Health and Nutrition Studies

Health and Nutrition Studies encompass educational initiatives focused on improving students' understanding of their health and nutritional needs. These studies are rooted in frameworks established by national standards, such as the National Health Education Standards and the National Science Education Standards, which guide the development of curricula across various grade levels. Effective health and nutrition education aims to enhance students' knowledge, promote healthy decision-making, and foster lifelong habits that contribute to overall well-being.

The curricula often integrate topics such as diet, exercise, mental health, and disease prevention, emphasizing the interconnectedness of health and nutrition. Research indicates that students who receive comprehensive health education demonstrate improved behaviors and reduced engagement in high-risk activities. However, challenges exist, including varying degrees of implementation across educational systems and the potential lack of trained personnel to effectively deliver this education. As health literacy becomes increasingly important, schools are encouraged to create dynamic and age-appropriate programs that not only cover essential content but also engage students actively in their health journeys.

Published in: 2023

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Subject Terms

Health and Nutrition Studies

Abstract

Health and nutrition-related curricular competencies are incorporated in the National Health Education Standards published in 1995 and the National Science Education Standards published in 1996. In addition to these national health standards, there are also state health standards and curriculum frameworks. Most states have health and nutrition education guidelines for curriculum and instruction. Effective school nutrition education programs and curricula increase students' nutrition-related knowledge and improve their nutrition-related decisions and behaviors. Health and nutrition education helps students to enhance their individual lifestyles, develop good personal habits, avoid high-risk behaviors, and control their own health destinies. Schools may provide less health and nutrition education in the upper grades, although adolescents and high school students are more likely to engage in high-risk behaviors. Research has demonstrated that the most important factor in understanding students' health behaviors is grade level.

Overview

School curricula today must address students' health and nutritional needs. The goal is for students to achieve health and nutrition literacy. Dynamic curriculum models need to be developed and implemented to promote health and nutrition among elementary, middle, junior-high and high-school students (American Association for the Advancement of Science, 1993; Smith, 2003; Wigginton, 1986). The desire of health and nutrition educators is "to have our students be whole" (Wigginton, 1986, p. 308). Students should be given knowledge of health as a total package—health as an understanding of self, health as a growing quality of "wholeness" and health as a way of life. Students should leave schools with a sense of physical and mental wellness (American Association for the Advancement of Science, 1993; Smith, 2003; Wigginton, 1986).

According to O'Byrne (2001), "Good health supports successful learning. Successful learning supports health. Education and health are inseparable" (O'Byrne, 2001, p. 1). Ultimately, the general public's and society's investment in education yields the greatest benefits. As education and health are inseparable, so are health and nutrition. Good health depends on good nutrition, and good nutrition supports good health. A philosophy of nutrition education for schoolchildren is "eat to learn, learn to eat" (Troccoli, 1993).

Background. Historically, one of the primary missions of schools has been to help children grow into healthy and productive adults. The knowledge, skills and attitudes that are manifested in health- and nutrition-education curricula are a selection of what is known and valued at a particular place and time. In addition to specific stand-alone classes and courses in health and nutrition, instruction in these areas has traditionally been incorporated in science curricula (Garrard, 1986; MacDonald & Hunter, 2005; Smith, 2003).

Public school instruction in health and nutrition has been dependent on key medical science and public health issues of the times. This is especially true in the area of communicable diseases. For example, in 1854, the English physician, John Snow (1813–1858), determined that cholera was transmitted and spread by contaminated water. For his contributions to medical science and public health education, Snow has been hailed as the father of modern epidemiology (Melville & Fazio, 2007; Merriam-Webster Inc., 1988).

As health education depended on discoveries and innovations in related medical and health science, nutrition education has been dependent on discoveries and advances in nutrition science. For example, Elmer Vernon McCollum (1879–1967) was one of the earliest nutrition educators in the United States. Among McCollum's scientific accomplishments was his discovery of vitamin A. In addition, McCollum was an important early twentieth-century communicator of nutrition education to the public (Johns Hopkins University, 2007; Todhunter, 1979). Graham (2000) traces McCollum's life from a Kansas farm boy to 'Dr. Vitamin,' and proudly proclaims that he "taught the world about nutrition."

The curriculum of health and nutrition education grew along with important medical-, health- and nutrition-related science topics. A curriculum developed by Oliver Byrd in a 1950 paper included some 300 health-science topics and another 200 were subsequently added by 2001 (Byrd, 2001). During the latter half of the twentieth century, health and nutrition education struggled to reach a working consensus on what the philosophy and goals of instruction should be. In the 1960s and 1970s, for example, health educators labored at coalescing the philosophical premise and goals of school health education (Belcastro, 1979). This debate continued through the 1980s and early 1990s. Then in the mid-1990s, progress actually began to be made in developing specific curricular objectives for health and nutrition education.

Establishing Health Education Standards. Many public schools have adopted the National Health Education Standards first released in 1995 by the Joint Committee on National Health Education Standards (JCNHES), with a second edition released by JCNHES and the American Cancer Society in 2007 after a review started in 2004 (Centers for Disease Control and Prevention, 2013). The general standards listed below inform specific performance indicators for pre-kindergarten through grade 2, grades 3–5, grades 6–8, and grades 9–12, respectively. These standards detail what K–12 students should know and be able to do in health education (Joint Committee on National Health Education Standards, 1995; Smith, 2003; CDC, 2013):

On September 1, 2022, The National Consensus for School Health Education released its Third Edition of the National Health Education Standards. These standards were modified to now read:

Students comprehend functional health knowledge to enhance health.
Students will analyze the influence of family, peers, culture, social media, technology, and other determinants on health behaviors.
Students demonstrate health literacy by accessing valid and reliable health information, products, and services to enhance health.
Students demonstrate effective interpersonal communication skills to enhance health.
Students demonstrate effective decision-making skills to enhance health.
Students demonstrate effective goal-setting skills to enhance health.
Students demonstrate observable health and safety practices.
Students advocate for behaviors that support personal, family, peer, school, and community health.

Health and nutrition-related competencies were incorporated in the 1996 National Science Education Standards. These put health and nutrition in the curricular context of 'science in personal and social perspective' (National Research Council, 1996; Rye, Zizzi, Vitullo, & Tompkins, 2005). The National Science Education Standards produced by the National Institutes of Health (NIH) Curriculum Supplement Series bring cutting-edge medical science and basic research discoveries into classrooms. The NIH curriculum modules are ideal for middle-school life-science classes for integrating human health, inquiry science, mathematics and science-technology-society issues (National Institutes of Health, 2005).

As of 2020, more than 80 percent of US school districts required schools to teach health education (Smith, 2003). However, a study by the Centers for Disease Control and Prevention's Division of Adolescent and School Health concluded that health education in many schools and school districts was not nearly as effective as it could have been (Kolbe, Kann, & Brener, 2001).

In 2012, the National Academies Press published A Framework for K–12 Science Education: Practices, Crosscutting Concepts, and Core Ideas, which served as the basis for the development of 2013's Next Generation Science Standards (NGSS). The NGSS have been adopted by nineteen states as of December 2017 (Higgins, 2013; National Science Teachers Association, n.d.). Unlike previous national science standards, as of 2023 the NGSS does not include a specific standard for personal health.

Further Insights

Health Education Curricula. School-age youth in health classes learn current, research-based, health content knowledge, health concepts, health enhancing skills, and risk-reducing health behaviors. Sound and effective health education programs are comprehensive, competency-based and learner-centered, and involve interactive and meaningful, hands-on activities and experiential learning (Rudy, 2000).

In addition to national health standards, there are state health standards curriculum frameworks. Most states have health-education guidelines for curriculum and instruction. Among the readily accessible examples are those published for the states of Alabama (Geiger, Myers, Atchison, & LaFollette, 2000), Arkansas (Arkansas State Department of Education), South Dakota (South Dakota Department of Education and Cultural Affairs, 2000), Vermont (Vermont Department of Education, 2004; Vermont Agency of Education, 2013), and Wisconsin (Wisconsin Department of Public Instruction, 2002). Although these health education documents capture essential learning competencies that are meant to be assessed on a statewide basis, they are not intended to 'narrow' the curriculum for instructional purposes (Vermont Department of Education, 2004). District-level curriculum guides are based on and developed from state-level documents.

In 2018, New York and Virginia became the first states to require mental health education in public schools. New York updated the elementary, middle, and high school health curricula to include content on mental health. Virginia requires ninth- and tenth-grade physical education and health curricula to include mental health education (Kaufman, 2018). Studies showed that in 2019, an estimated 16.5 percent of American children were believed to suffer from at least one mental health disorder. Following the Covid-19 pandemic, a flurry of legislation, primarily at the state level, emerged to support the mental health of children. Thirty-eight states enacted 100 laws to assist in behavioral health care.

The general priorities in health instruction have included a knowledge of:

Diet, eating disorders and obesity prevention and oral health;
The essential nature of vigorous exercise and activity to physical fitness;
Mental and emotional health including the management of stress and the control of emotions;
Environmental and community health;
Communicable diseases and disease prevention;
Drug, alcohol and tobacco use and prevention;
Violence and the prevention of injuries; and
Sexuality, teen pregnancy, sexually transmitted diseases, and HIV and AIDS prevention (Pealer, 2000; Rudy, 2000; Stang& Miner, 1994).

Nutrition Education Curricula. Effective school nutrition-education programs and curricula increase students' nutrition-related knowledge and improve their nutrition-related decisions and behaviors. Integrated instructional practices and pedagogical approaches foster and improve nutrition education. Practically all United States public elementary, middle, and secondary schools offer nutrition education somewhere in the curriculum. Most schools cover many of the following topics as priorities in nutrition education:

Children's food-related habits and eating behaviors;
The relationship of food, diet, and nutrients to health;
The links between nutrition and cardiovascular health;
The food-guide pyramid;
Finding and choosing healthy foods and increasing positive eating patterns;
Nutrients and their food sources;
Dietary guidelines and goals that emphasize low-fat, low-salt and increased complex-carbohydrate foods (Celebuski & Farris, 1996; Troccoli, 1993).

Students in nutrition education programs are well-schooled in the use and interpretation of US Department of Agriculture's (USDA) nutrient tables and database. The USDA database of common nutrients explains what different nutrients are, what they do in the human body and common foods in which the nutrients are found. Nutrient tables list the amounts of nutrients and proportions of recommended daily totals. Dietary suggestions for men, women and various age groups differ, and nutrient input varies based on the particular form of food, the number and size of servings and the total weight of food consumed (American Association for the Advancement of Science, 2000).

Grade-Appropriate Curricula. The study of many health and nutrition issues is interdisciplinary in nature and provides an opportunity for teachers of different subject areas to integrate relevant aspects of health and nutrition education into their own curricula. Although science is a key discipline for the study of health and nutrition, other areas such as history and social studies can introduce other aspects. Many health- and nutrition-related issues-for example, calorie intake and expenditure, human-energy balance, exercise and childhood obesity-cut across the National Science Education Standards (American Association for the Advancement of Science, 1993; National Research Council, 1996; Rye et al., 2005).

It is useful to consider mental and psychological health in understanding how students' knowledge grows and transitions from kindergarten through grade 12. Grade K–2 students, for example, can be helped to identify internal feelings and distinguish them from external sensations. Grade 3–5 students know that everyone has emotions and respond to them differently, and that different ways of dealing with emotions have different consequences. Grade 6–8 students connect extremes of emotion to their own intense thoughts and feelings and understand the relationship between emotion and risky behavior. Grade 9–12 students want to know why people behave the way they do and will seek general truths about social and psychological processes (American Association for the Advancement of Science, 1993).

Elementary Grades. The emphasis of early-childhood health education curricula and programs should be to promote healthy environments and to learn simple rules related to preventing and controlling the spread of contagious diseases (Squibb & Yardley, 1999). At grades K–2, good health habits should be taught and encouraged. Instruction for K–2 students should build on the ways one can be in poor health. Children in grades K–2 may not understand why certain diets, exercise and rest help but they can learn to keep healthy. K–2 students may know that germs make them sick even though they may not understand exactly what germs are (American Association for the Advancement of Science, 1993).

All grade K–4 students should develop initial understandings of personal health (National Research Council, 1996). Teachers should be aware that K–4 students have many misconceptions about health. Most children use the word 'germs' for all microbes and attribute all illnesses to germs. They are not likely to use the words 'virus' or 'bacteria' but when they do, they do not understand the difference between the two. In addition, children do not understand the difference between contagious and noncontagious diseases. K–4 students have little understanding of ideas such as the different origins of disease, resistance to infection and prevention and cure of disease. They have no understanding of organic, functional or dietary diseases. Although they link eating with health, growth, strength, and energy, they have no detailed understanding of these ideas. They understand the connection between diet and health and that some foods are nutritionally better than others, but they do not generally know the reasons for these conclusions (National Academy Press, 1996).

Table 1 summarizes the main health and nutrition curricular concepts and principles that underlie the related 1996 K–4 National Science Education Standard.

Students in grades 3–5 explore ways in which good health can be promoted and begin to understand some of the evidence related to good health but not in great detail. They can collect basic information on their own health with simple devices such as watches, thermometers and stethoscopes, and they can get a sense of how such information can vary. Children in grades 3–5 may get their first look at microorganisms through a microscope (American Association for the Advancement of Science, 1993).

Middle Grades. The study of personal health and nutrition is an important endeavor for science education at the middle level (National Academy Press, 1996). Students in grades 5–8 can undertake a more sophisticated and expanded study of personal health and nutrition that builds on the foundation established in grades K–4. Grade 5–8 students are capable of developing a more "scientific" understanding of health and nutrition, although they still do not have a firm understanding of the science related to the terminology. Teachers must work to overcome middle-school students' perceptions that most health-related factors are beyond their control. Middle-school teachers have a tough task in helping students develop an understanding of health-related risks and benefits. Middle-grade students are able to consider the effects of tobacco, alcohol, and other drugs on the way the body functions (American Association for the Advancement of Science, 1993; National Research Council, 1996).

Students in grades 5–8 extend their study of how the human body works, its healthy functioning and the ways it can be disrupted and promoted by lifestyle, diet, bacteria, and viruses (American Association for the Advancement of Science, 1993). Middle-school students begin to understand that illness can be caused by various factors such as microorganisms, genetic predisposition, malfunctioning of organs and organ systems, health habits and environmental conditions. The study of germ theory and its related science can be developed in middle school. This may include what causes diseases, how they are transmitted and how the body protects itself from disease (American Association for the Advancement of Science, 1993; National Academy Press, 1996). Table 2 summarizes the main health and nutrition curricular concepts and principles that underlie the related grades 5–8 National Science Education Standard.

Middle-grade students can start reading food-product labels and begin considering what healthful diets should be like. Teachers in grades 5–8 can capitalize on students' interest in their changing bodies by having them monitor and assess basic vital signs and other health-related characteristics. Students at this level can use somewhat more sophisticated tools such as electronic blood-pressure devices, digital thermometers, biofeedback monitors and cardiovascular-fitness software to monitor their own health (American Association for the Advancement of Science, 1993; National Research Council, 1996).

High School Level. High-school students should know that science can inform choices about nutrition and exercise but that it cannot ensure healthy practices. Grade 9–12 students may have difficulty with specific mechanisms and processes related to health issues, so students at this level should relate their knowledge of normal body functioning to situations, both hereditary and environmental, in which functioning is impaired. High-school students have a fairly sound understanding of overall functioning of some human systems such as the digestive, circulatory, and respiratory. However, they may not have a clear understanding of other systems such as the nervous, endocrine, and immune systems. As students come across medical news in the media, they can identify new ways of detection, diagnosis, treatment, prevention, and/or monitoring. Grade 9–12 students can collect data on their own vital signs to include response to exercise and schedule changes, cycles in temperature and heart rate, and individual differences in findings. High-school students should be able to learn the basics of good nutrition. Although ideas of what constitutes good nutrition change somewhat as new information becomes available, the basics are quite stable (American Association for the Advancement of Science, 1993; National Academy Press, 1996).

Table 3 summarizes the main health and nutrition curricular concepts and principles that underlie the related grades 9–12 National Science Education Standard.

Viewpoints

Benefits of a Health & Nutrition Curriculum. Systematic, integrated and coordinated health and nutrition education programs reduce behavior problems, increase attendance, enhance relationships, and improve student achievement, helping them to control their own health destinies. Focusing on health and nutrition helps students to develop critical-thinking and problem-solving skills and fosters their ability to make better personal decisions. Since students at all levels are generally interested in health and nutrition, this area provides an opportunity for academic enrichment activities (Brown, Teufel, & Birch, 2007; Lai & Shimabukuro, 1982; Marx, Wooley, & Northrup, 1998; Rye et al., 2005; Smith, 2003).

The study of health and nutrition increases students' awareness of the importance of good personal habits, and can have a lasting influence on the direction students take in their own lives. Providing students with the knowledge and skills needed to make healthy decisions and progress in solving health issues in their lives and communities helps to prepare them for becoming responsible contributing members of society. Health and nutrition education also helps prevent students from developing high-risk behaviors, as it addresses many of the preventable behaviors established in childhood and adolescence. These include poor eating habits, physical inactivity, tobacco use, alcohol and drug abuse, sexual activity leading to unwanted teen pregnancies and resulting in sexually transmitted diseases, and accidental and intentional behaviors causing injury or even death (Rye et al., 2005; Smith, 2003).

Challenges. Health and nutrition education requirements add to the ever-increasing curricular mandates, time demands and financial strains on school systems, and topics on health and nutrition are often sandwiched into classes devoted to other subjects. The time spent in teaching health and nutrition topics in other subjects may reduce the time commitment to the other subjects and simultaneously decrease the effectiveness in learning the integrated topics (Kolbe et al., 2001; Smith, 2003).

Other pressures and challenges that impinge on schools' abilities to teach about health and nutrition include teaching to increasingly diverse populations of students at all levels of ability as well as the demands related to high-stakes testing. Thus, school district health and nutrition education programs may not prove to be efficacious based on the number of students served, the outcomes or results, the relative difficulty in bringing about attitude changes, and the related effects of school and community interactions (Kolbe et al., 2001; Miller-Whitehead, 2001a; Smith, 2003).

Schools may actually provide less health and nutrition education in the upper grades although adolescents and high school students are more likely to engage in high-risk behaviors. Nutrition education may be lacking entirely at the senior-high school level—the level at which students have the poorest diets (Kolbe et al., 2001; Lai & Shimabukuro, 1982; Smith, 2003).

Professional development and training are generally required for teachers to teach health and nutrition education curricula. Health and nutrition teachers may not be, and in most cases are not, certified to teach in these areas, and this may impact their ability to teach related curricula effectively. Teacher training programs may not provide information on nutrition education teaching strategies or related support services to teachers for improving students' poor health habits. The majority of schools have no nutrition-education coordinator and teachers have the added responsibility of developing their own lessons. School nurses and health aides also may not have training in nutrition. In addition, school nutrition education activities are rarely coordinated with school food service programs (Celebuski & Farris, 1996; Lai & Shimabukuro, 1982).

The fact that parents may not set good examples for their children may impact the effects of nutrition education received in schools. Some parents feel that schools should not teach certain health issues, particularly those related to sexuality, reproduction or other potentially controversial issues (Lai & Shimabukuro, 1982).

Conclusions. Research has shown a need to design health and nutrition education curricula appropriate to students' cognitive developmental levels. Although students' understanding of health improves with cognitive-developmental level, overall, there is still evidence of general poor understanding (Contento & Michela, 1981).

The most important factor in teaching healthy behaviors is grade level (Cartland & Ruch-Ross, 2006). Older elementary school children score higher than younger students on factors associated with improved health behaviors including health knowledge. However, older elementary students score lower on healthy behaviors, especially risky behaviors, such as "those associated with later adolescent risk taking. As health knowledge, refusal skills and other protective factors increase, health behaviors improve slightly" (Cartland & Ruch-Ross, 2006, Abstract).

Research has investigated whether health literacy motivates early adolescents to practice health-enhancing behaviors (Brown et al., 2007). Age, difficulty understanding health information and a belief that kids can do little to effect changes in their future health decrease the likelihood of interest in and desire to follow what they were taught about health. Low or little interest causes decreased motivation in nine- to thirteen-year-old students in grades 5–8 to follow what was taught. Girls were found to be more likely to seek health information in school, from parents or medical personnel. Older students were more likely to turn to school and to seek information on the Internet (Brown et al., 2007). Youth in middle and high schools are more susceptible to engaging in high-risk health- and nutrition-related behaviors (Smith, 2003). Relevant and meaningful nutrition education has produced significant improvement in reported nutrition-related behaviors of ninth-grade students at the most risk for poor nutrition (Miller-Whitehead & Abbott, 2001).

Terms & Concepts

Curricular Competencies: Also curricular standards; specific performance standards or objectives which are used to assess and evaluate the effectiveness of instruction in a particular subject area, academic class, or course of study.

Health Behaviors: Also health habits. Actions or practices that relate to and deal with personal body care, maintenance of functioning and wellness, that are acquired through repetition, are adhered to and that may be good or poor.

Health Education Curriculum: Curricular program based on defined performance standards or competencies, and encompassing specific grade-level lessons and activities in courses related to personal health, diseases and disease prevention, physical fitness, healthy habits and behaviors, hygiene, nutrition, injury prevention and safety, mental and emotional health, substance-abuse prevention, and community and environmental health.

Health Educators: School teachers, specialists or other professionals who have been credentialed in health education, curricula and instruction and who plan, implement, and evaluate health education programs.

Health Literacy: A given functional level-low to high-of knowledge and skills related to personal health-care issues that is suitable for:

Meeting individual health goals and maintaining one's own health;
Engaging in thinking, learning and informed decision-making about one's own health;
Accessing, understanding and using health information;
Participating actively in and advocating for one's own health; and
Communicating with medical professionals and acquiring needed health services.

Nutrition Education: Instructional program based on defined performance standards or competencies, and encompassing specific grade-level lessons and activities in a class or course related to good nutrition, nutrient sources, food choices, dietary guidelines, eating habits, and nutritional behaviors.

Nutrition Education Coordinator: A school professional with specialized knowledge of nutrition who assists teachers in curriculum development, lesson planning, and instruction and who facilitates the implementation of a related educational program.

Nutrition Literacy: A given functional level—low to high—of knowledge and skills related to good nutrition, nutrients and their food sources, the relationship of diet to health, healthy and responsible eating habits, nutritional concepts and behaviors, dietary guidelines, the food-guide pyramid, understanding food labels and making health-conscious food choices.

Public Health Education: A community-wide health information and communication dissemination program emphasizing disease prevention and control, early-intervention efforts, good nutrition, hygiene, and medical and sanitary services to address primary needs.

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