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National Health Education Standards
By American Cancer Society
American Cancer SocietyCopyright © 2007 The American Cancer Society
All rights reserved.
Prelude to Excellence
No knowledge is more crucial than knowledge about health. Without it, no other life goal can be successfully achieved.
— Ernest Boyer, President, The Carnegie Foundation for the Advancement of Teaching (1979-1995)
Developing Standards for Educational Excellence
In the early 1990s, education leaders across the country agreed that schools needed new strategies, tools, and resources to support the highest levels of achievement by students in the United States. Following the lead of the National Education Goals (established in 1989 under President George H.W. Bush and a coalition of governors) and the "Goals 2000: Educate America" Act (established under President William J. Clinton), the U.S. Department of Education funded the creation of model standards in the arts, civics and government, economics, English, foreign languages, geography, history, and science.
In response, a coalition of health education organizations and professionals from across the country was convened in July 1993 to write the National Health Education Standards (NHES). First published in 1995, the NHES were designed to support schools in meeting the essential goal of helping students acquire the knowledge and skills to promote personal, family, and community health.
A decade later, most states and many districts around the country had either adopted or adapted the NHES. Recognizing the critical role of schools in combating our nation's health problems while simultaneously acknowledging research-based advances related to effective practice in the field, a new panel of organizations and professionals was convened in 2004 to review and revise the NHES for use in American schools.
The revised NHES provide a framework for aligning curriculum, instruction, and assessment practices for the following groups, all of which play crucial roles in health instruction:
State and local education agencies
Parents and families
Community agencies, businesses, organizations, and institutions
Health education curriculum developers and publishers
Institutions of higher education
Local and national organizations
Teachers, administrators, and policy makers can use the NHES as a framework for designing or selecting curricula, for allocating instructional resources, and for providing a basis for the assessment of student achievement and progress. The NHES also provide students, families, and communities with concrete expectations for health education. Although the standards identify what knowledge and skills students should have and be able to achieve, they leave precisely how this is to be accomplished to teachers and other local specialists who formulate, deliver, and evaluate curricula.
The revision of the NHES makes a number of important contributions to the potential for delivery of improved health education programs across the country, including increased focus on education and behavior theory, inclusion of pre-K grades, emphasis on assessment, and an expanded call for collaboration and partnerships.
Implementation of the revised NHES with a commitment to providing qualified teachers, adequate instructional time, and increased linkages to other school curricular areas significantly increases the likelihood that schools will provide high-quality health instruction to all young people.
Health Education as a Component of Coordinated School Health Programs
Health education is not the only school-based approach used to support students in attaining positive health outcomes. Health education is an essential component of a Coordinated School Health Program (CSHP) (Fig. 1.1), a planned, sequential, and integrated set of courses, services, policies, and interventions designed to meet the health and safety needs of students in kindergarten through grade 12. One widely recognized model for CSHP consists of eight interactive components, each of which plays a vital role in supporting the health of students, school staff, and the community. In addition to health education, these components include physical education; health services; counseling, psychological, and social services; nutrition services; a healthy school environment; parent, family, and community involvement; and health promotion for school staff. The effectiveness of school health education is enhanced when it is implemented as part of a larger school health program and when health education outcomes are reinforced by the other components.
The NHES can be used to support the effective implementation of health education as one of the eight components of a CSHP. They are carefully designed to support schools, educators, families, and other stakeholders in helping students meet the primary goal of health education: for students to adopt and maintain healthy behaviors.
Adopting and Maintaining Healthy Behaviors: The Goal of Health Education
To help students adopt and maintain healthy behaviors, health education should contribute directly to a student's ability to successfully practice behaviors that protect and promote health and avoid or reduce health risks.
The educator's role in contributing to this goal includes the following:
Teaching functional health information (essential concepts)
Helping students determine personal values that support healthy behaviors
Helping students develop group norms that value a healthy lifestyle
Helping students develop the essential skills necessary to adopt, practice, and maintain health-enhancing behaviors
The NHES describe the knowledge and skills that are essential to the achievement of these factors. "Knowledge" includes the most important and enduring health education ideas and concepts. Essential "skills" encompass analysis and communication that lead to the practice and adoption of health-enhancing behaviors.
If the goal of health education is for students to adopt and maintain healthy behaviors, it is important that health educators have information about the behavioral outcomes on which to focus. While the NHES do not focus on specific behaviors, they provide a framework within which educators and curriculum specialists can focus on healthy behavior outcomes that are particular to the needs of their students.
In the development of the 1995 NHES, health literacy was accepted as the primary outcome of a comprehensive K — 12 health education program. The Joint Committee on Health Education Terminology (1990) defined "health literacy" as "the capacity of an individual to obtain, interpret, and understand basic health information and services, and the competence to use such information and services in ways which are health enhancing." A strong relationship continues to exist between goals of health literacy and school health education. The development of health literacy is presently considered to be essential for students to adopt and maintain healthy behaviors. A 2004 report by the Institute of Medicine on Health Literacy states that "the most effective means to improve health literacy is to ensure that education about health is part of the curriculum at all levels of education."
The Scope of the National Health Education Standards: Parameters and Underlying Assumptions
In light of the role of health education as but one part of a student's learning during the school day, the development and revision of standards require maintenance of a clear, precise scope and focus. Before revising the NHES and accompanying performance indicators, the NHES Review and Revision Panel established parameters for its development and implementation. Specifically, the Panel determined that the revised NHES and performance indicators should accomplish the following:
Provide a framework for curriculum development, instruction, and student assessment
Reflect the research-based characteristics of effective health education
Be informed by relevant health behavior theories and models
Focus on personal health within the context of families, schools, and communities
Focus on emotional, intellectual, physical, and social dimensions of health
Focus on functional health knowledge and essential personal and social skills that contribute directly to healthy behaviors
Focus on health promotion as well as avoidance and reduction of health risks
Consider the developmental appropriateness of material for students in specific grade spans
Include a progression of higher-order thinking skills
Allow for the integration of health content as appropriate
Similarly, to establish consistency throughout the NHES document, the NHES Review and Revision Panel operated under the following set of assumptions, drawn from current theory and research in the field:
1. Academic achievement and the health status of students are interrelated.
2. All students, regardless of physical or intellectual ability, deserve the opportunity to achieve personal wellness.
3. Through the achievement of the NHES, students will adopt, practice, and maintain health-enhancing behaviors.
4. Instruction by qualified health education teachers is essential for student achievement of the NHES.
5. Sufficient instructional time is needed to influence the health behaviors of students through health instruction.
6. Health education emphasizes the teaching of functional health information and essential skills necessary to adopt, practice, and maintain health-enhancing behaviors.
7. Students need opportunities to engage in cooperative and active learning strategies, including practice and reinforcement of skills.
8. Health education encourages the use of technology to access multiple valid sources of health information.
9. Local curriculum planners should develop curricula based upon local health needs.
10. Students need multiple opportunities and a variety of assessment strategies to determine their achievement of the health standards and performance indicators.
11. Improvements in public health can contribute to a reduction in health care costs.
12. Effective health education can contribute to the establishment of a healthy and productive citizenry.
A Closer Look at the Standards Document
The NHES document displays each standard (and its supporting information) as follows:
1. The standard
2. A rationale statement
3. Performance indicators (organized by grade span)
Knowledge of core health concepts and underlying principles of health promotion and disease prevention are included in Standard 1. Standards 2 to 8 identify key processes and skills that are applicable to healthy living. These include identifying the impact of family, peers, culture, media, and technology on health behaviors; knowing how to access valid health information; using interpersonal communication, decision-making, goalsetting, and advocacy skills; and enacting personal health-enhancing practices (Table 1.1).
A rationale statement is provided for each standard. The rationale illustrates the importance of each standard and is intended to provide additional clarity, direction, and understanding.
Performance indicators are provided for each of the NHES, delineated by the following grade spans: pre-K to grade 2, grades 3 to 5, grades 6 to 8, and grades 9 to 12. Each performance indicator is introduced by this stem: "As a result of health instruction in [grade range], students will be able to ..." The performance indicators are meant to be achieved by the end of the grade span in which they are identified.
Because learning best occurs when students perform at all levels of the cognitive domain, the performance indicators encompass application, analysis, synthesis, and evaluation, as well as knowledge and comprehension. Even primary grade students can learn at the higher levels of the cognitive domain if the concepts and learning activities are developmentally appropriate.
Performance indicators are also intended to serve as a blueprint for organizing student assessment. Student achievement of all performance indicators specified for each standard supports the successful attainment of that standard, ultimately increasing the likelihood that students will adopt and maintain healthy behaviors.
Building Curriculum: Integrating Health Content into the Standards and Performance Indicators
Historically, health education curricula were often organized around health content or topic areas. More recently, many health education curricula reflect the six priority adolescent risk behaviors identified by the U.S. Centers for Disease Control and Prevention. The object of the NHES is to provide a framework from which curricula can be developed, allowing for the inclusion of health content and concepts that are appropriate for local needs. This approach allows the NHES to remain relevant over time, and it enables state and local education agencies to determine the curriculum content that best addresses the state and local health needs of students.
Table 1.2 shows the relationship between the NHES and health content areas and risk behaviors. The standards are designed to encompass a wide range of content areas as well as promote healthy behaviors and decrease risky behaviors.
Many state education agencies will interpret the standards and provide further direction to local education agencies to assist them with development of specific curricula that meet national and state standards. In recognition of this process, the NHES do not address specific health education content areas; instead, they provide a framework from which curricula can be developed, allowing for the inclusion of health content appropriate to local needs. The selection of specific health content is left to state and local education agencies.
Table 1.3 shows how specific health content can be matched to selected performance indicators across the grade spans.
Characteristics of Effective Health Education Curricula
One of the key parameters of the NHES revision requires that the standards and performance indicators be based in research that identifies those characteristics of curricula that most positively influence students' health practices and behaviors. The Centers for Disease Control and Prevention, Division of Adolescent and School Health (CDC-DASH), has examined a synthesis of professional literature to determine the common characteristics of effective health education curricula. Reviews by CDC-DASH of effective programs and curricula, along with input from experts in the field of health education, have identified the following characteristics of effective health education curricula (many of which are reflected in the revised standards and performance indicators).
An effective health education curriculum achieves the following:
Focuses on specific behavioral outcomes
Curricula have a clear set of behavioral outcomes. Instructional strategies and learning experiences focus exclusively on these outcomes.
Is research-based and theory-driven
Instructional strategies and learning experiences build on theoretical approaches, such as social cognitive theory and social inoculation theory, that have effectively influenced health-related behaviors among youth. The most promising curricula go beyond the cognitive level and address the social influences, attitudes, values, norms, and skills that influence specific health-related behaviors.
Addresses individual values and group norms that support health-enhancing behaviors
Instructional strategies and learning experiences help students accurately assess the level of risk-taking behavior among their peers (e.g., how many of their peers use illegal drugs), correct misperceptions of peer and social norms, and reinforce health-enhancing attitudes and beliefs.
Focuses on increasing the personal perception of risk and harmfulness of engaging in specific health risk behaviors, as well as reinforcing protective factors
Curricula provide opportunities for students to assess their actual vulnerability to health risk behaviors, health problems, and exposure to unhealthy situations. Curricula also provide opportunities for students to affirm health-promoting beliefs, intentions, and behaviors.
Addresses social pressures and influences
Curricula provide opportunities for students to deal with relevant personal and social pressures that influence risky behaviors, such as the influence of the media, peer pressure, and social barriers.
Builds personal and social competence
Curricula build essential skills, including communication, refusal, assessing accuracy of information, decision making, planning, goal setting, and self-management, that enable students to build personal confidence and ability to deal with social pressures and avoid or reduce risk-taking behaviors. For each skill, students are guided through a series of developmental steps:
1. Discussing the importance of the skill, its relevance, and its relationship to other learned skills
2. Presenting steps for developing the skill
3. Modeling the skill
4. Practicing and rehearsing the skill by using real-life scenarios
5. Providing feedback and reinforcement
Provides functional health knowledge that is basic, accurate, and directly contributes to health-promoting decisions and behaviors
Curricula provide accurate, reliable, and credible information for a usable purpose: so students can assess risk, correct misperceptions about social norms, identify ways to avoid or minimize risky situations, examine internal and external influences, make behaviorally relevant decisions, and build personal and social competence. A curriculum that relies exclusively or primarily on disseminating information for the sole purpose of improving knowledge is inadequate and incomplete.
Excerpted from National Health Education Standards by American Cancer Society. Copyright © 2007 The American Cancer Society. Excerpted by permission of American Cancer Society.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Table of Contents
ContentsPreface A Vision of Excellence,
Introduction Prelude to Excellence,
The Standards The Foundation of Excellence,
Acesss and Equity Principles Opportunities for Achieving Excellence,
Assessment Measuring Excellence,
Background on Standard Development A Background for Excellence,