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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 14 characteristics for effective health education curricula that positively influence students’ health practices and behaviors. This week we will examine those characteristics of effective health education curricula.

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This has been a huge change in my thinking and this can really informed and guided my teaching. If we believe that our health education curriculum should change behavior than we need to start with the specific behaviors that we want to change. If you think backwards design the ultimate standards or goal is to either reduce or prevent specific behaviors or improve others. For example, if we look at a curriculum on nutrition education are the lessons focused on increasing fruits and vegetable consumption or decreasing foods with little or no nutritional value or does the curriculum just teaching about the food plate? When I was teaching I spent a lot of time on activities that were fun and engaging for students but they really had little focus on any specific behavior. Only teaching about the food plate for example, I’m not saying that you should not teach about the food plate but I am encouraging you to think specifically about the behaviors you are trying to change or maintain. After the basics of the food pyramid focusing on building skills to advocate or communicate the need for more fruits and vegetables or setting goals around healthy eating behaviors might have been a better us of my time. If you are looking at tobacco prevention what are the specific behaviors that you are trying to prevent, for some students it would be for them to quit smoking but for most it would be prevent them from starting or to at least delay onset of use.

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Is the curriculum research based or theory driven? Can you clearly identify the theory that drives the curriculum. Can you link your lessons and activities back to a behavior theory such Health Behavior Model or at least a set of key constructs from Behavior Theory does it focus on changing attitudes about perceived risks and rewards, does it focus on the perceived social norms? Last semester you had the opportunity to examine these behavior change theories and begin to examine how they can help inform curriculum and teaching. Research based in another factor to consider, the gold standard is random control trials (RCT) studies with replication. There are a number of websites that have attempted to identify research based curricula, for example www.findyouthinfo.gov, and the blueprints for violence prevention http://www.colorado.edu/cspv/blueprints/ are two organizations that have identified research based programs for example Life Skills Training, Project Alert, Towards No Tobacco, and Towards No Drug Abuse are all research based curriculum that are supported by extensive research. Other comprehensive curricula such as The Great Body Shop and Health Smart have been shown to change behavior in random control trials, however replication has not been shown in additional studies.

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Does the curriculum address the individual values that are important to students, does it allow students to examine what they value? I’m working with several teachers who are teaching the Life Skills Training Curriculum, one teacher has addressed this characteristics by working with students to examine what they value about their families and friends. What do you value in a friend, and in a relationship this sparked some great discussion about what students really value. This discussion lead into an activity that allowed student to practice how they communicate with their friends and family. This communication is linked back to what students value in a relationship. Also think about how you can shift from negative to positive social norms, what positive social norms can be supported in your teaching? Are group and social norms addressed. What do most middle school students think about tobacco use at the middle and high school. Students consistently estimate that 30 – 40% of students smoke in high school. In reality it’s closer to 17%. Changing examining the mis-perceptions of norms and examining the positive social norms should be encouraged.

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This goes back to behavior theory. Think about students some students will perceive this as a risky bet but other will bet the house and everything on this hand. What are the risk associated with betting on this hand? Youth in general are risk takers who feel invincible, they are not really influenced by the long-term risks. For this reason it is important to examine the immediate risks to a given behavior both positive or negative. We need to work to address the risks of injury or drug use and provide statistics that provide a clear, realistic message regarding the risks of drug use. For example the number of youth in Colorado that use Meth is very small but the potential dangers of addiction is very high. Telling students that they will die if they use drugs doesn’t cut it. Especially for those students who have parents, peers, siblings that use drugs. When you talk to kids about tobacco there will always be that one student who says yea but I have a grand mother who is 80 and has smoked since she was 16. Their perception of risk to tobacco use may be very different for this student. One alarming statistic that we need to watch is the perception of risks around marijuana use, 52% of high school seniors thought that marijuana had a great risk of harm if smoked regularly, this is down from 58% in 2006. Marijuana use has increased compared to 2005 data from 22.7% to 24.8%. Looking at this trend as a health educator changing the social norms that we talked about in the previous slide and linking the potential risks, as well as educating youth on the intent of medical marijuana laws will be important. In general we want to realistically portray the risk and harmfulness of specific behaviors and give students opportunities to assess their individual vulnerability. Thinking more broadly about the social determinants of health the effects of SES, and race and ethnicity on the risks of disease is key information to share with student to give them an accurate picture of their individual or personal risk.

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Here we are talking not only about peer pressure but the influences from the media, and social pressures and barriers. Students analyze the influence the factors that influence healthy and unhealthy behaviors, how do families, peers, culture, media and technology influence behaviors. Tobacco print ads is a great place to start but tobacco advertisements are now banned thanks to public health policies. Today examining how tobacco is portrayed in movies on TV, and online should be examined. Also consider how students are influenced by social media. The New Mexico Media http://www.nmmlp.org/ literacy project is doing some wonderful work on analyzing the media. What are the cultural factors influence the foods that we eat, and how are those engrained into the fabric of the community and pressure to conform?

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Addressing skills is a key to changing behavior. Think about developing a skill like hitting a baseball. You don’t start with a 90 mile and hour fast ball off the mound. You start with presenting the skill of hitting by breaking it down into steps, then practicing swinging without a ball. Then adding a T, soft toss, to soft pitch then off a mound. Then you get to a point where you can bat in a specific situation 2 outs 3 balls and 1 strike with a runner on second. Well in health you need to think in the same terms when you talk about teaching a skill like communication skills. Talking about the importance of learning the skill. Present steps to the skill Model the skill Practice and rehearse the skill using real life scenarios Provide feedback and reinforcement Personal, social competency and students feeling like they can be effective in using the skills is important to examine in the curriculum. This semester we will be developing this idea of skills development.

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4,800 chemicals are found in tobacco smoke. What is the functional knowledge that students need to take away in terms of this knowledge. How many chemicals do students need to really know? Does the curriculum provide accurate, reliable, and credible information for students. Is the information that is provided relevant to your students, and can they use it to help them make decisions and change behaviors. I taught way too much knowledge. Make the knowledge essential what are the big ideas that students need to know to make good decisions and move onto decision making and communication. Think about how the facts you are teaching directly relate to changing a behavior or a skill.

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These 3 characteristics are grouped together on this slide. We will be spending a lot of this semester talking about what these practices are. One of the main focuses of this class is to develop an understanding of what a culturally responsive classrooms and curriculum

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Short term one shot events are not going to change behavior. The effectiveness and quality of health education programs have been linked to adequate instructional time devoted to health education in the classroom. The Joint Committee on National Health Education Standards recommends that students in Pre-K to grade 2 receive a minimum of 40 hours and students in grades 3 to 12 receive a minimum of 80 hours of instruction in health education per academic year. It takes time to build skills in health education. In order to see behavior change repeated practice of skills is needed and this takes time.

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Skills should be taught across a number of topic areas. For example the basic skill of accessing information can be taught in a nutrition unit then reinforced in a tobacco prevention unit, or substance use and abuse unit. As a health educator the reality is that you do not have the time to teach all the skills needed in every topic area every year. For that reason having a clear scope and sequence that supports re-enforcement of the skills across topic areas is important. It is also important to continue to reframe health education by reinforcing positive behaviors that many students are engaged in.

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This may be difficult to do in a classroom but providing opportunities for students to think about and connect with positive role models and influential people in the community. A recent study findings show that those from a higher income family were more likely to have a role model than those from a lower income family but overall 59% reported that they had a role model. The type of role model was significantly associated with health related behaviors; those who identified a teacher as their role model were more likely to show positive health related behaviors where as those who identified a peer or an entertainer role model were more likely to show health-risk behaviors. Yancey, A.; Grant D.; Kurosky, S.; Kravitz-Wirtz, N.; Mistry, E. (2011) Role modeling, risk, and resilience in California adolescents Journal of Adolescent Health (48), 1, 36-43

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Specific professional development that supports effective curriculum and supports the specific needs of health educators is key. Often school trainings are geared towards general professional development for teachers as opposed to the specific needs of health educators looking to change behaviors. This is an area that needs to be addressed RMC is trying to provide this type of training.

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