Preservice teachers' attitudes toward teaching health education.

Abstract: Researchers explored the influence of three-credit elementary-level focused Health Education methods-intensive courses on preservice teachers' attitudes, familiarity, and confidence toward comprehensive school health education. Reliability and validity measures were calculated, and found to be acceptable. The population consisted of 170 preservice education majors. Frequency analysis, non-parametric tests, and bivariate analytic procedures were used. Results showed significant increases in "ability to recall content" and "confidence to teach "school health content. At posttest, respondents felt significantly more "confident in their ability" to teach only five of the following 10 school health content: (1) mental health, (2)substances, (3) body systems/growth and development, (4) nutrition, and (5) injury prevention/safety. Recommendations for future research were made.

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The purpose of this study was to assess the effect of a three-credit methods-intensive health education course on preservice teachers' attitudes toward coordinated school health. This introduction contains a brief review of school health education, priority areas for child health promotion and disease prevention, the national health education standards, and current school health education models used for university-level preservice teacher training. In addition, a description of issues related to inadequate teacher preparation programs, teachers' confidence regarding implementing health education, and the need for more sophisticated assessments of the preservice training are presented.

Both historically and contemporarily, the need for health education has been well-documented (Allensworth & Kolbe, 1987; Centers for Disease Control and Prevention [CDC], 1991; Cortese, 1993; Cortese & Middleton, 1994; Joint Committee on National Health Education Standards (1995); McKenzie, & Richmond, 1998; Nader, 1990). While school age children historically were at risk for communicable diseases leading to high child fatality rates (Cortese, 1993), presently many children and adolescents engage in risk behaviors that may jeopardize their self-esteem and health, and increase the likelihood of illness, injury, and premature death (Cortese & Middleton, 1994; Meeks, Heit & Page, 1996; Nader, 1993). Specifically, in 1991, the CDC reported that the following six behaviors, often established during childhood, contribute markedly to today's leading causes of death: (1) tobacco use, (2) unhealthy dietary behavior, (3) inadequate physical activity, (4) alcohol and other drug use, (5) sexual behaviors, and (6) intentional and unintentional injuries. Finally, the CDC (1991) has highlighted other major problems of American youth, noting, for example, that "every day, nearly 3,000 young people take up smoking;" "daily participation in high-school physical education classes dropped from 42% in 1991 to 27% in 1997;" "almost three-fourths of young people don't consume the recommended number of fruits and vegetables each day;" and "every year almost one million adolescents become pregnant, and about three million become infected with a sexually transmissible disease" (p. 2).

With the guidance of the Coordinated School Health Program (CSHP) model, elementary education teachers play a crucial role in assisting children and adolescents learn how to assume healthful and productive lives and reduce these risk behaviors (CDC, 1991). It is during preservice training that comprehending the CSHP model is of most importance. The CSHP model is designed to give elementary education majors a picture of health education beyond classroom instruction that ultimately improves the health status of children, youth, families, and communities (Lavin, 1993). Traditionally, health education at the elementary (K-6) level is the responsibility of the classroom teacher (i.e., inservice teacher), who unfortunately receives little, if any, preservice training in health (American School Health Association, 1993, p. 54). It is unclear whether the preservice teachers, who have fulfilled a methods-intensive health education course, are truly confident in their ability to teach health as part of the daily curriculum (Torabi, et al., 1999). It is probable, in fact, that one's motivations for learning how to teach health at the elementary level are related to confidence levels, or attitudes toward the subject in general.

Becoming a health literate individual also is a goal of preservice training. The four bases of the health literate individual, as defined by the National Health Education Standards, include being a: (1) critical thinker and problem solver, (2) responsible and productive citizen, (3) self-directed learner, and (3) effective communicator (Joint Committee on National Health Education Standards, 1995). In concert with these health literacy objectives, six specific health education standards targeting Kindergarten through grade four have been devised. Further supporting the need for health education, these developmentally appropriate standards provide that students: (1) comprehend concepts related to health promotion and disease prevention; (2) demonstrate the ability to access valid health information and health-promoting products and services; (3) practice health-enhancing behaviors and reduce health risks; (4) analyze the influence of culture, media, technology, and other factors on health; (5) use interpersonal communication skills to enhance health; and (6) use goal setting and decision-making skills to enhance health (Joint Committee on National Health Education Standards, 1995, pp. 27-29). The relevance of national health education standards, theoretical school health models, and priority areas for prevention aside, the choice to implement health education at the elementary-level ultimately lies with the elementary inservice teacher.

Thus, how does the preservice teacher learn to appreciate health education as crucial to developing health literate individuals? A contemporary school health model, the "Coordinated School Health Program" (CSHP), which is an expansion of the Allensworth and Kolbe (1987) "Comprehensive School Health Education" model and is aligned with the above standards. The model presently guides the practice of school health education and is an excellent foundation. The CSHP's eight foci, which McKenzie & Richmond (1998) describe, encompass: (1) comprehensive school health education; (2) physical education; (3) school health services; (4) school nutrition services; (5) school counseling, psychological, and social services; (6) a healthy school environment; (7) school-site health promotion for staff; and (8) family and community involvement in school health. It is important to note, however, that the interrelationships among goals for health literacy, the eight CSHP components, and collaborations among professionals and community members are critical to health promotion and disease prevention (Boyer, 1998).

Another host of researchers (Cortese, 1993; Allensworth & Kolbe, 1987; Boyer, 1988; McKenzie & Richmond, 1998; Meeks, Hight, & Page, 1996) strongly advocates school health programs as a means of improving the future health of American youth. While comprehensive school health education is designed to motivate and assist students to maintain and improve their health, prevent disease, and reduce health-related risk behaviors, some researchers contend comprehensive school health education is lacking. For example, while school districts provide instruction in a variety of health topics, this instruction is not provided at every grade, is not of sufficient duration to improve health practices, and is often taught by teachers who lack professional preparation in health education (Lohrman & Wolley, 1998).

Regardless of the goals of preservice teacher training, however, many elementary and secondary teachers remain uncomfortable when teaching health education (Ross, Luepker, Nelson, Saavedra, & Hubbard, 1991). For instance, many teachers are inadequately prepared to assist students who disclose personal health concerns (Lohrman & Wooley, 1998). Additionally, teachers' professional preparation is insufficient, their motivation for teaching health is low, or their attitudes toward health content is conservative (Lavin, 1993; Collins, et al., 1995). Lavin (1993) also reported that "lack of teacher training in health education continues to present a major obstacle to program implementation and effectiveness" (p. 25). He discussed health teaching efficacy and noted that "few teachers like to teach health [and] whenever it is possible, they `slight' and `dodge' it ... a result of indifference to the subject itself" (p. 24). Other researchers assert that familiarity with health content is at issue, stating, for example, that "improving the health status of children and youth depends to an extent on the adequate preparation of elementary teachers to teach health," and that "the extent of this coursework often varies from nothing to one or more teacher preparation courses" (Ubbes, et al., 1999, p. 17).

This study involved an assessment of one part of the CSHP model, "comprehensive school health education," and in particular the professional preparation of preservice teachers to teach health. Torabi et al., (1999) most recently noted that "health education teacher training is often conducted without any serious evaluation of its impact on teachers or students" (p. 173), supporting this study's goal to assess preservice teachers' attitudes toward health education in particular, and the CSHP in general. The purpose of this study was to document, from pretest-to-posttest measure, the influence of a three-credit methods-intensive course on preservice teachers' attitudes toward teaching health.

Over the past 15 years, instructors of elementary-level health education methods intensive courses observed that preservice teachers generally hold conservative attitudes about health and preferred to complete lesson plans on non-controversial content areas such as nutrition, drug education, body systems, and safety. The preferences have resulted in a general lack of understanding and appreciation for the concept of comprehensiveness (Collins, et al., 1995). The goals of the course are to understand the six priority behaviors outlined above, know the eight components of the coordinated school health model, and understand how to complete a traditional lesson plan assignment. The instructor of the course usually spends the first one-third of the 16-week semester introducing the eight components of the CSHP model and the remaining two-thirds of the course on the 10 specific comprehensive school health content, consistent with the CSHE model used today (Allensworth & Kolbe, 1987; Meeks, Heir, & Page, 1996). The specific instructional strategies used in the course are founded on The National Health Education Standards and the CSHE model, and include didactic presentations focusing on the CDC (1991) priority areas for prevention, health education theory, the 10 health education content, contemporary teaching strategies, interactive discussion of teaching methods, role plays, bulletin board presentations, lesson planning, and objective examinations.

A 12-item "School Health Instruction" questionnaire to measure preservice teachers' attitudes, familiarity with health content, and health-teaching confidence was developed, tested for reliability and validity, and administered. This questionnaire allowed the researchers to test the relationship between completing a three-credit course and preservice teachers' perceived confidence toward teaching health education.

METHODS

Because this study involved preservice students currently enrolled in health education methods-intensive courses, the study population was one of convenience. A total of 170 students pursuing Elementary Education certification, or Health and Physical Education certification and who were enrolled at a large northeastern university during Fall Semester, 1998, comprised the study population. These majors were required to take a three-credit health pedagogy course prior to being certified to teach elementary education, or health and physical education. It is important to recognize that due to the structure and scheduling of this course, it was not possible to employ a control group as part of the pretest/posttest design.

In accordance with the university's regulatory compliance policy, standard procedures for the ethical treatment of human subjects were followed during data collection. As a group, these respondents were generally representative of elementary education majors at the university. Over two-thirds (70.5%) of the study population were women and 29.5% were men; the average age was 20.8 (SD = 2.60). A total of 112 respondents provided matched data from pretest-to-posttest measures, representing a 65.9% response rate.

Given how these elementary-education focused, health-education courses are scheduled and taught, it was necessary to use a one-group pretest/posttest research design, to test the influence of a three-credit Health Education methods-intensive course on preservice teachers' attitudes, familiarity, and confidence toward teaching health education. Students were asked to complete a "School Health Instruction Questionnaire." To offset the possibility of students' preferences for completing a lesson plan on one health content versus another, the researchers assigned each student one of 10 health-education content at random. Next, the pretest was implemented. Subjects then participated in a 16-week methods-intensive health education course. Finally, an identical posttest was administered to measure any differences in attitude, familiarity, and confidence for teaching health content. The reliability and validity of the instrument is described below.

INSTRUMENT RELIABILITY

The following results are based on 12 Likert-type response options measuring confidence toward teaching school health and four additional items measuring preferences for health content. The strength of the attitudes toward teaching health were measured using 1 = strongly disagree, 2 = disagree, 3 = agree, and 4 = strongly agree, while dichotomous response options were used for the preferences scale. Higher scores represented more confident attitudes toward teaching health education content. The scale measuring confidence to recall and teach school health included items such as "I am confident in my ability to:" "recall all 10 content areas," "teach all 10 content areas," and to "teach environmental health," for example. A Cronbach's alpha coefficient was calculated to determine the item homogeneity and reliability of the 12-item scale. Based on 157 responses, the alpha coefficient was found to be at an acceptable value ([alpha] = .64), and thus the scale was considered to be adequately reliable.

INSTRUMENT VALIDITY

To confirm the construct validity of the "confidence toward teaching health" portion of the scale, factor analysis (alpha factoring with varimax rotation) was performed. Factor analytic analysis determined patterns of co-variation among scale items. Three factors were identified with Eigenvalues greater than one, accounting for 49.5% of the total variance of responses. Factor 1 was labeled "conservative attitude" and was perhaps related to confidence toward teaching more controversial health content such as sexuality, mental health, personal health, chronic and communicable disease, and environmental health. Factor 2 was defined as "familiarity with the content" (e.g., conceivably, prior exposure to health content during elementary, secondary, or higher education) and was comprised of items measuring confidence toward teaching nutrition, injury, and body systems. Factor 3 was labeled "efficacy for teaching health" and in all likelihood was related to confidence for recalling and teaching the health education content. Therefore, the three factors of "conservative attitude," "familiarity with the content," and "efficacy for teaching health" adequately supported the authors' interpretation of the structures of the "confidence toward teaching health" scale.

The content validity of the scale was determined using two pedagogy experts at other universities who determined that the instrument was a reasonable and feasible measure of perceived confidence for teaching health education. Given the expert feedback, minor changes in wording and sentence structure were made.

RESULTS

The demographic highlights of this study are summarized below based on the matched pretest and posttest data (n = 112). More respondents were women (67.3%) than men (32.7%). The average age of all respondents was 20.4 (SD = 1.25), and nearly all were Caucasian (96.4%). Most respondents were Junior (58.9%) or Senior (31.3%) status and were majoring in Elementary Education (71.2%) or Health and Physical Education (26.1%).

CONFIDENCE FOR TEACHING

A pretest and posttest frequencies analysis of respondents' confidence levels for teaching health education is shown in Table 1. When asked about their confidence to recall all 10 health education content areas at pretest, half (52.3%) said they "agreed," and 6.3% "strongly agreed." At posttest measure, there was an increase in reported confidence levels: two-thirds (67.0%) of respondents "agreed" and 15.2% "strongly agreed" that they could recall the 10-health education content. When asked to rate their confidence to teach health education content areas, fewer "agreed" (54.5%) or "strongly agreed" (15.5%) to teach health education content areas at pretest than "agreed" (62.5%) or "strongly agreed" at posttest (26.8%).

Also shown in Table 1 are percentage-point differentials regarding confidence to teach health education content areas separately. Nearly half of the respondents "strongly agreed" that they could teach the following content areas at pretest measure: drugs (45.5%), nutrition (45.5%), or safety (41.1%). At posttest, there was an increase among those who "strongly agreed" in their confidence to teach the same content: drugs (60.7%), nutrition (58.9%), and safety (54.5%). No substantial percentage-point differentials were noted from pretest to posttest measure with regard to confidence for teaching personal health, of for teaching chronic and communicable disease. Interestingly, almost twice as many respondents "strongly agreed" at posttest in their confidence to teach environmental health (43.8%) or consumer health (31.3%) than at pretest measure, which was 24.3% and 15.3%, respectively.

ASSIGNMENT PREFERENCES

Respondents' preferences for being assigned content are shown in Table 2 and are ranked in ascending order (e.g., nutrition was ranked the most preferred assignment, while consumer health was ranked the least preferred content). The posttest results showed that respondents more frequently preferred to have been assigned content such as nutrition (30.6%), drugs (19.8%), safety (13.5%), personal health (7.2%) or environmental health (7.2%). Conversely, respondents less frequently preferred to be assigned content such as consumer health (0.9%), body systems (0.9%), disease (5.4%) and sexuality (5.4%). Also illustrated in Table 2 are mean and standard deviation scores regarding confidence ratings for teaching health content. It is interesting to note, for example, that while mental health and consumer health were the least frequently preferred content to have been assigned, these also were the content with which respondents reported lower confidence scores.

A final way to examine the results shown in Table 2 is to consider familiarity with the content from pretest to posttest measure. If increased familiarity with the content is related to a positive increment in confidence to teach about the content, then from pre- to posttest, students should report an increase in confidence to teach the assignment content. This prediction was investigated using a comparison between confidence ratings, for students within each of the 10 content areas. A Wilcoxon signed rank test was performed using one-tailed significance. The results of the rank test showed that respondents' confidence to teach four of the 10 areas improved significantly from pretest to posttest measure. For example, respondents reported significant improvements in their confidence to teach mental health, (pretest X = 2.80, posttest X = 3.40, p < .001) consumer health, (pretest X = 2.92, posttest X = 3.67, p < .05) nutrition, (pretest X = 3.36, posttest X = 3.82, p < .05) and environmental health (pretest X = 3.00, posttest X = 3.56, p < .05) at the conclusion of the three-credit course. The failure to identify significant changes from pretest to posttest with regard to the remaining six health education content may reflect a ceiling effect, wherein the responses across time simply reflect respondents' perceived high confidence to teach these content at pretest.

BIVARIATE DATA ANALYSIS

Pretest data regarding student variables also was examined in relation to perceived confidence to teach each of the 10 areas. An analysis of variance procedure was applied to the data to determine whether differences in students' confidence to teach the 10 areas differed at pretest, as a function of academic major. Table 3 shows the means, standard deviations, and significant differences for respondents' confidence to teach each of the 10 content areas based on academic major. Since the vast majority of students (97%) were either Elementary Education, or Kinesiology majors, the other cases (n=4) were excluded from the analysis.

As shown in Table 3, at pretest measure respondents who reported Kinesiology as their academic major were significantly more confident in their ability to teach the areas of drugs, (p < .05) chronic and communicable disease, (p < .01)personal health, (p < .05) nutrition, (p < .05) and safety (p < .05) than were Elementary Education majors. Given the pretest difference between respondents, an analysis of co-variance procedure was employed to control for the pretest effect in accounting for variance among the posttest responses regarding confidence to teach health. Specifically, it was of interest to note whether the semester course eliminated this difference and/or increased the perceived confidence of one group more than the other. As shown by the mean scores for each group, when controlling for pretest differences in confidence to teach, no statistically significant differences emerged between preservice Kinesiology majors and preservice Elementary Education majors following the semester-long course (See Table 3). These results confirm the importance of the stressing all 10 content areas equally during preservice training as a means of improving teaching efficacy.

When examining the average confidence scores from pretest to posttest measure, a variety of significant differences emerged. As shown in Table 4, all respondents had = 2.95). Likewise, respondents showed significantly (p < .01) higher confidence in their average ratings of ability to teach the 10 health education content areas from pretest (X = 2.85) to posttest (X = 3.15) measures. Table 4 shows the significant increases in respondents' average confidence levels for teaching the following content areas: mental health (pretest X = 3.04, posttest X = 3.22, p <. 05), drugs (pretest X = 3.38, posttest X = 3.59, p < .05), body systems (pretest X = 3.22, posttest = X3.38, p < .01), nutrition (pretest X = 3.40, posttest = X 3.57, p < .001), and safety (pretest X = 3.34, posttest X = 3.51, p < .05). No significant differences, however, were noted with regard to respondents' average confidence levels for teaching sexuality, chronic and communicable disease, personal health, consumer health, and environmental health from pretest to posttest measures.

DISCUSSION

This study focused on the influence of a three-credit methods-intensive elementary education health course on preservice teachers' attitudes toward teaching health education. Overall, the three-credit course had only a moderate influence on respondents' confidence levels for teaching five of the 10 health education content areas. The fact that confidence toward teaching sexuality, chronic and communicable disease, personal health, consumer health, and environmental health did not change significantly from pretest to posttest is alarming. These findings are consistent with other recent research (Lavin, 1993; Collins, et al., 1995) results showing that many in-service teachers who received sufficient preservice health education training continue to maintain a conservative attitude or narrow focus with regard to their health instruction. These attitudes may be due, in part, to the controversial nature of sexuality and some communicable diseases such as HIV. On the other hand, respondents' lack of confidence to teach the more controversial content areas (e. g., sexuality) may largely be the result of limited familiarity with the content, such as having received limited or no exposure to sexuality and family life education prior to enrollment in college.

Nevertheless, there also were no significant increases in respondents' confidence to teach social-science content areas such as consumer health or environmental health. Again, these findings may reflect lack of familiarity with the content. For example, given the relative importance of health education in the traditional curriculum (Hedrich, 1998) it is plausible that these respondents received very little, if any, consumer health and environmental health education prior to college education.

Interestingly, there was a significant increase in confidence to teach body systems (p < .01) well as a significant increase in confidence to teach safety education (p < .05). It could be argued that teaching body systems and safety education would seem to be a health content that is less controversial in nature, or is perhaps more familiar to the respondents. Overall, these results, which show significantly improved confidence for recalling and teaching health content, while simultaneously a low level of confidence for teaching half of the 10 health content, are disconcerting.

The study was limited in that it was a sample of convenience, it was not possible to employ a control group, and the researchers could not control for the effect of previous learning.

Therefore, the following recommendations, which encompass preservice teaching and learning, are directed especially toward the following health content: sexuality, disease, personal health, environmental health, and consumer health:

1) Mentoring the experienced inservice teachers [and related community health professionals] with preservice teachers would be fundamental. This would serve to authenticate the classroom learning experience. Such partnerships would allow students to observe, at first hand, the realities of teaching as one part of the CSHP (Ubbes, et al., 1999).

2) Requiring peer-to-peer learning opportunities such as "micro-teaching" assignments during the regular-class learning process. This would improve students' active involvement in the instruction. Peer-to-peer teaching helps learners validate the relationships between health education and everyday life.

3) Providing a "daily open-forum" that allows students to engage in meaningful dialogue. This type of activity would provide opportunities to correct myths and misperceptions about many of the content with which students' report less confidence.

Finally, the authors of this study make the following four recommendations for future research in this area. First, replicating the study using an experimental design would strengthen the results of future studies. This would require random assignment to different course sections, training instructors to implement curriculum consistently, using similar teaching styles, and accessing a representative control group. Second, conducting a longitudinal study (e.g., over five years) of the preservice respondents as they transition into inservice teaching, to assess how extensively CSHE content is taught. Third, directly comparing the attitudes of preservice teachers to inservice teachers regarding the CSHP and health instruction. Finally, collecting qualitative data via focus group study to explore student opinions, levels of familiarity with health education, and teaching efficacy regarding school health instruction would strengthen this study.

Table 1. Frequencies: Pretest to Posttest Confidence
for Teaching Comprehensive School Health Education

                   Strongly
                   Disagree     Disagree     Agree

  Variable         %    (N)     %    (N)     %    (N)

CONFIDENCE IN RECALLING CSHE CONTENT
Pretest           3.6%  (4)    37.8  (42)   52.3  (58)
Posttest          2.7%  (3)    15.2  (17)   67.0  (75)

CONFIDENCE IN TEACHING CSHE CONTENT
Pretest            0.9   (1)   29.1  (32)   54.5  (60)
Posttest           0.9   (1)    9.8  (11)   62.5  (70)

CONFIDENT TO TEACH:
Mental Health
Pretest           0.9%  (1)   14.3%  (16)  64.3%  (72)
Posttest          0.0%  (0)   10.7%  (12)  56.3%  (63)

Sexuality
Pretest            0.9  (1)    14.3  (16)   53.6  (60)
Posttest           0.0  (0)     9.8  (11)   51.8  (58)

Drugs
Pretest            0.0  (0)     8.0  ( 9)   46.4  (52)
Posttest           0.0  (0)     1.8  ( 2)   37.5  (42)

Disease
Pretest            0.0  (0)    13.4  (15)   47.3  (48)
Posttest           0.0  (0)     8.9  (10)   48.2  (54)

Personal Health
Pretest            0.0  (0)     3.6  ( 4)   45.5  (50)
Posttest           0.0  (0)     3.6  ( 4)   45.5  (50)

Body Systems
Pretest            0.0  (0)    14.3  (16)   49.1  (55)
Posttest           0.0  (0)     6.3  ( 7)   50.0  (56)

Nutrition
Pretest            0.0  (0)     5.4  ( 6)   49.1  (55)
Posttest           0.0  (0)     1.8  ( 2)   39.9  (44)

Safety
Pretest            0.0  (0)     7.1  ( 8)   51.8  (58)
Posttest           0.0  (0)     3.6  ( 4)   42.0  (47)

Consumer
Pretest            0.9  (1)    21.6  (24)   62.2  (69)
Posttest           0.0  (0)    11.6  (13)   57.1  (64)

Environmental
Pretest            0.0  (0)    15.3  (17)   60.4  (67)
Posttest           0.9  (1)     4.5  ( 5)   50.9  (57)

                   Strongly
                    Agree        Total

Variable          %     (N)     %    (N)

CONFIDENCE IN RECALLING CSHE CONTENT
Pretest            6.3  (7)   100.0  (111)
Posttest          15.2  (17)  100.0  (112)

CONFIDENCE IN TEACHING CSHE CONTENT
Pretest           15.5  (17)  100.0  (110)
Posttest          26.8  (30)  100.0  (112)

CONFIDENT TO TEACH:
Mental Health
Pretest          20.5%  (23)  100%   (112)
Posttest         33.0%  (37)  100%   (112)

Sexuality
Pretest           31.3  (35)  100.0  (112)
Posttest          38.4  (43)  100.0  (112)

Drugs
Pretest           45.5  (51)  100.0  (112)
Posttest          60.7  (68)  100.0  (112)

Disease
Pretest           38.2  (42)  100.0  (110)
Posttest          42.9  (48)  100.0  (112)

Personal Health
Pretest           50.9  (56)  100.0  (110)
Posttest          50.9  (56)  100.0  (110)

Body Systems
Pretest           36.6  (41)  100.0  (112)
Posttest          43.8  (49)  100.0  (112)

Nutrition
Pretest           45.5  (51)  100.0  (112)
Posttest          58.9  (66)  100.0  (112)

Safety
Pretest           41.1  (46)  100.0  (112)
Posttest          54.5  (61)  100.0  (112)

Consumer
Pretest           15.3  (17)  100.0  (112)
Posttest          31.3  (35)  100.0  (112)

Environmental
Pretest           24.3  (27)  100.0  (111)
Posttest          43.8  (49)  100.0  (112)

significantly (p < .001) higher ratings for ability to recall
all 10 content areas from pretest (X = 2.61) to posttest (X
Table 2. Pretest / Posttest Preferences for Teaching
Comprehensive School Health Content

Preferred Assignment       %    N   Total N  Mean

Nutrition
             Pretest     27.7%  31    112    3.36
             Posttest    30.6%  34    111    3.82

Drugs
             Pretest     20.5%  23    112    3.63
             Posttest    19.8%  22    111    3.88

Safety
             Pretest     14.3%   6    112    3.46
             Posttest    13.5%  15    111    3.54

Personal
             Pretest     8.9%   10    112    3.38
             Posttest    7.2%    8    111    3.62

Environment
             Pretest     3.6%    4    112    3.00
             Posttest    7.2%    8    111    3.56

Mental
             Pretest     9.8%   11    112    2.80
             Posttest    6.3%    7    111    3.40

Sexuality
             Pretest     8.0%    9    112    3.30
             Posttest    5.4%    6    111    3.50

Disease
             Pretest     0.9%    1    112    3.43
             Posttest    5.4%    6    111    3.50

Body System
             Pretest     4.5%    5    112    3.20
             Posttest    0.9%    1    111    3.00

Consumer
             Pretest     1.8%    2    112    2.92
             Posttest    0.9%    1    111    3.67

Preferred    Assignment   SD  N     Z     p

Nutrition
             Pretest     .67
             Posttest    .40  11  -2.99   *

Drugs
             Pretest     .52
             Posttest    .35  8   -1.42  N.S.

Safety
             Pretest     .66
             Posttest    .52  13  -0.48  N.S

Personal
             Pretest     .51
             Posttest    .51  13  -1.34  N.S.

Environment
             Pretest     .50
             Posttest    .73  9   -1.67   *

Mental
             Pretest     .63
             Posttest    .52  10  -2.45   **

Sexuality
             Pretest     .69
             Posttest    .64  10  -1.00  N.S.

Disease
             Pretest     .68
             Posttest    .64  14  -0.29  N.S.

Body System
             Pretest     .63
             Posttest    .67  10  -0.82  N.S.

Consumer
             Pretest     .67
             Posttest    .49  12  -2.07   *

* p < .05, ** p < .01
Table 3. One-Way Analysis of Variance: Major by Perceived
Confidence for Teaching Comprehensive School Health Education

                     Degrees of  Sum of   Mean
Source of Variance    Freedom    Squares  Squares   F        p

Major by Teaching
   Drug Education
   Between                 2       1.65     .82    3.03  ([dagger])
   Within                108      29.29     .27
   Total                1030        .94

Major by Teaching
   Body Systems
   Between                 2       2.50    1.25    3.59      *
   Within                108      37.61     .39
   Total                 110      40.10

Major by Teaching
   Safety Education
   Between                 2       2.30    1.15    3.71      *
   Within                108      33.49     .31
   Total                 110      35.75

([dagger]) Probability = .052

* Probability < .05
Table 4. One-Way Analysis of Variance: Perceived Confidence
for Teaching Comprehensive School Health Education

                           PRETEST                      POSTTEST
                                       Range
    Content         x     (n)   SD   ([dagger])   x     (n)   SD

Recall 10 Content  2.61  (111)  .66     3.00     2.95  (112)  .64
Teach l0 Content   2.85  (110)  .68     3.00     3.15  (112)  .62
Mental Health      3.04  (112)  .62     3.00     3.22  (112)  .63
Sexuality          3.15  (112)  .69     3.00     3.29  (112)  .64
Drugs              3.38  (112)  .63     3.00     3.59  (112)  .53
Disease            3.25  (110)  .68     3.00     3.34  (112)  .64
Personal Health    3.47  (110)  .57     3.00     3.48  (112)  .52
Body Systems       3.22  (112)  .68     3.00     3.38  (112)  .60
Nutrition          3.40  (112)  .59     3.00     3.57  (112)  .53
Safety             3.34  (112)  .61     3.00     3.51  (112)  .57
Consumer Health    2.92  (111)  .63     3.00     3.20  (112)  .63
Environmental
 Health            3.09  (111)  .63     3.00     3.38  (112)  .62

    Content        Range  df  Square    F      p

Recall 10 Content  3.00   3    3.02   8.22   ***
Teach l0 Content   3.00   3    2.62   6.55    **
Mental Health      3.00   2    1.65   4.55     *
Sexuality          3.00   2     .60   1.68  N.S.
Drugs              3.00   2    2.14   5.85     *
Disease            3.00   2     .79   1.72  N.S.
Personal Health    3.00   2     .71   2.24  N.S.
Body Systems       3.00   2    2.26   5.25    **
Nutrition          3.00   2    3.88  13.56   ***
Safety             3.00   2    1.58   4.50     *
Consumer Health    3.00   2     .41   1.02  N.S.
Environmental
 Health            3.00   3     .26   .65   N.S.

([dagger]) scores ranged from 1 = strongly disagree to
4 = strongly agree

* = p < .05,

** = p < .01,

*** = p < .001,

N.S. = Not Significant

REFERENCES

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American School Health Association (1993). Critical issue: Professional preparation and practice. American Journal of School Health 63(1), 54-57.

Boyer, E. L. (1998). Foreword. In: Marx E., Wolley S., Northrop D., (Eds.) Health is academic: A guide to coordinated school health programs (pp. xi - xv). New York: Teachers College Press.

Centers for Disease Control and Prevention (1991). School health programs: An investment in our nation's future. (http:/ /www.cdc.gov/nccdphp/dash/ataglanc.htm), 1-5.

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Joint Committee on National Health Education Standards (1995). National health education standards: Achieving health literacy. Collaborations among: the AAHE, the ASHA, the APHA, the Society of State Directors for Health, Physical Education, and Recreation, and the American Cancer Society, Inc.: Washington, D.C.

Lavin, A. T. (1993). Comprehensive school health education: Barriers and opportunities. Journal of School Health. 63 (1): 24-27.

Lohrman, D. K., & Wooley, S. F. (1998). Comprehensive school health education. In: Marx, E., Wolley, S., & Northrop, D., (Eds.) Health is academic: A guide to coordinated school health programs (pp. 43-66). New York: Teachers College Press.

McKenzie, F. D. & Richmond, J. B. (1998). Linking health and learning: An overview of coordinated school health programs. In: Marx E., Wolley, S., Northrop, D., (Eds.) Health is academic: A guide to coordinated school health programs (pp. 1-14). New York: Teachers College Press, 1-14.

Meeks, L., Heit, P., & Page, R. (1996). Comprehensive school health education. Blacklick, OH: Meeks Heit Publishing Company, 3-33.

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Ross, J. G., Luepker, R. V., Nelson, G. D., Saavedra, P., & Hubbard, B. M. (1991). Teenage health teaching modules: Impact of teacher training on implementation and student outcomes. Journal of School Health, 61(1), 31-34.

Torabi, M. R., Ellis, N., Al born, B., Wanz, M., Tappe, M., & Jeng, I. (1999). Evaluation of an innovative comprehensive school health education teacher training. Journal of Health Education. 30, (3), 173-179.

Ubbes, V. A., Cotrell, R. R., Ausherman, J. A., Black, J. M., Wilson, P., Gill, C., & Snider, J. (1999). Professional preparation of elementary teachers in Ohio: Status of K-6 health education. Journal of School Health, 69(1), 17-21.

Dolores W. Maney, Ph.D., is an Assistant Professor of Health Education in the Department of Kinesiology at Penn State Universtiy; 275-G Recreation Building; University Park, PA, 16802; [e-mail]. Helene L. Monthley, Ph.D., ATC is an instructor of Health Education and Joanna Garner, M. Phil. is a Doctoral Candidate at Penn State University. Address all correspondence to Dr. Maney.