a resource that goes over why we shouldn't be using scare tactics in the health education classroom.

Sex Education
Oregon Youth Sexual Health Plan- this document is a part of a larger state-wide approach to increasing the sexual health of adolescents in Oregon. However, objective #5 is on Providing Education and skill building for youth and families and includes comprehensive sex education language and goals.  

Just Say Know- Texas Freedom Network. To read full report on status of sex education in Texas click here.

The 17 Characteristics of Effective HIV and Pregnancy Prevention Programs- This is a larger document developed by Doug Kirby, Lori Rolleri and Mary Martha Wilson. It is incredibly helpful, but page 9 lists these characteristics. 

Age/Developmentally Appropriate, Comprehensive Sexuality Education Topic Guidelines- I supported Brad Victor on this document when I was overseeing K-12 Health Education for the Oregon Department of Education. It could be a useful advocacy tool, or help with developing a unit or lessons.

National Sexuality Education Standards- Great tool to develop your scope and sequence or units/lessons on sex education!

Promoting Implementation of a School District Sexual Health Education Policy Through an Academic-Community Partnership

Positive Youth Development as a Strategy to Promote Adolescent Sexual and Reproductive Health



The Case Against Zero-Just an article I like on how grading on a curve isn't best practice.

Time to Include Nutrition Ed into PE?

I'm responding to an article written in Strategies: A Journal for Physical and Sport Educators, in the January/February issue called, It's Time to Include Nutrition Education in the Secondary Physical Education Curriculum.

The authors did a good job of 'making the case' to increase both physical activity and nutrition education in schools. We have a childhood obesity problem and schools do play a role in awareness, education and prevention of this issue. The authors advocate for PE teachers to include a 17-week nutrition program within their PE class. Now, I see that suggestion as a  two-fold problem. First, I'm not a PE teacher, but I assume that PE courses in high school do not have a ton of time leftover if addressing and aligning their program to the National PE Content Standards. Secondly, although incredibly supportive of more nutrition education and integrated learning, the article wasn't written or apparently reviewed by a health educator.  I'm concerned the authors, Susan L Bertelsen and Ben Thompson, associate professors in the Human Performance and Sport Department at Metropolitan State University of Denver in CO, did not work with a health educator. And, here's how I know this. They don't mention the importance of alignment to the the National Health Education Content Standards. They don't talk about the Health Education Curriculum Analysis Tool and developing a sequential health education program integrated to what their health teachers are teaching and aligned to the Healthy Behavior Outcomes (HBOs) within the HECAT. What they have in the article as a suggested 'curriculum' (which it's not by definition a curriculum, but rather a scope and sequence, or list of topics), is not all function knowledge. I recently blogged about functional knowledge. It means- what are the concepts students REALLY need to know to change their behavior or intend to stay healthy? What the authors have listed there isn't all functional knowledge. The authors also state nothing about reviewing your local or state Youth Risk Behavior Survey Data... using data to drive curricular decisions. Instead they just suggest nutrition topics that don't necessarily lead to behavior outcomes. 

I hate to pick on these two authors. I mean- I get at the core of what they are saying is that we need more nutrition ed (amen!) and integrated learning (amen!). But, next time, please advocate for strong implementation of ideas using what we know is best practice in health education.


4 More Paradigm Shifts in Health Education (continued)

This is a continuation of yesterday's post on 4 of the 8 paradigm shifts in school health education. 8 paradigm shifts in total. Just as social studies used to be about learning facts and dates but has shifted to interpreting and analyzing, health education has shifted from knowledge to skills-based. Read on to learn more about what we know now.

5. Health Fairs; Know Your Objective
Many times when a school wants to work on the overall health and well-being of their school community they host a health fair. What are the objectives? What do you hope to gain? Health Fairs may be great for building partnerships (local organizations have an opportunity to showcase their resources), offer health screenings, share information, connect people. Health Fairs haven't been shown to change behavior, attitudes or deliver skill practice. With that in mind, don't NOT have one, but have a clear understand of the pros and cons of holding this event.

6. Prevention Should Begin 2 Years Before Initiation of a Behavior
I was told by an education trainer once that prevention in school should start 2 years before initiation of the behavior. I couldn't find the cite, so I'm skeptical to say that as fact, however, it makes sense. We should not wait to teach students about contraception in their junior year in HS when we know nationally a little over 45% of our 12th graders are currently sexual active when in 9th grade the rate of currently sexually active teens is around 20%, according to CDCs Youth Risk Behavior Survey (YRBS). That is why we advocate for prevention to begin in middle school. More information means more students have access to make healthy decisions... now or even in their 20s, 30s and 40s. So, safe to say, look at the YRBS for your state or local area if your state has local data and plan on delivering prevention programs, not intervention programs for risk behaviors.

7. Use Data to Drive Curricular Decisions
Research demonstrates you need to practice skills many times to form habits. If you've read Malcolm Gladwell's Outliers, you know that it might take about 10,000 hours to become a champion in that skill. We aren't necessarily looking for champions in the 7 National Skill-Based Health Education Standards (although that would be nice!), but the idea is practice. Health teachers want to teach it all. All topics! Alcohol, tobacco and drug prevention, nutrition, physical activity, environmental health, violence and suicide prevention, sexual health, prevention and control of disease, mental, social and emotional health, and unintentional injury prevention. PHEW! With only 6 weeks to teach health education? Do NOT try and teach 4 days on each topic. It's not effective. Instead, pick the top 3 topics based on risk behaviors among your students (anecdotal is ok too) and do two weeks each on three topics. Focus on the skills. Yes, I'm talking about the skills that keep coming up- advocacy, analyzing influences, interpersonal communication, goal-setting, self-management, decision making and accessing information. Because with more time to demonstrate the skill, we hope it becomes habit. As a math teacher drills us over and over on addition and subtraction so that when we learn higher level math problems, we have the basics... a health teacher needs to drill the skills so when a student is at a party on a Saturday night, they know how to refuse alcohol so easily, it comes to them like the answer for 2+2. And the refusal skill practice can happen throughout the 3 topics you select and will hopefully transfer to one of the other topics you didn't have a chance to teach. It's sad that we don't have the time to do everything. But remember paradigm shift #2 on Functional Knowledge (yesterday's post)? Less is more. What do students really need to know and be able to demonstrate to change behavior or maintain healthy ones? If you need support on using data to drive decisions, I have facilitated that process many times. 

8. Use the Coordinated School Health (CSH) model!
It's not a program. It's a process we know works. And, health education is a piece of a larger puzzle. In my own words (not CDCs or I'll bore you... sorry federal government!), CSH means:

  • Key component of a CSH model is collaboration. Everyone comes together to work on sending consistent health messages throughout the school environment- staff, parents and students. This includes policies, programs, practices and curriculum. From the school nurse, to the health and PE teacher, to the school counselor and food service director.
  • Starting or maintaining a School Health Advisory Council (SHAC). This helps ensures sustainability in case the champion leaves. It's a time for everyone to meet (usually monthly) to work on the process.
  • Complete a needs assessment tool. There are really 2 free strong tools out there now that ask about your current schools policies, practices and programs within topic areas. CDCs School Health Index (includes nutrition, physical activity, tobacco, unintentional injury, sexual health, asthma, violence). The Alliance for a Healthier Generation's Healthy Schools Program Inventory is another tool focused only on nutrition and physical activity. These tools aren't meant to be an evaluation tool, but rather an assessment of where you are and what your possibilities/opportunities may be!
  • Develop an action plan based on data and your needs assessment results
  • Implement your action plan and celebrate success. Repeat. 


Questions on these paradigm shifts? Contact me! Have more to add? Contact me! 




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.



How to Teach Health Education, Like Really Teach It.

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. 

Picture this...
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-K12 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.

Accessing Information

  • 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.