Health education check-up.

While reports of rising childhood obesity rates have prompted schools to examine what gets served in the cafeteria and in school vending machines, interest in student health has not yet sparked a revolution in what gets served in the classroom. Health education is not identified as a core subject in the No Child Left Behind act; neither does the legislation call for highly qualified health teachers. Only 16 percent of states require student testing on health education topics.

Yet health education has the potential to mitigate high-risk behaviors that can negatively affect health and, consequently, young people's potential for personal and academic success. Six of these behaviors have been identified as "high priority" by the Centers for Disease Control and Prevention: behaviors that result in unintentional and intentional injuries; tobacco use; alcohol and other drug use; sexual behavior; dietary behavior; and physical activity.

What is the role of health education in addressing these and other health-related issues? (Some experts estimate that "one child out of four has an emotional, social or physical health limitation that interferes with learning.") What can school districts do to ensure effective health education practices? Let's begin with an examination of available research and data.

Policies and guidelines for health instruction vary across states and districts, but 96 percent of all schools require some health education for students, either in health classes, in combined health and physical education classes, or within other courses such as science or social studies.

National standards Nearly all states require or recommend that districts or schools follow national or state-developed health education standards. Among those that do, 76 percent base their guidance on the 1995 National Health Education Standards.

Instructional time The School Health Education Evaluation examined four health curricula for 30,000 fourth-through seventh-grade students in 20 states. Researchers found that bringing about significant changes in health attitudes and behaviors requires at least 50 hours of classroom instruction.

Most schools fall short of this threshold, according to data collected during the CDC's School Health Policies and Programs Study 2000--the largest and most comprehensive assessment of school health policies and programs.

Other factors affecting effectiveness Studies suggest the effectiveness of health education also depends on teacher training, the comprehensiveness of the health program, family involvement and community support.

"Sequential school health education programs for K-12 students have been found to be more effective in changing health behaviors than occasional programs on single health topics," according to Liane Summerfield, who also finds the most effective methods of instruction in health to be student-centered approaches that develop skills in critical thinking and communication.

About prevention education When it comes to school-based prevention education, "disappointingly little is known about what works, what doesn't, and why," according to David Kirp and colleagues. When he looked at meta-analyses of high-quality pregnancy, HIV/AIDS, tobacco, alcohol, drug, and violence prevention studies, however, he found these program shared several common features: (1) focus on broader social skills, (2) provide basic and accurate information, (3) emphasize clear social norms and communicate a clear message, (4) use a variety of teaching styles, (5) are culturally and experience- or age-appropriate, (6) last sufficiently long and/or provide "boosters, and (7) rely on well-trained teachers or adult leaders.

Percentage of Schools with Specific Health Class-Time Requirements

                     Elementary   Middle/Junior High   High School
At least 7.5 hours      58%              80%               84%
At least 15 hours       43%              67%               75%
At least 30 hours       20%              38%               37%
At least 60 hours        5%              14%               14%

Source: CDC, 2001

The Seven National Health Education Standards

Students will:

* comprehend concepts related to health promotion and disease prevention

* demonstrate the ability to access valid health information and healthy products and services

* demonstrate the ability to practice healthy behavior and reduce health risks

* analyze the influence of culture, media, technology and other factors on health

* demonstrate the ability to use interpersonal communication skills to enhance health

* demonstrate the ability to use goal-setting and decision-making skills to enhance health

* demonstrate the ability to advocate for personal, family and community health

Source: Developed by the Joint Committee on National Health Education Standards, Association for the Advancement of Health Education, American School Health Association, and American Public Health Association, Sponsored by the American Cancer Society.

For citation of the references used in this article, go to www.districtadministration.com

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