Youth Risk Behavior Surveillance System (YRBSS)
What is the Youth Risk Behavior Surveillance System (YRBSS)?
The YRBSS was developed in 1990 to monitor priority health risk behaviors that contribute markedly to the leading
causes of death, disability, and social problems among youth and adults in the United States. These behaviors,
often established during childhood and early adolescence, include:






Behaviors that contribute to unintentional injuries and violence.
Sexual behaviors that contribute to unintended pregnancy and sexually transmitted infections, including HIV
infection.
Alcohol and other drug use.
Tobacco use.
Unhealthy dietary behaviors.
Inadequate physical activity.
In addition, the YRBSS monitors the prevalence of obesity and asthma.
From 1991 through 2013, the YRBSS has collected data from more than 2.6 million high school students in more
than 1,100 separate surveys.
What are the purposes of the YRBSS?
The YRBSS was designed to:






Determine the prevalence of health risk behaviors.
Assess whether health risk behaviors increase, decrease, or stay the same over time.
Examine the co-occurrence of health risk behaviors.
Provide comparable national, state, territorial, tribal, and local data.
Provide comparable data among subpopulations of youth.
Monitor progress toward achieving the Healthy People objectives and other program indicators.
What are the components of the YRBSS?
The YRBSS includes national, state, territorial, tribal government, and local school-based surveys of representative
samples of 9th through 12th grade students. These surveys are conducted every two years, usually during the
spring semester. The national survey, conducted by CDC, provides data representative of 9th through 12th grade
students in public and private schools in the United States. The state, territorial, tribal government, and local
surveys, conducted by departments of health and education, provide data representative of mostly public high
school students in each jurisdiction.
YRBSS includes a national school-based survey conducted by CDC and state, territorial, tribal, and local surveys
conducted by state, territorial, and local education and health agencies and tribal governments.
For more information: Contact
cdc.gov/yrbss
Youth Risk Behavior Surveillance System: Youth Online
YRBSS
What is Youth Online?
Youth Online is a web-based Youth Risk Behavior Surveillance System (YRBSS) data exploration tool. Youth Online lets
you create tables and graphs of Youth Risk Behavior Survey (YRBS) results and lets you compare results from different
locations, across health risk behavior topics, and by demographic subgroups.
What is included?



National, state, local, territorial, and tribal government YRBS results from 1991 to 2013
High school and middle school YRBS results
Results on the following health risk behavior categories:
o Behaviors that contribute to unintentional injuries and violence
o Sexual behaviors that contribute to unintended pregnancy and sexually transmitted
diseases, including HIV infection
o Alcohol and other drug use
o Tobacco use
o Unhealthy dietary behaviors
o Physical inactivity
o Plus, obesity and asthma
What can I do with Youth Online?








Create tables using filtering and sorting by race/ethnicity, sex, grade, or location
Export results to spreadsheets for additional analyses
Sort results
Test for statistically significant differences between groups, years, or locations (without programming!)
Customize tables by selecting variables to use in columns and rows
Display the “Greater Risk” or “Lesser Risk” direction for all variables
Drill down for more detail
Create graphs for publications or presentations
Where can I get more information? Visit www.cdc.gov/yrbss or call 800−CDC−INFO (800−232−4636).
What is the Health Education Curriculum Analysis Tool?
The Health Education Curriculum Analysis Tool (HECAT) contains guidance, appraisal tools, and resources for
comprehensively examining a health education curriculum. HECAT builds on the characteristics of effective
health education curricula and the National Health Education Standards for schools.
It includes modules on the following health topics:
Mental and Emotional Health
Healthy Eating
Personal Health and Wellness
Alcohol and Other Drug Prevention
Tobacco Prevention
Physical Activity
Safety
Sexual Health
Violence Prevention
The HECAT instrument contains age-appropriate skill examples for all grade bands, K-2, 3-5, 6-8 and 9-12.
The national HECAT can be customized to meet local community needs and conform to the
curriculum requirements of the state or school district.
Advantages of a HECAT-Aligned Curriculum
 Addresses priority health risk behaviors and health concerns for youth
 Respects local authority for curriculum decisions
 Provides for consistency of analysis
 National tool, used by multiple states
Research on effective programs suggests those that focus on skills, attitudes, and beliefs are more
likely to affect behavior than those that focus heavily on facts. Use of research-proven programs
should be encouraged because they are more likely to result in healthy decisions and healthy
outcomes.
For more information, contact: www.cdc.gov/HECAT.
Health-Risk Behaviors and Academic Achievement
What is the relationship between health-risk behaviors and academic achievement?
Data presented below from the 2009 National Youth Risk Behavior Survey (YRBS) show a negative association between
health-risk behaviors and academic achievement among high school students after controlling for sex, race/ethnicity, and
grade level. This means that students with higher grades are less likely to engage in health-risk behaviors than their
classmates with lower grades, and students who do not engage in health-risk behaviors receive higher grades than their
classmates who do engage in health-risk behaviors. These associations do not prove causation. Further research is
needed to determine whether low grades lead to health-risk behaviors, health-risk behaviors lead to low grades, or some
other factors lead to both of these problems.
Students with higher grades are significantly less likely to have engaged in behaviors such as

Carrying a weapon (for example, a gun, knife, or club on at least 1 day during the 30 days before the survey).

Current cigarette use (smoking cigarettes on at least 1 day during the 30 days before the survey).

Current alcohol use (having at least one drink of alcohol on at least 1 day during the 30 days before the survey).

Being currently sexually active (having sexual intercourse with at least one person during the 3 months before
the survey).

Watching television 3 or more hours per day (on an average school day).

Being physically active at least 60 minutes per day on fewer than 5 days (doing any kind of physical activity
that increased their heart rate and made them breathe hard some of the time on fewer than 5 days during the 7
days before the survey).
Health and Academic Achievement, released in 2014, further details the relationship between children’s
health and their capacity for academic success. This document, designed by the National Center for Chronic
Disease Prevention and Health Promotion Division of Population Health, is available from
www.cdc.gov/healthyyouth
For more information visit www.cdc.gov/HealthyYouth/health_and_academics or call 800-CDC-INFO (800-232-4636).
U.S. Department of Health and Human Services
Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion
Division of Adolescent and School Health
www.cdc.gov/HealthyYouth
OHIO REVISED CODE: HEALTH EDUCATION
3313.60 [Effective 3/23/2015] Prescribed curriculum.
Link: http://codes.ohio.gov/orc/3313.60
(5) Health education, which shall include instruction in:
(a) The nutritive value of foods, including natural and organically produced foods, the relation of nutrition
to health, and the use and effects of food additives;
(b) The harmful effects of and legal restrictions against the use of drugs of abuse, alcoholic
beverages, and tobacco;
(c) Venereal disease education, except that upon written request of the student's parent or guardian, a
student shall be excused from taking instruction in venereal disease education;
(d) In grades kindergarten through six, instruction in personal safety and assault prevention, except
that upon written request of the student's parent or guardian, a student shall be excused from taking
instruction in personal safety and assault prevention;
(e) In grades seven through twelve, age-appropriate instruction in dating violence prevention
education, which shall include instruction in recognizing dating violence warning signs and characteristics of
healthy relationships.
In order to assist school districts in developing a dating violence prevention education curriculum, the
department of education shall provide on its web site links to free curricula addressing dating violence
prevention.
If the parent or legal guardian of a student less than eighteen years of age submits to the principal of the
student's school a written request to examine the dating violence prevention instruction materials used at that
school, the principal, within a reasonable period of time after the request is made, shall allow the parent or
guardian to examine those materials at that school.
(f) Prescription opioid abuse prevention, with an emphasis on the prescription drug epidemic and the
connection between prescription opioid abuse and addiction to other drugs, such as heroin.
Amended by 130th General Assembly File No. TBD, HB 367, §1, eff. 3/23/2015.
Amended by 130th General Assembly File No. 25, HB 59, §101.01, eff. 9/29/2013.
Amended by 129th General Assembly File No.91, SB 165, §1, eff. 6/29/2012.
Amended by 128th General Assembly File No.16, HB 19, §1, eff. 3/29/2010.
Amended by 128th General Assembly File No.9, HB 1, §101.01, eff. 10/16/2009.
Effective Date: 09-11-2001
Related Legislative Provision: See 130th General Assembly File No. TBD, HB 367, §9.
Note: This section is set out twice. See also § 3313.60 , effective until 3/23/2015.
3313.603 [Effective 3/23/2015] Requirements for high school graduation - workforce or
college preparatory units.
Section A
(2) "One-half unit" means a minimum of sixty hours of course instruction, except that for physical education
courses, "one-half unit" means a minimum of one hundred twenty hours of course instruction.
Section B
(2) Health, one-half unit, which shall include instruction in nutrition and the benefits of nutritious foods and
physical activity for overall health;
3313.6011 Instruction in venereal disease education emphasizing abstinence.
(A) As used in this section, "sexual activity" has the same meaning as in section 2907.01 of the Revised Code.
(B) Instruction in venereal disease education pursuant to division (A)(5)(c) of section 3313.60 of the Revised
Code shall emphasize that abstinence from sexual activity is the only protection that is one hundred
per cent effective against unwanted pregnancy, sexually transmitted disease, and the sexual
transmission of a virus that causes acquired immunodeficiency syndrome.
(C) In adopting minimum standards under section 3301.07 of the Revised Code, the state board of education
shall require course material and instruction in venereal disease education courses taught pursuant to division
(A)(5)(c) of section 3313.60 of the Revised Code to do all of the following:
(1) Stress that students should abstain from sexual activity until after marriage;
(2) Teach the potential physical, psychological, emotional, and social side effects of participating in
sexual activity outside of marriage;
(3) Teach that conceiving children out of wedlock is likely to have harmful consequences for the child,
the child's parents, and society;
(4) Stress that sexually transmitted diseases are serious possible hazards of sexual activity;
(5) Advise students of the laws pertaining to financial responsibility of parents to children born in and
out of wedlock;
(6) Advise students of the circumstances under which it is criminal to have sexual contact with a person
under the age of sixteen pursuant to section 2907.04 of the Revised Code;
(7) Emphasize adoption as an option for unintended pregnancies.
(D) Any model education program for health education the state board of education adopts shall conform to the
requirements of this section.
(E) On and after March 18, 1999, and notwithstanding section 3302.07 of the Revised Code, the superintendent
of public instruction shall not approve, pursuant to section 3302.07 of the Revised Code, any waiver of any
requirement of this section or of any rule adopted by the state board of education pursuant to this section.
Effective Date: 09-11-2001; 2008 HB7 04-07-2009
RECENT NEWS: Ohio Health Education
Ohio Establishes New School Safety Tip Line
2/13/2015
844-SaferOH – Ohio’s new school safety tip line – gives students, parents, teachers and school administrators a way
to anonymously report student safety threats to school officials and law enforcement officers – whether they involve a potential
incident of mass violence, a suicide threat or the bullying of a single student.
Research shows that in 81 percent of violent incidents in U.S. schools, someone other than the attacker knew something
but didn’t report it for fear of being identified. This is why Gov. Kasich asked Ohio’s law enforcement and education leaders to
establish the confidential SaferOH tip line. This free service is available to any Ohio public or private school. If you do not
already have a tip line, please consider signing up for SaferOH right away. It is one of the best things you can do to make
sure all of your students feel safe at school every day. If you already have signed up your school, there is no need to sign up
again.
Once your school registers, the tip line will serve your community 24 hours a day, whenever a student or concerned
adult senses a threat to student safety. The call center guarantees the anonymity of the person who calls or texts. Tip line
workers may ask for additional information, but the one who calls or texts may remain anonymous or leave contact information
for follow-up.
Trained professionals at Ohio Homeland Security’s Threat Assessment and Prevention (TAP) unit answer all
calls and texts to 844-SaferOH. When action is needed, TAP staff immediately forward information to the school staff
member you designate. Local law enforcement agencies or others may be notified, if the situation warrants. Tip line staff will
follow up quickly with the affected school and law enforcement agencies to make sure the incident was investigated and the
outcome was tracked.
To sign up for this free service, simply click here to supply the SaferOH team with contact information for your
school and community. You will receive posters and information cards you can use to publicize the tip line. If you have
questions about the tip line, please call SaferOH at (614) 644-2641.
New Prescription Painkiller Education Law
(Dayton Daily News, 1/5/2015)
A law requires Ohio schools to teach children about the dangers of prescription painkillers, which some believe
may lead to heroin abuse. The Governor’s Opiate Action Team must recommend lessons to the Ohio Education
Department by July1, under the bill signed into law last month. Nationally, 1 in 5 high school students use painkillers
without a prescription, while about half of young people who become addicted to heroin were addicted to prescription
painkillers first.
CDC Fact Sheet - Binge Drinking
Binge drinking is the most common pattern of excessive alcohol use in the United States. The National
Institute on Alcohol Abuse and Alcoholism (http://www.niaaa.nih.gov) defines binge drinking as a pattern of
drinking that brings a person’s blood alcohol concentration (BAC) to 0.08 grams percent or above. This
typically happens when men consume 5 or more drinks, and when women consume 4 or more drinks, in about
2 hours.
Most people who binge drink are not alcohol dependent.
According to national surveys:










One in six U.S. adults binge drinks about four times a month, consuming about eight drinks per binge.
While binge drinking is more common among young adults aged 18–34 years, binge drinkers aged 65
years and older report binge drinking more often—an average of five to six times a month.
Binge drinking is more common among those with household incomes of $75,000 or more than among
those with lower incomes.
Approximately 92% of U.S. adults who drink excessively report binge drinking in the past 30 days.
Although college students commonly binge drink, 70% of binge drinking episodes involve adults age 26
years and older.
The prevalence of binge drinking among men is twice the prevalence among women.
Binge drinkers are 14 times more likely to report alcohol-impaired driving than non-binge drinkers.
About 90% of the alcohol consumed by youth under the age of 21 in the United States is in the form of
binge drinks.
More than half of the alcohol consumed by adults in the United States is in the form of binge drinks.
Binge drinking is associated with many health problems, including—
o
o
o
o
o
o
o
o
o
o
o
Unintentional injuries (e.g., car crashes, falls, burns, drowning)
Intentional injuries (e.g., firearm injuries, sexual assault, domestic violence)
Alcohol poisoning
Sexually Transmitted Diseases
Unintended pregnancy
Children born with Fetal Alcohol Spectrum Disorders
High blood pressure, stroke, and other cardiovascular diseases
Liver disease
Neurological damage
Sexual dysfunction, and
Poor control of diabetes.
Binge drinking costs everyone.
 Drinking too much, including binge drinking, cost the United States $223.5 billion in 2006, or $1.90 a
drink, from losses in productivity, health care, crime, and other expenses.
 Binge drinking cost federal, state, and local governments about 62 cents per drink in 2006, while
federal and state income from taxes on alcohol totaled only about 12 cents per drink.
Evidence-based interventions to prevent binge drinking and related harms include:
 Increasing alcoholic beverage costs and excise taxes.
 Limiting the number of retail alcohol outlets that sell alcoholic beverages in a given area.
 Holding alcohol retailers responsible for the harms caused by their underage or intoxicated patrons
(dram shop liability).
 Restricting access to alcohol by maintaining limits on the days and hours of alcohol retail sales.
 Consistent enforcement of laws against underage drinking and alcohol-impaired driving.
 Maintaining government controls on alcohol sales (avoiding privatization).
 Screening and counseling for alcohol misuse.
References:
1. National Institute of Alcohol Abuse and Alcoholism. NIAAA council approves definition of binge
drinking(http://pubs.niaaa.nih.gov/publications/Newsletter/winter2004/Newsletter_Number3.pdf) [PDF1.62MB]. NIAAA Newsletter 2004; No. 3, p. 3.
2. CDC. Vital signs: binge drinking prevalence, frequency, and intensity among adults—U.S., 2010.
MMWR Morb Mortal Wkly Rep 2012; 61(1):14 –9.
3. Town M, Naimi TS, Mokdad AH, Brewer RD. Health care access among U.S. adults who drink alcohol
excessively: missed opportunities for prevention. Prev Chronic Dis [serial online] April 2006.
4. Naimi TS, Brewer RD, Mokdad A, Clark D, Serdula MK, Marks JS. Binge drinking among US adults
(http://www.ncbi.nlm.nih.gov/pubmed/12503979?dopt=Abstract). JAMA 2003;289(1):70–75.
5. Office of Juvenile Justice and Delinquency Prevention. Drinking in America: Myths, Realities, and
Prevention Policy (http://www.udetc.org/documents/Drinking_in_America.pdf) [PDF-1.08MB].
6. Bouchery EE, Harwood HJ, Sacks JJ, Simon CJ, Brewer RD. Economic costs of excessive alcohol
consumption in the United States, 2006 (http://www.ncbi.nlm.nih.gov/pubmed/22011424). Am J Prev
Med 2011;41:516–24.
7. Guide to Community Preventive Services. Preventing excessive alcohol consumption
(http://www.thecommunityguide.org/alcohol/default.htm). Atlanta, GA: Centers for Disease Control
and Prevention, 2011.
8. Babor TF, Caetano, R., Casswell S, et al. Alcohol and Public Policy: No Ordinary Commodity. New York:
Oxford University Press, 2003.
9. National Research Council and Institute of Medicine. Reducing Underage Drinking: A Collective
Responsibility (http://www.iom.edu/Reports/2003/Reducing-Underage-Drinking-A-CollectiveResponsibility.aspx). Washington, DC: National Academies Press, 2004.
10. U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Prevent and
Reduce Underage Drinking (http://www.surgeongeneral.gov/topics/underagedrinking/). U.S.
Department of Health and Human Services, Office of the Surgeon General, 2007.
11. U.S. Preventive Services Task Force. Screening and behavioral counseling interventions in primary care
to reduce alcohol misuse: recommendation statement
(http://www.uspreventiveservicestaskforce.org/3rduspstf/alcohol/alcomisrs.htm). Ann Intern Med
2004;140:554–556.
Page last reviewed: January 16, 2014
Page last updated: January 16, 2014
Content source: Division of Population Health (http://www.cdc.gov/NCCDPHP/dph/), National Center for
Chronic Disease Prevention and Health Promotion (/chronicdisease), Centers for Disease Control and Prevention
(www.cdc.gov)
CDC Fact Sheets - Underage Drinking
Alcohol use by persons under age 21 years is a major public health problem. Alcohol is the most
commonly used and abused drug among youth in the United States, more than tobacco and illicit drug ,
and is responsible for more than 4,300 annual deaths among underage youth . Although drinking by
persons under the age of 21 is illegal, people aged 12 to 20 years drink 11% of all alcohol consumed in the
United States. More than 90% of this alcohol is consumed in the form of binge drinks. On average,
underage drinkers consume more drinks per drinking occasion than adult drinkers. In 2010, there were
approximately 189,000 emergency rooms visits by persons under age 21 for injuries and other conditions
linked to alcohol.
Drinking Levels among Youth
The 2013 Youth Risk Behavior Survey (http://www.cdc.gov/healthyyouth/yrbs/) found that among high
school students, during the past 30 days
 35% drank some amount of alcohol.
 21% binge drank.
 10% drove after drinking alcohol.
 22% rode with a driver who had been drinking alcohol.
Other national surveys

In 2012 the National Survey on Drug Use and Health (http://www.oas.samhsa.gov/nhsda.htm)
reported that 24% of youth aged 12 to 20 years drink alcohol and 15% reported binge drinking.

In 2013, the Monitoring the Future Survey (http://www.monitoringthefuture.org) reported that 28% of
8th graders and 68% of 12th graders had tried alcohol, and 10% of 8th graders and 39% of 12th
graders drank during the past month.
Consequences of Underage Drinking
Youth who drink alcohol are more likely to experience:













School problems, such as higher absence and poor or failing grades.
Social problems, such as fighting and lack of participation in youth activities.
Legal problems, such as arrest for driving or physically hurting someone while drunk.
Physical problems, such as hangovers or illnesses.
Unwanted, unplanned, and unprotected sexual activity.
Disruption of normal growth and sexual development.
Physical and sexual assault.
Higher risk for suicide and homicide.
Alcohol-related car crashes and other unintentional injuries, such as burns, falls, and drowning.
Memory problems.
Abuse of other drugs.
Changes in brain development that may have life-long effects.
Death from alcohol poisoning.
Consequences of Underage Drinking (cont.)
In general, the risk of youth experiencing these problems is greater for those who binge drink than for those
who do not binge drink.
Youth who start drinking before age 15 years are five times more likely to develop alcohol dependence or
abuse later in life than those who begin drinking at or after age 21 years.
Prevention of Underage Drinking
Reducing underage drinking will require community-based efforts to monitor the activities of youth and
decrease youth access to alcohol. Recent publications by the Surgeon General and the Institute of Medicine
outlined many prevention strategies that will require actions on the national, state, and local levels, such as
enforcement of minimum legal drinking age laws, national media campaigns targeting youth and adults,
increasing alcohol excise taxes, reducing youth exposure to alcohol advertising, and development of
comprehensive community-based programs. These efforts will require continued research and evaluation to
determine their success and to improve their effectiveness.
References:
1. U.S. Department of Health and Human Services. The Surgeon General's Call to Action to Prevent and
Reduce Underage Drinking (http://www.surgeongeneral.gov/topics/underagedrinking/). Rockville,
MD: U.S. Department of Health and Human Services; 2007.
2. Centers for Disease Control and Prevention (CDC). Alcohol-Related Disease Impact (ARDI)
(http://apps.nccd.cdc.gov/DACH_ARDI/Default/Default.aspx). Atlanta, GA: CDC.
3. Office of Juvenile Justice and Delinquency Prevention. Drinking in America: Myths, Realities, and
Prevention Policy (http://www.udetc.org/documents/Drinking_in_America.pdf) [PDF-1.08MB].
Washington, DC: U.S. Department of Justice, Office of Justice Programs, Office of Juvenile Justice and
Delinquency Prevention, 2005.
4. Bonnie RJ and O’Connell ME, editors. National Research Council and Institute of Medicine, Reducing
Underage Drinking: A Collective Responsibility (http://www.nap.edu/catalog.php?record_id=10729).
Committee on Developing a Strategy to Reduce and Prevent Underage Drinking. Division of
Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press, 2004.
5. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics
and Quality. The DAWN Report: Highlights of the 2010 Drug Abuse Warning Network (DAWN)
Findings on Drug-Related Emergency Department Visits
(http://www.samhsa.gov/data/2k12/DAWN096/SR096EDHighlights2010.pdf) [PDF-410KB].
Rockville, MD; 2012.
6. Kann L, Kinchen SA, Shanklin S,et al. Youth Risk Behavior Surveillance—United States, 2013
(http://www.cdc.gov/mmwr/preview/mmwrhtml/ss6304a1.htm?s_cid=ss6304a1_e) [PDF-3.46MB].
CDC Morb Mort Surveil Summ 2014;63(SS-04):1–168.
7. Substance Abuse and Mental Health Services Administration. Results from the 2012 National Survey
on Drug Use and Health: Summary of National Findings
(http://www.samhsa.gov/data/NSDUH/2012SummNatFindDetTables/NationalFindings/NSDUHresult
s2012.pdf) [PDF-3.16MB] (NSDUH Series H-46, HHS Publication No. SMA 13-4795). Rockville, MD:
Substance Abuse and Mental Health Services Administration, 2013.
8. Johnston, L D, O'Malley P M, Bachman, J G, & Schulenberg J E. "Monitoring the Future national results
on drug use: 2013 Overview- of key findings on Adolescent Drug Use
(http://www.monitoringthefuture.org/pubs/monographs/mtf-overview2013.pdf) [PDF 3.37 MB] Ann
Arbor, MI: Institute for Social Research, The University of Michigan.
9. Miller JW, Naimi TS, Brewer RD, Jones SE. Binge drinking and associated health risk behaviors among
high school students. Pediatrics 2007;119:76–85.
10. Hingson RW, Heeren T, Winter MR. Age at drinking onset and alcohol dependence: age at onset,
duration, and severity. Pediatrics 2006;160:739–746.
11. Office of Applied Studies. The NSDUH Report: Alcohol Dependence or Abuse and Age at First Use
(http://www.oas.samhsa.gov/2k4/ageDependence/ageDependence.htm). Rockville, MD: Substance
Abuse and Mental Health Services Administration, October 2004.
Page last updated: October 31, 2014 Content source: Division of Population Health (http://www.cdc.gov/NCCDPHP/dph/), National
Center for ChroniDisease Prevention and Health Promotion (/chronicdisease), Centers for Disease Control and Prevention
(http://www.cdc.gov/)
Facts: E-cigarettes
Source: Monitoring the Future, University of Michigan
E-cigarettes surpass tobacco cigarettes among teens —In 2014, more teens use e-cigarettes than traditional, tobacco
cigarettes or any other tobacco product—the first time a U.S. national study shows that teen use of e-cigarettes
surpasses use of tobacco cigarettes. These findings come from the University of Michigan's Monitoring the Future study,
which tracks trends in substance use among students in 8th, 10th and 12th grades. Each year the national study, now in
its 40th year, surveys 40,000 to 50,000 students in about 400 secondary schools throughout the United States. "As one
of the newest smoking-type products in recent years, e-cigarettes have made rapid inroads into the lives of American
adolescents," said Richard Miech, a senior investigator of the study. The survey asked students whether they had used
an e-cigarette or a tobacco cigarette in the past 30 days. More than twice as many 8th- and 10th-graders reported using
e-cigarettes as reported using tobacco cigarettes. Specifically, 9 percent of 8th-graders reported using an e-cigarette in
the past 30 days, while only 4 percent reported using a tobacco cigarette. In 10th grade, 16 percent reported using an ecigarette and 7 percent reported using a tobacco cigarette. Among 12th-graders, 17 percent reported e-cigarette use
and 14 percent reported use of a tobacco cigarette.
Specifically, 9 percent of 8th-graders reported using an e-cigarette in the past 30 days, while only 4 percent reported
using a tobacco cigarette. In 10th grade, 16 percent reported using an e-cigarette and 7 percent reported using a
tobacco cigarette. Among 12th-graders, 17 percent reported e-cigarette use and 14 percent reported use of a tobacco
cigarette. The older teens report less difference in use of e-cigarettes versus tobacco cigarettes. "This could be a result
of e-cigarettes being relatively new," said Lloyd Johnston, principal investigator of the project. "So today's 12th-graders
may not have had the opportunity to begin using them when they were younger. Future surveys should be able to tell us
if that is the case." E-cigarettes are battery-powered devices with a heating element. They produce an aerosol, or vapor,
that users inhale. Typically, this vapor contains nicotine, although the specific contents of the vapor are proprietary and
are not regulated. The liquid that is vaporized in e-cigarettes comes in hundreds of flavors. Some of these flavors, such
as bubble gum and milk chocolate cream, are likely attractive to younger teens.
E-cigarettes may serve as a point of entry into the use of nicotine, an addictive drug. The percentages of all youth in each
grade who used e-cigarettes in the prior 30 days, but had never smoked a cigarette in their lives, ranged from 4 percent
to 7 percent in 8th, 10th, and 12th grades. For these youth, e-cigarettes are a primary source of nicotine and not a
supplement to tobacco cigarette use. Whether youth who use e-cigarettes exclusively later go on to become tobacco
cigarette smokers is yet to be determined by this study, and is of substantial concern to the public health community. Ecigarette use among youth offsets a long-term decline in the use of tobacco cigarettes, which is at a historic low in the
life of the study—now in its 40th year. In 2014, the prevalence of smoking tobacco cigarettes in the past 30 days was 8
percent for students in 8th, 10th and 12th grades combined. This is a significant decline from 10 percent in 2013, and is
less than a third of the most recent high of 28 percent in 1998. One important cause of the decline in smoking is that
many fewer young people today have ever started to smoke tobacco cigarettes. In 2014, only 23 percent of students had
ever tried tobacco cigarettes, as compared to 56 percent in 1998. Of particular concern is the possibility that e-cigarettes
may lead to tobacco cigarette smoking, and reverse this hard-won, long-term decline. "Part of the reason for the
popularity of e-cigarettes is the perception among teens that they do not harm health," Miech said. Only 15 percent of
8th-graders think there is a great risk of people harming themselves with regular use of e-cigarettes. This compares to
62 percent of 8th-graders who think there is a great risk of people harming themselves by smoking one or more packs of
tobacco cigarettes a day. Because e-cigarettes are relatively new, a comprehensive assessment of their health impact—
especially their long-term consequences—has yet to be developed. Tables and figures associated with this release may
be accessed at: http://monitoringthefuture.org/data/ data.html
E-cigarettes (cont.)
Monitoring the Future Data
http://monitoringthefuture.org
In 2014, past-year hookah use continued to increase among 12th graders to 22.9 percent—the highest rate since
2010, when the survey started capturing this type of tobacco use.
Also popular among teens is the use of e-cigarettes, which was measured for the first time in 2014. Use of ecigarettes in the past 30 days was reported by 8.7 percent of 8th graders, 16.2 percent of 10th graders, and 17.1
percent of 12th graders. Only 14.2 percent of 12th graders view regular e-cigarette use as harmful. The nicotine
in e-cigarettes is vaporized and inhaled (not smoked), but the health impact of e-cigarette use is not yet clear,
nor do we know if e-cigarette use makes it more likely for people to use conventional cigarettes or other
tobacco products. Survey findings show that while most e-cigarette users have also smoked conventional
tobacco products, approximately 2.9 percent of 8th graders, 4.5 percent of 10th graders, and 3.8 percent of 12th
graders who report past month use of e-cigarettes deny ever using tobacco cigarettes or smokeless tobacco.
NIH
National Institute on Drug Abuse
http://www.drugabuse.gov/publications/drugfacts/high-school-youth-trends
Drug Facts: High School and Youth Trends
2014’s Monitoring the Future survey of drug use and attitudes among American 8th, 10th, and 12th
graders continued to show encouraging news about youth drug use, including decreasing use of
alcohol, cigarettes, and prescription pain relievers; no increase in use of marijuana; decreasing use
of inhalants and synthetic drugs, including K2/Spice and bath salts; and a general decline over the
last two decades in the use of illicit drugs. However, the survey highlighted growing concerns over
the high rate of e-cigarette use and softening of attitudes around some types of drug use,
particularly decreases in perceived harm and disapproval of marijuana use.
PRESCRIPTION DRUG ABUSE
National Institute on Drug Abuse
The National Institute on Drug Abuse (NIDA) is a part of the National Institutes of Health, U.S. Department of
Health and Human Services. NIDA supports most of the world’s research on how drug abuse affects the brain
and body, including how it leads to addiction. In addition to supporting and conducting research, NIDA
disseminates its findings through science-based materials such as Web sites, publications, and curricula
supplements.
Teen Prescription Drug Abuse and PEERx
Prescription drug abuse among teens is a significant problem. In 2014, the Monitoring the Future study
reported that 13.9% of high school seniors used a prescription drug not prescribed for them or for nonmedical
reasons in the past year. Monitoring the Future 2012: http://www.drugabuse.gov/related-topics/trendsstatistics/monitoring-future/ monitoring-future-survey-overview-findings-2012 Findings also showed that
after marijuana, prescription and over-the-counter medications account for most of the top drugs abused by
12th graders in the past year, with Adderall and Vicodin being the most commonly abused prescription drugs.
In response to this serious public health problem, NIDA developed PEERx, an online educational initiative to
discourage abuse of prescription drugs among teens. A component of the NIDA for Teens program, PEERx
provides science-based information about prescription drug abuse prevention. PEERx has a variety of free
resources, including Choose Your Path videos, which allow you to assume the role of the main character and
make decisions about whether to abuse certain prescription drugs. PEERx also includes an Activity Guide for
planning events in schools and communities, a partner toolkit, fact sheets about prescription drugs, and other
helpful resources.
For the full PEERx program visit http://teens.drugabuse.gov/peerx.
(May download for free.)
The Dietary Guidelines for Americans, 2010
NOTE: The Dietary Guidelines for Americans, 2010 is the current federal nutrition policy document. The
process for revising the policy for 2015 is currently underway.
The Dietary Guidelines, 2010 is the current federal nutrition policy document. The policy document is available
online at www.DietaryGuidelines.gov. Federal agencies, regional and state offices, food assistance programs,
food and health organizations and industry partners, as well as local community educators and advocates
communicate message and implement guidelines based on the latest Dietary Guidelines.
Taken together, the Dietary Guidelines, 2010 emphasize two overarching concepts:


Maintain calorie balance over time to achieve and sustain a healthy weight.
Focus on consuming nutrient-dense foods and beverages.
A healthy eating pattern needs not only to promote health and help to decrease the risk of chronic diseases, but
it needs to prevent foodborne illness. Four basic food safety principles work together to reduce the risk of
foodborne illnesses: CLEAN, SEPARATE, COOK, CHILL.
KEY RECOMMENDATIONS
Balancing Calories to Manage Weight




Prevent and/or reduce overweight and obesity through improved eating and physical activity.
Control total calorie intake to manage body weight.
Increase physical activity and reduce time spend in sedentary behaviors.
Maintain appropriate calorie balance during each stage of life – childhood, adolescence,
adulthood, pregnancy and breastfeeding, and older age.
Foods and Food Components to Reduce






Reduce daily sodium intake to less than 2,300 milligrams (mg.) and further reduce intake
to 1,500 mg. amount persons who are 51 and older and those of any age who are African
American or have hypertension, diabetes, or chronic kidney disease.
Consume less than 10% of calories from saturated fatty acids by replacing them with
monounsaturated and polyunsaturated fatty acids.
Consume less than 300 mg. per day of dietary cholesterol.
Reduce the intake of calories from solid fats and added sugars.
Limit the consumption of foods that contain refined grains, especially refined grain foods
that contain solid fats, added sugars, and sodium.
If alcohol is consumed, it should be consumed in moderation – up to one drink per day for
women and two drinks per day for men – and only by adults of legal drinking age.
(cont.)
Dietary Guidelines (cont.)
KEY RECOMMENDATIONS (cont.)
Foods and Nutrients to Increase









Increase vegetable and fruit intake.
Eat variety of vegetables, esp. dark green, red and orange vegetables and beans and peas.
Consume at least half of all grains as whole grains.
Increase intake of fat-free o9r low-fat milk and milk products, such milk, yogurt, cheese or
fortified soy beverage.
Choose variety of protein foods, which include seafood, lean meat and poultry, eggs, beans and
pes, soy products, and unsalted nuts and seeds.
Increase amount of seafood consumed by choosing seafood in place of some meat and poultry.
Replace protein food that are higher in solid fats with choices that are lower in solid fats and
calories and/or are sources of oils.
Use oils to replace solid fats where possible.
Choose foods that provide more potassium, dietary fiber, calcium, and Vitamin D, which are
nutrients of concern in American diets. These foods include vegetables, fruits. Whole grains, and
milk and milk products.
NOTE: The following specific population groups need to access the Dietary Guidelines (website above)
for special recommendations:
 Women capable of becoming pregnant
 Women who are pregnant or breastfeeding
 Individuals ages 50 or older.
www.DietaryGuidelines.gov.
VIOLENCE: 2013 Youth Risk Behavior Surveillance Survey Data
During the 12 months before the 2013 YRBSS
 14.8% of high school students had been electronically bullied
 19.6% had been bullied on school property
 17% seriously considered suicide
 8% had attempted suicide
 10.3% reported physical dating violence
 10% reported sexual victimization from a dating partner
 24.7% were in a physical fight
 17.9 % carried a weapon on at least 1 day during the 30 days before the survey
Statistics may be viewed at www.cdc.gov/healthyyouth/data/yrbs/results.htm
TEXTING: 2013 Youth Risk Behavior Surveillance Survey Data
During the 12 months before the 2013 YRBSS
 64.7% who drove a car or other vehicle had texted or e-mailed while driving
Compare State and National YRBSS Results:
www.cdc,gov/healthyyouth/data/yrbs/results
Educational Books for the Health Education Professional
Health-Related Books
Joint Committee on National Health Education Standards. The National Health Education Standards, 2nd
Edition. Sponsored by the American Cancer Society, 2007. (May download portions from
www.cdc.gov/healthyyouth/sher/standards/ )
World Health Organization. Healthy Action: An Activity Book for Teachers and Learners.
Herod, Leslie. Discovering Me: A Guide to Teaching Health and Building Adolescents’ Self-Esteem. Allyn and
Bacon, 1999.

Activity Ideas Include: Self-Discovery, Personality Development, Relationships, Goals, Decisions-making,
Changing Behavior, Stress Management, Communication, Human Growth & Development, Nutrition,
Hygiene. Etc. (Grades 6-10)
Jackson, Tom. Activities That Teach Family Values. Red Rock Publishing, 1998.
 A timeless book of activities to help students, ages 8 to 16 understand the significance of values, clarify
their own values, and recognize how values influence healthy (or unhealthy) choices.
Jackson, Tom. Activities That Teach. Red Rock Publishing, 1993

Sixty creative, innovative, teacher-proven and user-friendly activities which will influence student
behavior and attitudes.. These activities cover topics such as alcohol and drug prevention,
communication, problem solving, working together, decision making, self esteem, character, goal
setting, anger management, stress management, peer pressure, etc.
Jackson, Tom. More Activities That Teach. Red Rock Publishing, 1995
McTavish, Sandra. Life Skills: 225 Read-to-Use Health Activities for Success and Well-Being. Jossey-Bass,
2004. (Grades 6-12)
Meeks, Linda and Heit, Philip. Comprehensive School Health Education: Totally Awesome Strategies for
Teaching Health. McGraw-Hill Humanities, 2012.

This text prepares teachers to design and implement a curriculum that integrates the 2007 National
Health Education Standards (NHES), the six categories of risk behavior identified by the CDC, and the
ten content areas of school health. Included are Totally Awesome Teaching Strategies™, reproducible
Teaching Masters, and a Curriculum Guide, all keyed to the NHES at age-appropriate grade levels (K12).
Grechus, Marilyn. Innovative Tools for Health Education: Making Inexpensive Props, Visuals and
Manipulatives. Human Kinetics, 2010.

Innovative Tools for Health Education offers 30 projects (including Clogged Arteries, Breathless
Cigarettes, and a DUI Game Kit) that engage and inform students about various vital health topics. The
book also supplies ideas for using recycled materials as props and visual aids and gives guidance in
buying low-cost items to use in your health class.
Tummers, Nanette. Teaching Stress Management: Activities for Children and Young Adults, Human Kinetics,
2011.
Biegel, Gina. The Stress Reduction Workbook for Teens: Mindfulness Skills to Help You Deal with Stress.
Self-Help, 2010.
Educational Books of Interest (cont.)
Health-Related Books
Fox, Anne. Too Stressed to Think? A Teen’s Guide to Staying Sane When Life Makes You Crazy. Free Spirit
Publishing, 2005.
Kane, B. Marijuana (Understanding Drugs). Chelsea House, 2011. (Grades 6-10)
Pike, R. William. Facing Substance Abuse: Discussion-Starting Skits for Teenager. Resource Publications, Inc.,
1996
Capacchoine, Lucia. The Creative Journal for Teens: Making Friends With Yourself. Career Press, 2008
Lewis, Barbara. What Do You Stand For? For Teens: Building Character. Free Spirit Publishing, 2009
Katz, Orly. Peer Pressure vs. True Friendship! Surviving Junior High: A self- Help Guide for Teens, Parents &
Teachers
CreateSpace Independent Publishing Platform, 2013. (7th & 8th gr)
Domitrz, Michael. May I Kiss You: A Candid Look at Dating Communication, Respect and Sexual Assault
Awareness. Awareness Publications, 2008.
Covey, Sean. The 7 Habits of Highly Effective Teens. Touchstone, 2014.
Gasberg, Lynn and G. Oldenburg. Great Group Skits. Search Institute Press, 2009.
Puza, Roger. Health Ideas and Activities. Human Kinetics, 2008.
Nygard, B., Green, T., Koonce, S. Wow! Health Education Teacher’s Guide. Human Kinetcs, 2005. (Grades K-6)
Carter, Jill, Karen Peterson, Suzanne Nobrega, Steven Gortmaker. Planet Health: An Interdisciplinary
Curriculum for Teaching Middle School Nutrition and Physical Activity. Human Kinetics, 2007. (K-8)
Connolly, Mary. Skill-Based Health Education. Jones & Bartlett Learning, 2012
Tellajohann, Susan and Simons, C. Health Education: Elementary and Middle School Applications. McGrawHill Humanities, 2015.

This book emphasizes the skills necessary to teach health while providing background information on
key health topics. Valuable activities in each chapter are aligned with National Health Education
Standards and include sample assessment strategies.
Whalen, Shannon, Splendorio, D. and Chiariello, S. Tools for Teaching Health. Jossey-Bass, 2007
 This book is filled with health education activities aligned to most health education content areas
CDC/Healthy Youth. Parent Engagement: Strategies for Involving Parents in School Health. May download
from www.cdc.gov/healthyyouth/protective/pdf/parent_engagement_strategies.pdf
For Teachers of Students with Special Needs:
Mannix, Darlene. Life Skill Activities for Secondary Students with Special Needs. Jossey-Bass, 2009

Includes a variety of health education topics
Mannix, Darlene. Life Skill Activities for Special Children. Jossey –Bass, 2009 (Grades K-5)

Similar to the Secondary Version except it is developmentally appropriate for special needs children in
elementary
Educational Books of Interest (cont.)
General Pedagogy
Allen, Janet. Tools for Teaching Content Literacy. Stenhouse Publishers, 2004

Many research-based instructional strategies that could be applied to any content area, including
health education. These are organized in a booklet form with hard copies of instructional sheets
included.
Silver, Harvey, Strong, R. and Perini, M. The Strategic Teacher: Selecting the Right Research-based Strategy
for Every Lesson. Pearson, 2007.

Great resource for instructional strategies that can be applied to health education lessons.
Tileston, Donna. Ten Best Teaching Practices: How Brain Research, Learning Styles and Standards Define
Teaching Competencies. Corwin Press, 2005

This book incorporates brain research, learning styles information, and the issue of standards into a
classroom instructional model that is useful in all content areas.
McNeeley, Clea and J Blanchard. The Teen Years Explained: A Guide to Healthy Adolescent Development.
John Hopkins University School of Health, 2009. (May download from: www.jhsph.edu/research/centers-andinsitutes/center-for-adolescent-health/_includes/Interactive%20Guide.pdf )
VARIETY OF ONLINE VIDEOS FROM CDC
ACCESS from : http://www.cdc.gov/cdctv/
Topics include:
o
o
o
o
Binge drinking
Ebola
HIV/AIDS
Vaccinations
Characteristics of an Effective Health Education Curriculum
Today’s state-of-the-art health education curricula reflect the growing body of research that emphasizes:




Teaching functional health information (essential knowledge)
Shaping personal values and beliefs that support healthy behaviors
Shaping group norms that value a healthy lifestyle
Developing the essential health skills necessary to adopt, practice, and maintain health-enhancing
behaviors.
**Less effective curricula often overemphasize teaching scientific facts and increasing student knowledge.**
An effective health education curriculum has the following characteristics, according to reviews of effective
programs and curricula and experts in the field of health education:
1. Focuses on clear health goals and related behavioral outcomes. An effective curriculum has clear healthrelated goals and behavioral outcomes that are directly related to these goals. Instructional strategies and
learning experiences are directly related to the behavioral outcomes.
2. Is research-based and theory-driven.* An effective curriculum has instructional strategies and learning
experiences built on theoretical approaches (for example, social cognitive theory and social inoculation theory)
that have effectively influenced health-related behaviors among youth. The most promising curriculum goes
beyond the cognitive level and addresses health determinants, social factors, attitudes, values, norms, and skills
that influence specific health-related behaviors.
3. Addresses individual values, attitudes, and beliefs. An effective curriculum fosters attitudes, values, and
beliefs that support positive health behaviors. It provides instructional strategies and learning experiences that
motivate students to critically examine personal perspectives, thoughtfully consider new arguments that
support health-promoting attitudes and values, and generate positive perceptions about protective behaviors
and negative perceptions about risk behaviors.
4. Addresses individual and group norms that support health-enhancing behaviors. An effective
curriculum provides instructional strategies and learning experiences to help students accurately assess the level
of risk-taking behavior among their peers (for example, how many of their peers use illegal drugs), correct
misperceptions of peer and social norms, emphasizes the value of good health, and reinforces health-enhancing
attitudes and beliefs.
5. Focuses on reinforcing protective factors and increasing perceptions of personal risk and
harmfulness of engaging in specific unhealthy practices and behaviors. An effective curriculum provides
opportunities for students to validate positive health-promoting beliefs, intentions, and behaviors. It provides
opportunities for students to assess their vulnerability to health problems, actual risk of engaging in harmful
health behaviors, and exposure to unhealthy situations.
6. Addresses social pressures and influences. An effective curriculum provides opportunities for students to
analyze personal and social pressures to engage in risky behaviors, such as media influence, peer pressure, and
social barriers.
7. Builds personal competence, social competence, and self-efficacy by addressing skills. An effective
curriculum builds essential skills — including communication, refusal, assessing accuracy of information,
decision-making, planning and goal-setting, self-control, and self-management — that enable students to build
their personal confidence, deal with social pressures, and avoid or reduce risk behaviors.
For each skill, students are guided through a series of developmental steps:
a. Discussing the importance of the skill, its relevance, and relationship to other learned skills.
b. Presenting steps for developing the skill.
c. Modeling the skill.
d. Practicing and rehearsing the skill using real–life scenarios.
e. Providing feedback and reinforcement.
8. Provides functional health knowledge that is basic, accurate, and directly contributes to healthpromoting decisions and behaviors. An effective curriculum provides accurate, reliable, and credible
information for usable purposes so students can assess risk, clarify attitudes and beliefs, 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 provides
information for the sole purpose of improving knowledge of factual information will not change behavior.
9. Uses strategies designed to personalize information and engage students. An effective curriculum
includes instructional strategies and learning experiences that are student-centered, interactive, and
experiential (for example, group discussions, cooperative learning, problem solving, role playing, and peer-led
activities). Learning experiences correspond with students’ cognitive and emotional development, help them
personalize information, and maintain their interest and motivation while accommodating diverse capabilities
and learning styles. Instructional strategies and learning experiences include methods for
a. Addressing key health-related concepts.
b. Encouraging creative expression.
c. Sharing personal thoughts, feelings, and opinions.
d. Thoughtfully considering new arguments.
e. Developing critical thinking skills.
10. Provides age-appropriate and developmentally-appropriate information, learning strategies,
teaching methods, and materials. An effective curriculum addresses students’ needs, interests, concerns,
developmental and emotional maturity levels, experiences, and current knowledge and skill levels. Learning is
relevant and applicable to students’ daily lives. Concepts and skills are covered in a logical sequence.
11. Incorporates learning strategies, teaching methods, and materials that are culturally inclusive. An
effective curriculum has materials that are free of culturally biased information but includes information,
activities, and examples that are inclusive of diverse cultures and lifestyles (such as gender, race, ethnicity,
religion, age, physical/mental ability, appearance, and sexual orientation). Strategies promote values, attitudes,
and behaviors that acknowledge the cultural diversity of students; optimize relevance to students from multiple
cultures in the school community; strengthen students’ skills necessary to engage in intercultural interactions;
and build on the cultural resources of families and communities.
12. Provides adequate time for instruction and learning. An effective curriculum provides enough time to
promote understanding of key health concepts and practice skills. Behavior change requires an intensive and
sustained effort. A short-term or “one shot” curriculum, delivered for a few hours at one grade level, is generally
insufficient to support the adoption and maintenance of healthy behaviors.
13. Provides opportunities to reinforce skills and positive health behaviors. An effective curriculum builds
on previously learned concepts and skills and provides opportunities to reinforce health-promoting skills across
health topics and grade levels. This can include incorporating more than one practice application of a skill,
adding "skill booster” sessions at subsequent grade levels, or integrating skill application opportunities in other
academic areas. A curriculum that addresses age-appropriate determinants of behavior across grade levels and
reinforces and builds on learning is more likely to achieve longer-lasting results.
14. Provides opportunities to make positive connections with influential others. An effective curriculum
links students to other influential persons who affirm and reinforce health–promoting norms, attitudes, values,
beliefs, and behaviors. Instructional strategies build on protective factors that promote healthy behaviors and
enable students to avoid or reduce health risk behaviors by engaging peers, parents, families, and other positive
adult role models in student learning.
15. Includes teacher information and plans for professional development and training that enhance
effectiveness of instruction and student learning. An effective curriculum is implemented by teachers who
have a personal interest in promoting positive health behaviors, believe in what they are teaching, are
knowledgeable about the curriculum content, and are comfortable and skilled in implementing expected
instructional strategies. Ongoing professional development and training is critical for helping teachers
implement a new curriculum or implement strategies that require new skills in teaching or assessment.
References
1.
Botvin GJ, Botvin EM, Ruchlin H. School-Based Approaches to Drug Abuse Prevention: Evidence for Effectiveness and Suggestions for Determining CostEffectiveness. In: Bukoski WJ, editor. Cost-Benefit/Cost-Effectiveness Research of Drug Abuse Prevention: Implications for Programming and Policy. NIDA
Research Monograph, Washington, DC: U.S. Department of Health and Human Services, 1998;176:59–82.
2.
Contento I, Balch GI, Bronner YL. Nutrition education for school-aged children. Journal of Nutrition Education 1995;27(6):298–311.
3.
Eisen M, Pallitto C, Bradner C, Bolshun N. Teen Risk-Taking: Promising Prevention Programs and Approaches. Washington, DC: Urban Institute; 2000.
4.
Gottfredson DC. School-Based Crime Prevention. In: Sherman LW, Gottfredson D, MacKenzie D, Eck J, Reuter P, Bushway S, editors. Preventing Crime:
What Works, What Doesn’t, What’s Promising. National Institute of Justice; 1998.
5.
Kirby D. Emerging Answers: Research Findings on Programs to Reduce Teen Pregnancy. Washington, DC: National Campaign to Prevent Teen Pregnancy;
2001.
6.
Kirby D, Coyle K, Alton F, Rolleri L, Robin L. Reducing Adolescent Sexual Risk: A Theoretical Guide for Developing and Adapting Curriculum-Based Programs.
Scotts Valley, CA: ETR Associates; 2011.
7.
Lohrmann DK, Wooley SF. Comprehensive School Health Education. In: Marx E, Wooley S, Northrop D, editors. Health Is Academic: A Guide to Coordinated
School Health Programs. New York: Teachers College Press; 1998:43–45.
8.
Lytle L, Achterberg C. Changing the diet of America’s children: what works and why? Journal of Nutrition Education 1995;27(5):250–60.
9.
Nation M, Crusto C, Wandersman A, Kumpfer KL, Seybolt D, Morrissey-Kane, E, Davino K. What works: principles of effective prevention programs.
American Psychologist 2003;58(6/7):449–456.
10. Stone EJ, McKenzie TL, Welk GJ, Booth ML. Effects of physical activity interventions in youth. Review and synthesis. American Journal of Preventive
Medicine 1998;15(4):298–315.
11. Sussman, S. Risk factors for and prevention of tobacco use. Review. Pediatric Blood and Cancer 2005;44:614–619.
12. Tobler NS, Stratton HH. Effectiveness of school-based drug prevention programs: a meta-analysis of the research. Journal of Primary Prevention
1997;18(1):71–128.
13. U.S. Department of Health and Human Services. Preventing Tobacco Use Among Young People–An Update: A Report of the Surgeon General. Atlanta (GA):
U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health
Promotion, Office on Smoking and Health, 2011: 6-22–6-45.
14. Weed SE, Ericksen I. A Model for Influencing Adolescent Sexual Behavior. Salt Lake City, UT: Institute for Research and Evaluation; 2005. Unpublished
manuscript.
* COMMON HEALTH BEHAVIOR THEORIES & MODELS
The following Health Behavior Theories and Models align with this curriculum:
Theory/ Model
Health Belief Model
Planned Behavior/
Reasoned Action
Key Concepts
Perceived Susceptibility
Perceived Severity
Perceived Benefits of the Behavior
Cues to Action
Self-efficacy
A person decides to stop
using e-cigarettes based on
his/her perceived severity
of the physical
consequences.
Intention to Change an Unhealthy Behavior



Attitude
Outcome expectations
Value of outcome


What Others Think
Motive to comply
Social Environment
Perceived Control


Classic Learning Theory
Example
Opportunities
Skills and resources
Cues
Shaping
Reinforcement/ rewards
 Future (looking better)
 Extrinsic ( praise)
 Intrinsic (feel good)
A person consumes a lowfat diet and begins an
exercise program, resulting
in weight loss that is
noticed by co-workers who
want to lose weight.
A person establishes a daily
walking program and
rewards self with a new
pair of tennis shoes.
NATIONAL HEALTH EDUCATION STANDARDS:
Explanations, Key Criteria, Basic Rubric
NHES 1: CORE CONCEPTS
Students will comprehend concepts related to health promotion and disease prevention to enhance health.
This standard is linked to all health education content areas. To meet this standard students must demonstrate
functional knowledge of the most important and enduring ideas, issues, and concepts related to achieving optimal
health.
KEY CRITERIA FOR CORE CONCEPTS:




Use complete, factual information
Show relationships among ideas/ concepts
Be certain the facts are accurate
Make factual conclusions about health
BASIC CONCEPTS RUBRIC:
4 – The response is complex, accurate, and comprehensive.
3 – The response identifies relationships between two or more health concepts;
is some breadth of information, although there may be minor inaccuracies.
2 - The response presents some accurate information about the relationships
between health concepts, but the response is incomplete and there are some
inaccuracies.
1 - The responses addresses the assigned task but provides little or no accurate
information about the relationships between health concepts.
NHES 2: ANALYZING INTERNAL AND EXTERNAL INFLUENCES
Students will analyze the influence of family, peers, culture, media, technology, and other factors on health
behaviors.
Analyzing influences "means knowing what influences you and how you are influenced when you make certain health
choices." A student demonstrates appropriate application of this skill when he / she can show different ways that health
choices are affected, including internal feelings and external things that influence health choices, and that he / she has
considered why different things affect health choices. Some examples of activities that help to build this skill include reworking an advertisement, doing a skit on peer pressure, re-writing a tale that helps explain influences. (from: Assessing
Health Literacy: A Guide to Portfolios).
Influences on Decisions
The skill category of Analyzing Internal and External Influences helps develop students' ability to analyze the influence of
internal and external elements on health behavior. Unfortunately, many young people do not recognize the role internal
and external factors play in their decisions regarding personal, family and community health. These decisions are more
likely to result in risky behavior. Students must learn to appreciate the complexity of these influences and be able to
determine how these factors can positively or negatively affect health decisions.
ANALYZING INFLUENCES (cont.)
There are two major types of influences - internal and external.
Internal Influences:
 knowledge/factual information/what I know
 curiosity
 interests, likes/dislikes
 desires (to feel accepted, loved, powerful, competent, etc.)
 fears
External Influences:
 media/advertising
 legal restrictions (speed limit, drinking age laws, driver's license, no smoking signs)
 setting/location
 culture
 parents/family/relatives
 peers/friends/other teens
 role models outside the family (celebrities, athletes, singers, leaders)
Media-Literacy
Media literacy is defined as "the ability to access, analyze, evaluate, and communicate information in a variety of format
including print and non-print. It is an expanded information and communication skill that is responsive to the changing
nature of information in our society. It addresses the skills students need to be taught in school, the competencies
citizens must have as we consume information in our homes and living rooms, the abilities workers must have as we
move toward the 21st century and the challenges of a global economy." (Appalachian State University definition)
KEY CRITERIA FOR ANALYZING INFORMATION SKILLS:




Identifies and analyzes external factors: media, parents, ethnic, legal, peers, geographic, societal, technology
Identifies and analyzes internal factors: curiosity, interests, desires, fears, likes/dislikes
Addresses interrelationships and complexity of influences; Shows how influences affect health choices
Presents variety of influences, as appropriate
BASIC CONCEPTS RUBRIC:
4 – The response is complex, accurate, and comprehensive.
3 – The response identifies relationships between two or more health concepts;
is some breadth of information, although there may be minor inaccuracies.
2 - The response presents some accurate information about the relationships
between health concepts, but the response is incomplete and there are some
inaccuracies.
1 - The responses addresses the assigned task but provides little or no accurate
information about the relationships between health concepts.
NHES 3: ACCESSING INFORMATION
Students will demonstrate the ability to access valid health information and products and services to enhance health.
Accessing information is a basic skill. It means "knowing how to find correct information about health and knowing how
to choose a health-related product or service". A student demonstrates appropriate application of this skill when he /
she identifies the information source and can defend it as a reliable way to get correct information; uses a variety of
sources and shows them to be reliable", and when the student demonstrates knowing where to go to get help to solve
problems. Some examples of activities that help to build this skill include research projects, surveys, and reports. (from:
Assessing Health Literacy: A Guide to Portfolios).
Identifying Valid Sources for Information
To make wise decisions about health, students must be able to access valid sources of information-sources that will
provide accurate information about health and health-promoting products and services. Students may have had practice
in evaluating printed sources of information, where publication dates, authors and place of publication are clearly listed.
However, the vastness and accessibility of the Internet requires some additional criteria. Anyone can post anything on
the Net, so the ability to access information and evaluate sources becomes even more critical.
Internet Information
The URL, or address, of a Website provides some information about the host of the site. Commercial organizations have
URLs that end in ".com." Community organizations, such as the American Heart Association and the American Cancer
Society, usually have URLs that end in ".org." The URLs for government agencies end in ".gov," and the URLs for
educational organizations, such as colleges, end in ".edu."
These designations can provide an initial clue to the value of the site. Commercial sites are usually trying to sell a
product. Depending on the product they're selling, they may or may not be trustworthy. For example, sites hosted by
tobacco companies are unlikely to provide the real truth about tobacco. If the site is hosted by an organization, what is
the organization's purpose? Sources such as the Encyclopedia of Associations (which can be found in the library) may
provide more information about the organization that sponsors a Website.
The dates the site was created and revised offer clues about how current the information is likely to be. If no dates are
posted, clicking on any listed links may indicate how current the site is. If the links have expired, the site probably has
not been updated in a while. Up-to-date information may not be important for all research. For example, current
information is important when researching new tobacco laws, but less crucial to a report on the history of tobacco use.
Information about the author of the content of the site also provides clues about the validity of the information. Do the
author's credentials suggest that he or she is qualified to provide information on the topic? Does the Website include
contact information for the author? If not, you may be able to contact the Webmaster by e-mail to check the author's
credentials. What is the purpose of the website? (e.g., commercial) If an author or Webmaster is not listed, look for
another site for information. Knowing who is providing the information is a vital component in evaluating its validity.
KEY CRITERIA FOR ACCESSING INFORMATION SKILLS:





Identifies or cites specific sources
Evaluates validity of sources
Provides rationale for appropriateness of source
Demonstrates ability to access appropriate community resources to meet specific needs
Identifies the type of health available from source
ACCESSING INFORMATION (cont.)
GENERIC SKILLS RUBRIC:
4 – The response is complex, accurate, and comprehensive.
3 – The response identifies relationships between two or more health concepts;
is some breadth of information, although there may be minor inaccuracies.
2 - The response presents some accurate information about the relationships
between health concepts, but the response is incomplete and there are some
inaccuracies.
1 - The responses addresses the assigned task but provides little or no accurate
information about the relationships between health concepts.
NHES 4: INTERPERSONAL COMMUNICATION
Students will demonstrate the ability to use interpersonal communication skills to enhance health and avoid or
reduce health risks.
Interpersonal communication "means showing appropriate ways to exchange your ideas and needs." A student
demonstrates appropriate application of this skill when he / she can do a good job of presenting both sides of an issue,
showing how both sides feel and interact, showing respect, using appropriate language, not using "put downs", and
using strategies such as "I messages" and refusal techniques. Some examples of activities that help to build this skills
include skills, role plays, dialogue, and puppet shows. (from: Assessing Health Literacy: A Guide to Portfolios).
Interpersonal Communication Primer
Most people want to be understood and accepted more than anything else in the world. Knowing this is the first step
toward good communication. Good communication has two basic components:


You listen to and acknowledge other people's thoughts and feelings: Rather than showing that you only care
about broadcasting your feelings and insisting that others agree with you, you encourage others to express what
they are thinking and feeling. You listen and try to understand.
You express your own thoughts and feelings openly and directly: If you only listen to what other people are
thinking or feeling and you don't express your own thoughts or feelings, you end up feeling shortchanged or
"dumped on."
To communicate effectively, practice using these interpersonal communication skills.





I-statements help you express the way you feel and what you want with great clarity. Sometimes people use
"you" statements, such as "You never call when you are going to be late." This type of statement can make
others feel angry and defensive immediately. When you use I-statements, such as, "I really need to know when
you're going to be here so I can make plans," you express your the concern in terms of you.
A respectful tone of voice conveys that you are taking others seriously and that you also expect to be taken
seriously. In addition, people with good communication skills are assertive without being aggressive or
manipulative.
Eye contact is vital for good communication. For example, how would you feel if the person you were talking to
kept looking around the hallway or out the window?
Appropriate body language encourages conversation. Nodding your head, smiling, laughing, using words such as
"uh-huh" and "yeah" and asking questions at appropriate times assure the person that you are really listening.
Clear, organized ideas help you accurately and honestly describe your feelings and contribute to conversations
and to decisions that need to be made. Good communicators are also specific. For example, a good
INTERPERSONAL COMMUNICATION (Cont.)
communicator would say, "I need to use the computer from 7-9," as opposed to "I'll need the computer
tonight."
Refusal Techniques
Saying No! Skill Practice
Young people may find themselves in a variety of pressure situations, so no single refusal strategy can be adequate for
safeguarding their health. Students must be equipped with a repertoire of strategies to choose from, depending on the
setting. Effective skill practice has the following components.
1. Introduce the skill.
2. Present steps for developing the skill (if applicable).
3. Model the skill correctly.
4. Allow learners to practice and rehearse the skill.
5. Provide feedback and reinforcement.
Ways to Say No
1. Say no firmly.
When you are asked or pressured to do something you don't want to do, say no firmly and convincingly.
Sometimes it's best to say no and physically turn away.
2. Repeat the word no over and over.
If teased or called a name, don't counter with your own "put downs"; just continue to repeat the word no.
Usually, the other person eventually gets tired and leaves.
3. Give an excuse (a believable excuse).
Examples:
o
o
o
o
I tried it once, and when I got home, my folks could smell smoke on my clothes, and I was grounded for
a week.
I tried smoking a couple of times and always got sick. The doctor said I'm probably allergic to tobacco
smoke.
I gotta’ go home and babysit my kid sister.
I've got a cold sore in my mouth, and everything hurts.
4. Give reasons.
Similar to the "Give an excuse" refusal strategy, this technique stresses the use of a rationale to explain why one
is not participating in a certain behavior. Knowing the facts about tobacco can help.
Examples:
 Tobacco would be one more thing to worry about. Besides, I need the money for other things.
 Diabetes runs in my family, so I don't want to risk my health with nicotine.
 My dad just quit smoking, so he could smell cigarette smoke on me a mile away.
5. Avoid or leave the situation.
When in an unfamiliar setting such as a party, scan the room to see what different people are doing. Many times
the tobacco users hang out by themselves. Avoid these people while looking for those who share your values to
talk to. If you find yourself getting pressured or just feel uncomfortable with what is going on around you, say
that you have to meet someone (or will be back later) and then leave immediately.
Ways to Say No (cont.)
6. Change the subject.
If the conversation begins to drift to the topic of drug use, subtly change the subject. Examples:
 "Hey, let me tell you how wasted I got last week."
 "Speaking of wasted, did you see how Stone Cold Steve Austin 'wasted' the Undertaker on WWF last
night?"
7. Suggest an alternative activity.
Invite your friends to do something else, which leaves the door to the friendship open.
 I'm going to my house to play Nintendo, want to come?
 No thanks, Dude, let's go to the video arcade.
 I'm starving; I want to get a taco. Who wants to go with me?
Examples:
8. Ignore the problem/act dumb.
Remind students of the tone of voice they employ when they try to convince you that they just can't remember
that you said they were going to have a quiz today.
Examples:
 Huh?
 Yeah, right?
 Say what?
 Duh, I don't know what you're talking about.
9. Find friends who feel the same way you do.
There really is safety in numbers, especially if the "numbers" (your friends) share your beliefs and values about
not smoking or not using drugs. For example, at a party, you and your friends can watch out for each other. If
pressured to use a drug by someone, you could turn to your friends and say, "Do the rest of you go along with
this?" or "Are they crazy or what?"
10. Reverse the pressure.
Shift the focus away from the tobacco and onto your friendship. People who are really your friend will usually
back off at this point. If friends keep pressuring you, rather than argue with them, simply say, "Why are you
hassling me on this?" or "Why are you on my case so much today?" People who are really your friends will
usually back off at this point. This skill is effective only if a friendship already exists. A person who doesn't really
care for the other isn't going to be put off by these questions.
Another version of this is the Fairness Argument. For example, you could say, "Look, I'm not telling you not to
smoke, so why are you telling me I have to smoke?" or "I'm not telling you what to do with your life, so why are
you trying to tell me what to do with mine?"
11. Delay your decision.
If you're being pressured, this skill buys you time and temporarily, at least, gets you off the hook. Responses
include: In a minute; catch me later; not yet.
Another version is to combine this strategy with Number 6, Change the Subject. For example, you could say,
"Not now, I'm getting ready to dance/talk to, check out that person over there."Be aware that using this strategy
may give the impression that you are a person who sometimes uses tobacco. If you want to get the word out
that you are tobacco free, this strategy may send mixed messages. It may be more appropriate to use when you
are with a group of people you don't expect to see again.
12. Tell your friends, "I have made a decision."
The best decision for your health is to be tobacco free. If you're clear about your decision, your friends may stop
pressuring you.
Communication Styles
Without adequate communication skills, adolescents may be unable to release their feelings. This lack of communication
can increase stress and lower self-esteem.
There are three styles of communication:
1. passive
2. assertive
3. aggressive
Passive communication involves the inability or unwillingness to express thoughts and feelings. Passive people will
do something they don't want to do or make up an excuse rather than say how they feel.
Assertive behavior involves standing up for oneself. Assertive people will say what they think and stand up for their
beliefs without hurting others.
The aggressive style of communication involves overreaction, blaming and criticizing. Aggressive people try to get
their way through bullying, intimidating or even physical violence. They do not or will not consider the rights of
others.
Types of Messages
There are two types of messages that accompany each style of communication: nonverbal and verbal. Signs, symbols,
posture, body movements, dress, facial expressions and gestures are examples of nonverbal messages. The nonverbal
messages reinforce what the speaker is saying.
For example, passive communicators often have slumped posture and a lack of eye contact. Assertive people exhibit
erect posture and direct eye contact. Forward-leaning posture, pointing and a glaring look are nonverbal signals of
aggressive communication.
The verbal messages for each communication style are very different. People who are passive will often ask questions to
determine what others want, or they may say, "I don't care." Assertive communicators use I-messages to say what they
want or need. They use refusal skills to say no while maintaining important relationships. People who are aggressive
often use you-statements to blame or criticize.
Components of Assertive Communication
The components of verbal messages for assertive communication include I-messages and refusals. I-messages state
what the sender thinks, feels, needs, wants or believes. They begin with the word I.
Examples of I-messages:
 I want to see Star Wars.
 I feel angry about the game.
There are a variety of refusal strategies, including:
 Say the word no firmly.
 Repeat no (if needed).
 Let the other person know you want to stay friends.
Examples of refusals:
 No, I can't sleep over on Friday, but I would like to another time.
 No, thanks. I'm allergic to peanuts. The cookies look really delicious, and I'm sorry I can't have
one.
Assertiveness Skills
What is the difference between assertiveness (confrontation) and aggressiveness?
Assertiveness, or confrontation, means taking the initiative or first steps to deal with a problem in a
constructive, self-protective manner. Assertiveness attacks the problem, not the person.
Aggressiveness attacks the other person rather than the problem. It is a destructive desire to dominate another
person or to force a position or viewpoint on another person; it starts fights or quarrels.
When do you use assertiveness skills?
These skills can be used when another's behavior is not acceptable or when continued "listening and accepting"
isn't appropriate. People often avoid confronting others about their behavior because they don't want to hurt
the relationship. However, avoiding problems may cause bad feelings to build and may result in an explosion or
withdrawal from the relationship. Using I-messages to be assertive is constructive, rather than destructive. It
helps people deal with problem behavior in a way that allows the other person to agree to change while not
damaging the relationship.
How do you use this skill?
The goal is to get other people to change their behavior without putting them down or making them feel badly
toward you. You may like the person; it's a particular behavior of the person that you don't like. Your purpose is
to address the behavior, not to "dress down" the person.
The Importance of I-messages
I-messages are designed to deal with problems. The purpose of an I-message is to express your needs. It expresses the
attitude "I am not going to give up my needs and I'm willing to help you meet your needs," creating a win-win situation.
I-messages attempt to deal with the problem situation by talking about it in terms of what is happening to me-I've got a
problem. An I-message is disarming. It's hard for someone to say something nasty in response to a good I-message. On
the other hand, a "you" message blames others and puts them on the defensive. Then they want to retaliate, to get
even.
Steps in Using I-Messages
There are three parts to delivering an I-message, although sometimes not all three parts are used.
A description of the behavior. What is it the other person is doing that gives you a problem? You are describing
something to the other person, not blaming her or him for something. I-messages tell others that their behavior
is interfering with something you need (not just something that you want). Give the other person a clear idea of
what he has done without extra blame or guilt added.
A description of the feeling this behavior causes you. How does what the other person is doing affect you?
A description of the effects produced by the behavior. What concrete problem is the behavior causing you? If
you can help other people see how their behavior affects you, then they are more likely to change the behavior.
Examples:
Mother to teenage son:

"You" message: You just tracked mud all over my clean floor! I just mopped that floor! You are such a
slob.

I-message: When I see mud tracked into my clean kitchen, I get irritated, because I have to clean it up
again.
INTERPERSONAL COMMUNICATION: I-Messages (Cont.)
Description of Behavior: What’s the behavior that bothers you?
Mud tracked on the clean floor
Description of Feeling: What are you feeling as a result of this behavior?
Irritated
Description of Effects: How does this behavior affect you?
I have to do more work
One friend to another:


"You" message: You don't care about anyone but your own fat self!
I-message: I feel hurt when you only call me to come over to visit when none of your other friends are
available. I get left out.
Description of Behavior: What’s the behavior that bothers you?
You only call me when you don't have anyone else to visit
Description of Feeling: What are you feeling as a result of this behavior?
Hurt
Description of Effects: What's the behavior that bothers you?
Left out of things
Dad yelling at child:


"You" message: You're late again! I told you to be home by 9:00 and it's 10:00. You have no
consideration at all and care for no one but yourself."
I-message: When you come home late, I get really upset because I worry that something bad has
happened to you.
Description of Behavior: What’s the behavior that bothers you?
Coming home late
Description of Feeling: What are you feeling as a result of this behavior?
Upset
Description of Effects: What's the behavior that bothers you?
Worried that something bad has happened
Hints for Successful I-messages




Be specific in describing the problem behavior
Make eye contact
Use a respectful tone of voice, not an aggressive or confrontational tone
Be aware of what your body language is saying-that it is reinforcing what your words say.
When an I-message Doesn't Work
If an I-message isn't working, it may be a lousy message. Yes, the words may be OK, but the tone may be full of
blame or rage or disrespect. Pay attention to the non-verbal message. Is your face red; are your eyes bulging;
are you yelling to the top of your voice? Or are you cool, calm and collected?
There is little to be gained by sending an anger message. Try to stop and think about why you are so angry. You
will likely find other feelings underneath the anger: frustration, embarrassment, rejection, fear, hurt and
loneliness.
INTERPERSONAL COMMUNICATION: I-Messages (Cont.)
Sometimes, an I-message may not work if the other person has a strong need to continue her or his behavior. If
the other person is upset and out of control, shift gears. Try active listening, change the environment, or let him
or her blow off steam.
I-messages also may not work if the other person doesn't agree that the "effect" on you is a real problem. This is
a values collision, which occurs often in families. If there is a conflict of needs, an I-message won't be enough.
You'll need to give up on the I-message and work out the conflict with some other techniques.
Each of these processes has similar characteristics, including:
 Parties identify their own needs and interests.
 Parties work cooperatively to find solutions to meet those needs and interests.
 Parties stay focused on the problem.
 Parties work cooperatively to find a mutually acceptable solution.
Each problem-solving process has similar steps:
 Agree that you disagree (agree to negotiate; set the stage).
 Take turns talking (gather perspectives/identify interests).
 Restate what you think you heard (explain the other's viewpoint).
 Come up with a solution that works for both parties (create and evaluate options/generate agreement).
Negotiation
Negotiation is a problem-solving process in which there are face to face efforts by those involved to resolve the dispute
or problem. Representatives of those involved may also meet face to face to negotiate on behalf of the disputing
parties.
Steps in Negotiation
1.
2.
3.
4.
Agree that you disagree and you will try to negotiate.
Take turns talking; look at things from the viewpoint of the other party.
Describe what you want, how you feel, and the reasons for your wants and feelings.
Take the other person's point of view and then summarize your understanding of what he or she wants and
feels and the reasons for his or her wants and feelings.
5. Think of several ways to solve the conflict in a way that works for both parties (create win-win options).
6. Choose the best way and make an agreement to do it.
7. Get outside help if unable to resolve the conflict.
Mediation
Mediation is a problem-solving process in which the two parties in the dispute are assisted by a neutral third party
known as the "mediator". Face to face meetings of the parties involved, or their representatives, occur during the
mediation process.
CRITERIA FOR INTERPERSONAL COMMUNICATION SKILLS


Show dialogue that express needs, ideas, and opinions.
Message tactics and strategies: clear, organized ideas or beliefs, use of “I” message, tone-respectful vs.
aggressive and confrontational, body language
 Demonstrate effective refusals: clear “no” statement, walk away, provide a reason, delay, change the
subject, repeat refusal, provide an excuse, put it off, etc.
 Use appropriate and effective verbal and nonverbal strategies: body language, appropriate, respectful tone of
voice, attentive listening.
COMMUNICATION (cont.)
GENERIC SKILLS RUBRIC:
4 – The response is complex, accurate, and comprehensive.
3 – The response identifies relationships between two or more health concepts;
is some breadth of information, although there may be minor inaccuracies.
2 - The response presents some accurate information about the relationships
between health concepts, but the response is incomplete and there are some
inaccuracies.
1 - The responses addresses the assigned task but provides little or no accurate
information about the relationships between health concepts.
NHES 5: DECISION-MAKING
Students will demonstrate the ability to use decision-making skills to enhance health.
Development of Decision-Making skills is needed by students to help them make health-enhancing choices, to choose
behaviors that promote health and reduce the risk of illness and injury. These skills include the recognition of need and
understanding of how to make a decision. Decision-making skills are needed to improve health status in each of the
health education content areas
Decision-making includes applying the all steps of a decision-making process (Steps listed below). Students demonstrate
appropriate application of this skill when they can show the steps of making a good decision, can demonstrate that
alternative actions were considered and that they considered whether or not they were making a good decision.
Activities that can help build this skill include: creating a wellness plan, a fitness calendar, or role-playing scenarios using
the decision-making process. (from: Assessing Health Literacy: A Guide to Portfolios).
Steps of Decision Making
Decision-making involves choosing between alternative courses of action to deal with a problem. Steps in the DecisionMaking Process:
1.
2.
3.
4.
Analyze the situation. Define what is happening. Get input from others. Be objective rather than emotional.
Define the problem. Don't deal with symptoms, but focus on the actual problem.
Consider options / Develop solution alternatives. Each alternative must solve the problem.
Evaluate the solution alternatives. Look at both the positive and the negative consequences of each alternative.
Some alternatives will have fewer "side effects", or unintended consequences. Get input from others if needed.
5. Make a choice / decision. Make the choice that has the least negative consequences and that solves the
problem, accomplishes the purpose, and meets the goal.
6. Implement the plan and evaluate the decision. Make changes in the plan if needed, again using the steps of the
decision-making process.
Teaching Decision Making
Many students are not accustomed to breaking down the decision making process. To make this process relevant,
remind students that decision-making and problem solving are things they do several times a day.
Some students may resist employing a structured decision-making process, because they think it takes too much time or
is too "mechanical" and does not allow spontaneity. For most minor decisions, a formal decision-making process is not
necessary. However, using a decision-making model in complex situations can help people avoid serious negative
consequences. Becoming a good decision-maker doesn't mean people lose the ability to have fun or to do things "on a
DECISION-MAKING: Steps of Decision-Making (Cont.)
whim." Rather, it means they look before they leap and are fully aware of their options. There are many types of
decision-making/problem-solving models, and they are all more alike than different. If students have already been
exposed to decision-making or problem-solving models, this one is similar and contains the same important ideas. These
models provide only a framework for making decisions. It is appropriate at times to skip certain steps or to compress
others. Steps may vary slightly at different grade levels.
Step 1: Define the problem to be solved. This includes thinking about the facts of the situation as well as the feelings
of people directly involved.
Step 2: Generate at least three options or alternative courses of action. We often feel stressed about major decisions
because we are only thinking of two solutions. In fact, there may be ten ways to solve that problem
effectively. This is why it is so important to spend some time gathering information related to the problem.
Step 3: Think about the positive and negative consequences of each option. This may include answering questions
such as: What are my responsibilities to my parents? What are my feelings and fears about each option? In
addition to the positive and negative consequences of decisions, we often have to consider the questions of
short-term and long- term consequences. For example: If Sam saw his buddy purchase steroids from a high
school student, Sam might decide not to confront his friend. Sam might believe that this is a positive
consequence, because he did not jeopardize the friendship. However, this is a short-term positive
consequence, and Sam might not feel positive about his decision later. (Consider: Is the option Safe? Legal?
Healthful? Respectful to self and others? Does it follow the Guidelines of Responsible Adults? Does it show
Good Character Traits?
Step 4: List others affected by these options and describe any feelings, emotions, or values that may be in conflict
with the options you have named. This step allows time to think about the other "key players" involved. Major
decisions usually involve others in a meaningful way.
Step 5: After weighing all the options, choose the best one.
Step 6: Design a plan of action to carry out this decision. For example: Sam has chosen a drug free lifestyle, but still
wants to hang out with his friends. There is a party in his neighborhood next week. Sam should get as much
information about the upcoming party as possible, so he could have fun and be safe. Knowing drugs might be
there, he could plan to practice refusal skills and also plan to have several drug-free friends meet him at the
party.
Step 7: Evaluate your decision. How did it work out? Were there any consequences you had not thought about
before? What would you do differently next time?
*Note there are a variety of decision-making models. This is not the only one, but it is comprehensive.
Consensus Decision Making
Consensus decision-making is a group problem-solving process in which all of the parties in the dispute, or
representatives of each party, work together to resolve the dispute. A plan of action is created that all parties can and
will support. Consensus decision-making may or may not be facilitated by a neutral party.
DECISION-MAKING (Cont.)
KEY CRITERIA FOR DECISION-MAKING SKILLS





Show all the steps of the decision-making model used.
Identify the decision to be made.
Identify options and possible consequences.
State the decision clearly.
Evaluate and reflect on the decision.
GENERIC SKILLS RUBRIC:
4 – The response is complex, accurate, and comprehensive.
3 – The response identifies relationships between two or more health concepts;
is some breadth of information, although there may be minor inaccuracies.
2 - The response presents some accurate information about the relationships
between health concepts, but the response is incomplete and there are some inaccuracies.
1 - The responses addresses the assigned task but provides little or no accurate
information about the relationships between health concepts.
NHES 6: Goal Setting
Goal-setting is essential to acting upon the decisions an individual makes. Students demonstrate understanding of goalsetting skills when they can chose a reachable goal and develop a plan with several steps to reach it, then reconsider to
see if the plan is helping to reach the goal.
Goal-setting Process: The process of setting goals includes making a clear goal statement that defines a realistic goal, a
plan for reaching the goal, and a reward for when the goal is reached. There are a variety of processes that can be used
to set goals. Important goal-setting steps include:
1.
2.
3.
4.
5.
6.
Set a goal. (Specific, Measurable, Attainable, Realistic, Time included)
Look at options to meet the goal.
Establish a plan.
Think about rewards for reaching the goal.
Monitor your progress toward the goal.
Evaluate progress. If needed, adjust the goal and redo the plan.
KEY CRITERIA FOR GOAL-SETTING SKILLS




Show all the steps in a goal-setting process.
Write a clear, specific, measurable goal statement.
Be certain the goal is realistic.
Show how to evaluate and adjust the goal’s action plan, if needed.
GENERIC SKILLS RUBRIC:
4 – The response is complex, accurate, and comprehensive.
3 – The response identifies relationships between two or more health concepts;
is some breadth of information, although there may be minor inaccuracies.
2 - The response presents some accurate information about the relationships
between health concepts, but the response is incomplete and there are some inaccuracies.
1 - The responses addresses the assigned task but provides little or no accurate
information about the relationships between health concepts.
NHES 7: SELF MANAGEMENT
Students will demonstrate the ability to practice health-enhancing behaviors and avoid or reduce health risks.
Having self-management skills "means following specific steps or actions for safety, hygiene and stress management.” A
student demonstrates appropriate application of this skill when he / she can show the correct steps to take in an
emergency, the actions to avoid risk and stay safe, the habits to develop to stay healthy, and the ways to keep stress
from having an unhealthy impact. Some examples of activities that build this skill include demonstrations, interviews,
role plays. (from: Assessing Health Literacy: A Guide to Portfolios).
Examples of self-management strategies:



Stress Management
First Aid Prevention and Care
Recommendations for Brushing and Flossing
KEY CRITERIA FOR SELF-MANAGEMENT SKILLS
 Demonstrate habits that contribute to health.
 Describe or demonstrate specific first aid and safety techniques.
 Identify strategies to avoid or manage unhealthy or dangerous situations.
 List the steps in the correct order, if there are steps.
GENERIC SKILLS RUBRIC
4 - The response shows evidence of the ability to apply health skills; the response is complete
and shows proficiency in the skill.
3 - The response shows evidence of the ability to apply health skills; the response is mostly
complete but may not be fully proficient.
2 - The response shows some evidence of the ability to apply health skills; the response may
have inaccuracies or be incomplete.
1 - The response shows little or no evidence of the ability to apply health skills.
NHES 8: ADVOCACY
Students will demonstrate the ability to advocate for personal, family, and community health.
Advocacy involves feeling passionately about behaviors that are healthy and encouraging family, friends, and/or
community members to make healthy choices. Students demonstrate appropriate application of advocacy when they
can demonstrate they believe in a health message, understand the purpose of the message, provide appropriate reasons
why the message is healthful, and promote the message/behavior by expressing accurate, comprehensive information
that supports the message/ behavior.
Some examples of activities that help to build this skill include: brochures, shirts, songs, posters with healthful
messages/ information/ resources. (from: Accessing Health Literacy: A Guide to Portfolios)
KEY CRITERIA FOR ADVOCACY SKILLS
 Take a clear stand for a healthy choice.
 Explain why the stand taken is healthy.
 Use accurate, current information to support the choice.
 Show awareness of the audience for the message.
 Be persuasive.
 Show conviction about the health message.
ADVOCACY (cont.)
GENERIC SKILLS RUBRIC
4 - The response shows evidence of the ability to apply health skills; the response is complete
and shows proficiency in the skill.
3 - The response shows evidence of the ability to apply health skills; the response is mostly
complete but may not be fully proficient.
2 - The response shows some evidence of the ability to apply health skills; the response may
have inaccuracies or be incomplete.
1 - The response shows little or no evidence of the ability to apply health skills.