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##  Preparing Classroom Teachers for Delivering Health Instruction. ERIC            Digest.                                                                      

Children's health and learning are unquestionably linked. Healthy               children are more able to learn and achieve academic success.                   According to one study comparing students at low and high risk for              food insufficiency, students who were undernourished scored lower on            math tests, were more likely to have been suspended from school, and            had more problems getting along with others (Alaimo, Olson, &                   Frongillo, 2001). Conversely, schools that offer physical education             and health education produce students with higher scores on tests of            reading, writing, and mathematics; higher grade point averages; and             better attendance than comparable schools without an emphasis on                health (Improving Academic Performance, 2000). 
Schools are often              described as being ideal environments for teaching children about               health because they provide access to large numbers of children, are            staffed by professionally trained educators and nurses, and                     frequently offer services that promote health, such as nutrition                programs and health centers.  This digest examines the preparation              of classroom teachers in health and what teachers should know to                effectively provide school health education. WHO TEACHES                      HEALTH?About 90% of the states and school districts in the                  United States require some health education for students (Marx,                 2001, in press). Fewer than 20% of states and districts require                 health to be taught as a separate subject at the elementary level;              28-44% require a separate subject at the middle school level; and               more than half require a separate subject in high school. 
In U.S.             elementary schools (grades kindergarten through 5 or 6), health                 education is most commonly taught by regular classroom teachers                 rather than trained health education specialists. In middle                     schools (grades 6-8), health is often taught by regular classroom               teachers who have obtained certification in health, science, home               economics, or physical education.  At the high school level (grades             9-12), health education is most often taught by teachers with a                 health credential. According to the results of the School Health                Policies and Programs Study (2000), health education specialists are            the only teachers who teach required health education in 25.8% of               the senior high schools in the United States (Kann, Brener, &                   Allensworth, 2001).  However, the 50 states vary widely in the                  requirements for obtaining that credential.  The evidence is clear:             regular classroom teachers have a significant influence on the                  quantity and the quality of health education.  In addition, at all              levels of education, trusted teachers of any subject may be seen as             health resources by students who need information. HOW WELL ARE               TEACHERS PREPARED IN HEALTH?Teacher licensure or                            certification (academic and other requirements teachers must meet to            get a teaching certificate) is governed by the states, and each                 state may have different regulations for what teachers need to know             to become licensed or certified.  A 1999 survey found that only                 eight states require coursework in health for prospective elementary            teachers, and four states require health or physical education                  coursework; 16 states require elementary teachers to demonstrate                competency or knowledge of health.  Half of the states require                  coursework in health for middle school teachers (Marx, 2002, in                 press). 
About half of the teacher training programs in the United             States are approved by the National Council for Accreditation of                Teacher Education (NCATE).   The NCATE recently released new Program            Standards for Elementary Teacher Preparation, which state (in                   standard 2g) that teacher education candidates "must know,                      understand, and use the major concepts in the subject matter of                 health education to create opportunities for student development and            practice of skills that contribute to good health"  (NCATE, 2000).              This standard can be met in a different way by each teacher                     education institution.   Some institutions require one or more                  health courses for teacher education students, while others justify             using first aid or psychology courses to meet health requirements.              It's no surprise that first year elementary school teachers report              considerable discomfort when teaching health education (Hausman &               Ruzek, 1995). 
Lack of teacher preparation has been called "a major            obstacle to implementing high-quality school health                             instruction" (Peterson, Cooper, & Laird, 2001).  Inservice training             cannot make up for this. For example, a CDC study examining HIV/AIDS            education found that in states mandating HIV prevention education,              only one-third of teachers attended inservice training on the topic             in the past two years (School-based HIV prevention education,                   1994). WHAT HINDERS TEACHER PREPARATION IN HEALTH?Several                 factors may account for poor teacher preparation in health: 
*                 Lack of time in the teacher education curriculum.  The increased                demands placed on teacher education programs to produce teachers who            are competent in numerous subject areas, as well as proficient in               classroom management, technology, and multicultural education,                  results in fewer hours to devote to subjects seen as less important,            such as health. 
*  Emphasis on standardized testing.  Teacher                 education programs must produce teachers who are able to prepare                students to take state-mandated standardized tests in math, reading,            science, social studies, and several other areas. Subjects like                 health, for which standardized testing is rare, may be de-emphasized            in favor of devoting more time to subjects that are tested. 
*                 Lack of comfort.  Health education includes many sensitive and                  controversial topics.  Teacher education faculty may find it                    difficult to overcome their own discomfort with these topics and                fail to prepare student teachers adequately to address such                     topics. WHAT SHOULD TEACHERS KNOW ABOUT HEALTH AND HEALTH                     INSTRUCTION?Teachers who will be providing health education need            to have teacher health literacy. This is defined as, "the capacity*             to obtain, interpret, and understand basic health information and               services, with the competence to use such information and services              in ways that enhance the learning of health concepts and skills by              school students" (Peterson et al., 2001). 
There is no nationally              recognized standard for teacher preparation in health education to              achieve health literacy.  However, several groups have developed                what they believe such a standard should be. 
*  The Institute of              Medicine issued a report in 1997 that recommended substantive                   preservice preparation in health education content and methodology              for all elementary teachers.  "This preparation should give                     elementary generalist teachers strategies for infusing health                   instruction into the curriculum and prepare upper elementary                    teachers to lay the groundwork for the intensive middle or junior               high health education program" (Allensworth,   1997, p. 142). 
*               The American Cancer Society convened a conference in 1992 that made             two recommendations for PreK-12 teacher preparation: that all                   teacher preparation programs include content and process courses in             health instruction, and that K-6 student teachers in regular and                special education be supervised by a health educator or health                  coordinator when teaching health lessons.  The full report is                   printed in the Journal of School Health, January 1993, vol. 63, No.             1. 
*  The American Association for Health Education (AAHE) has                developed Health Instruction Responsibilities for Elementary (K-6)              Classroom Teachers, and Responsibilities of Teachers of Young                   Adolescents in Coordinated School Health Programs for Middle                    School-Level (Grades 5-9) Classroom Teachers. AAHE suggests there               are five responsibilities and 17 competencies at the elementary                 level and eight responsibilities and 27 competencies at the middle              school level. To access these, visit their web site                             www.aahperd.org/aahe/aahe-main.html. 
The competencies in health               education that are generally recommended for elementary, middle                 school, and special education teachers include (Peterson et al.,                2001): 
*  Use the National Health Education Standards.  Forty of              the 50 states use the National Health Education Standards in                    curriculum planning (Bennett, Perko, & Herstine, 2000). 
*                     Demonstrate knowledge of community health, consumer health,                     environmental health, family life, mental and emotional health,                 injury prevention and safety, nutrition, personal health, disease               prevention and control, and alcohol, tobacco, and other drugs. 
*              Incorporate health concepts into other curricular areas. 
* Develop            age-appropriate and culturally relevant health lessons. 
* Help                children develop not only health knowledge but health skills. 
*               Select and use valid and reliable sources of health                             information. 
These competencies may be met by requiring a separate            health course for preservice teachers or by integrating health                  education into other curricular areas in the teacher education                  program (Pateman, 2002; in press).   For example, a children's                  literature course might include readings from books dealing with                specific diseases, death, and customs.  A math methods course might             teach math concepts using health data from federal health                       databases. CONCLUSIONSome type of health education,                       or "hygiene," has been a part of American public education for over             100 years. Regular classroom teachers are the backbone of school                health instruction, particularly at the elementary level. Thus,                 colleges and universities can directly impact the quality of health             instruction in our public schools by addressing key standards for               health education and incorporating important health concepts into               their teacher preparation curriculum. REFERENCESReferences                identified with an EJ or ED number have been abstracted and are in              the ERIC database. Journal articles (EJ) should be available at most            research libraries; most documents (ED) are available in microfiche             collections at more than 900 locations. Documents can also be                   ordered through the ERIC Document Reproduction Service: (800)                   443-ERIC. 
Alaimo, K., Olson, C.M., & Frongillo, E.A., Jr. (2001).             Food insufficiency and American school-aged children's cognitive,               academic, and psychosocial development. Pediatrics, 108(1),                     44-53. 
Allensworth, D., Lawson, E., Nicholson, L., & Wyche,                   J. (Eds). (1997).  Schools & health: Our nation's investment.                   Washington DC: National Academy Press.  ED 425 801. 
Bennett, J.P.,            Perko, M.A., & Herstine, J.H. (2000).  1988-1998 national practices             in K-12 health education and physical education teacher                         certification.  Journal of Health Education, 31(3),                             143-14. 
Hausman, A.J., & Ruzek, S.B. (1995).  Implementation of               comprehensive school health education in elementary schools: Focus              on teacher concerns.  Journal of School Health, 65(3), 81-86.  EJ               505 813. 
Improving academic performance by meeting student health             needs. (2000, October 13). National Governors' Association Issue                Brief. Available online at                                                      http://www.nga.org/cda/files/001013PERFORMANCE.pdf 
Kann, L.,                  Brener, N.D., & Allensworth, D.D. (2001).  Health education: Results            from the School Health Policies and Programs Study (2000).  Journal             of School Health, 71(7), 266-278. 
Marx, E. (2002; in press).                  Matching expectations: What states say that young people need to                know about health and HIV and how well teachers are prepared to                 provide it.  Washington, DC: AACTE. 
National Action Plan for                  Comprehensive School Health Education. (1993, January).  Journal of             School Health, 63(1), 46-66. EJ 469 780. 
National Council for                 Accreditation of Teacher Education [NCATE]. (2000).  Program                    standards for elementary teacher preparation. Washington, DC:                   Author.  Available online at http://www.ncate.org 
Pateman,                    B. (2002; in press).  Linking national subject area standards with              priority health-risk issues in PK-12 curricula and teacher education            programs.  Washington, DC: AACTE. 
Peterson, F.L., Cooper, R.J., &             Laird, J.M. (2001). Enhancing teacher health literacy in school                 health promotion: A vision for the new millennium. American Journal             of School Health, 71(4), 138-144.  EJ 625 708. 
School-based HIV               prevention education - United States, 1994. (1996).  Morbidity and              Mortality Weekly Reports, 45(35), 760-766. 
ADDITIONAL                         RESOURCES 
The Division of Adolescent and School Health (DASH) of              the Centers for Disease Control and Prevention (CDC) has numerous               publications on school health.  Their web address is                            www.cdc.gov/nccdphp/dash/index.htm.  CDC also publishes Programs                that Work at                                                                    www.cdc.gov/nccdphp/dash/rtc/hiv-curric.htm 
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This project              has been funded at least in part with Federal funds from the U.S.               Department of Education, Office of Educational Research and                     Improvement, under contract number ED-99-COO-0007.  The content of              this publication does not necessarily reflect the views of or                   policies of the U.S. Department of Education nor does mention of                trade names, commercial products, or organizations imply endorsement            by the U.S. Government.                                                      **Title:** Preparing Classroom Teachers for Delivering Health Instruction. ERIC            Digest.                                                                      **Document Type:** Information Analyses---ERIC Information Analysis Products (IAPs) (071); Information Analyses---ERIC Digests (Selected) in Full Text (073); **Available From:** ERIC Clearinghouse on Teaching and Teacher Education, American                  Association of Colleges for Teacher Education, 1307 New York Ave.,              N.W., Suite 300, Washington, DC 20005-4701. Tel: 202-293-2450; Tel:             800-822-9229 (Toll Free); e-mail: [email protected]. For full text:               http://www.ericsp.org.                                                       **Descriptors:** Elementary Secondary Education,  Health Education, Higher Education,            Preservice Teacher Education, Teacher Certification,  Teacher                   Competencies                                                                 **Identifiers:** ERIC Digests,  Health Educators                                              
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