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COMPREHENSIVE SCHOOL
HEALTH EDUCATION
TOTALLY AWESOME STRATEGIES
FOR TEACHING HEALTH™
This page intentionally left blank
COMPREHENSIVE SCHOOL
HEALTH EDUCATION
TOTALLY AWESOME STRATEGIES
FOR TEACHING HEALTH™
Ninth Edition
Linda Meeks
Emeritus Professor, The Ohio State University
Philip Heit
Emeritus Professor, The Ohio State University
Randy Page
Professor, Brigham Young University
Phillip Ward
Professor, The Ohio State University
Material from Comprehensive School Health Education: Totally Awesome Strategies for Teaching
Health™ may be reproduced by the teacher for his or her individual classroom use only.
Material from this publication may not be adapted or reproduced, in part or whole, for other
teachers or classrooms, or for inclusion in curriculum guides, other printed works, and other
forms of media, without prior written permission from The McGraw-Hill Companies, Inc.
©McGraw-Hill Education
COMPREHENSIVE SCHOOL HEALTH EDUCATION: TOTALLY AWESOME STRATEGIES FOR
TEACHING HEALTH, NINTH EDITION
Published by McGraw-Hill Education, 2 Penn Plaza, New York, NY 10121. Copyright ©2020 by McGraw-Hill
Education. All rights reserved. Printed in the United States of America. Previous editions ©2013, 2011, and
2009. No part of this publication may be reproduced or distributed in any form or by any means, or stored in a
database or retrieval system, without the prior written consent of McGraw-Hill Education, including, but not
limited to, in any network or other electronic storage or transmission, or broadcast for distance learning.
Some ancillaries, including electronic and print components, may not be available to customers outside the
United States.
1 2 3 4 5 6 7 8 9 QVS 21 20 19
All credits appearing on page or at the end of the book are considered to be an extension of the copyright
page.
Names: Meeks, Linda Brower, author. | Heit, Philip, author. | Page, Randy M., author. |
Ward, Phillip, 1957- author.
Title: Comprehensive school health education : totally awesome strategies for teaching health / Linda Meeks,
Philip Heit, Randy Page, Phillip Ward.
Description: Ninth edition. | New York, NY : McGraw-Hill Education, [2020] | Includes bibliographical
references and index.
Identifiers: LCCN 2018056962 | ISBN 9780078028632 (alk. paper) | ISBN 0078028639 (alk. paper) |
ISBN 9781260137309 (loose-leaf edition) | ISBN 1260137309 (loose-leaf edition)
Subjects: LCSH: Health education (Secondary) | Health education (Elementary)
Classification: LCC RA440 .M447 2020 | DDC 613.071/2—dc23 LC record available at https://lccn.loc
.gov/2018056962
The Internet addresses listed in the text were accurate at the time of publication. The inclusion of a website
does not indicate an endorsement by the authors or McGraw-Hill Education, and McGraw-Hill Education
does not guarantee the accuracy of the information presented at these sites.
mheducation.com/highered
BRIEF CONTENTS
SECTION 1 Chapter 11 Communicable and Chronic
Diseases 279
Comprehensive School Health
Education 1 Chapter 12 Consumer and Community
Health 303
Chapter 1 A Nation at Risk:
The Need for Chapter 13 Environmental Health 327
Comprehensive School Chapter 14 Injury Prevention and
Health Education 3 Safety 346
Chapter 2 School Health Services
and Healthful School SECTION 3
Environment:
Promoting and Protecting Totally Awesome Teaching
Health and Safety 27 Strategies™ 373
Chapter 3 The Comprehensive Chapter 15 Using the Totally Awesome
School Health Education Teaching Strategies™ 375
Curriculum:
A Blueprint for Implementing SECTION 4
the National Health Education
Standards 47
The Meeks Heit K–12 Health Education
Curriculum Guide: A Model for
Chapter 4 Instructional Strategies Implementing the National Health
and Technologies: Education Standards 683
Motivating Students to
Chapter 16 Using the Meeks Heit K–12
Learn 75
Health Education Curriculum
Guide 685
SECTION 2
Health Content 91 APPENDIXES
Chapter 5 Mental and Emotional Appendix A National Health Education
Health 93 Standards: Teaching
Masters A–1
Chapter 6 Family and Social
Health 121 Appendix B The Teacher’s Encyclopedic
Guide for Health Concerns
Chapter 7 Growth and of School-Age Youths . . .
Development 160 from A to Z A–34
Chapter 8 Nutrition 187 Appendix C Health Resources A–55
Chapter 9 Personal Health and
Physical Activity 214 Glossary G–1
Chapter 10 Alcohol, Tobacco, and Other
Drugs 245 Index I–1
©McGraw-Hill Education v
CONTENTS
Preface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xviii Implementing the Comprehensive
School Health Education
Curriculum . . . . . . . . . . . . . . . . . . . . . . . . . 23
SECTION 1
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Comprehensive School
Health Education. . . . . . . . . . . 1
CHAPTER 2
vi ©McGraw-Hill Education
Contents vii
©McGraw-Hill Education
viii Contents
©McGraw-Hill Education
Contents ix
Using Social Media to Stay Health Goal #13: I Will Make Healthful
Connected as a Stressor. . . . . . . . . . . . . . 109 Adjustments to Family Changes. . . . . . . . . . . . . 127
Stress Management Skills. . . . . . . . . . . . . . . 109
Marital Stress and Conflict . . . . . . . . . . . . . 127
Parental Divorce. . . . . . . . . . . . . . . . . . . . . . 128
Health Goal #7: I Will Seek Help
Adjustments to Divorce. . . . . . . . . . . . . . . . . 129
If I Feel Depressed. . . . . . . . . . . . . . . . . . . . . . 110
Single-Custody Families. . . . . . . . . . . . . . . . 130
Recognizing Depression. . . . . . . . . . . . . . . . . 110 Remarriage of a Parent. . . . . . . . . . . . . . . . . 130
Childhood and Adolescent Other Situations Requiring
Depression. . . . . . . . . . . . . . . . . . . . . . . . . . 110 Adjustment. . . . . . . . . . . . . . . . . . . . . . . . . 131
Facebook Depression Study. . . . . . . . . . . . . . 111
Treatment for Depression. . . . . . . . . . . . . . . . 112 Health Goal #14: I Will Develop
Coping with Depression. . . . . . . . . . . . . . . . . 113 Healthful Friendships. . . . . . . . . . . . . . . . . . . . 131
Initiating Friendships . . . . . . . . . . . . . . . . . . 132
Health Goal #8: I Will Use Suicide
Balanced Friendships . . . . . . . . . . . . . . . . . . . 133
Prevention Strategies When Appropriate. . . . . . . 113
Ending Friendships. . . . . . . . . . . . . . . . . . . . . 133
Suicide Prevention. . . . . . . . . . . . . . . . . . . . . . 113 Friendships and Social Media. . . . . . . . . . . . 133
Health Goal #9: I Will Cope with Health Goal #15: I Will Develop
Loss and Grief in Healthful Ways . . . . . . . . . . . 115 Dating Skills. . . . . . . . . . . . . . . . . . . . . . . . . . 134
Loss and Grief. . . . . . . . . . . . . . . . . . . . . . . . . 115 Dating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
Causes of Loss and Grief. . . . . . . . . . . . . . . . 115 Establishing Dating Standards. . . . . . . . . . . 134
Drug and Alcohol Use and Loss Dating Skills . . . . . . . . . . . . . . . . . . . . . . . . . 136
and Grief. . . . . . . . . . . . . . . . . . . . . . . . . . . 116 Dating and Online Contacts. . . . . . . . . . . . . 137
Five Stages of Loss and Grief. . . . . . . . . . . . . 116
Dealing with a Terminal Illness. . . . . . . . . . . 116 Health Goal #16: I Will Practice
Healthful Ways to Respond Abstinence from Sex. . . . . . . . . . . . . . . . . . . . . 137
to a Loss. . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Benefits of Abstinence from Sex. . . . . . . . . . 137
Setting Limits for Expressing
Health Goal #10: I Will Be Resilient
Physical Affection. . . . . . . . . . . . . . . . . . . 138
in Difficult Times. . . . . . . . . . . . . . . . . . . . . . . 118
Resisting Negative Peer Pressure
to Be Sexually Active . . . . . . . . . . . . . . . . 138
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
Changing Behavior. . . . . . . . . . . . . . . . . . . . 139
Using Technology to Talk
CHAPTER 6 to Teens about Sex. . . . . . . . . . . . . . . . . . . 140
Family and Social Health. . . . 121 Health Goal #17: I Will Recognize
Harmful Relationships . . . . . . . . . . . . . . . . . . . 140
Health Goal #11: I Will Develop Harmful Ways of Relating. . . . . . . . . . . . . . . 140
Healthful Family Relationships . . . . . . . . . . . . . 121 What to Do about Harmful
Relationships. . . . . . . . . . . . . . . . . . . . . . . . 142
A Word from the Authors. . . . . . . . . . . . . . . . 121
The Healthful Family . . . . . . . . . . . . . . . . . . 122 Health Goal #18: I Will Develop
Skills Learned in a Healthful Skills to Prepare for Marriage. . . . . . . . . . . . . . 142
Family . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122
Preparing for Marriage. . . . . . . . . . . . . . . . . . 142
Health Goal #12: I Will Work Predicting Success in Marriage . . . . . . . . . . . 143
to Improve Difficult Family Marriage Commitment. . . . . . . . . . . . . . . . . . 143
Relationships. . . . . . . . . . . . . . . . . . . . . . . . . . 124 Teen Marriage Is Risky. . . . . . . . . . . . . . . . . 144
Family Relationships. . . . . . . . . . . . . . . . . . . 124
Health Goal #19: I Will Develop
Dysfunctional Family
Skills to Prepare for Parenthood . . . . . . . . . . . . 145
Relationships. . . . . . . . . . . . . . . . . . . . . . . 124
Recognizing Codependence. . . . . . . . . . . . . 125 Things to Consider before
Improving Dysfunctional Becoming a Parent . . . . . . . . . . . . . . . . . . . 145
Family Relationships. . . . . . . . . . . . . . . . . 127 Responsible Parenting. . . . . . . . . . . . . . . . . . 146
©McGraw-Hill Education
x Contents
Growth and Development. . 160 Health Goal #28: I Will Achieve the
Developmental Tasks of Adolescence . . . . . . . . . 178
Health Goal #21: I Will Keep
My Body Systems Healthy. . . . . . . . . . . . . . . . . 160 Health Goal #29: I Will Develop
Nervous System. . . . . . . . . . . . . . . . . . . . . . . . 161 Habits That Promote Healthful Aging . . . . . . . . 180
Cardiovascular System . . . . . . . . . . . . . . . . . . 161 Physical Changes in Middle
Immune System. . . . . . . . . . . . . . . . . . . . . . . . 162 and Late Adulthood . . . . . . . . . . . . . . . . . 180
Respiratory System. . . . . . . . . . . . . . . . . . . . . 162 Mental Changes in Middle
Skeletal System . . . . . . . . . . . . . . . . . . . . . . . . 163 and Late Adulthood . . . . . . . . . . . . . . . . . . 181
Muscular System. . . . . . . . . . . . . . . . . . . . . . . 163 Social Changes in Middle
Endocrine System. . . . . . . . . . . . . . . . . . . . . . 163 and Late Adulthood . . . . . . . . . . . . . . . . . . 182
Digestive System. . . . . . . . . . . . . . . . . . . . . . 164 Habits That Promote Healthful Aging. . . . . . 182
Urinary System. . . . . . . . . . . . . . . . . . . . . . . . 165 Protecting the Brain in
Integumentary System. . . . . . . . . . . . . . . . . . . 165 the Later Years . . . . . . . . . . . . . . . . . . . . . . 182
Health Goal #22: I Will Recognize Habits Health Goal #30: I Will Share
That Protect Female Reproductive Health. . . . . . 166 with My Family My Feelings
Puberty in Females. . . . . . . . . . . . . . . . . . . . 166 about Dying and Death. . . . . . . . . . . . . . . . . . . 183
The Female Reproductive System . . . . . . . . . 167 Dying and Death. . . . . . . . . . . . . . . . . . . . . . . 183
The Menstrual Cycle. . . . . . . . . . . . . . . . . . . . 167 Grief. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
Female Reproductive Health. . . . . . . . . . . . . . 168 Helping Children and Adolescents
Deal with Tragedies and Loss. . . . . . . . . . 184
Health Goal #23: I Will Recognize
Habits That Protect Male References. . . . . . . . . . . . . . . . . . . . . . . . . . . . 186
Reproductive Health. . . . . . . . . . . . . . . . . . . . . 170
Puberty in Males. . . . . . . . . . . . . . . . . . . . . . . 170 CHAPTER 8
The Male Reproductive System . . . . . . . . . . . 171
Male Reproductive Health . . . . . . . . . . . . . . . 171 Nutrition. . . . . . . . . . . . . . . . . 187
Health Goal #24: I Will Learn about Health Goal #31: I Will Select
Pregnancy and Childbirth. . . . . . . . . . . . . . . . . 172 Foods That Contain Nutrients. . . . . . . . . . . . . . 187
Conception. . . . . . . . . . . . . . . . . . . . . . . . . . . 172 Proteins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188
Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 Carbohydrates. . . . . . . . . . . . . . . . . . . . . . . . 188
©McGraw-Hill Education
Contents xi
Health Goal #38: I Will Protect Health Goal #45: I Will Participate
Myself from Food-Borne Illnesses . . . . . . . . . . . 203 in Regular Physical Activity. . . . . . . . . . . . . . . . 228
Food-Borne Illnesses. . . . . . . . . . . . . . . . . . . 203 The Health Benefits of Regular
Food Safety. . . . . . . . . . . . . . . . . . . . . . . . . . 204 Physical Activity. . . . . . . . . . . . . . . . . . . . 229
Food Safety Offenders. . . . . . . . . . . . . . . . . . 205 Physical Activity Guidelines for Youth . . . . . 231
©McGraw-Hill Education
xii Contents
Health Goal #70: I Will Choose Behaviors Health Goal #77: I Will Make
to Reduce My Risk of Cancer. . . . . . . . . . . . . . . 300 Responsible Choices about Health
Care Providers and Facilities. . . . . . . . . . . . . . . 315
Cancer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 300
Cancer Treatment. . . . . . . . . . . . . . . . . . . . . 300 Health Care Providers. . . . . . . . . . . . . . . . . . . 315
Reducing the Risk of Cancer . . . . . . . . . . . . 301 Health Care Facilities. . . . . . . . . . . . . . . . . . . 316
Health Goal #76: I Will Analyze Health Goal #83: I Will Help
Ways Messages Delivered Keep the Air Clean. . . . . . . . . . . . . . . . . . . . . . 331
through Technology Might
Air Quality. . . . . . . . . . . . . . . . . . . . . . . . . . . . 331
Affect My Health Status. . . . . . . . . . . . . . . . . . 313
Air Pollution . . . . . . . . . . . . . . . . . . . . . . . . . . 331
Analyzing Social Media Sources of Air Pollution. . . . . . . . . . . . . . . . . 331
and Digital Media. . . . . . . . . . . . . . . . . . . . 314 Keeping the Air Clean . . . . . . . . . . . . . . . . . . 333
©McGraw-Hill Education
Contents xv
©McGraw-Hill Education
xvi Contents
CHAPTER 16
SECTION 3
Using the Meeks Heit
Totally Awesome K–12 Health Education
Teaching Strategies™. . . . . . 373 Curriculum Guide. . . . . . . . . 685
©McGraw-Hill Education
PREFACE
Tell me, I forget.
Show me, I remember.
Involve me, I understand.
Comprehensive School Health Education: Totally Awesome Section 3. Totally Awesome Teaching Strategies™
Strategies for Teaching Health™ has been the leading explains the format and how to use Totally Awesome
teacher resource book used to prepare future and current Teaching Strategies™ to help students develop and
elementary school, middle school, and secondary school practice life skills and achieve health goals. Chapter 15
teachers to teach health since the publication of the first includes Totally Awesome Teaching Strategies™ for each
edition in 1991. It also has been the most widely used grade level from K to 12 for each of the ten content areas.
teacher resource book selected by state departments of
education, school districts, and departments of health for Section 4. The Meeks Heit K–12 Health Education Curric-
inservice and train-the-trainers programs. As you read ulum Guide is a state-of-the-art curriculum guide focusing
about its contents, you will learn why teachers who pur- on the National Health Education Standards using the
chase it find it the most teacher-friendly resource book ten content areas. The Curriculum Guide in Chapter 16
available for health education. can be used as is or can be adapted for a specific school
district.
Section 1. Comprehensive School Health Education
includes four chapters and is designed to provide you Appendix A. National Health Education Standards:
with a framework for comprehensive school health educa- Teaching Masters provides reproducible masters with
tion. In Chapter 1, you will learn about the six categories steps for teaching each of the National Health Education
of risk behaviors that affect today’s students, guidelines Standards at age-appropriate grade levels: K–2, 3–5, 6–8,
for promoting school health, and the ten components and 9–12. Appendix B includes The Teacher’s Encyclope-
of the Whole School, Whole Community, Whole Child dic Guide for Health Concerns of School-Age Youth . . .
(WSCC) model. Chapter 2 prepares you for your role from A to Z. Appendix C includes Health Resources, a
in school health services and explains how to provide a listing of the names and contact information for agencies
healthful and safe school environment. Chapter 3 teaches and organizations in the ten health content areas.
you how to design comprehensive school health curric-
ula, implement the National Health Education Standards, For information about the resources available to instruc-
and effectively assess students, teachers, and school tors online, please see page xx.
health programs. Chapter 4 describes instructional strat-
egies and technologies you might use in the classroom.
We are committed to helping teachers with the awesome
task of providing quality health education.
Section 2. Health Content contains up-to-date health
knowledge in the ten areas of health: Chapter 5, Men-
tal and Emotional Health; Chapter 6, Family and Social Linda Meeks
Health; Chapter 7, Growth and Development; Chapter 8,
Nutrition; Chapter 9, Personal Health and Physical Philip Heit
Activity; Chapter 10, Alcohol, Tobacco, and Other Randy Page
Drugs; Chapter 11, Communicable and Chronic Dis-
eases; C hapter 12, Consumer and Community Health;
Phillip Ward
C hapter 13, Environmental Health; and Chapter 14,
Injury Prevention and Safety.
Brian Colwell, Ph.D. the American School Health Association (ASHA), and the
Associate Professor and Department Head Society of State Directors of Health, Physical Education
School of Rural Public Health and Recreation (SSDHPER).
Texas A&M University
College Station, Texas
NHES Revision Initiative
Dawn Graff-Haight, Ph.D., CHES
Professor and Chairperson
Advisory Panel
Health and Human Performance Steve Dorman
Linfield College Advisory Panel Chair
McMinnville, Oregon Texas A&M University
©McGraw-Hill Education
HIGHLIGHTS OF THIS EDITION
©McGraw-Hill Education
ABOUT THE AUTHORS
Linda Meeks and Philip Heit are emeritus professors in Walking Classic) in the world. Randy Page is a professor
the College of Education and Human Ecology at The of Health at Brigham Young University. He has written
Ohio State University. They have authored more than more than 75 articles in professional journals, consulted
350 health and wellness textbooks including Health with the Centers for Disease Control and Prevention,
and Wellness K-12, published by Glencoe/McGraw-Hill. and conducted research on adolescent health in the
Linda and Phil have helped state departments of educa- United States, Asia, Eastern Europe, and Latin America.
tion and numerous school districts develop comprehen- He is co-author of Totally Awesome Teaching Strategies for
sive school health education curricula and implement the Teaching Health™; Drugs, Alcohol, and Tobacco: Totally
National Health Education Standards. Their textbooks Awesome Teaching Strategies™; and Violence Prevention:
and curricula have been adopted in many languages Totally Awesome Teaching Strategies™ for Safe and Drug-
and foreign countries and they have trained teachers in Free Schools.
Egypt, J ordan, Greece, Japan, Germany, England, Spain,
Bermuda, Saudi Arabia, the Virgin Islands, and Puerto
Rico. Both Linda and Phil are active in promoting Phillip Ward is a professor in the Department of Human
health and well-being globally and locally. Linda serves Sciences at the Ohio State University where he teaches
on the Board of Directors for the International Women health and physical education to preservice and inser-
Presidents’ Organization and is active in global educa- vice teachers. He is a fellow of SHAPE America and the
tion as a member of the International Women’s Forum National Academy of Kinesiology. Ward has published
and supports its Presidents’ Circle Leadership Founda- more than 100 articles and 5 books; he has been invited
tion. Phil initiated and directs Healthy New Albany, a to speak in Belgium, China, Cyprus, Israel, Japan, Korea,
model community organization made up of residents Turkey, and throughout the United State. He is a co-author
of a community who set goals for fitness, nutrition, dis- of the recent SHAPE America and NAKHE policy report
ease prevention, mental health awareness, and safety on health and physical education teacher recruitment in
and coordinates the largest race walk (The New Albany the United States.
Comprehensive School
Health Education
A Nation at Risk
The Need for Comprehensive
School Health Education
P
erhaps no profession is more vital to the future This totally awesomeTM teacher resource book, Comprehen-
of this nation than teaching. Every teacher has sive School Health Education, was written by teachers, for
the potential to affect the lives of many stu- teachers who want to make a difference. The style of this
dents. Many students are at risk in ways that resource book is teacher-friendly and interactive. This is
influence their ability to learn. Some students lack ade- not a resource book to gather dust on your bookshelf; it is
quate nourishment, sleep, immunizations, and proper a resource book you can use. This chapter begins with a
clothing. Others are being reared in families in which review of the six categories of risk behaviors identified by
there is domestic violence, chemical dependency, or some the Centers for Disease Control and P revention (CDC).
other dysfunction. Still others are managing health con- You will learn more about the risk behaviors that compro-
ditions such as asthma, anorexia nervosa, or depression. mise the health status of today’s students.
Effective teachers are aware of the health status of their The purpose of the chapter is to introduce core elements
students and are committed to working with their stu- in today’s health education and to conclude by showing
dents to maintain and improve their health status. Teach- how Comprehensive School Health Education: Totally Awe-
ers must be positive role models for healthful living. some Strategies for Teaching Health™ provides teachers
And, of course, teachers must be motivated to create a with the resources to teach health education successfully.
dynamic and challenging classroom where students can The chapter begins with an overview of health risk behav-
learn and practice life skills and the National Health iors identified by the CDC. We then introduce the Whole
Education Standards. In other words, today’s teachers School, Whole Community, Whole Child (WSCC) model
must be totally awesomeTM. A Totally Awesome TeacherTM that represents a child-centered public health framework,
is committed to promoting health literacy, improving situating the child in the school and community contexts. It
health, preventing disease, reducing health-related risk is important for teachers to understand how school health
behaviors in students, and creating a dynamic and chal- education in the WSCC model is now tied to the educa-
lenging classroom where students learn and practice life tional mission of the school and to the larger community
skills and the National Health Education Standards. and public health contexts. Next, we discuss the school
Although this task demands training and effort, it has health education curriculum in the 21st century, and the
many rewards—the future of this nation depends on chapter finishes showing how the Meeks Heit Umbrella of
students being able to practice life skills for health and Comprehensive School Health Education connects core
achieve health goals. understandings about school health education together.
©McGraw-Hill Education
4 Section 1 Comprehensive School Health Education
Each year, more than 5,000 teens (aged sixteen to twenty) In addition, more than 17,000 people are injured in home
are killed in passenger vehicle crashes. This amounts to fires. Of the many who are hospitalized for severe burns,
a teen dying in a traffic crash an average of once every some are disfigured for life. Fires in the home are the lead-
hour on weekends and nearly once every two hours ing cause of death for children under the age of f ifteen.
during the week (National Highway Traffic Safety Admin-
istration, 2011). Teens also are involved in more than Children who live in homes without smoke and heat detec-
2 million nonfatal crashes each year (National Highway tors and those who live in below-standard housing are
Traffic Safety Administration, 2008). Although teen- especially vulnerable to fire-related injuries. Smoke detec-
agers between fifteen and twenty years of age make up tors cut in half the chance of dying in a home fire. The
only 6.3 percent of all licensed drivers, 12.9 percent of all National Fire Protection Association (2011a) estimates
the drivers involved in fatal crashes are in this age group. that 96 percent of homes have at least one smoke detec-
Driver fatalities for teens fifteen to twenty years of age tor installed. However, many homes have smoke detectors
increased by 3 percent between 1996 and 2006. For young that do not function properly, often because batteries
males, driver fatalities rose by 5 percent, compared with a are missing or not working. Injury prevention programs
3 percent decrease for young females (National Highway should work with children and parents so that they under-
Traffic Safety Administration, 2008). stand the importance of having smoke and heat detectors
installed in the home and checking the batteries regularly.
Inexperience, risk-taking behavior, immaturity, and greater Smoke alarms should be installed on every level of the
risk exposure place teens at high risk for being involved in home, including the basement, garage, and attic. They also
a motor vehicle crash. Driving a motor vehicle requires should be installed outside each sleeping area. New homes
complex skills that take time to develop. Safe driving are required to have a smoke alarm in each sleeping area
requires experience, technical ability, good judgment, and as well. Contrary to popular belief, the smell of smoke may
the avoidance of high-risk behaviors. High-risk behaviors not awaken a person who is sleeping. Instead, the poison-
such as speeding, inattention, talking on a cell phone or ous gases and smoke produced by a fire can numb the
text messaging, using portable entertainment devices (e.g., senses and put a person into a deeper sleep.
iPods), and driving under the influence of alcohol or other
drugs increase the likelihood of a crash. Peer pressure Many fatal home fires are caused by improper use and
often encourages risk taking. Driving at night and driving disposal of cigarettes. Children whose parents smoke
with other teens in the car increase the risk of a crash. cigarettes are at high risk of fatal fire injuries. An all-too-
Adolescents are much less likely to wear safety belts, com- common scenario is an adult who smokes falling asleep
pared to other age groups. Alcohol consumption is often with a lit cigarette. The risk of falling asleep is enhanced
a factor in motor vehicle crashes. Twenty-nine percent of when the person who smokes has been drinking alcohol.
drivers aged fifteen to twenty who died in motor vehicle Children playing with cigarette lighters and matches are
crashes had been drinking alcohol (National Center for also a significant cause of fires that result in fatalities, inju-
Injury Prevention and Control, 2009). Many teens expose ries, and property damage. Two of every five fires that kill
themselves to the effects of drinking and driving. Accord- young children are started by children playing with light-
ing to the Youth Risk Behavior Survey (Kann, McManus, ers or matches. Injury prevention programs should teach
Harris et al., 2016), 20 percent all high school students children how dangerous it is to play with matches and
report that in the past month they rode with a driver lighters. Another important means of protection against
who had been drinking alcohol, and 7.8 percent report fire injury is having a fire escape plan. A fire escape plan
driving after drinking alcohol (Kann, McManus, Harris should be set up in advance, include at least two differ-
et al., 2016). Adolescents are far less likely to use safety ent ways to escape from each room, and designate a place
belts than any other group. About one in sixteen (6.1 per- outside the home to meet.
cent) high school students report that they rarely or never
wear safety belts while riding in a car (Kann, McManus, Drowning
Harris et al., 2016). It is obvious that injury prevention Drowning is a leading cause of death from unintentional
programs must focus on teaching about the dangers of injury in today’s students. Drowning as a cause of death is
driving while talking on a cell phone or text messaging, highest among children five and under and among males
driving after drinking alcohol or using other drugs, riding ages fifteen to twenty-four. Many children who survive
in a car with someone who has been drinking or using near drownings suffer severe and permanent disability.
other drugs, and failing to use safety belts.
Many children and adolescents who drown are strong
Fires swimmers who became tired or were pulled under by the
Another leading cause of unintentional injuries in today’s current. Drowning also can result from boating accidents.
students is fire. Most fire-related deaths and injuries Many incidents of drowning occur in swimming pools and
occur in the home. Nearly 3,000 people die each year in hot tubs. Many young children are injured or drown in
home fires (National Fire Protection Association, 2011b). bathtubs, toilets, and sinks.
©McGraw-Hill Education
6 Section 1 Comprehensive School Health Education
Young children need to be observed closely when they TBI can affect the brain’s ability to think, perceive sensa-
are near swimming pools and other bodies of water. tions such as taste and smell, use language, and express
Many children who drown in swimming pools were out and feel emotion. TBI can also cause epilepsy and increase
of sight from adults for only five minutes or less. Adults the risk for other brain disorders such as Alzheimer’s dis-
can improve safety and reduce the risk of childhood ease and Parkinson’s disease. Repeated mild TBIs over
drownings by installing childproof enclosures to prevent time can impair thinking ability and the brain’s ability to
children from entering home swimming pools and whirl- function normally (NCIJ, 2011).
pools. Turn-off valves for swimming pools and hot tub
suction drains should be readily accessible in case a child Repetitive head impacts to children and youth playing
is held under by a suction drain. contact sports has become a significant public health
concern. There is increasing evidence that repetitive head
As children reach adolescence, they need to be educated impacts with or without concussion can lead to long-
about the dangers of participating in boating and other term neuropsychiatric and executive function challenges
water activities under the influence of alcohol or other and to degenerative chronic traumatic encephalopathy or
drugs. Many adolescent drownings occur in remote, CTE. This has become most prominent in football, but
unsupervised areas of lakes, rivers, canals, and the ocean. all sports where severe contact is possible such as basket-
The risks of swimming in these remote areas (e.g., rough ball, soccer, lacrosse, and field hockey place children and
waters, submerged rocks, strong undertow) increase youth at risk. Because initial engagement with the sports
when adolescents use alcohol or other drugs. Alcohol occurs between ages five and fourteen, there is concern of
use is involved in up to half of all adolescent drown- damage that can be done to a developing brain. Because
ings (National Center for Injury Prevention and Con- of the brain’s susceptibility to injury, a growing number
trol, 2010). Drinking alcohol impairs swimming ability, of scientists argue children should avoid playing sports
judgment, coordination, and balance, and the ability to such as tackle football (McCrory et al., 2013).
recover after being submerged. Alcohol also can delay
laryngospasm, a protective reflex that closes the opening TBIs can be minimized by wearing a seat belt when driving
to the lungs to prevent water from entering. or riding in a motor vehicle and buckling up children in child
safety seats and booster seats. Wearing a helmet during the
Traumatic Brain Injury following activities is important for preventing TBI: riding a
Traumatic brain injury (TBI) is a leading cause of death bicycle, motorcycle, snowmobile, scooter, or all-terrain vehi-
and disability in the United States, contributing each cle; playing a contact sport such as football, ice hockey, or
year to a substantial number of deaths, hospitalizations, boxing; using in-line skates or riding a skateboard; batting
emergency room visits, and cases of permanent disability and running bases in baseball or softball; riding a horse;
(Coronado et al., 2011). A TBI is a bump, blow, or jolt to or skiing and snowboarding. Making sure that the surface
the head or a penetrating head injury that disrupts the of children’s playgrounds is made of shock-absorbing mate-
normal functioning of the brain (National Center for rial, such as hardwood mulch or sand, is another means of
Injury Control, 2011). About three-quarters of the TBIs preventing TBIs in children (NCIJ, 2011).
that occur each year are concussions or other forms of
mild TBI. Children aged zero to four years and adoles- Other Unintentional Injuries
cents aged fifteen to nineteen years are among the age Other leading unintentional injuries that cause death and
groups most likely to sustain a TBI (Faul et al., 2010). injury include falls, suffocation, poisoning, and bicycling
accidents. Falls are the leading cause of injury and death
The severity of a TBI can range from mild to severe. Mild in the home. Most spinal cord injuries are the result of
could be a brief change in mental status or consciousness, falls. Young children are at particular risk of spinal cord
while severe could be an extended period of unconscious- injuries from falls because their sense of balance is not
ness or amnesia after the injury. The majority of TBIs fully developed. Teens injured by falls often have taken
that occur are concussions or other forms of mild TBI. unnecessary risks and may have ignored safety precau-
A concussion is a type of TBI that can change the way tions or have been showing off. Suffocation due to chok-
the brain normally works. In addition to being caused ing is the leading cause of death among infants. Young
by a bump, blow, or jolt to the head, concussions can children can choke on small objects they put in their
also occur from a blow to the body that causes the head mouths, such as small toys, coins, or food. Suffocation
to move rapidly back and forth. Most concussions occur also may be due to strangulation. Some children and
without a loss of consciousness. A concussion is a brain teens accidentally strangle themselves on material tied
injury and all concussions should be considered serious. around their necks, such as a scarf, that has caught on
Children and teens are more likely to get a concussion another object, such as a car door. Children also have
and take longer to recover from them than adults. Ath- been strangled on cords from window coverings, strings
letes who have already had a concussion are at increased on toys, ropes tied into lassoes, and pieces of clothing.
risk for another concussion (NCIJ, 2011). Most cases of poisoning in a home result from young
©McGraw-Hill Education
Chapter 1 A Nation at Risk 7
children swallowing household products and over-the- Carrying a gun increases the risk of injury due to acci-
counter drugs. Poisoning deaths and injuries also occur dents, the risk that a gun will be used to settle a fight, the
as a result of inhaling poisonous substances such as auto risk that it will be used in a crime, and the risk of it being
exhaust, airplane glue, gasoline, and carbon monoxide. used for suicide. Among adolescents fifteen to nineteen
Carbon monoxide is emitted from motor vehicles, stoves, years old, one in every four deaths is caused by a firearm.
heaters, lawn mowers, and chimneys. Most deaths and Fortunately, the rate of physical fighting and weapon
serious injuries due to bicycling involve head injuries. carrying among adolescents declined during the 1990s.
Therefore, it is imperative that children and teens be
instructed to wear bicycle safety helmets. The most seri- The United States has an average of seventeen youth homi-
ous injuries occur when bikes collide with motor vehicles. cides per day. The percentage of homicide victims fifteen
to nineteen years of age who are killed with a firearm is
Violence 82 percent. Homicide is the leading cause of death for
Unfortunately, many students are at risk for violence in African American youths and the second leading cause
their own homes. An estimated 3 million children per for Hispanic youths fifteen to twenty-four years of age
year are reported as victims of child abuse and neglect (National Center for Injury Prevention and Control, 2009).
to Child Protection Services (CPS) agencies. More than
1,500 children die from abuse each year (Child Welfare Suicide
Information Gateway, 2016). A family member is the Suicide is the third leading cause of death among teens
abusive person in a large proportion of child abuse cases. and also occurs among younger children. Young people
Many young people who are abused later become abu- who commit suicide usually have experienced depression,
sive when they are older and become parents if they have anger, hopelessness, alcohol and other harmful drug use,
not received counseling. A high proportion of violent family problems, and relationship problems for which
offenders in prison report that they were abused during they might have received help. Teen males are much more
childhood. likely to commit suicide than teen females. However, teen
females attempt suicide at a much higher rate than teen
Other forms of violence occur between students. males. Suicide rates are highest among white males. Rates
Today’s students are more likely to bully one another among young African American males have risen in
and to get into fights. Many teens have been bullied recent years. Nationwide, 17.7 percent of high school stu-
at one time or another. Bullying often leads to fight- dents (23.4 percent of females and 12.2 percent of males)
ing. The first e xperience children have with fighting is report considering suicide during the past twelve months
often a fistfight. According to the Youth Risk Behavior in the Youth Risk Behavior Survey (Kann, McManus,
Survey, 28.4 percent of male high school students and Harris et al., 2016). The majority of youths who attempt
16.4 percent of female high school students say that they suicide do not receive follow-up medical or mental health
have been in a fight within the past year; 2.9 percent of care. This places them at risk for making another suicide
students say that they have received medical treatment for attempt.
injuries from a fight in the past year (Kann, M cManus,
Harris et al., 2016).
Bullying, Cyberbullying, and Other Risks
Carrying a weapon increases the risk of violence for teens. Involving the Digital World and Social Media
Guns, knives, razor blades, pipe bombs, brass knuckles, Between one in four and one in three students in U.S.
clubs, and stun guns are examples of weapons. Today, many schools report that they have been bullied at school (Stop-
students carry weapons, including guns, or have access to bullying.gov, 2018). In 2014, the CDC and the Department
them. Many firearms and handguns are in circulation in this of Education released the first federal uniform definition
country. Guns and handguns are present in many homes. of bullying (Stopbullying.gov, 2018). This definition
It is possible for students to obtain a gun from their home acknowledges two modes and four types of bullying. The
without their parents or guardians knowing. Unfortunately, two modes of bullying include direct (e.g., bullying in
students can buy guns on the street from drug dealers and person of a targeted person) and indirect (e.g., bullying
from pawnshops. Nearly one-sixth (16.2 percent) of high not directly communicated to a person such as spreading
school students say they carried a weapon (e.g., gun, knife, rumors). In addition to these two modes, the four types
or club) in the past month. The percentage of high school of bullying include broad categories of physical, verbal,
students who said they carried a gun on one or more days relational (e.g., efforts to harm the reputation or relation-
in the past month is 5.3 percent (8.7 percent of boys and ships of individuals), and damage to property. Stopbully-
1.6 percent of girls) (Kann, McManus, Harris et al., 2016). ing.gov (2018) also notes that some bullying actions may
fall into criminal categories, such as harassment, hazing,
Guns are the weapons most likely to be used to harm or assault. The definition recognizes that bullying can
teens. Having access to guns and carrying firearms are happen anywhere and in many different contexts. Bully-
risk factors for homicide, suicide, and accidental injury. ing that occurs through the use of technology (e.g., cell
©McGraw-Hill Education
8 Section 1 Comprehensive School Health Education
phones, email, gaming devices, chat rooms, instant mes- A final concern for online presence are privacy risk behav-
saging, and online posts such as Instagram, Snapchat, and iors. These are types of behaviors that place a person’s
Twitter) is considered electronic bullying and is viewed as privacy at risk, such as sharing too much information
a unique context. Electronic bullying or cyberbullying (addresses, phone numbers, email addresses), posting
involves primarily verbal aggression (e.g., threatening false information about themselves or others, and a lack
or harassing electronic communications) and relational of understanding that when users visit various websites,
aggression (e.g., spreading rumors electronically). Elec- they leave behind evidence of which sites have been vis-
tronic bullying or cyberbullying may also involve property ited. Privacy threats include identity theft, home break-
damage resulting from electronic attacks that lead to the ins, cyberstalkers, cyberbullies, and child predators.
modification, dissemination, damage, or destruction of an
individual’s privately stored electronic information.
Alcohol
Alcohol depresses the central nervous system, dulls the
mind, impairs thinking and judgment, lessens coordina-
Sexual Behaviors That
tion, and interferes with the ability to respond quickly to Contribute to Unintended
dangerous situations. The effects of alcohol increase as
blood alcohol level increases. This has especially dan-
Pregnancy, HIV Infection,
gerous implications for young people—a smaller body and Other STDs
means a higher blood alcohol level and faster impairment
of judgment and motor coordination. This is alarming,
given that the average age at which students take their first The fourth category of risk behaviors is sexual behaviors
drink of alcohol is between twelve and thirteen. Almost that contribute to unintended pregnancy, HIV infection,
three-fourths (63.2 percent) of high school students have and other sexually transmitted diseases (STDs). Fewer
had at least one drink of alcohol during their lifetime, than half (41.2 percent) of all high school students report
and 32.8 percent have had a drink of alcohol in the past having had sexual intercourse, and about one-third (30.1
month. Nationwide, 17.7 percent of students report epi- percent) report having had intercourse in the past three
sodic heavy drinking in the past month. Episodic heavy months. The percentage of students who have had sexual
drinking is having five or more drinks on a single occa- intercourse with four or more sex partners is 11.5 percent
sion (Kann, McManus, Harris et al., 2016). Episodic (Kann, McManus, Harris et al., 2016). Youth Risk Behav-
heavy drinking, or binge drinking, is associated with ior Surveys (YRBS) show that the proportion of high
injuries, fights and arguments, rapes and other forms of school students engaging in sexual activity has decreased
sexual assault, reckless driving, infection with sexually since 1991.
transmitted diseases (STDs, including HIV), unplanned
pregnancy, and other problems among youth. Having early sexual experience, and being at a particu-
larly young age at first intercourse, greatly increases a
young person’s risk of unintended pregnancy and infec-
Other Drugs tion with STDs. Youths who begin having sex at younger
Illicit drug abuse accounts for numerous problems in ages are exposed to these risks over a longer period of
our society including drug abuse and addiction, family time. Sexual intercourse during the teen years, especially
disintegration, loss of employment, failure in school, first intercourse, usually is unplanned. As a result, teens
domestic violence, child abuse, and increased risk of do not take measures to prevent pregnancy or infection
HIV infection. with STDs, including HIV. Youths who have early sexual
experience are more likely at later ages to have more sex-
According to the Youth Risk Behavior Survey, 38.6 percent ual partners and more frequent intercourse. The greater
of high school students report having tried marijuana and the number of sexual partners a person has, the greater
21.7 percent report having used marijuana in the past the risk of contracting sexually transmitted diseases,
thirty days (Kann, McManus, Harris et al., 2016). The including HIV.
increase in marijuana use seen in the early 1990s, which
has now leveled off, was associated with a decreasing
belief that marijuana use increased health risks. Increas-
HIV Infection
ing use also is associated with increased perception of the Human immunodeficiency virus (HIV) is the pathogen
availability of marijuana (Johnston et al., 2011). that destroys the body’s immune system, allowing the
©McGraw-Hill Education
10 Section 1 Comprehensive School Health Education
development of AIDS. Currently, there is no cure for Most teens giving birth prior to 1980 were married,
AIDS, and AIDS is fatal. During sexual contact, HIV whereas most teens giving birth in recent years were
from an infected partner may enter the body of an unin- unmarried. Also, pregnant teens are much less likely than
fected partner through exposed blood vessels in small older pregnant females to receive timely prenatal care and
cuts or tiny cracks in mucous membranes. HIV can spread are more likely to receive no care at all. Pregnant teens
from male to male, male to female, female to male, or also are more likely to smoke and less likely to gain ade-
female to female. Unprotected sexual intercourse (sexual quate weight during pregnancy. Babies born to these teens
intercourse without a latex condom) is a risk behavior for are at greatly elevated risk of low birthweight (less than
HIV infection, yet many students engage in unprotected 2,500 grams, or 5 pounds 8 ounces), of serious and long-
sexual intercourse. A significant proportion of young term disability, and of dying during the first year of life.
adults who currently have AIDS were infected with HIV
during their adolescent years as a result of risk behaviors Clearly, student sexual behavior is risky and can have
they practiced. serious consequences. Much effort must be directed at
encouraging students to choose abstinence from sex and
delay the onset of sexual intercourse.
Infection with Other Sexually
Transmitted Diseases
Common STDs reported in students include chlamydia,
gonorrhea, syphilis, chancroid, genital herpes, human Dietary Patterns That
papilloma virus (HPV), and genital warts. Chlamydia Contribute to Disease
is the most common STD in the United States. STDs
can result in serious consequences, including sterility,
increased risk of cancer, blindness and other difficulties The fifth category of risk behaviors in today’s students is
in newborns, and severe discomfort. Some sexually trans- dietary patterns that contribute to disease. Seven of the
mitted diseases, such as genital herpes, are recurring. For ten leading causes of death are related to nutritional and
example, a person who is infected with genital herpes dietary choices. Unhealthful eating patterns increase the
always will be infected. risk of diet-related chronic diseases. Unhealthful eating
habits are established early in life, and young people tend
Teenagers are at high risk for becoming infected with an to maintain these eating habits as they age. An unhealth-
STD because they are more likely to have multiple sex part- ful diet is a known risk factor for the three leading causes
ners, they are more likely to have unprotected intercourse, of death in the United States: coronary heart disease, can-
and their sex partners are likely to be other teens (there cer, and stroke. Other health problems associated with an
is a higher prevalence of STDs among teens than among unhealthful diet are diabetes, high blood pressure, over-
adults). Compared to older adult females, teen females weight, and osteoporosis. An unhealthful diet accounts
are more susceptible to cervical infections, such as gon- for many deaths and substantial chronic illnesses in the
orrhea and chlamydia, due to having an immature cervix. United States each year.
Chlamydia is more common among teenagers than among
adults. Most young people do not meet recommendations for
healthful eating. Unhealthful eating habits can have
immediate and lasting effects on their health status. On
Unintended Pregnancies average, young people consume too much fat, saturated
Students who choose to be sexually active are at increased fat, cholesterol, and sodium and not enough fruits, vege-
risk for having unintended pregnancies. The United tables, and calcium. Approximately three-fourths of the
States has one of the highest adolescent birthrates among student population has an eating pattern that is low in
developed nations with approximately 730,000 teens vegetables, fruits, dairy, and oils. Failure to obtain ade-
becoming pregnant each year. These pregnancies result quate nutrients can result in deficiency diseases such as
in more than 350,000 teen births annually. Since peaking iron deficiency anemia, which is the most common cause
in the early 1990s, the teen birthrate has fallen 67 percent of anemia in the United States. Preventing iron defi-
overall (CDC, 2016). ciency anemia requires adequate intake of foods high in
iron. Vitamin C intake also is important, in part because
Most pregnant teens are unmarried, and most are not it helps the body efficiently absorb iron.
ready for the emotional, psychological, and financial
responsibilities and challenges of parenthood. Teen moth- Excess consumption of calories and fats can lead to a
ers are likely to have a second birth relatively soon—a high person being overweight or obese. The prevalence of
proportion of teen mothers have a second child within overweight and obesity are increasing among children,
twenty-four months of the first. adolescents, and adults in the United States (Flegal et al.,
©McGraw-Hill Education
Chapter 1 A Nation at Risk 11
2010; Ogden et al., 2010). The prevalence of overweight which impairs their school performance, especially in
among youths aged six to seventeen has more than dou- problem-solving tasks.
bled since the 1970s. Being overweight in childhood
and adolescence is associated with many negative health
and social consequences. Overweight children are at
increased risk of high blood pressure and elevated blood
cholesterol levels. They also might suffer from respi-
Insufficient Physical Activity
ratory disorders and bone and joint problems. Young
people who are overweight to psychological stress and The sixth category of risk behaviors in today’s students is
often exclusion and discrimination from peers and oth- insufficient physical activity. Despite the health benefits
ers. Overweight during childhood and adolescence also of physical activity, many children and adolescents are
is associated with a higher death rate during adulthood. sedentary or less physically active than is recommended.
More than one-third of adults in the United States are Only 48.6 percent of high school students engage in vig-
now obese, compared to one-fourth in 1980. orous physical activity (doing any kind of physical activ-
ity that increased their heart rate and made them breathe
At the other extreme, today’s enormous pressure on young
hard some of the time for a total of at least 60 minutes) for
people to attain a slender body increases the risk that
at least 5 days each week (Kann, McManus, Harris et al.,
females as young as nine will choose harmful weight loss
2016). A disturbing trend is that children and adolescents
practices. Unsafe weight loss methods can lead to poor
tend to become increasingly less physically active as they
growth and delayed sexual development. In the United
age. Also, fewer children and adolescents are enrolled
States, 45.6 percent of teens report trying to lose weight.
in daily physical education classes. In 2015, only 29.8
Many teens turn to dieting to try to change their body
percent of high school students were enrolled in daily
shape and to feel better about themselves. About one-half
physical education classes, compared with 42 percent of
of teenage girls (one in every two) and one-quarter (one
students in 1991 (Kann, McManus, Harris et al., 2016).
in every four) of teenage boys have tried dieting to change
As a result, there has been a significant decline in the per-
the shape of their body (USDA, 2018). More than one-
centage of children and adolescents who can perform sat-
half of teenage girls and nearly one-third of teenage boys
isfactorily on a series of physical fitness tests, compared
use unhealthy weight control behaviors, such as skipping
to children and adolescents of previous generations. It
meals, fasting, taking laxatives, smoking cigarettes, and
appears that sedentary activities such as viewing tele-
purging (Neumark-Sztainer, 2005). Unfortunately, it typ-
vision, playing video games, and using a computer con-
ically does not work, and in many cases, dieting causes
tribute to a general pattern of physical inactivity among
some people to gain weight. Also, the rate of cigarette
children and adolescents.
smoking is higher for adolescent females who diet or who
are concerned about their weight than for adolescent Physical activity and fitness is associated with numer-
females who do not diet or have weight concerns. Some ous health benefits in school-age children and youth
females smoke to control their appetite in order to keep (Janssen & LeBlanc, 2010). Physically active children
from gaining weight. are energetic. They are more likely to avoid obesity and
maintain a healthful body weight. They cope better with
It is common for eating disorders to begin during ado-
stress. Also, physically active children will suffer less
lescence or even earlier in childhood. Many adolescents
chronic disease (e.g., heart disease, high blood pressure,
who have eating disorders have low self-esteem, a nega-
osteoporosis) as adults.
tive body image, and feelings of inadequacy. They also
might feel anxious and depressed. Eating disorders can
cause many severe complications, and the death rates for
Health problems can result for children who are malnour- Whole Community,
Whole Child Model
ished. These children develop more infections and subse-
quently experience more illnesses, miss more school, and
are more likely to fall behind in class. Other problems
associated with being malnourished include having diffi-
culty concentrating in class, having low energy, and lack- The primary public policy dealing with health promotion
ing the energy to participate in physical activity. Having in school settings has been the coordinated school health
a healthful breakfast is an important way for children program established in 1987 (Kann, McManus, Harris
to start the day off right, nutritionally. Many children et al., 2016). In 2014, the Association for Supervision
and adolescents frequently skip or do not eat breakfast, and Curriculum Development (ASCD) and the CDC
©McGraw-Hill Education
12 Section 1 Comprehensive School Health Education
FIGURE 1-1
Source: www.cdc.gov
introduced the Whole School, Whole Community, Whole integrating health and education elements in promoting
Child (WSCC) model. The model shown in Figure 1.1 the whole child. The model expands outward to include
incorporates the components of a coordinated school ten components:
health program around the five tenets of a whole child
approach to education, placing the child in the center 1. Health education
place of the model. The tenets are as follows: 2. Physical education and physical activity
3. Nutrition environment and services
• Each student enters school healthy and learns about 4. Health services
and practices a healthy lifestyle. 5. Counseling, psychological, and social services
• Each student learns in an environment that is physi- 6. Social and emotional climate
cally and emotionally safe for students and adults. 7. Physical environment
• Each student is actively engaged in learning and is 8. Employee wellness
connected to the school and broader community. 9. Family engagement
• Each student has access to personalized learning and 10. Community involvement
is supported by qualified, caring adults.
• Each student is challenged academically and prepared These components incorporate the previous eight com-
for success in college or further study and for employ- ponents of the coordinated school health program and
ment and participation in a global environment. were updated to reflect a more comprehensive framework
as the intent behind the WSCC requires and also reflects
These tenets reflect the core nature of the collabora- updated understandings of health and school contexts.
tion between the ASCD and the CDC in aligning and The WSCC model focuses places such as the child center
©McGraw-Hill Education
Chapter 1 A Nation at Risk 13
place, emphasizes a school-wide approach, and acknowl- The CDC (2018b) describes the National Health Educa-
edges learning, health, and the school as being situated in tion Standards as written expectations for what students
a community. A key assumption of which is that students should know and be able to do by grades 2, 5, 8, and 12
do not learn in isolation but rather in their various com- to promote personal, family, and community health. The
munities of friends, class, school, family, and neighbor- standards provide a framework for curriculum develop-
hood. The final layer of the model illustrates situatedness ment and selection, instruction, and student assessment
of the other layers within a community. in health education. The standards are also organized
in a developmentally appropriate manner by grade level
The School Health Index (SHI) is a self-assessment with each grade level serving as prior knowledge for the
and planning tool that helps individual schools identify next.
the strengths and weaknesses of their health policies
and programs (Brener, Pejavara, & McManus, 2011; Standard 1 Students will comprehend concepts
National Center for Chronic Disease Prevention and related to health promotion and disease
Health Promotion, 2010). The SHI is based on CDC’s prevention to enhance health.
research-based guidelines for school health programs,
Standard 2 Students will analyze the influence of fam-
which identify the policies and practices most likely to
ily, peers, culture, media, technology, and
be effective in reducing youth health risk behaviors, and
other factors on health behaviors.
it is available at https://www.cdc.gov/healthyschools/shi/
index.htm as an online or paper version. Standard 3 Students will demonstrate the ability to
access valid information, products, and
services to enhance health.
Standard 4 Students will demonstrate the ability to
use interpersonal communication skills
Comprehensive School to enhance health and avoid or reduce
Health Education health risks.
Standard 5 Students will demonstrate the ability to
use decision-making skills to enhance
School health education helps students develop the health.
knowledge and skills they need to avoid or modify Standard 6 Students will demonstrate the ability to
behaviors that contribute to the leading causes of use goal-setting skills to enhance health.
death, illness, and injury during both youth and adult- Standard 7 Students will demonstrate the ability to
hood. Studies have demonstrated that health education practice health-enhancing behaviors and
in schools can reduce the prevalence of health-related avoid or reduce health risks.
risk behaviors among young people and have a positive
effect on academic performance (CDC, 2018a). The Standard 8 Students will demonstrate the ability
comprehensive school health education curriculum is an to advocate for personal, family, and
organized, sequential K–12 plan for teaching students community health.
information and helping them develop life skills that pro- Joint Committee on National Health
mote health literacy and maintain and improve health, Education Standards. (2007). National
prevent disease, and reduce health-related risk behaviors. Health Education Standards, Second Edi-
The comprehensive school health education curriculum tion: Achieving Excellence. Washington,
addresses the physical, mental, emotional, and social DC: The American Cancer Society.
dimensions of health and is tailored to each age level.
The curriculum is designed to motivate students and help The school health education curriculum includes a vari-
them maintain and improve their health, prevent disease, ety of topics:
and reduce their health-related risk behaviors. It helps
students develop and demonstrate increasingly sophis- 1. Health education
ticated health-related knowledge, skills, and practices. 2. Physical education and physical activity
Skilled health education teachers teach students health 3. Nutrition environment and services
concepts and skills through a variety of methods that 4. Health services
engage students in active manner (Geiger, Fulmore, & 5. Counseling, psychological, and social services
Werner, 2010a). School health education programs are 6. Social and emotional climate
most effective when they are developmentally appro- 7. Physical environment
priate (Inman et al., 2011). Therefore, health problems 8. Employee wellness
and issues are addressed at developmentally appropriate 9. Family engagement
grade levels. 10. Community involvement
©McGraw-Hill Education
14 Section 1 Comprehensive School Health Education
One of the objectives of Healthy People 2020 is to learning objectives; and assessment strategies to deter-
increase the proportion of elementary, middle, and high mine if students achieved the desired learning.
schools that provide comprehensive school health edu-
cation to prevent health problems in the following areas: HECAT recommends that schools establish a process for
unintentional injury; violence; suicide; tobacco use and ensuring that key stakeholders from the school and com-
addiction; alcohol or other drug use; unintended preg- munity review curricular materials through the forma-
nancy, HIV/AIDS, and STD; unhealthy dietary pat- tion of a health education curriculum review committee.
terns; and inadequate physical activity (Inman et al., The organization of this committee will differ between
2011). The Health Education Curriculum Analysis communities but may include key school policymakers
Tool (HECAT), available on the Centers for Disease and staff (including school board members, principals,
Control and Prevention Web site (see www.cdc.gov/ curriculum directors, administrators); teachers responsi-
healthyyouth/hecat/index.htm), can help schools select ble for implementing health education curricula; repre-
or develop appropriate and effective health education sentatives from other school health program components
curricula, enhance existing curricula, and improve the such as physical education and school health services;
delivery of health education. The HECAT is an assess- representatives from relevant community agencies and
ment tool that helps to provide an analysis of health organizations such as the health department, health
education curricula based on the National Health Edu- care providers, and youth-serving organizations; repre-
cation Standards and Characteristics of Health Effective sentatives from other groups within the community with
Health Education Curricula. These standards and char- interest in the positive health and development of stu-
acteristics are presented in this chapter and can also be dents; parents and caregivers of students who receive the
found at www.cdc.gove/healthyyouth. The HECAT also curriculum; and students. This representation helps to
helps to determine if a curriculum is based on properties increase the relevance and acceptability within a com-
determined to be effective based on research and from munity and to reflect local school and community health
suggestions from health education experts (Herbert & interests, priorities, and values. The assessment results
Lohrmann, 2011). The HECAT includes all the needed obtained from using these HECAT tools and resources
guidance and appraisal tools for carrying out a thor- can help schools select or develop appropriate and effec-
ough assessment of a health education curriculum. The tive health education curricula, strengthen the delivery of
HECAT can be customized to meet local community health education, and improve the ability of health educa-
needs and to conform to the curriculum requirements of tors to influence healthy behaviors and healthy outcomes
the state or school district. among school-age youth.
The national standards for physical education reflect America and the CDC developed the Comprehensive
these values: School Physical Activity Program (CSPAP). CSPAP is
a multicomponent approach where school districts and
Standard 1. The physically literate individual demon- schools are encouraged to use all opportunities for stu-
strates competency in a variety of motor skills and dents to be physically active, meet the nationally recom-
movement patterns. mended 60 minutes of physical activity each day, and
Standard 2. The physically literate individual applies develop the knowledge, skills, and confidence to be phys-
knowledge of concepts, principles, strategies, and ically active for a lifetime (see https://www.shapeamer-
tactics related to movement and performance. ica.org/cspap/what.aspx for more details).
Standard 3. The physically literate individual demon-
strates the knowledge and skills to achieve and main- Physical educators in schools should coordinate with the
tain a health-enhancing level of physical activity and other components of the WSCC model. Physical edu-
fitness. cators can help school nutrition services staff to plan
Standard 4. The physically literate individual exhib- weight loss and weight management programs for stu-
its responsible personal and social behavior that dents and staff who need and would like to participate.
respects self and others. Physical educators can contribute to a healthful school
Standard 5. The physically literate individual recognizes environment by ensuring that facilities at the school are
the value of physical activity for health, enjoyment, safe and free of hazards, and they can increase family and
challenge, self-expression, and/or social interaction. community involvement by offering activities for families
(SHAPE America, 2013) that include physical activity and by encouraging com-
munity organizations to use school facilities for physical
Physical education is enacted as a planned, sequential K–12 activity during nonschool hours.
curriculum that provides cognitive content and learning
experiences in a variety of activity areas including basic Classroom health education also can complement physi-
movement skills; physical fitness; rhythms and dance; cal education. Health education can help students acquire
games; team, dual, and individual sports; tumbling and the knowledge and self-management skills they need to
gymnastics; and aquatics. One of the main goals of the maintain a physically active lifestyle and to reduce the
physical education curriculum should be to help students time they spend in sedentary activities such as watching
develop a physically active lifestyle that will persist into television. Health and physical educators can collaborate
and throughout adulthood. Therefore, quality physical edu- to reinforce the link between sound dietary practices and
cation should help students develop the attitudes, motor regular physical activity for weight management. Col-
skills, behavioral skills, and confidence they need to engage laboration also helps these educators to focus on other
in lifelong physical activity (Institute of Medicine, 2013). behaviors that can limit student participation in physical
activity, such as using tobacco or other drugs.
Quality physical education in schools can have a positive
impact on the health of children and the adults they will
become. Physical education can also improve children’s
academic achievement. Yet according to the Centers for
Disease Control and Prevention, the number of adoles-
Nutrition Environment
cents who participate in daily physical education has and Services
declined in recent years. Nearly half of those aged twelve
to twenty-one are not vigorously active on a regular basis
(CDC, 2003). Physical education programs can increase The nutrition environment and the services that support
students’ knowledge about ways to be physically active. it is part of the WSCC model and can help shape lifelong
Physical education also can be instrumental in increasing healthy eating behaviors. The nutrition environment and
the amount of time that school-age youth are physically its services should provide students with nutritionally
active in physical education classes. Physical education balanced, appealing, and varied meals and snacks in
interventions are important strategies for obesity preven- settings that promote social interaction and relaxation.
tion in school children (Budd & Volpe, 2006). Those who plan meals and snacks should take into con-
sideration the health and nutrition needs of all students.
The Institute of Medicine (2013) recommended that School nutrition programs should reflect the U.S. Dietary
schools in their district policies and supported by admin- Guidelines for Americans and other quality criteria to
istrators and parents should provide access to at least achieve nutrition integrity. School nutrition programs
60 minutes per day of moderate-to-vigorous physical activ- should offer an opportunity for students to experience a
ity (MVPA) for children in schools. They note that more learning laboratory for applying classroom nutrition and
than half of the MVPA should be accomplished during health education and serve as a resource for links with
regular school hours. To meet this challenge, SHAPE nutrition-related community services. Food service staff
©McGraw-Hill Education
16 Section 1 Comprehensive School Health Education
have the primary responsibility for providing adequate Schools are an ideal place for providing health services
and appropriate foods. However, the effective operation as most children over age five attend school. Schools
of school nutrition services requires coordination and provide a favorable setting for preventive health services
cooperation from school administrators, school health (e.g., health screening for vision and hearing) and health
coordinators, teachers, families, school nurses, coun- services that are limited or unavailable to many students.
selors, and other school staff. Food service personnel Services and settings vary widely, ranging from traditional
should play an active role on school health committees. core services, such as vision and hearing screenings, to
comprehensive primary care in school-based health cen-
School nutrition services are aided when supported by ters or in off-campus health centers (Story et al., 2006).
community resources and professionals. In addition to the
nutrition services provided onsite by school personnel, School health services are provided mainly by qualified
schools should establish links with qualified public health professionals such as physicians, nurses, dentists, social
and nutrition professionals in the community. These workers, speech pathologists, and other allied health per-
professionals can inform families and school staff about sonnel. Teachers also play an important role in school
nutritional services available in the community, such as health services. For example, teachers might be called
the Special Supplemental Program for Women, Infants, on to participate in various health screenings (e.g., visual
and Children (WIC), the Food Stamp Program, the Sum- testing, scoliosis screening) and to provide emergency
mer Food Program, and local food and nutrition pro- care for students involved in sudden illness or accident.
grams. Qualified public health and nutrition professionals Chapter 2 in this book discusses school health services.
in the community can also serve as resources for nutrition
education and health promotion activities for school staff.
Voluntary health agencies such as the A merican Diabetes
Association and American Heart Association can pro-
vide educational resources and materials to schools for Counseling, Psychological,
nutrition education. The American Diabetic Associa- and Social Services
tion (ADA), School Nutrition Association (SNA), and
Society for Nutrition Education (SNE) jointly recognize
the importance of nutrition services integrated with coor- Counseling, psychological, and social services provide
dinated school health programs for the nation’s students broad-based individual and group assessments, interven-
(Briggs, Fleischhacker, & Mueller, 2010). tions, and referrals that attend to the mental, emotional,
and social health of students. Organizational assessment
and consultation skills of counselors, psychologists, and
social workers contribute to the overall health of students
and to the maintenance of a safe and healthful school
Health Services environment. Services are provided by professionals such
as trained/certified school counselors, psychologists, and
social workers. The need for these professionals is par-
School health services are services designed to appraise, ticularly highlighted by tragedies, as when schools need
protect, and promote the health of students. Health ser- to provide services to students when a student or teacher
vices differ widely among individual school systems, has died. Professionals can provide invaluable services in
depending on the resources in the school and community helping students, staff, and families deal with the shock
as well as students’ health needs. Examples of health ser- and grieving process. Personnel such as physicians,
vices that are offered in schools are nurses, speech and language therapists, special education
school staff, and classroom teachers also provide ser-
• Urgent and emergency care. vices that contribute to the mental, emotional, and social
• Timely identification of and appropriate intervention health of students.
for health problems (e.g., infections, injuries, asthma,
emotional difficulties). Counseling, psychological, and social services can prevent
• Mandated and necessary screenings for all students and address problems, enhance student learning, encour-
(e.g., vision, hearing). age healthy behavior, and promote a positive school cli-
• Assistance with medication during the school day. mate. These services are especially needed because of the
• Health services for children with special health needs. emotional challenges many students face owing to paren-
• Health counseling. tal divorce or death, family or peer conflicts, alcoholism,
• Health promotion for students and staff. and drug abuse. School counseling and psychological ser-
• Preventive health services (e.g., immunizations, den- vices are capable of intervening in areas of assertiveness
tal sealants). training, life skills training, peer interaction, self-esteem,
• Referrals and links with other community providers. problem solving, and conflict resolution.
©McGraw-Hill Education
Chapter 1 A Nation at Risk 17
It is impossible for schools to offer or fund direct services such as self-awareness, self-management, social aware-
to meet all of the mental, emotional, and social needs ness, relationship skills, and responsible decision mak-
of children. Schools have to develop linkages with com- ing. A social and emotional climate is also in part the
munity resources so that services can be extended to a responsibility of everyone in the school. A school-wide
greater number of children in need of services. Collab- culture should focus on a consistent message to students
orations between school and community resources help from teachers and staff that reinforces these skills before
improve school-age youth’s access to services. The school and after school, on the playgrounds, in the hallways, in
health council plays a vital role in this collaboration and study halls, and in sports and extra-curricular activities.
in advocating for increased resources for counseling, psy-
chological, and social services.
make good sense. The 2016 School Health Policy and family engagement consists of robust, trusting relation-
Practices Study reports that 54 percent of school districts ships between teachers, families, and community that
require schools to have an employee wellness program. place the child at the center of the engagement. There is
Importantly, 40.7 percent of districts provided funding or no fixed model for family engagement and because of the
offered health risk appraisals for employees, 27.8 percent factors that influence engagement it can take many forms.
of districts provided incentives for employee’s participa-
tion in wellness programs, and 60.8 percent of districts In their review of the benefits of family engagement, the
provided funding or offered immunizations such as influ- New Hampshire Department of Education (2018) notes
enza injections for employees. The good news regarding that research shows that students whose parents are
these data is that they have been trending upward since involved in their education are more likely to:
1994 (School Health Policy and Practices Study, 2016).
• Adapt well to school
It is critical that school staff be offered regular opportu- • Attend school more regularly
nities to cultivate their own physical, mental, and emo- • Complete homework more consistently
tional well-being. Health promotion can include health • Earn higher grades and test scores
education, employee-assistance programs, health care, • Graduate and go on to college
and other activities. Activities that might be offered to • Have better social skills
school staff include fitness classes, fitness testing and • Show improved behavior
assessment, health screening for early signs of disease • Have better relationships with their parents
(e.g., blood pressure measurements, blood cholesterol • Have higher self-esteem
testing), smoking cessation classes, nutrition or healthy
cooking classes, walking or exercise groups, yoga or Schools can encourage family involvement in projects
meditation classes, conflict resolution training, finan- that improve the community environment (e.g., recy-
cial planning sessions, and support groups for various cling programs, providing safe bicycle paths). School
stressful life situations. Various personnel throughout the staff can invite interested parents to participate in health
school and community can lend their skills and resources promotion activities such as exercise or smoking cessa-
to providing health promotion activities for staff. For tion classes. Parents can serve on school health advisory
example, physical education teachers can help plan and boards and school committees.
provide fitness activities. School food service personnel
can teach healthy cooking classes. School psychologists Health education teachers can send home with students
and counselors can offer stress management and conflict health information for families that reinforces health
resolution to school staff. School health services person- education lessons. Families can be invited to health fairs
nel, such as nurses, can conduct medical screenings and held at schools and to participate in health fair promo-
give immunizations for influenza and other infectious tion and activities. School food service personnel can
illnesses. Public health and health care professionals in provide information to families about school nutrition
the community are often willing to provide services that programs and recipes for nutritious meals. School facil-
would promote the health and well-being of school staff. ities for physical fitness activities can be made available
to families and community members. School counselors
can refer families to community services that meet emo-
tional or social needs.
Family Engagement
Families and schools share a reciprocal and collaborative Community Involvement
partnership. Both function as the student’s most import-
ant teachers. It is in the interest of the student’s growth
academically, socially, and emotionally that each knows Schools are situated in communities, and communities are
the context of the other. Parents should be active in their filled with resources that can support the school. It does
child’s engagement in school beyond parent–teacher take a village to raise a child, and the more involved the
conferences, and schools should solicit parent involve- village is, the better likelihood of raising a child in a good
ment. However, what is seen as family engagement with environment. When schools actively involve parents and
the school varies by parent, and it can be affected by the engage community resources, they are able to respond
level of education of the parent, the family unit (e.g., single more effectively to the health-related needs of students.
or dual parenting, guardians), the socioeconomic status of Linking community activities to the classroom (a) improves
the parents, the life history of the parent(s) with schools school-related behaviors, (b) positively impacts academic
and authorities, and the mobility of the family. At its best, achievement, and (c) reduces school suspension rates
©McGraw-Hill Education
Chapter 1 A Nation at Risk 19
(New Hampshire Department of Education, 2018). Health and reduce health-related risk behaviors. The comprehen-
education curricula implemented in classrooms with exten- sive school health education curriculum addresses the
sion activities to engage parents and community agencies physical, mental, emotional, family, and social dimen-
helps students to assume responsibility for their personal sions of health and is tailored to each age level.
health and well-being (Gieger, Fulmore, & Werner, 2010a).
Each of the fifty states in the United States has its own
In their influential chapter on “School and Family Part- set of health education standards. In some cases, these
nerships,” Epstein and Salinas (1992) describe six types are exactly the same national health education standards,
of community involvement: and in other cases, a state’s standards for health educa-
tion have been shaped to serve state-specific needs. The
• Parenting. Where the intent is to assist families with curriculums that serve each state vary greatly across states
parenting skills, provide knowledge relative to child and within each state by district. As such, while the gen-
and adolescent development, helping families under- eral focus in the United States is for the most part on a
stand the expectations of the school. Schools need to common set of standards and on a skills-based, decision-
understand their families’ backgrounds, cultures, and making curriculum, the approaches vary. This teaching
goals. resource book has been designed to focus on one compo-
• Communicating. Families and schools represent a nent of the WSCC model: comprehensive school health
two-way communication model, and schools and fam- education. The book is organized around the Meeks Heit
ilies are each obligated to find the best ways for this Umbrella of Comprehensive School Health Education.
to happen.
• Volunteering. Schools require engagement from the
community, but they are responsible for creating
mechanisms for such engagement, including the The Meeks Heit Umbrella
recruitment of families as volunteers, meaningful
work, and flexible scheduling. of Comprehensive School
• Learning at Home. Many parents do not have a strong Health Education
understanding of what it means for their children to
engage in academic learning at home, such as home-
work, goal setting, and other curriculum-related activ- The Meeks Heit Umbrella of Comprehensive School
ities. As such there is an important need for family Health Education illustrates how a curriculum can be
education on these issues. designed to protect young people from the six categories
• Decision Making. If families and schools are to of risk behaviors identified by the Centers for Disease
engage in democratic governance of schools, then Control and Prevention by teaching them to comprehend
families should be involved in school decisions, gov- health concepts; analyze influences on health; access
ernance, and advocacy activities such as school coun- valid health information and products and services; use
cils or improvement teams and permanent and ad hoc communication skills; use resistance skills; use conflict
committees. resolution skills; make responsible decisions; set health
• Collaborating with the Community. Schools have the goals; practice healthful behaviors; manage stress; be
responsibility to share in the coordination of support health advocates; and demonstrate good character.
services for families with community groups, includ-
ing businesses, agencies, cultural and civic organiza- Figure 1-2 shows the Meeks Heit Umbrella of Compre-
tions, and colleges or universities. hensive School Health Education protecting young peo-
ple from raindrops—the six categories of risk behaviors
identified by the Centers for Disease Control and Pre-
vention. If young people do not have protection, they will
Comprehensive School
indeed be drenched in troubles! The six categories of risk
behaviors from which young people need protection are
Health Education
these:
FIGURE 1-2
En
alth
Chro
and Physical Activity
Inj and
Co
alth
Co
vir
l He
ury Sa
Personal Health
ent
mm
al H d
Deve h and
mun
on
nsu nity H
n
e
Alcohol,
Tobacco, and
Other Drugs
ocia
Emo ental a
Pre ety
Nutrition
lopm
me
u
me eal
icab ses
nd S
ve
t
nta
tion
Grow
r an th
f
nti
le an
lH
a
ily a
M
on
d
ea
Fam
lth
Use Conflict
Comprehend Analyze Access Valid Health Use Use
Resolution
Health Influences Information and Communication Resistance
on Health Skills
Concepts Products and Skills Skills
(NHES 4C)
(NHES 1) (NHES 2) Services (NHES 3) (NHES 4A) (NHES 4B)
Be a Demonstrate
Set Practice Manage Good
Make Health
Health Healthful Stress Character
Responsible Advocate
Goals Behaviors (NHES 7B) (NHES 1-8)
Decisions (NHES 8)
(NHES 5) (NHES 6) (NHES 7A)
Telles sont les affinités de toute erreur avec toutes les erreurs, et
telle est la pente commune des erreurs limitées vers l’erreur
générale, que nous voyons le libéralisme catholique, si fier dans son
attitude extérieure, converger vers le césarisme du même pas que la
Révolution. Et c’est au nom de la liberté de conscience que l’on tend
à cet universel écrasement de la conscience humaine ! Il faut
concilier les principes du christianisme avec ceux de la société
moderne ; la société moderne l’exige, il faut en passer par là,
accepter toutes ses conditions, rejeter tout ce qui lui déplaît,
protester contre tout retour à des idées dont elle ne veut plus ! Mais
ceux qui trouvent que la société moderne a tort ; ceux qui estiment
que ce personnage fantasque — et peut-être fantastique, — affiche
d’iniques prétentions ?… Ceux-là, quels que soient leur dignité et
leur nombre, doivent se taire, subir le joug, disparaître d’un monde
que leur présence irrite. La société libérale, l’humanité émancipée
n’entend pas subir leurs contradictions. Il faut courir à cette unité
renversée qu’elle rêve pour empêcher l’unité que réaliserait le
Pasteur divin, l’unité infernale qui mettra le troupeau sous la seule
houlette de César ! Évidemment, à l’exemple des autres docteurs
révolutionnaires, les docteurs du libéralisme catholique ont laissé
entrer dans leur pensée qu’un même mode de vivre peut et doit être
institué dans tous les États européens. Quant aux différences de
races, de caractères, d’habitudes religieuses et politiques qu’il
faudrait briser et broyer pour obtenir une pareille assimilation, ils
n’en tiennent pas compte : la société moderne exige ce sacrifice, la
liberté de conscience le fera ! Ne faut-il pas agréer à la « société
moderne » ? Ne faut-il pas sauver la liberté de perdition ?…
Au moment où je relis ces lignes, les journaux nous apportent
des paroles de Pie IX. Elles sont pleines à la fois de tristesse, de
lumière et de fermeté, et elles s’appliquent au sujet de cet écrit. Je
m’interromps pour écouter avec le respect et l’amour que nous
devons tous au Père des chrétiens.
Le Saint-Père vient de dire qu’il déplore et condamne les
usurpations, l’immoralité croissante, la haine contre la religion et
l’Église. Il ajoute cet avertissement solennel :
« Mais, tout en déplorant et condamnant, je n’oublie pas les
paroles de Celui dont je suis le représentant sur la terre, et qui, dans
le jardin de son agonie et sur la croix de ses douleurs, élevait vers le
ciel ses yeux mourants et disait : Pater, dimitte illis, nesciunt enim
quid faciunt ! Moi aussi, en face des ennemis qui attaquent le Saint-
Siége et la doctrine catholique elle-même, je répète : Pater, dimitte
illis, nesciunt enim quid faciunt !
« Il y a deux classes d’hommes opposés à l’Église. La première
comprend des catholiques qui la respectent et qui l’aiment, mais
critiquent ce qui émane d’elle. Depuis le concile de Nicée jusqu’au
concile de Trente, comme l’a dit un savant catholique, ils voudraient
réformer tous les canons. Depuis le décret du Pape Gélase sur les
Livres saints, jusqu’à la bulle qui a défini le dogme de l’Immaculée
Conception, ils trouvent à redire à tout, à corriger en tout ; ils sont
catholiques, ils se disent nos amis, mais ils oublient le respect qu’ils
doivent à l’autorité de l’Église, et s’ils n’y prennent garde, s’ils ne
reviennent promptement sur leurs pas, je crains bien qu’ils ne
glissent sur cette pente jusqu’à l’abîme où déjà est tombée la
seconde classe de nos adversaires.
« Celle-ci est la plus déclarée et la plus dangereuse. Elle se
compose de philosophes, de tous ceux qui veulent atteindre la vérité
et la justice avec la seule ressource de leur raison. Mais il leur arrive
ce que l’apôtre des nations, saint Paul, disait il y a dix-huit siècles :
Semper discentes et nunquam ad cognitionem veritatis
pervenientes. Ils cherchent, ils cherchent, et bien que la vérité
semble fuir devant eux, ils espèrent toujours trouver et nous
annoncent une ère nouvelle où l’esprit humain dissipera de lui-même
toutes les ténèbres.
« Priez pour ces hommes égarés, vous qui ne partagez pas leurs
erreurs. Vous êtes vraiment les disciples de Celui qui a dit : Ego sum
via, veritas et vita. Vous savez aussi que tout le monde n’est pas
appelé à interpréter sa parole divine, qu’il n’appartient pas aux
philosophes d’expliquer sa doctrine, mais seulement à ses ministres,
à ceux auxquels il a donné la mission d’enseigner en leur disant :
Qui vos audit me audit, quand vous parlerez aux hommes, c’est ma
voix même qu’ils entendront [18] . »
[18] Réponse du Saint-Père, à l’Adresse des fidèles
de diverses nations réunis à Rome, le 17 mars 1866.
XXVII
S’il est une chose évidente, c’est que les libéraux non chrétiens,
tous révolutionnaires, ne veulent pas plus des catholiques libéraux
que des autres catholiques. Ils le disent formellement, sans cesse,
sur tous les tons ; le Siècle en a fait des déclarations répétées qui ne
laissent rien à deviner, et qui, certes, ne manquent pas d’écho. Plus
de christianisme, qu’il n’en soit plus question ! voilà le cri de la
Révolution partout où elle domine. Et où ne domine-t-elle pas en
Europe ? Aucun révolutionnaire n’a protesté contre les hurlements
de bête féroce de Garibaldi, contre les thèses plus froidement
meurtrières de M. Quinet, demandant que le catholicisme soit
« étouffé dans la boue », contre l’impiété inepte de ces séides qui
s’associent pour refuser les sacrements. D’un autre côté, aucun
groupe, aucun notable révolutionnaire n’a encore été converti par les
programmes, les avances, les tendresses, et il faut le dire, hélas ! les
faiblesses des catholiques libéraux. Ils ont en vain renié leurs frères,
méprisé les bulles, expliqué ou dédaigné les encycliques : ces excès
leur ont valu de chiches éloges, d’humiliants encouragements, point
d’adhésion. Jusqu’ici la chapelle libérale n’a point d’entrée, et
semble n’être qu’une porte de sortie de la grande Église. L’explosion
de haine continue dans le camp libéral non chrétien : elle allume au
milieu du monde une sorte de fureur, non seulement contre l’Église,
mais même contre la simple idée de Dieu. Il se manifeste une
émulation générale parmi les chefs de partis qui gouvernent à
présent l’Europe, pour briser toute union entre l’homme et Dieu.
Chez les schismatiques, chez les hérétiques, chez les infidèles
enfin, pour peu qu’ils aient de contact avec la civilisation, partout on
dépouille l’Église. L’État musulman met la main sur les biens des
mosquées, comme ailleurs l’État chrétien sur la propriété
ecclésiastique ; il faut que Dieu, sous aucun nom, à aucun titre, ne
possède plus une parcelle de ce qu’il a créé. Tel est ce monde, dans
lequel les catholiques libéraux pensent trouver des défenseurs, des
gardiens probes et dévoués de la liberté catholique.
XXXI
Ils jurent volontiers par les principes de 89 ; ils disent même « les
immortels principes ». C’est le schibboleth [20] qui donne entrée au
camp du grand libéralisme. Mais il y a manière de le prononcer, et
nos catholiques n’y sont pas tout à fait, car malgré tout on les reçoit
froidement ; les plus avancés font encore quarantaine. Je les en
félicite. Pour avoir bien l’accent, il faut premièrement bien
comprendre et bien accepter la chose.
[20] Judic., XII, 6.