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1998 Massachusetts School Health Education Profile Report

Executive Summary

Introduction

The School Health Education Profile Survey (SHEP) was developed by the Division of Adolescent and School Health (DASH) of the U.S. Centers for Disease Control and Prevention (CDC) to assess the impact of state and federal resources on the implementation of comprehensive school health education. The survey was first conducted in 1994 to determine the status of comprehensive school health education and HIV prevention education in middle and high schools throughout the Commonwealth. The 1998 SHEP also includes, for the first time, information on additional school policies and programs that may be associated with student health and safety. The results of the 1998 SHEP, which allow us to monitor the state's progress in providing health education, can used in setting priorities for improving the delivery of comprehensive school health programs.

Method

The SHEP, conducted in the Spring of 1998, included three questionnaires: (1) a School Principal Survey to assess the status of health education at the school level from an administrative perspective; (2) a School Policies and Programs Supplement to assess the prevalence of selected health-related policies and programs in the school; and (3) a Lead Health Education Teacher Survey to assess health education at the classroom level. All 681 public schools in the state containing at least two of the grades 6 through 12 were contacted to participate. Usable questionnaires were returned by 577 principals (85% response rate) and 571 health teachers (84% response rate). These high response rates allowed the data to be statistically weighted, and indicate that the results of the 1998 SHEP accurately reflect health education characteristics of the Commonwealth's middle and high schools.

Results

Substantial increases in school health education requirements have occurred since 1994. In 1998, secondary schools on average report requiring two health education courses as contrasted with an average of slightly over one required course four years previously.

Important prevention topics are covered in health education classes, and the development of health-related skills is increasingly emphasized. Over 90% of all secondary schools teach information about tobacco, alcohol and drug use prevention, HIV and STD prevention, dietary behaviors and nutrition, violence prevention, physical activity, fitness, and other key health topics. Additionally, more health education teachers in 1998 than in 1996 reported that they structure their instruction to help adolescents learn health-related skills such as goal setting, analysis of media messages, resisting social pressure, and non-violent conflict resolution.

In contrast to increases in health education, requirements for HIV/AIDS prevention education, which had risen from 1994 to 1996, dropped from 1996 to 1998 in every grade but 10th. In grades 7 and 8, the decline was statistically significant. (See Figure below)

Almost nine of 10 (89%) secondary schools require some HIV/AIDS education in one or more grades, a figure that is somewhat lower than the 94% reported for 1996.

HIV prevention education is least frequently taught in the last two years of high school, at a time when more adolescents are sexually active than in earlier grades.

Over 90% of health teachers address how HIV is transmitted, needle-sharing and sexual behaviors that might transmit HIV, and reasons for choosing sexual abstinence. Correct use of condoms was taught by about half (52%) of teachers.

Health education in Massachusetts schools is becoming more standardized. Increasingly, health teachers use school, district, and state curriculum frameworks to plan their health courses. Over 80% of teachers report using one or more of these frameworks. From 1996 to 1998, there was also a significant increase (32% to 43%) in health teachers who report using commercial health education curricula, which are more likely than locally-developed curricula to have been widely tested and formally evaluated for effectiveness.

Health education in Massachusetts schools is less frequently being coordinated with other disciplines or with other constituencies than was true a few years ago. National recommendations for comprehensive school health programs suggest that health education is most effective when coordinated with other subjects and with community groups. Despite these recommendations, fewer secondary school health teachers in 1998 than in 1996 reported coordinating health programs with physical education teachers (67% vs. 73%) or with other subject area teachers (61% vs. 70%). The reasons for this decline are not clear, but may be related to greater pressure on other teachers to increase student performance in their own disciplines. From 1996 to 1998, there was also a decrease in coordination with local law enforcement and with PTA/PTO's.

Health education teachers are receiving inservice training on health-related topics, and are seeking more. Most (84%) secondary health teachers had received recent training of at least half a day on one or more health topics. They were especially interested in receiving more training on suicide prevention, death and dying, and emotional and mental health, with over half of health teachers mentioning one or more of these issues. School support for such professional development (reimbursements for training expenses, substitute teachers to cover classes) declined somewhat from 1996 to 1998.

Parents are largely supportive of health education. Principals report far more positive than negative feedback about their schools' health education programs, and teachers are far more likely to report expanded rather than restricted topic coverage due to parental feedback. Even though most schools have a policy permitting parents to exempt children from all or part of health education, very few parents actually do so. Over three-quarters of teachers reported using one or more strategies to increase parent involvement in health education in general; approximately one third attempted to involve parents in HIV/AIDS education specifically.

Virtually all schools have adopted basic policies regarding school health and safety issues. Written policies on HIV/AIDS, school safety and weapons possession, alcohol and drug use and possession, sexual harassment, and harassment due to race or ethnicity were in place in over 95% of all secondary schools and seem to be written with appropriate levels of specificity. Policies regarding general bullying, harassment of gay and lesbian students, and adult attendance at school-related events are less common. Also, many schools have not provided recent staff training on the policies they do have, making strong and uniform enforcement of the policies problematic.

Most schools have programs in place that support health, safety, and achievement by monitoring the progress of at-risk students; by providing academic tutoring, non-academic counseling, and various kinds of support groups; and by fostering links between youth and the larger community through community service learning or opportunities for volunteer work.

Conclusions

The 1998 Massachusetts School Health Education Profile documents the status of many important aspects of school health education across the Commonwealth and monitors changes since 1994. Results indicate that Massachusetts has made significant progress in most areas of school health education. Requirements for health education have risen at every grade level; most important prevention topics are being taught and instruction aimed at developing health-related skills has increased. Basic policies regarding school health and safety issues are in place in almost all schools, and most schools have programs to support student health, safety, and achievement.

Some areas of concern remain. Coordination of health education with local law enforcement, with PTA/PTOs, and with other academic disciplines has declined. Also, requirements for HIV/AIDS prevention education have dropped since 1996, and too often students in the upper grades of high school receive neither health education nor HIV/AIDS education. Further, though schools have adopted policies on violence, bullying and harassment, alcohol and drug use and possession, in many instances staff have not been trained on these policies recently enough to ensure effective enforcement. Increased attention to these issues is clearly warranted.

Acknowledgements

Carol Goodenow, Ph.D., Research Coordinator for the HIV/AIDS Program and the Safe and Drug-Free Schools Program, was the principal investigator for the 1998 Massachusetts School Health Education Profile Survey and was author of this report. The Massachusetts Department of Elementary and Secondary Education extends its thanks to the principals and health teachers who participated in the 1998 SHEP. We would also like to thank the Division of Adolescent and School Health (DASH) at the U.S. Centers for Disease Control and Prevention (CDC) which provided funding for this project, and the staff of Westat, Inc., who provided valuable technical assistance.

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