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1998 Massachusetts School Health Education Profile Report

Content of Health Education

A documented, planned, and sequential program of health education for students is a key element of school health education (Allensworth & Kolbe, 1987; National Association of State Boards of Education, 1989). The School Health Education Evaluation Study (Connell, Turner, & Mason, 1985) found that full implementation of planned curricula was linked directly to changes in students' attitudes and behaviors. Additionally, it is important that health education curricula cover a broad range of health-related topics and that they aim not only to increase factual knowledge but also to help young people develop the skills needed to take responsibility for their own health and to avoid health-damaging behaviors. Finally, the use of peer educators in health education may be one important influence leading to increased student learning and decreased risk behavior.

Resources Used in Planning Health Education Programs. The use of curriculum frameworks helps to ensure that key topics are taught and that these topics are developed in a sequential, increasingly complex fashion over the school years. At the time of the survey, most Massachusetts health teachers had access to an initial version of the Massachusetts Comprehensive Health Curriculum Framework, designed to serve as a basis for school health education courses across the state. A final version of the framework was approved by the Board of Education in September 1999.

Commercially-developed health curricula can also be effective in shaping students' health-related behaviors, especially since they are more likely than locally-developed curricula to be based on research on effective practices and to have been carefully evaluated for their impact on youth. The Massachusetts AIDS Program Intensive Evaluation (Blake et al, 1998), for example, found that teachers who used commercially-developed research-based curricula to teach about HIV/AIDS were more likely than those who did not to emphasize skills rather than factual knowledge only.

• In 1998, most health teachers reported that they were required to use school curriculum guides/ frameworks, district curriculum guides/frameworks, and the state curriculum framework in planning health education courses. Significant increases have occurred since 1996 in the required use of frameworks. (See Figure 5.)
• For the most part, teachers appeared to rely on locally-developed curricula, with fewer than half (43%) reporting that their school required the use of commercially-developed health education curricula in health education courses. Even so, this figure represents a significant increase above the 32% reported in 1996.
• High school teachers were significantly more likely than middle school teachers to use the state curriculum framework as a basis for planning (88% vs. 79%) and to be required to use teacher's guides (42% vs. 30%).

* statistically significant increase from 1996 to 1998

Topics Covered in Health Education Classes: The CDC recommends that health education programs address behaviors associated with leading causes of morbidity and mortality among adolescents and adults. Six categories of behavior are especially relevant to health and safety: (1) tobacco use, (2) alcohol and other drug use, (3) behaviors related to intentional and unintentional injury (for example, suicide attempts, fighting, driving while intoxicated, lack of seat belt use), (4) sexual behaviors related to unintended pregnancy or sexually transmitted disease, (5) dietary behaviors, and (6) lack of physical activity. Every other year, the Massachusetts Youth Risk Behavior Survey collects data on the prevalence of these behaviors among public high school students. Additionally, the Massachusetts Comprehensive Health Curriculum Framework recommends coverage of fourteen content areas, grouped into major "strands" of (1) physical health, (2) social and emotional health, (3) safety and prevention, and (4) personal and community health. Health teachers were asked to indicate whether their required health courses aimed to increase student knowledge about these and other health-related topics.

• Topics covered by virtually all teachers were alcohol and drug use prevention, HIV/AIDS prevention, tobacco use prevention, dietary behaviors and nutrition, disease prevention, and personal health. (See Figure 6).

• The topics least frequently taught in required health courses concerned death and dying, dental/oral health, cardiopulmonary resuscitation, environmental health, chronic diseases, first aid, and suicide prevention. Even so, over half of lead health teachers reported teaching about each of these.
• Substantial increases in the coverage of many topics occurred from 1994 to 1996. From 1996 to 1998, there were small but statistically significant increases in the percent of teachers reporting that they taught about community health (from 72% to 76%), sexual harassment (87% to 92%), and physical activity and fitness (90 to 94%). Teaching about first aid declined from 71% to 67%. Other changes were too small to be statistically significant.
• High school teachers were significantly more likely than middle school teachers to report teaching for knowledge on several topics, including:
  • cardiopulmonary resuscitation (66% in high school vs. 46% in middle school),
  • suicide prevention (77% vs. 60%),
  • pregnancy prevention (91% vs. 75%),
  • death and dying (56% vs. 43%),
  • sexually transmitted disease (97% vs. 90%),
  • human sexuality (93% vs. 88%),
  • reproductive health (90% vs. 85%), and
  • sexual harassment (94% vs. 89%)
• Three topics were taught more frequently at the middle school than at the high school level. These were dental and oral health (58% vs. 46%), first aid (68% vs. 61%), and growth and development (94% vs. 88%).

Skill development is a critical part of health education. Factual knowledge is necessary but far from sufficient to influence personal health-related behavior. Both young people and adults, for example, may know that a certain behavior such as cigarette smoking is harmful but may not be able to resist the temptation to smoke. Ample research has shown that effective health education programs - that is, programs that have been demonstrated to influence behavior -- are those that include a focus on the development of key skills (Kirby, 1992; Reid, McNeill, & Glynn, 1995). Teachers were asked whether or not their required course in health education aimed to develop skills known to be related to health-protective behavior.

• Almost all teachers included skills instruction in their health education courses. This instruction focused on students learning to make healthy decisions, set goals for themselves, communicate clearly about personal health-related concerns, resolve conflict non-violently, resist social pressure for unhealthy behavior, manage stress in healthy ways, access accurate information about health topics, analyze media messages related to health and risk behavior, and advocate for personal, family and community health. (See Figure 7.)
• Significant increases occurred from 1996 to 1998 in teaching students the skills they need to analyze media messages (from 88% to 94%), to resolve conflicts nonviolently (90% to 93%), and to manage stress in health-enhancing ways (80% to 83%).
• Teachers' reports of skills instruction did not differ significantly by school level (middle, junior/senior high, and high school).

Peer Educators. The use of peer educators is an effective tool in health education (Allensworth, 1993). As a part of health education, peer educators may address attitudes and model behaviors in a manner that may be especially persuasive to youth.

• Principals in 44% of schools reported that trained peer educators had been used during the year to help teach about health. Peer educators were much more common at the high school level (60%) than at the middle school level (33%).

Summary and Implications

Virtually all Massachusetts secondary school health teachers are providing instruction in the topics related to priority health risk behaviors for youth. In particular, adolescent students are being taught the knowledge they need to avoid the risks of alcohol and drug use, tobacco use, HIV infection, and violent conflict. Equally as important, the vast majority of health educators are emphasizing the development of the skills young people need to make responsible, informed, and health-enhancing decisions. For example, students who have developed the capacity to recognize and resist media and social influences are less likely than others to succumb to tobacco advertisements or to peer pressures to smoke.

Health education in Massachusetts is becoming more standardized and consistent; that is, more health teachers are using guidelines, curriculum frameworks, and commercially developed health curricula in planning their instruction. These changes make it more likely that all students in the Commonwealth will benefit from carefully planned, sequential health education that incorporates the best practices in the field.

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