Health Education

This article discusses health education in U.S. public schools. American health education aims to promote social, physical, intellectual, spiritual, environmental, and emotional wellness in its students. However, health education has increasingly become the responsibility of physical education teachers, either as a singular course (secondary education) or integrated into the elementary physical education curriculum. The coordinated school health programs model integrates the health education concepts into all aspects of a student's education. Not all teachers work in a school or district that utilizes the coordinated health program model and this presents challenges to teachers in how to integrate a health education curriculum that meets the National Standards for Health Education into the physical education curriculum without compromising a teacher who is aiming to meet the National Standards for Physical Education in his/her curriculum. It is suggested that teachers attend professional development opportunities to broaden their knowledge and develop ideas to creatively and effectively meeting these goals.

Keywords Health Education; Healthy Lifestyles; Lifestyle Choices; Physical Activity; Physical Education; Wellness; Dimensions of Wellness

Overview

Many Americans think of health simply as the absence of disease, but health education focuses on more of a wellness approach to educating students about a variety of health-related topics that are encompassed in the six dimensions of wellness The “dimensions of wellness are physical wellness, emotional wellness, intellectual wellness, spiritual wellness, interpersonal and social wellness, and environmental (or planetary or occupational) wellness” (Insel & Roth, 2006). These dimensions include the following health-related topics: mental and emotional health, personal health, prevention and control of disease, injury prevention, intimate relationships, consumer health, environmental health, family life, substance use and abuse, and community health. With these dimensions of wellness in mind, health or wellness can then be defined as the "ability to live life fully-with vitality and meaning" (Insel & Roth, 2006, p. 1). Health education is important because people need to understand how controllable factors can affect their health. For example, heart disease is the number one cause of death for both men and women in the United States and obesity is on the rise (CDC, 2007). In 2010, according to the Centers for Disease Control and Prevention, the adult obesity rate in the United States was over 35 percent; the percentage of adults who are overweight (which includes obesity) was over 69 percent. Also in 2010 over 18 percent of both children from the ages of six to eleven and adolescents from twelve to nineteen were obese. The threat of these diseases can be reduced by engaging in and making healthy lifestyle choices. The alarming rate in increase of overweight and obese children and adults is of major concern due to the multiple diseases and conditions that these individuals become more susceptible to, for example heart disease, hypertension, sleep apnea, stroke, Type 2 diabetes, some cancers, and osteoarthritis (CDC, 2007). With deaths attributed to these and other diseases, health education provides a venue for discussing and educating students about how to prevent, recognize symptoms, and understand treatment of these and other diseases. Health education provides students with the tools to make personal decisions about how to live their lives (Insel & Roth, 2006).

In general, health behaviors are learned during childhood (Cox, Mazzacco & Herauf, 2003). This is a critical time for children to learn positive health behaviors, including those that will decrease the risk of premature death and disabling disease (Cox, Mazzacco & Herauf, 2003). By incorporating health education into formal education early on, students begin to learn about healthy behaviors and choices while they are forming their own personal health habits. Generally, health is taught as a separate class at the middle school and high school level; however, physical education teachers, particularly at the elementary level, have become increasingly responsible for incorporating health education concepts into their physical education curriculum (Beighle, 2004). Nevertheless in districts with budgetary challenges, physical educators may be required to teach health education as a separate class in the secondary school setting (Larson, 2003).

Physical education teachers may or may not have been formally trained as health educators, which poses a challenge for these teachers in feeling competent to teach some of the health topics, particularly those not closely related to their academic training in physical education. Larson (2003) conducted research to examine physical education teachers' perceived readiness to teach K-12 health. Of the 229 physical education teachers that responded to the online survey, 78 teachers were also teaching health but only nine of these teachers had been formally trained in health education. Results of the study indicated that the respondents were confident teaching some of the topics required in health education including safety education, exercise, tobacco use, personal safety and nutrition, yet felt least prepared to teach death education, cancer, relationships, behavior change, stress management, consumer health, and sexual orientation (Larson, 2003). The results of this study support the notion that during professional preparation and/or professional development activities health education should be included in some capacity. Despite these challenges, school physical education programs provide a unique opportunity to influence health and well-being as well as to promote physical activity, teach skills, and form or change behaviors especially at the elementary level (Lambert, 2000).

In an effort to address health-related problems with American youth, the United States Department of Education put forward the concept of a Coordinated School Health Program (CSHP) in the 1980's (Johnson & Deshpande, 2000). The Department of Education recognized physical education and health education as the two essential components of the CSHP. When it was proposed in the 1980's, the focus was on providing students with knowledge, skills, and fun as compared to current goals of the CSHP, which now focus on the development of the health and wellness of the whole person (Johnson & Deshpande, 2000). Despite the legislation and programs that promote and teach health education and physical activity, research has provided evidence that participation in these educational programs do not necessarily protect youth from the risks that occur as a result of a sedentary lifestyle (Johnson & Deshpande, 2000), yet McKenzie and Richmond (1998) found that coordinated school health programs may help to reduce absenteeism, reduce classroom behavior problems, reduce the number of students and staff who smoke, reduce the rate of teen pregnancy, and improve academic performance, interest in healthy diets, and increased participation in physical activity. This evidence suggests that there needs to be a concerted effort on the part of the U.S. government, the U.S. Department of Education, state departments of education, and local school districts to provide students with physical education and health education curricula that are comprehensive and well-rounded (Johnson & Deshpande, 2000).

The American Association for Health Education (AAHE) is part of the American Association of Health, Physical Education, Recreation and Dance (AAHPERD) and has set forth eight National Standards for Health Education. These standards include the following; students will demonstrate the ability to:

1. Comprehend concepts related to health promotion and disease prevention to enhance health;
2. Analyze the influence of family, peers, culture, media, technology, and other factors on health behaviors;
3. Access valid information and products and services to enhance health;
4. Use interpersonal communication skills to avoid or reduce health risks;
5. Use decision-making skills to enhance health;
6. Use goal-setting skills to enhance health;
7. Practice health-enhancing behaviors and avoid or reduce health risks; and
8. Advocate for personal, family, and community health (AAHE, 2007).

Physical education classes provide a setting for teachers to incorporate content related to meeting the above standards alongside the National Standards for Physical Education. In schools where there is a coordinated school health program, the integration of health education into the physical education setting presents less of a challenge to the teacher because the students are learning the health concepts in all aspects of their education. In schools where the coordinated school health program model is not being used, designing a physical education curriculum that incorporates health education without compromising the physical activity related curriculum is the challenge (Beighle, 2004). Professional development opportunities are an important part of teachers' continued education as these workshops, lectures, seminars, and conferences provide a forum for educating and sharing ideas about what teaching methods are successful and what methods are not.

Applications

How health education is successfully incorporated into the physical education class without compromising the physical education curriculum? This question is one that presents a challenge to physical education teachers in designing curriculum because, in essence, they are required to incorporate the National Standards for Health Education and the National Standards for Physical Education into one class curriculum (one standard that is physical activity based, one that is not). As mentioned earlier, there are several content areas of health education that are directly linked with physical education, such as exercise and injury prevention; however, there are several topics of health education that are not explicitly related to physical education (e.g., intimate relationships, substance abuse). Teachers need to be creative in order to effectively integrate the health education with their physical education curriculum. The following are some selected examples of how physical education teachers have incorporated health education concepts into the physical education classroom.

One example was presented by Edwards & Bibik (2000); HIV/AIDS affects children, and the Center for Disease Control reported that 7,902 children under the age of 13 had been diagnosed with HIV. Therefore, it is important to introduce HIV/AIDS education at the elementary level. This practice is not uncommon as this serves as a means to controlling the spread of HIV (Edwards & Bibik, 2000). Physical education teachers' lack of knowledge or discomfort with teaching this subject may cause them to avoid the topic altogether because they lack the tools and information to teach the topic in a comfortable and non-intimidating manner. Edwards and Bibik suggested how to incorporate teaching students about HIV/AIDS empathy through the process of storytelling and movement concepts. The method includes three of the National Standards for Health Education (concept comprehension, ability to access health information, and use of interpersonal communication skills to enhance health) and four of the National Standards for Physical Education (development of motor skills, responsible personal and social behavior in physical activity, respect for differences, and the opportunity to enjoy physical activity).

Edwards & Bibik (2000) identify the lesson focus as "students will participate in an activity designed to enhance their effective expression of emotion" (p. 24). The objectives include:

1. Students will participate in an interpretive movement storytelling activity, 'Z's Gift,' to assist them in understanding the importance of labeling feelings,
2. Students will discuss healthy, responsible responses to emotions, and
3. Students will discuss the importance of being kind to someone that is ill" (p.24).

The authors recommend that the physical education teacher choose a book that includes information that he/she is interested in sharing with the class. Edwards and Bibik (2000) chose Z's Gift, by Neal Starkman, which is the story of a fourth grade class that finds out their teacher has HIV and describes the emotions the students experience upon learning about their teacher's health. Within a school that uses the coordinated school health program, the physical education teacher may ask the art or classroom to teacher to have students draw "feeling faces" that can be glued onto a tongue depressor and depict the emotions sad, happy, frightened, and angry. Students would then bring the "feeling faces" with them to class and during warm-up stretching, while students are somewhat stationary, teachers can begin by discussing what the word 'feeling' means and discuss healthy ways in which to react to thoughts that may cause the students to act in different ways (Edwards & Bibek, 2000). The teacher may then ask the students to identify when certain emotions and how their face may look if they were feeling that way. Teachers should prompt students to be comfortable with and know that it is acceptable to feel a certain way (Edwards & Bibik, 2000, p. 25).

Teachers are encouraged to then play music during the aerobic portion of the warm-up that evokes a spectrum of feelings while asking the students to move in a manner that illustrates how they feel. Teachers may use music to accompany the story and to facilitate the students' movement. Once the teacher has begun to read the story, students can be prompted to show the appropriate "feeling face" when prompted by the story. After the story, the teacher may use the cool-down period as a time of reflection by prompting students to discuss questions related to the overall lesson. This example of a class lesson illustrates how physical education teachers may incorporate health education topics into the classroom setting without compromising the opportunity to teach or have students engage in movement concepts. This lesson was very focused on another concept in health education, mental health, while maintaining a level of physical activity.

Another example of how to effectively integrate health education into physical education is an exercise addressing and reinforcing nutrition concepts in class. Beighle (2004) offered suggestions and strategies to teachers on how to incorporate lessons on healthy lifestyles. One of Beighle's (2004) activities, entitled Borrow a Meal, focuses on reviewing the food pyramid and how to maintain a balanced diet. Beighle's (2004) games include four of the National Standards for Health Education (concept comprehension, decision-making, ability to access health information, and use of interpersonal communication skills to enhance health) and three of the National Standards for Physical Education (development of motor skills, responsible personal and social behavior in physical activity, and the opportunity to enjoy physical activity).

Teachers use plastic food or cards with foods drawn on or pasted on them and hula hoops. The teacher should place the hula hoops with 10 pieces of food inside the hoop around the perimeter of the area in which the activity will take place. There are four games to play with this lesson. Each game should be played for one minute to keep students very active during this time, but also so that students do not "get away" from the purpose and organization of the game. During the first game, the teacher should instruct the students to move quickly to borrow as much "food" as they can get from other groups' hoops, or "plates." Students should be instructed to only take one piece of food at a time and to set the food in their hoop, not throw. The next game requires that the students borrow food from only one food group, but taking one of their foods and exchanging it for a food from the specified group. Following game two, the groups will be asked to create a well-balanced meal on their "plate." Students are asked to again trade food with other groups while applying their knowledge of what makes up a balanced meal. The final game is the opposite of game three as students are then asked to create an unhealthy meal and must trade food again from other groups to create their meal. This series of games assesses and reinforces the students' knowledge of the food pyramid as well as how to make healthy choices about the foods they consume while still including vigorous physical activity in short bursts (Beighle, 2004).

Physical education teachers, most often at the elementary school level, are often required to incorporate health education into their physical education curriculum. This may be due to the school having a Coordinated School Health Program where health concepts are taught across all subjects or because the school district has had to make budget cuts or changes in classroom curriculum that require the physical education teacher to be responsible for this content. Regardless of the reason, physical educators are faced with the challenge to learn, understand, and teach the health content, while at the same time maintaining the integrity of their physical education curriculum. The National Standards for Health Education are set forth as a guideline for health teachers and as the two examples described above illustrate, they can be effectively integrated with the National Standards for Physical Education.

Terms & Concepts

Consumer Health: The area of health education that focuses on individuals learning how to manage their personal health care by self-assessing symptoms, determining when and when not to see a physician, how to choose a physician, how to choose between conventional medicine and other alternatives, understanding, and choosing, and paying for health care/insurance plans.

Coordinated School Health Programs: “Coordinated school health programs are designed to allow schools to work with students, their families, and their community to provide health strategies, activities, and services in a coordinated, planned way” (AAHE, 2007).

Dimensions of Wellness: Six interrelated and dynamic dimensions that are related to an individual's health (Insel & Roth, 2006).

Emotional Wellness: One of the six dynamic dimensions of wellness that includes optimism, trust, self-esteem, self-acceptance, self-confidence, self-control, relationships, and ability to share feelings, which is maintained by learning to monitor and explore personal thoughts and feelings to overcome emotional obstacles (Insel & Roth, 2006).

Environmental or Planetary Wellness: One of the six dimensions of wellness that relates how the health of the planet and society impacts personal health (e.g., ultraviolet radiation from the sun, water pollution, violence). Wellness is maintained by learning how to protect oneself from hazards in our environment (Insel & Roth, 2006).

Health Education: Education that focuses on teaching strategies, activities, content that assists students' in understanding their physical, emotional, and social development.

Healthy Lifestyle Choices: Choices that an individual makes based on their knowledge and understanding of how to live a healthy lifestyle.

Intellectual Wellness: One of the six dynamic dimensions of wellness that includes being open to new ideas, ability and capacity to think critically, challenge oneself to learn, creativity, sense of humor, and curiosity. Intellectual wellness allows individuals to learn, evaluate, and store information that is related to health so that the mind may detect problems and influence or direct behavior (Insel & Roth, 2006).

Interpersonal and Social Wellness: One of the six dimensions of wellness that includes learning how to communicate effectively, develop a social network of support, and develop the capacity for intimacy (Insel & Roth, 2006).

National Standards for Health Education: content standards for physical education curricula set forth by the American Association of Health Education (AAHE).

Physical Wellness: One of the six dynamic dimensions of wellness that includes "eating well, exercising, avoiding harmful habits, making responsible decisions about sex, learning about and recognizing the symptoms of disease, getting regular medical and dental checkups, and taking steps to prevent injuries" (Insel & Roth, 2006, p. 1).

Spiritual Wellness: One of the six dynamic dimensions of wellness that includes possessing a set of "guiding beliefs, principles, or values that give meaning and purpose to your life especially during difficult times….involves the capacity for love, compassion, forgiveness, altruism, joy, and fulfillment" (Insel & Roth, 2006, p. 2).

Wellness: "Ability to live life fully-with vitality and meaning" (Insel & Roth, 2006, p. 1).

Bibliography

American Association for Health Education. (2007). National Standards for Health Education. American Alliance for Health, Physical Education, Recreation, and Dance. Retrieved April 25, 2007, from http://www.aahperd.org/aahe/pdf_files/standards.pdf

American Association of Health Education. (2007). Position statement on coordinated school health programs. American Alliance for Health, Physical Education, Recreation, and Dance. Retrieved April 25, 2007, from http://www.aahperd.org/aahe/template.cfm?template=interest.html

Beighle, A. (2004, Nov.). Teaching healthy lifestyles with low organized games. Teaching Elementary Physical Education, 23-25. Retrieved April 21, 2007 from EBSCO online database SPORTDiscuss with Full Text. http://search.ebscohost.com/login.aspx?direct=true&db=s3h&AN=15107366&site=ehost-live

Centers for Disease Control and Prevention. (2007). Overweight and obesity. Retrieved April 25, 2007, from http://www.cdc.gov/nccdphp/dnpa/obesity/

Corngold, J. (2013). Introduction: The Ethics of Sex Education. Educational Theory, 63, 439–442. Retrieved December 17, 2013 from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=86929591

Cox, C. C., Mazzacco, S., & Herauf, J. (2003, Sept.). School health advocacy in Missouri. Journal of School Health, 73 , 252. Retrieved April 21, 2007 from EBSCO online database SPORTDiscuss with Full Text.

Edwards, K. F. & Bibik, J. M. (2000, Sept.). Teaching HIV/AIDS empathy through storytelling and movement. Teaching Elementary Physical Education, 11 24-26. Retrieved April 21, 2007 from EBSCO online database SPORTDiscuss with Full Text.

Erwin, H., Beets, M. W., Centeio, E., & Morrow, J. R. (2014). Best Practices and Recommendations for Increasing Physical Activity in Youth. JOPERD: The Journal Of Physical Education, Recreation & Dance, 85, 27-34. Retrieved October 27, 2014, from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=97627002

Fielding, J. E. (2013). Health Education 2.0: The Next Generation of Health Education Practice. Health Education & Behavior, 40, 513–519. Retrieved December 17, 2013 from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=90310670

Insel, P. M. & Roth, W. T. (2006). Core Concepts in Health Brief (10th Ed.). New York: McGraw-Hill.

Johnson, J. & Deshpande, C. (2000, Feb.). Health education and physical education: Disciplines preparing students as productive, healthy citizens for the challenges of the 21st century. Journal of School Health, 70 , 66-68. Retrieved April 21, 2007 from EBSCO online database SPORTDiscuss with Full Text.

Lamb, S. (2013). Just the Facts? The Separation of Sex Education from Moral Education. Educational Theory, 63, 443–460. Retrieved December 17, 2013 from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=91280792

Lambert, L. T. (2000, Mar.). The new physical education. Educational Leadership, 57. Alexandria, Va.: Association for Supervision and Curriculum Development. Retrieved April 24, 2007, from http://www.nea.org/teachexperience/hlthk040627.html

Larson, K. L. (2003, Oct.). Physical educators teaching health. Journal of School Health, 78 , 291-292. Retrieved April 21, 2007 from EBSCO online database SPORTDiscuss with Full Text.

Leow, A., Macdonald, D., Hay, P., & McCuaig, L. (2014). Health-education policy interface: the implementation of the Eat Well Be Active policies in schools. Sport, Education & Society, 19, 991-1013. Retrieved October 27, 2014, from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=98307806

McKenzie, F. & Richmond, J. (1998). Linking health and education: An overview of school coordinated health programs. In Marx and Wooley (eds.) Health is Academic: A Guide to Coordinated School Health Programs. New York. Teachers College Press.

National Education Association. (2007). 'No child left behind' act/ESEA. National Education Association Website. Retrieved April 25, 2007 from http://www.nea.org/esea/index.html

Suggested Reading

Agron, P., Berends, V., Ellis, K., & Gonzalez, M. (2010). School wellness policies: Perceptions, barriers, and needs among school leaders and wellness advocates. Journal Of School Health, 80, 527–535. Retrieved December 5, 2013 from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=54300992

Allensworth, D., & Kolbe, L. (1987). The comprehensive school health program: Exploring an expanded concept. Journal of School Health, 57, 409-412.

Armour, K., & Harris, J. (2013). Making the Case for Developing New PE-for-Health Pedagogies. Quest (00336297), 65, 201–219. Retrieved December 17, 2013 from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=86929591

Joint Committee on National Health Education Standards. (1995). National health education standards: Achieving health literacy. Atlanta, GA: American Cancer Society.

Marx, E., Wooley, S. F., & Northrop, D. (Eds). Health Is Academic: A Guide to Coordinated School Health Programs. New York: Teachers College Press.

McAvoy, P. (2013). The Aims of Sex Education: Demoting Autonomy and Promoting Mutuality. Educational Theory, 63, 483–496. Retrieved December 17, 2013 from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=91280787

National Association for Sport and Physical Education. (1995). Moving into the future: National physical education standards: A guide to content and assessment. New York: Mosby.

Pennington, T.R. & Krouscas, J. A. (1999). Connecting secondary physical education with the lives of students. Journal of Physical Education, Recreation, and Dance, 70 , 34-39.

Prout, S., Lin, I., Nattabi, B., & Green, C. (2014). 'I could never have learned this in a lecture': transformative learning in rural health education. Advances In Health Sciences Education, 19, 147-159. Retrieved October 27, 2014, from EBSCO Online Database Education Research Complete. http://search.ebscohost.com/login.aspx?direct=true&db=ehh&AN=95632688

Sallis, J., & McKenzie, T. (1991). Physical education's role in public health. Research Quarterly for Exercise and Sport, 62, 124-137.