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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
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Library of Congress Cataloging-in-Publication Data

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

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 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
SECTION 1
Comprehensive School
Health Education. . . . . . . . . . . 1
CHAPTER 1
A Nation at Risk:
The Need for Comprehensive School
Health Education. . . . . . . . . . . . . . . . . . . . . . . . 3
Six Categories of Risk Behaviors in
Today’s Students . . . . . . . . . . . . . . . . . . . . . . . . 4
Unintentional Injuries and Violence. . . . . . . . . 4
Tobacco Use. . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Alcohol and Other Drug Use. . . . . . . . . . . . . . 9
Sexual Behaviors That Contribute
to Unintended Pregnancy, HIV
Infection, and Other STDs. . . . . . . . . . . . . . 9
Dietary Patterns That Contribute
to Disease . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Insufficient Physical Activity. . . . . . . . . . . . . . 11
The Whole School, Whole Community,
Whole Child Model . . . . . . . . . . . . . . . . . . . . . . 11
Comprehensive School Health
Education. . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Physical Education and Physical Activity . . . . 14
Nutrition Environment and Services. . . . . . . 15
Health Services. . . . . . . . . . . . . . . . . . . . . . . . 16
Counseling, Psychological, and
Social Services. . . . . . . . . . . . . . . . . . . . . . . 16
Social and Emotional Climate. . . . . . . . . . . . . 17
The Physical Environment������������������������������17
Employee Wellness������������������������������������������17
Family Engagement����������������������������������������� 18
Community Involvement. . . . . . . . . . . . . . . . . 18
Comprehensive School Health Education . . . . . . . 19
The Meeks Heit Umbrella of
Comprehensive School
Health Education. . . . . . . . . . . . . . . . . . . . . 19
vi
Implementing the Comprehensive
School Health Education
Curriculum . . . . . . . . . . . . . . . . . . . . . . . . . 23
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
CHAPTER 2
School Health Services and
Healthful School Environment:
Promoting and Protecting Health
and Safety. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
School Health Services. . . . . . . . . . . . . . . . . . . . 27
Providers of School Health
Services. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Teachers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
School Nurses. . . . . . . . . . . . . . . . . . . . . . . . . 28
School Health Aides. . . . . . . . . . . . . . . . . . . . 29
Confidentiality of Student Health
Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Community Partnerships for School
Health Services . . . . . . . . . . . . . . . . . . . . . . . . . 30
School-Based Health Centers. . . . . . . . . . . . . . . . 31
Accommodations for Special School
Health Services . . . . . . . . . . . . . . . . . . . . . . . . . 32
School-Based Mental
Health Services . . . . . . . . . . . . . . . . . . . . . . . . . 32
Administration of Medications
at School. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Emergency Care in Schools. . . . . . . . . . . . . . . . . 33
Healthful and Safe School
Environment . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Teachers as Advocates for Healthful
and Safe School Environment . . . . . . . . . . 34
©McGraw-Hill Education
 Contents   vii

Student Involvement. . . . . . . . . . . . . . . . . . . . 34 CHAPTER 3

Parent and Community
Involvement. . . . . . . . . . . . . . . . . . . . . . . . . 34 The Comprehensive School
Physical Conditions That
Health Education Curriculum:
Facilitate Optimal Learning A Blueprint for Implementing the
and Development . . . . . . . . . . . . . . . . . . . . . . . . 35 National Health Education Standards. . . . . . . 47
School Size. . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Lighting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 The Framework
Color Choices . . . . . . . . . . . . . . . . . . . . . . . . . 36 for the Curriculum. . . . . . . . . . . . . . . . . . . . . . . 47
Temperature and Ventilation. . . . . . . . . . . . . . 36 Health Literacy . . . . . . . . . . . . . . . . . . . . . . . . 47
Noise Control . . . . . . . . . . . . . . . . . . . . . . . . . 36 The National Health
Sanitation and Cleanliness. . . . . . . . . . . . . . . 37 Education Standards. . . . . . . . . . . . . . . . . . 48
Other Physical Environment The Performance Indicators. . . . . . . . . . . . . . 49
Concerns. . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Accessibility. . . . . . . . . . . . . . . . . . . . . . . . . . . 37 The Philosophy of the Curriculum . . . . . . . . . . . . 49
A Positive Emotional The Domains of Health. . . . . . . . . . . . . . . . . . 49
Environment . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 The Wellness Scale. . . . . . . . . . . . . . . . . . . . . 50
The Model of Health
Emotional Security. . . . . . . . . . . . . . . . . . . . . 38 and Well-Being. . . . . . . . . . . . . . . . . . . . . . . 51
Sensitivity to Differences . . . . . . . . . . . . . . . . 38
The Scope and Sequence Chart . . . . . . . . . . . . . . 52
A Safe School Environment. . . . . . . . . . . . . . . . . 38
The Components of Health Literacy . . . . . . . 52
Teacher Responsibilities. . . . . . . . . . . . . . . . . 39 The Content Areas . . . . . . . . . . . . . . . . . . . . . 52
Safe Transportation. . . . . . . . . . . . . . . . . . . . . 40 Health Goals. . . . . . . . . . . . . . . . . . . . . . . . . . 52
Safe Playgrounds. . . . . . . . . . . . . . . . . . . . . . . 40 The National Health Education
Disaster and Emergency Standards. . . . . . . . . . . . . . . . . . . . . . . . . . . 52
Preparedness. . . . . . . . . . . . . . . . . . . . . . . . . 41 The Objectives (Performance
Indicators). . . . . . . . . . . . . . . . . . . . . . . . . . 53
A Secure School Environment. . . . . . . . . . . . . . . 41
Characteristics of a Secure Introducing and Teaching
Physical Environment. . . . . . . . . . . . . . . . . . 41 the National Health
Protection from Violence While Education Standards. . . . . . . . . . . . . . . . . . . . . . 54
at School . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 How to Introduce the National Health
School Security Measures. . . . . . . . . . . . . . . . 42 Education Standards. . . . . . . . . . . . . . . . . . 54
State Laws Requiring Mandatory How to Teach Health Education
Reporting of Suspected Standard 1: Comprehend Health
Child Abuse. . . . . . . . . . . . . . . . . . . . . . . . . 42 Concepts . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
How to Teach Health Education
A Tobacco-Free School Standard 2: Analyze Influences on
Environment . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
How to Teach Health Education
Healthy Eating and Nutrition. . . . . . . . . . . . . . . . 43 Standard 3: Access Valid Health
Information and Products and
School Food Services . . . . . . . . . . . . . . . . . . . 43 Services. . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Child Nutrition Law. . . . . . . . . . . . . . . . . . . . 44 How to Teach Health Education
Standard 4: Use Interpersonal
School Health Policies and Communication Skills . . . . . . . . . . . . . . . . 58
Programs Study (SHPPS). . . . . . . . . . . . . . . . . . 44 How to Teach Health Education
Standard 5: Make Responsible
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Decisions. . . . . . . . . . . . . . . . . . . . . . . . . . . 60

©McGraw-Hill Education
viii   Contents
How to Teach Health Education
Standard 6: Set Health Goals. . . . . . . . . . . 60
How to Teach Health Education
Standard 7: Practice Health-
Enhancing Behaviors . . . . . . . . . . . . . . . . . 62
How to Teach Health Education
Standard 8: Be a Health Advocate. . . . . . . 63
Creating Lesson Plans Using
Totally Awesome Teaching
Strategies™. . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Applying Assessment Techniques. . . . . . . . . . . . . 65
Assessment of the Curriculum. . . . . . . . . . . . 65
Assessment of Students. . . . . . . . . . . . . . . . . . 68
Assessment of Teachers. . . . . . . . . . . . . . . . . . 72
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74
CHAPTER 4
Instructional Strategies
and Technologies:
Motivating Students to Learn . . . . . . . . . . . . . 75
Instructional Strategies. . . . . . . . . . . . . . . . . . . . 75
Lecture. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Lecture and Discussion. . . . . . . . . . . . . . . . . . 77
Role Play . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Brainstorming. . . . . . . . . . . . . . . . . . . . . . . . . 78
Buzz Groups . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Panel Discussions . . . . . . . . . . . . . . . . . . . . . . 80
Debate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
Cooperative Learning. . . . . . . . . . . . . . . . . . . 80
Decision Making. . . . . . . . . . . . . . . . . . . . . . . . 81
Self-Appraisals and Health
Behavior Inventories. . . . . . . . . . . . . . . . . . . 81
Student Presentations. . . . . . . . . . . . . . . . . . . 82
Field Trips. . . . . . . . . . . . . . . . . . . . . . . . . . . . 82
Demonstrations. . . . . . . . . . . . . . . . . . . . . . . . 83
Guest Speakers . . . . . . . . . . . . . . . . . . . . . . . . 83
Educational Technologies . . . . . . . . . . . . . . . . . . 84
Software. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
The Internet and Communication. . . . . . . . . 84
Multimedia. . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
White Boards. . . . . . . . . . . . . . . . . . . . . . . . . . 87
Mobile Devices . . . . . . . . . . . . . . . . . . . . . . . . 89
Social Media and Networking . . . . . . . . . . . . 89
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
©McGraw-Hill Education
SECTION 2
Health Content. . . . . . . . . . . . 91
CHAPTER 5
Mental and Emotional
Health. . . . . . . . . . . . . . . . . . . . 93
Health Goal #1: I Will Develop
Good Character. . . . . . . . . . . . . . . . . . . . . . . . . 94
Values and Character . . . . . . . . . . . . . . . . . . . 94
Self-Esteem . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
Developing Good Character and
Improving Self-Esteem. . . . . . . . . . . . . . . . 95
Health Goal #2: I Will Interact in Ways
That Help Create a Positive
Social-Emotional Environment. . . . . . . . . . . . . . . 96
Social-Emotional Environment. . . . . . . . . . . . 96
Social-Emotional Environment
and Health Status . . . . . . . . . . . . . . . . . . . . 96
Strategies to Improve the Social-
Emotional Environment. . . . . . . . . . . . . . . 97
Health Goal #3: I Will Develop
Healthful Personality Characteristics. . . . . . . . . . 97
Personality. . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Personality Characteristics
That Promote Good Health . . . . . . . . . . . . 98
Health Goal #4: I Will Choose
Behaviors to Promote a
Healthy Mind. . . . . . . . . . . . . . . . . . . . . . . . . . . 98
Mental Alertness and Mental
Health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98
Strategies for a Healthy Mind. . . . . . . . . . . . . 98
Health Goal #5: I Will Express
Emotions in Healthful Ways . . . . . . . . . . . . . . . 104
Emotions and the Mind-Body
Connection . . . . . . . . . . . . . . . . . . . . . . . . 104
Expressing Emotions
in Healthful Ways. . . . . . . . . . . . . . . . . . . 105
Anger Management Skills. . . . . . . . . . . . . . . 106
Health Goal #6: I Will Use Stress
Management Skills. . . . . . . . . . . . . . . . . . . . . . 107
Understanding Stress . . . . . . . . . . . . . . . . . . 107
The General Adaptation Syndrome. . . . . . . 107
How Stress Affects Health Status. . . . . . . . . 108
 Contents   ix
Using Social Media to Stay
Connected as a Stressor. . . . . . . . . . . . . . 109
Stress Management Skills. . . . . . . . . . . . . . . 109
Health Goal #7: I Will Seek Help
If I Feel Depressed. . . . . . . . . . . . . . . . . . . . . . 110
Recognizing Depression. . . . . . . . . . . . . . . . . 110
Childhood and Adolescent
Depression. . . . . . . . . . . . . . . . . . . . . . . . . . 110
Facebook Depression Study. . . . . . . . . . . . . . 111
Treatment for Depression. . . . . . . . . . . . . . . . 112
Coping with Depression. . . . . . . . . . . . . . . . . 113
Health Goal #8: I Will Use Suicide
Prevention Strategies When Appropriate. . . . . . . 113
Suicide Prevention. . . . . . . . . . . . . . . . . . . . . . 113
Health Goal #9: I Will Cope with
Loss and Grief in Healthful Ways . . . . . . . . . . . 115
Loss and Grief. . . . . . . . . . . . . . . . . . . . . . . . . 115
Causes of Loss and Grief. . . . . . . . . . . . . . . . 115
Drug and Alcohol Use and Loss
and Grief. . . . . . . . . . . . . . . . . . . . . . . . . . . 116
Five Stages of Loss and Grief. . . . . . . . . . . . . 116
Dealing with a Terminal Illness. . . . . . . . . . . 116
Healthful Ways to Respond
to a Loss. . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Health Goal #10: I Will Be Resilient
in Difficult Times. . . . . . . . . . . . . . . . . . . . . . . 118
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
CHAPTER 6
Family and Social Health. . . . 121
Health Goal #11: I Will Develop
Healthful Family Relationships . . . . . . . . . . . . . 121
A Word from the Authors. . . . . . . . . . . . . . . . 121
The Healthful Family . . . . . . . . . . . . . . . . . . 122
Skills Learned in a Healthful
Family . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122
Health Goal #12: I Will Work
to Improve Difficult Family
Relationships. . . . . . . . . . . . . . . . . . . . . . . . . . 124
Family Relationships. . . . . . . . . . . . . . . . . . . 124
Dysfunctional Family
Relationships. . . . . . . . . . . . . . . . . . . . . . . 124
Recognizing Codependence. . . . . . . . . . . . . 125
Improving Dysfunctional
Family Relationships. . . . . . . . . . . . . . . . . 127
©McGraw-Hill Education
Health Goal #13: I Will Make Healthful
Adjustments to Family Changes. . . . . . . . . . . . . 127
Marital Stress and Conflict . . . . . . . . . . . . . 127
Parental Divorce. . . . . . . . . . . . . . . . . . . . . . 128
Adjustments to Divorce. . . . . . . . . . . . . . . . . 129
Single-Custody Families. . . . . . . . . . . . . . . . 130
Remarriage of a Parent. . . . . . . . . . . . . . . . . 130
Other Situations Requiring
Adjustment. . . . . . . . . . . . . . . . . . . . . . . . . 131
Health Goal #14: I Will Develop
Healthful Friendships. . . . . . . . . . . . . . . . . . . . 131
Initiating Friendships . . . . . . . . . . . . . . . . . . 132
Balanced Friendships . . . . . . . . . . . . . . . . . . . 133
Ending Friendships. . . . . . . . . . . . . . . . . . . . . 133
Friendships and Social Media. . . . . . . . . . . . 133
Health Goal #15: I Will Develop
Dating Skills. . . . . . . . . . . . . . . . . . . . . . . . . . 134
Dating . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134
Establishing Dating Standards. . . . . . . . . . . 134
Dating Skills . . . . . . . . . . . . . . . . . . . . . . . . . 136
Dating and Online Contacts. . . . . . . . . . . . . 137
Health Goal #16: I Will Practice
Abstinence from Sex. . . . . . . . . . . . . . . . . . . . . 137
Benefits of Abstinence from Sex. . . . . . . . . . 137
Setting Limits for Expressing
Physical Affection. . . . . . . . . . . . . . . . . . . 138
Resisting Negative Peer Pressure
to Be Sexually Active . . . . . . . . . . . . . . . . 138
Changing Behavior. . . . . . . . . . . . . . . . . . . . 139
Using Technology to Talk
to Teens about Sex. . . . . . . . . . . . . . . . . . . 140
Health Goal #17: I Will Recognize
Harmful Relationships . . . . . . . . . . . . . . . . . . . 140
Harmful Ways of Relating. . . . . . . . . . . . . . . 140
What to Do about Harmful
Relationships. . . . . . . . . . . . . . . . . . . . . . . . 142
Health Goal #18: I Will Develop
Skills to Prepare for Marriage. . . . . . . . . . . . . . 142
Preparing for Marriage. . . . . . . . . . . . . . . . . . 142
Predicting Success in Marriage . . . . . . . . . . . 143
Marriage Commitment. . . . . . . . . . . . . . . . . . 143
Teen Marriage Is Risky. . . . . . . . . . . . . . . . . 144
Health Goal #19: I Will Develop
Skills to Prepare for Parenthood . . . . . . . . . . . . 145
Things to Consider before
Becoming a Parent . . . . . . . . . . . . . . . . . . . 145
Responsible Parenting. . . . . . . . . . . . . . . . . . 146
x   Contents
Health Goal #20: I Will Practice
Abstinence from Sex to Avoid the Risks
of Teen Marriage and Parenthood . . . . . . . . . . . 147
Risks Associated with Being
a Baby Born to Teen Parents. . . . . . . . . . . . 147
Risks Associated with Teen
Parenthood . . . . . . . . . . . . . . . . . . . . . . . . . 148
Faulty Thinking and Teen Pregnancy . . . . . . 148
Optional Health Goal: I Will Learn
Facts about Birth Control Methods . . . . . . . . . . 149
A Word from the Authors. . . . . . . . . . . . . . . . 149
Facts about Birth Control Methods. . . . . . . . 149
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . 159
CHAPTER 7
Growth and Development. . 160
Health Goal #21: I Will Keep
My Body Systems Healthy. . . . . . . . . . . . . . . . . 160
Nervous System. . . . . . . . . . . . . . . . . . . . . . . . 161
Cardiovascular System . . . . . . . . . . . . . . . . . . 161
Immune System. . . . . . . . . . . . . . . . . . . . . . . . 162
Respiratory System. . . . . . . . . . . . . . . . . . . . . 162
Skeletal System . . . . . . . . . . . . . . . . . . . . . . . . 163
Muscular System. . . . . . . . . . . . . . . . . . . . . . . 163
Endocrine System. . . . . . . . . . . . . . . . . . . . . . 163
Digestive System. . . . . . . . . . . . . . . . . . . . . . 164
Urinary System. . . . . . . . . . . . . . . . . . . . . . . . 165
Integumentary System. . . . . . . . . . . . . . . . . . . 165
Health Goal #22: I Will Recognize Habits
That Protect Female Reproductive Health. . . . . . 166
Puberty in Females. . . . . . . . . . . . . . . . . . . . 166
The Female Reproductive System . . . . . . . . . 167
The Menstrual Cycle. . . . . . . . . . . . . . . . . . . . 167
Female Reproductive Health. . . . . . . . . . . . . . 168
Health Goal #23: I Will Recognize
Habits That Protect Male
Reproductive Health. . . . . . . . . . . . . . . . . . . . . 170
Puberty in Males. . . . . . . . . . . . . . . . . . . . . . . 170
The Male Reproductive System . . . . . . . . . . . 171
Male Reproductive Health . . . . . . . . . . . . . . . 171
Health Goal #24: I Will Learn about
Pregnancy and Childbirth. . . . . . . . . . . . . . . . . 172
Conception. . . . . . . . . . . . . . . . . . . . . . . . . . . 172
Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
©McGraw-Hill Education
Childbirth . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174
Complications during Pregnancy
and Childbirth. . . . . . . . . . . . . . . . . . . . . . . 175
Health Goal #25: I Will Learn about
the Growth and Development
of Infants and Children. . . . . . . . . . . . . . . . . . . 175
Types of Development. . . . . . . . . . . . . . . . . . . 175
Developmental Milestones. . . . . . . . . . . . . . . 176
Health Goal #26: I Will Provide
Responsible Care for Infants
and Children . . . . . . . . . . . . . . . . . . . . . . . . . . 176
Preparation for Child-Sitting . . . . . . . . . . . . . 176
Caring for Infants and Toddlers. . . . . . . . . . . 177
Caring for Young Children. . . . . . . . . . . . . . . 177
Health Goal #27: I Will Develop
My Learning Style. . . . . . . . . . . . . . . . . . . . . . 177
Health Goal #28: I Will Achieve the
Developmental Tasks of Adolescence . . . . . . . . . 178
Health Goal #29: I Will Develop
Habits That Promote Healthful Aging . . . . . . . . 180
Physical Changes in Middle
and Late Adulthood . . . . . . . . . . . . . . . . . 180
Mental Changes in Middle
and Late Adulthood . . . . . . . . . . . . . . . . . . 181
Social Changes in Middle
and Late Adulthood . . . . . . . . . . . . . . . . . . 182
Habits That Promote Healthful Aging. . . . . . 182
Protecting the Brain in
the Later Years . . . . . . . . . . . . . . . . . . . . . . 182
Health Goal #30: I Will Share
with My Family My Feelings
about Dying and Death. . . . . . . . . . . . . . . . . . . 183
Dying and Death. . . . . . . . . . . . . . . . . . . . . . . 183
Grief. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
Helping Children and Adolescents
Deal with Tragedies and Loss. . . . . . . . . . 184
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . 186
CHAPTER 8
Nutrition. . . . . . . . . . . . . . . . . 187
Health Goal #31: I Will Select
Foods That Contain Nutrients. . . . . . . . . . . . . . 187
Proteins . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188
Carbohydrates. . . . . . . . . . . . . . . . . . . . . . . . 188
 Contents   xi
Fats. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188
Vitamins. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
Minerals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
Water. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
Nutrient Density. . . . . . . . . . . . . . . . . . . . . . 190
Health Goal #32: I Will Evaluate
Food Labels. . . . . . . . . . . . . . . . . . . . . . . . . . . 190
The Nutrition Facts Label. . . . . . . . . . . . . . . 190
Ingredients Listing . . . . . . . . . . . . . . . . . . . . . 191
Dates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
Food Additives. . . . . . . . . . . . . . . . . . . . . . . . 192
Health Claims. . . . . . . . . . . . . . . . . . . . . . . . 192
Health Goal #33: I Will Eat
the Recommended Daily Amounts
of Food from MyPlate. . . . . . . . . . . . . . . . . . . . 193
MyPlate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
Vegetarian Diets . . . . . . . . . . . . . . . . . . . . . . 193
Health Goal #34: I Will Follow
the Dietary Guidelines . . . . . . . . . . . . . . . . . . . 194
Health Goal #35: I Will Follow
a Healthful Diet That Reduces
the Risk of Disease. . . . . . . . . . . . . . . . . . . . . . 194
Diet and Cancer . . . . . . . . . . . . . . . . . . . . . . 194
Diet and Cardiovascular Diseases . . . . . . . . 196
Diet, Diabetes, and Hypoglycemia. . . . . . . . 196
Osteoporosis . . . . . . . . . . . . . . . . . . . . . . . . . 197
Food Allergies and Intolerances. . . . . . . . . . 197
Health Goal #36: I Will Develop
Healthful Eating Habits . . . . . . . . . . . . . . . . . . 198
Planning a Healthful Breakfast
and Lunch. . . . . . . . . . . . . . . . . . . . . . . . . 199
Planning Dinner and Snacks . . . . . . . . . . . . 199
Nutrition and Sports. . . . . . . . . . . . . . . . . . . 200
Health Goal #37: I Will Follow
the Dietary Guidelines when
I Go Out to Eat . . . . . . . . . . . . . . . . . . . . . . . . 201
Ordering from a Restaurant Menu. . . . . . . . 201
Ordering Fast Foods. . . . . . . . . . . . . . . . . . . 201
New Food Options for Healthful
Eating when Eating Out. . . . . . . . . . . . . . 202
Ethnic Restaurants. . . . . . . . . . . . . . . . . . . . 203
Health Goal #38: I Will Protect
Myself from Food-Borne Illnesses . . . . . . . . . . . 203
Food-Borne Illnesses. . . . . . . . . . . . . . . . . . . 203
Food Safety. . . . . . . . . . . . . . . . . . . . . . . . . . 204
Food Safety Offenders. . . . . . . . . . . . . . . . . . 205
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Health Goal #39: I Will Maintain
a Desirable Weight and Body Composition . . . . . 206
Desirable Weight and Body Composition. . . 206
Weight Management. . . . . . . . . . . . . . . . . . . 206
Weight Loss Strategies . . . . . . . . . . . . . . . . . 208
Healthful Weight in Children. . . . . . . . . . . . 209
The Obesity Epidemic. . . . . . . . . . . . . . . . . . . 210
Food Addiction. . . . . . . . . . . . . . . . . . . . . . . . 210
Health Goal #40: I Will Develop Skills
to Prevent Eating Disorders. . . . . . . . . . . . . . . . 211
The Addictive Nature of Eating
Disorders. . . . . . . . . . . . . . . . . . . . . . . . . . . 211
Risks for Developing Eating Disorders . . . . . 211
Types of Eating Disorders. . . . . . . . . . . . . . . . 212
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . 213
CHAPTER 9
Personal Health and
Physical Activity. . . . . . . . . . 214
Health Goal #41: I Will Have
Regular Examinations . . . . . . . . . . . . . . . . . . . 214
Physical Examinations . . . . . . . . . . . . . . . . . . 214
Eye Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215
Ear Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217
Health Goal #42: I Will Follow
a Dental Health Plan . . . . . . . . . . . . . . . . . . . . 219
Types of Teeth. . . . . . . . . . . . . . . . . . . . . . . . . 219
Dental Checkups. . . . . . . . . . . . . . . . . . . . . . . 219
Keeping the Teeth and Gums Healthy. . . . . 221
Health Goal #43: I Will Be Well Groomed . . . . . 222
Caring for Hair . . . . . . . . . . . . . . . . . . . . . . . 222
Caring for Skin and Nails. . . . . . . . . . . . . . . 223
Health Goal #44: I Will Get
Adequate Rest and Sleep. . . . . . . . . . . . . . . . . . 225
Types of Sleep . . . . . . . . . . . . . . . . . . . . . . . . 226
The Need for Sleep. . . . . . . . . . . . . . . . . . . . 226
Getting Adequate Sleep and Rest. . . . . . . . . 228
Relaxing and Resting . . . . . . . . . . . . . . . . . . 228
Health Goal #45: I Will Participate
in Regular Physical Activity. . . . . . . . . . . . . . . . 228
The Health Benefits of Regular
Physical Activity. . . . . . . . . . . . . . . . . . . . 229
Physical Activity Guidelines for Youth . . . . . 231
xii   Contents

Health Goal #46: I Will Follow Prescription Drugs . . . . . . . . . . . . . . . . . . . . 247

a Physical Fitness Plan. . . . . . . . . . . . . . . . . . . 231
Health Goal #47: I Will Develop
and Maintain Health-Related
Fitness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
Health-Related Fitness . . . . . . . . . . . . . . . . . 233
Exercise. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233
Cardiorespiratory Endurance. . . . . . . . . . . . 234
Muscular Strength and
Endurance. . . . . . . . . . . . . . . . . . . . . . . . . 235
Flexibility. . . . . . . . . . . . . . . . . . . . . . . . . . . . 236
Healthful Body Composition . . . . . . . . . . . . 237
Health Goal #48: I Will
Develop and Maintain
Skill-Related Fitness. . . . . . . . . . . . . . . . . . . . . 238
Skill-Related Fitness. . . . . . . . . . . . . . . . . . . 238
Lifetime Sports and Physical
Activities . . . . . . . . . . . . . . . . . . . . . . . . . . 239
Health Goal #49: I Will Be a
Responsible Spectator and
Participant in Sports. . . . . . . . . . . . . . . . . . . . . 240
Responsible Sport Spectatorship . . . . . . . . . 240
Responsible Sport Participation. . . . . . . . . . . 241
Health Goal #50: I Will Prevent
Physical Activity–Related
Injuries and Illnesses . . . . . . . . . . . . . . . . . . . . 241
Injuries Related to Physical
Activity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241
Participating in Physical Activity
during Extreme Weather
Conditions. . . . . . . . . . . . . . . . . . . . . . . . . 243
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . 244
CHAPTER 10
Alcohol, Tobacco,
and Other Drugs. . . . . . . . . . 245
Health Goal #51: I Will
Follow Guidelines for
the Safe Use of Prescription
and OTC Drugs. . . . . . . . . . . . . . . . . . . . . . . . 245
Drugs and Drug Use. . . . . . . . . . . . . . . . . . . 245
Ways Drugs Enter the Body. . . . . . . . . . . . . 246
Other Factors That Determine
Drug Effects . . . . . . . . . . . . . . . . . . . . . . . 246
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Over-the-Counter Drugs. . . . . . . . . . . . . . . . 248
Monitoring the Safety and
Effectiveness of Drugs . . . . . . . . . . . . . . . 249
Health Goal #52: I Will Not
Drink Alcohol . . . . . . . . . . . . . . . . . . . . . . . . . 249
Alcohol and Alcoholic Beverages. . . . . . . . . 249
Blood Alcohol Concentration. . . . . . . . . . . . 250
Effects of Alcohol on the Body. . . . . . . . . . . . 251
Effects of Drinking during
Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . 252
Effects of Alcohol on Thinking
and Decision Making . . . . . . . . . . . . . . . . 253
Alcoholism. . . . . . . . . . . . . . . . . . . . . . . . . . . 255
Alcohol Advertising . . . . . . . . . . . . . . . . . . . 255
Health Goal #53: I Will Avoid Tobacco
Use and Secondhand Smoke . . . . . . . . . . . . . . . 256
Nicotine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 256
Health Consequences of
Tobacco Smoking . . . . . . . . . . . . . . . . . . . 257
Health Consequences of
Breathing Secondhand Smoke. . . . . . . . . 258
Health Consequences of
Smokeless Tobacco. . . . . . . . . . . . . . . . . . 258
Tobacco Advertising
and Promotion. . . . . . . . . . . . . . . . . . . . . . 259
Quitting Tobacco Use. . . . . . . . . . . . . . . . . . 260
Health Goal #54: I Will Not Be
Involved in Illegal Drug Use. . . . . . . . . . . . . . . 261
Controlled Substances. . . . . . . . . . . . . . . . . . . 261
Stimulants . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261
Sedative-Hypnotics. . . . . . . . . . . . . . . . . . . . 263
Narcotics. . . . . . . . . . . . . . . . . . . . . . . . . . . . 263
Hallucinogens . . . . . . . . . . . . . . . . . . . . . . . . 264
Marijuana. . . . . . . . . . . . . . . . . . . . . . . . . . . . 265
Anabolic-Androgenic Steroids. . . . . . . . . . . 266
Inhalants . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267
Health Goal #55: I Will Avoid
Risk Factors and Practice
Protective Factors for Drug
Misuse and Abuse . . . . . . . . . . . . . . . . . . . . . . 267
Risk Factors. . . . . . . . . . . . . . . . . . . . . . . . . . 267
Protective Factors. . . . . . . . . . . . . . . . . . . . . 269
Health Goal #56: I Will Not Misuse
or Abuse Drugs . . . . . . . . . . . . . . . . . . . . . . . . 269
Risks of Using Drugs . . . . . . . . . . . . . . . . . . 269
Drug Dependence. . . . . . . . . . . . . . . . . . . . . . 271
Unhealthy Responses to a Family
Member’s Addiction. . . . . . . . . . . . . . . . . . 271
 Contents   xiii

Health Goal #57: I Will Use The Common Cold. . . . . . . . . . . . . . . . . . . . 282

Resistance Skills If Pressured
to Misuse or Abuse Drugs. . . . . . . . . . . . . . . . . 272
Peer Pressure to Use Drugs . . . . . . . . . . . . . 272
Resisting Pressure to Use Drugs. . . . . . . . . . 273
Being a Drug-Free Role Model. . . . . . . . . . . . 274
Health Goal #58: I Will Choose
a Drug-Free Lifestyle to Reduce
the Risk of HIV Infection
and Unwanted Pregnancy . . . . . . . . . . . . . . . . . 274
A Drug-Free Lifestyle. . . . . . . . . . . . . . . . . . . 274
Reducing the Risk of HIV Infection
and Unwanted Pregnancy. . . . . . . . . . . . . . 274
Health Goal #59: I Will Choose a
Drug-Free Lifestyle to Reduce the
Risk of Violence and Accidents . . . . . . . . . . . . . 275
Risk of Violence. . . . . . . . . . . . . . . . . . . . . . . . 275
Risk of Accidents. . . . . . . . . . . . . . . . . . . . . . 276
Health Goal #60: I Will Be Aware
of Resources for the Treatment
of Drug Misuse and Abuse . . . . . . . . . . . . . . . . 276
How Young People Can Help a
Person Who Needs Intervention . . . . . . . 276
Formal Intervention . . . . . . . . . . . . . . . . . . . 277
Treatment. . . . . . . . . . . . . . . . . . . . . . . . . . . . 277
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . 278
CHAPTER 11
Communicable and
Chronic Diseases . . . . . . . . . 279
Health Goal #61: I Will Choose Behaviors
to Reduce My Risk of Infection with
Communicable Diseases. . . . . . . . . . . . . . . . . . 279
Communicable Diseases. . . . . . . . . . . . . . . . 279
The Spread of Pathogens. . . . . . . . . . . . . . . . 280
The Immune System. . . . . . . . . . . . . . . . . . . 280
Health Goal #62: I Will Be Aware of
Immunizations That Protect Health. . . . . . . . . . 281
Recommended Immunizations for
Children and Adolescents. . . . . . . . . . . . . . 281
Health Goal #63: I Will
Choose Behaviors to Reduce
My Risk of Infection with
Respiratory Diseases. . . . . . . . . . . . . . . . . . . . . 282
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Influenza. . . . . . . . . . . . . . . . . . . . . . . . . . . . 282
H1N1 Influenza Virus. . . . . . . . . . . . . . . . . . 283
Pneumonia. . . . . . . . . . . . . . . . . . . . . . . . . . . 283
Strep Throat. . . . . . . . . . . . . . . . . . . . . . . . . . 283
Health Goal #64: I Will Recognize
Ways to Manage Asthma
and Allergies. . . . . . . . . . . . . . . . . . . . . . . . . . 284
Asthma. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 284
Preventing Asthma Attacks . . . . . . . . . . . . . 284
Managing Asthma. . . . . . . . . . . . . . . . . . . . . 284
Allergies. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285
Health Goal #65: I Will Choose
Behaviors to Reduce My Risk
of Infection with Sexually
Transmitted Diseases. . . . . . . . . . . . . . . . . . . . 285
Chlamydia. . . . . . . . . . . . . . . . . . . . . . . . . . . 286
Genital Herpes . . . . . . . . . . . . . . . . . . . . . . . 286
Genital Warts . . . . . . . . . . . . . . . . . . . . . . . . 287
Gonorrhea. . . . . . . . . . . . . . . . . . . . . . . . . . . 288
Syphilis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 288
Reducing the Risk of STDs. . . . . . . . . . . . . . 289
Health Goal #66: I Will Choose
Behaviors to Reduce My Risk
of HIV Infection. . . . . . . . . . . . . . . . . . . . . . . . 290
HIV Infection . . . . . . . . . . . . . . . . . . . . . . . . 290
HIV Transmission. . . . . . . . . . . . . . . . . . . . . . 291
HIV Testing. . . . . . . . . . . . . . . . . . . . . . . . . . 292
Treatment for HIV Infection
and AIDS. . . . . . . . . . . . . . . . . . . . . . . . . . 293
Reducing the Risk of
HIV Infection . . . . . . . . . . . . . . . . . . . . . . 294
Health Goal #67: I Will Choose
Behaviors to Reduce My Risk
of Cardiovascular Diseases . . . . . . . . . . . . . . . . 295
Cardiovascular Diseases. . . . . . . . . . . . . . . . 295
Reducing the Risk of
Cardiovascular Diseases. . . . . . . . . . . . . . 296
An Emerging Culprit. . . . . . . . . . . . . . . . . . . 297
Health Goal #68: I Will Choose
Behaviors to Reduce My Risk
of Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . 297
Diabetes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297
Managing Diabetes. . . . . . . . . . . . . . . . . . . . 298
Reducing the Risk of Type 2
Diabetes. . . . . . . . . . . . . . . . . . . . . . . . . . . 299
Health Goal #69: I Will Recognize Ways to
Manage Chronic Health Conditions. . . . . . . . . . 299
xiv   Contents
Health Goal #70: I Will Choose Behaviors
to Reduce My Risk of Cancer. . . . . . . . . . . . . . . 300
Cancer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 300
Cancer Treatment. . . . . . . . . . . . . . . . . . . . . 300
Reducing the Risk of Cancer . . . . . . . . . . . . 301
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . 302
CHAPTER 12
Consumer and
Community Health. . . . . . . . 303
Health Goal #71: I Will
Acquire Knowledge of Laws
to Protect Health. . . . . . . . . . . . . . . . . . . . . . . 303
Health Goal #72: I Will Recognize
My Rights as a Consumer. . . . . . . . . . . . . . . . . 304
Consumer Rights. . . . . . . . . . . . . . . . . . . . . . 304
Tips for Being a Successful
Consumer . . . . . . . . . . . . . . . . . . . . . . . . . 305
Health Fraud. . . . . . . . . . . . . . . . . . . . . . . . . 305
Health Goal #73: I Will Take
Action If My Consumer Rights
Are Violated. . . . . . . . . . . . . . . . . . . . . . . . . . . 306
Consumer Protection . . . . . . . . . . . . . . . . . . 306
Taking Action If Consumer
Rights Are Violated. . . . . . . . . . . . . . . . . . 307
Health Goal #74: I Will Make
a Plan to Manage Time and Money . . . . . . . . . . 308
Time Management. . . . . . . . . . . . . . . . . . . . . 308
Money Management. . . . . . . . . . . . . . . . . . . 309
Health Goal #75: I Will Choose
Healthful Entertainment. . . . . . . . . . . . . . . . . . 310
Media Entertainment . . . . . . . . . . . . . . . . . . . 310
Evaluating Entertainment Media. . . . . . . . . . 310
Using Online and Digital Media
Entertainment Wisely. . . . . . . . . . . . . . . . . 312
Health Goal #76: I Will Analyze
Ways Messages Delivered
through Technology Might
Affect My Health Status. . . . . . . . . . . . . . . . . . 313
Analyzing Social Media
and Digital Media. . . . . . . . . . . . . . . . . . . . 314
©McGraw-Hill Education
Health Goal #77: I Will Make
Responsible Choices about Health
Care Providers and Facilities. . . . . . . . . . . . . . . 315
Health Care Providers. . . . . . . . . . . . . . . . . . . 315
Health Care Facilities. . . . . . . . . . . . . . . . . . . 316
Health Goal #78: I Will Evaluate
Ways to Pay for Health Care. . . . . . . . . . . . . . . 317
Health Insurance. . . . . . . . . . . . . . . . . . . . . . . 318
Evaluating Health Insurance. . . . . . . . . . . . . 319
Health Goal #79: I Will Investigate
Health Careers. . . . . . . . . . . . . . . . . . . . . . . . . 319
Health Goal #80: I Will Investigate Public
and International Health Needs. . . . . . . . . . . . . 322
U.S. Public Health Agencies. . . . . . . . . . . . . 322
Public Health Needs. . . . . . . . . . . . . . . . . . . 323
International Health Needs. . . . . . . . . . . . . . 324
International Disasters. . . . . . . . . . . . . . . . . 325
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . 326
CHAPTER 13
Environmental Health . . . . . 327
Health Goal #81: I Will Stay Informed
about Environmental Issues. . . . . . . . . . . . . . . . 327
Population Growth. . . . . . . . . . . . . . . . . . . . 328
Poverty and Hunger. . . . . . . . . . . . . . . . . . . . 328
Greenhouse Effect and Global Warming. . . 328
Thinning of the Ozone Layer. . . . . . . . . . . . 329
Destruction of Rain Forests. . . . . . . . . . . . . 329
“Going Green”. . . . . . . . . . . . . . . . . . . . . . . . 329
Health Goal #82: I Will Be Aware of
Organizations and Global Initiatives
to Protect the Environment. . . . . . . . . . . . . . . . 330
Environmental Agencies and
Organizations . . . . . . . . . . . . . . . . . . . . . . 330
Federal Acts to Regulate the
Environment. . . . . . . . . . . . . . . . . . . . . . . 330
Nongovernmental Advocates. . . . . . . . . . . . 330
Health Goal #83: I Will Help
Keep the Air Clean. . . . . . . . . . . . . . . . . . . . . . 331
Air Quality. . . . . . . . . . . . . . . . . . . . . . . . . . . . 331
Air Pollution . . . . . . . . . . . . . . . . . . . . . . . . . . 331
Sources of Air Pollution. . . . . . . . . . . . . . . . . 331
Keeping the Air Clean . . . . . . . . . . . . . . . . . . 333
 Contents   xv
Health Goal #84: I Will Help
Keep the Water Safe. . . . . . . . . . . . . . . . . . . . . 333
Clean Water Needs. . . . . . . . . . . . . . . . . . . . . 333
Water Pollution. . . . . . . . . . . . . . . . . . . . . . . 334
Keeping Water Safe. . . . . . . . . . . . . . . . . . . . 336
Health Goal #85: I Will Help
Keep Noise at a Safe Level. . . . . . . . . . . . . . . . . 337
Sounds and Noise. . . . . . . . . . . . . . . . . . . . . 337
Noise Pollution . . . . . . . . . . . . . . . . . . . . . . . 337
Keeping Noise at Safe
Levels. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 338
Health Goal #86: I Will Help
Improve the Visual Environment. . . . . . . . . . . . . 338
The Visual Environment. . . . . . . . . . . . . . . . 338
Positive Visual Environment
and Health Status . . . . . . . . . . . . . . . . . . . 339
Improving the Visual
Environment. . . . . . . . . . . . . . . . . . . . . . . 339
Health Goal #87: I Will Help
Conserve Energy and Natural
Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . 340
Energy and Natural Resources. . . . . . . . . . . 340
Conservation of Energy
and Natural Resources. . . . . . . . . . . . . . . 340
Health Goal #88: I Will Precycle,
Recycle, and Dispose of Waste
Properly . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 341
Solid Waste . . . . . . . . . . . . . . . . . . . . . . . . . . . 341
Reduce and Reuse. . . . . . . . . . . . . . . . . . . . . . 341
Recycling. . . . . . . . . . . . . . . . . . . . . . . . . . . . 342
Waste Disposal . . . . . . . . . . . . . . . . . . . . . . . 342
Health Goal #89: I Will Protect
the Natural Environment. . . . . . . . . . . . . . . . . . 343
Appreciating the Natural
Environment. . . . . . . . . . . . . . . . . . . . . . . 343
The Natural Environment
and Health Status . . . . . . . . . . . . . . . . . . . 343
Protecting the Natural
Environment. . . . . . . . . . . . . . . . . . . . . . . 343
Health Goal #90: I Will Be a Health
Advocate for the Environment . . . . . . . . . . . . . . 344
Health Advocacy for the
Environment. . . . . . . . . . . . . . . . . . . . . . . 344
Opportunities for Health
Advocacy for the Environment. . . . . . . . . 345
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . 345
©McGraw-Hill Education
CHAPTER 14
Injury Prevention
and Safety. . . . . . . . . . . . . . . 346
Health Goal #91: I Will Follow Safety
Guidelines to Reduce the Risk of
Unintentional Injuries. . . . . . . . . . . . . . . . . . . . 346
Unintentional Injuries
in the Home. . . . . . . . . . . . . . . . . . . . . . . . 347
Unintentional Injuries
in the Community. . . . . . . . . . . . . . . . . . . 348
Health Goal #92: I Will Follow
Safety Guidelines for Severe
Weather, Natural Disasters,
and National Alerts . . . . . . . . . . . . . . . . . . . . . 349
Guidelines for Severe Weather,
Natural Disasters, and
National Alerts . . . . . . . . . . . . . . . . . . . . . 349
The Homeland Security
Advisory System. . . . . . . . . . . . . . . . . . . . . 353
Health Goal #93: I Will Follow
Guidelines for Motor
Vehicle Safety . . . . . . . . . . . . . . . . . . . . . . . . . 353
Motor Vehicle Safety. . . . . . . . . . . . . . . . . . . . 353
Motor Vehicle Violence. . . . . . . . . . . . . . . . . . 355
Health Goal #94: I Will Practice
Protective Factors to Reduce
the Risk of Violence . . . . . . . . . . . . . . . . . . . . . 355
Violence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 355
Protective Factors for Violence. . . . . . . . . . . . 357
Using Assertive Behavior to
Reduce the Risk of Violence. . . . . . . . . . . . 357
Health Goal #95: I Will Respect
Authority and Obey Laws . . . . . . . . . . . . . . . . . 358
Laws and Authority. . . . . . . . . . . . . . . . . . . . 358
Why Do Some Youths Challenge
Authority and Break Laws?. . . . . . . . . . . . 358
Health Goal #96: I Will Protect
Myself from Physical Violence
and Abuse. . . . . . . . . . . . . . . . . . . . . . . . . . . . 358
Bullying. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 358
Cyberbullying . . . . . . . . . . . . . . . . . . . . . . . . . 359
Online and Digital Media Safety . . . . . . . . . . 361
Hate Incidents. . . . . . . . . . . . . . . . . . . . . . . . 362
Child Abuse. . . . . . . . . . . . . . . . . . . . . . . . . . 362
Mental and Emotional Abuse. . . . . . . . . . . . 363
xvi   Contents

Dating Violence. . . . . . . . . . . . . . . . . . . . . . . 363 Grade 2 Teaching Strategies . . . . . . . . . . . . . . . 442

Hazing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 364
Grade 3 Teaching Strategies . . . . . . . . . . . . . . . 469
Health Goal #97: I Will Protect Myself
from Sexual Violence and Abuse . . . . . . . . . . . . 364
Grade 4 Teaching Strategies . . . . . . . . . . . . . . . 497
Rape. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 364
Predatory Drugs . . . . . . . . . . . . . . . . . . . . . . 366
Sexual Abuse. . . . . . . . . . . . . . . . . . . . . . . . . 366 Grade 5 Teaching Strategies . . . . . . . . . . . . . . . 518
Sexual Harassment . . . . . . . . . . . . . . . . . . . . 367
Stalking. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 367
Grade 6 Teaching Strategies . . . . . . . . . . . . . . . 546
Health Goal #98: I Will Stay Away
from Gangs. . . . . . . . . . . . . . . . . . . . . . . . . . . 368 Grade 7 Teaching Strategies . . . . . . . . . . . . . . . 573
Risks of Belonging to a Gang. . . . . . . . . . . . 368
Reasons for Gang Membership . . . . . . . . . . 368 Grade 8 Teaching Strategies . . . . . . . . . . . . . . . 611
Protection from Gangs. . . . . . . . . . . . . . . . . 369
Leaving a Gang. . . . . . . . . . . . . . . . . . . . . . . 369
Grades 9–12 Teaching Strategies. . . . . . . . . . . . 649
Health Goal #99: I Will Follow Guidelines
to Help Reduce the Risk of Weapon Injuries . . . . 369
Carrying a Weapon Can Increase
Risk of Injury. . . . . . . . . . . . . . . . . . . . . . . 370 SECTION 4
Reducing the Risk of Being
Injured by a Weapon. . . . . . . . . . . . . . . . . 370 The Meeks Heit K–12 Health
Gun Safety. . . . . . . . . . . . . . . . . . . . . . . . . . . . 371 Education Curriculum Guide:
Gun Laws. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 371
A Model for Implementing the
Health Goal #100: I Will Be National Health Education
Skilled in First-Aid Procedures . . . . . . . . . . . . . 371
Standards. . . . . . . . . . . . . . 683
References. . . . . . . . . . . . . . . . . . . . . . . . . . . . 372

CHAPTER 16
SECTION 3
Using the Meeks Heit
Totally Awesome K–12 Health Education
Teaching Strategies™. . . . . . 373 Curriculum Guide. . . . . . . . . 685

CHAPTER 15 The Meeks Heit K–12 Health

Education Curriculum Guide. . . . . . . . . . . . . . . 685
Using the Totally Awesome Goals and Philosophy. . . . . . . . . . . . . . . . . . 685
Teaching Strategies™ . . . . . . 375 Teaching Health Education
Standard 1. . . . . . . . . . . . . . . . . . . . . . . . . 688
Teaching Health Education
The Design of the Totally Standard 2. . . . . . . . . . . . . . . . . . . . . . . . . 689
Awesome Teaching Strategies™. . . . . . . . . . . . . 375 Teaching Health Education
Standard 3. . . . . . . . . . . . . . . . . . . . . . . . . 690
Family Health Newsletter . . . . . . . . . . . . . . . . . 378 Teaching Health Education
Standard 4A. . . . . . . . . . . . . . . . . . . . . . . . . 691
Teaching Health Education
Kindergarten Teaching Strategies . . . . . . . . . . . 381 Standard 4B. . . . . . . . . . . . . . . . . . . . . . . . 692
Teaching Health Education
Grade 1 Teaching Strategies . . . . . . . . . . . . . . . 412 Standard 4C. . . . . . . . . . . . . . . . . . . . . . . . 693
©McGraw-Hill Education
 Contents   xvii

Teaching Health Education The Meeks Heit K–12 Scope

Standard 5. . . . . . . . . . . . . . . . . . . . . . . . . 694 and Sequence Chart. . . . . . . . . . . . . . . . . . . . . 703
Teaching Health Education
Health Goals. . . . . . . . . . . . . . . . . . . . . . . . . 703
Standard 6. . . . . . . . . . . . . . . . . . . . . . . . . 695
The National Health Education
Teaching Health Education
Standards. . . . . . . . . . . . . . . . . . . . . . . . . . 703
Standard 7A. . . . . . . . . . . . . . . . . . . . . . . . 696
Objectives for Specific Grade Levels. . . . . . 704
Teaching Health Education
Grades K–2 . . . . . . . . . . . . . . . . . . . . . . . . . . 705
Standard 7B. . . . . . . . . . . . . . . . . . . . . . . . 697
Grades 3–5. . . . . . . . . . . . . . . . . . . . . . . . . . . . 718
Teaching Health Education
Grades 6–8. . . . . . . . . . . . . . . . . . . . . . . . . . . 740
Standard 8. . . . . . . . . . . . . . . . . . . . . . . . . 698
Grades 9–12. . . . . . . . . . . . . . . . . . . . . . . . . . 777
Character Education
(NHES 1–8). . . . . . . . . . . . . . . . . . . . . . . . 699 Appendix A National Health Education
Abstinence Education. . . . . . . . . . . . . . . . . . 700 Standards: Teaching
Totally Awesome
Teaching Strategies™ . . . . . . . . . . . . . . . . . 701 Masters A–1
Children’s Literature. . . . . . . . . . . . . . . . . . . 702 Appendix B The Teacher’s Encyclopedic
Curriculum Infusion. . . . . . . . . . . . . . . . . . . 702
Guide for Health Concerns of
Health Literacy . . . . . . . . . . . . . . . . . . . . . . . 702
Inclusion of Students with School-Age Youths . . . from
Special Needs . . . . . . . . . . . . . . . . . . . . . . 702 A to Z A–34
Service Learning. . . . . . . . . . . . . . . . . . . . . . 702
Technology. . . . . . . . . . . . . . . . . . . . . . . . . . . 702 Appendix C Health Resources A–55
Multicultural Infusion. . . . . . . . . . . . . . . . . . 703 Glossary G–1
Family Involvement. . . . . . . . . . . . . . . . . . . . 703
Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . 703 Index I–1

©McGraw-Hill Education
 PREFACE
Tell me, I forget.
Show me, I remember.
Involve me, I understand.
Comprehensive School Health Education: Totally Awesome
Strategies for Teaching Health™ has been the leading
teacher resource book used to prepare future and current
elementary school, middle school, and secondary school
teachers to teach health since the publication of the first
edition in 1991. It also has been the most widely used
teacher resource book selected by state departments of
education, school districts, and departments of health for
inservice and train-the-trainers programs. As you read
about its contents, you will learn why teachers who pur-
chase it find it the most teacher-friendly resource book
available for health education.
Section 1. Comprehensive School Health Education
includes four chapters and is designed to provide you
with a framework for comprehensive school health educa-
tion. In Chapter 1, you will learn about the six categories
of risk behaviors that affect today’s students, guidelines
for promoting school health, and the ten components
of the Whole School, Whole Community, Whole Child
(WSCC) model. Chapter 2 prepares you for your role
in school health services and explains how to provide a
healthful and safe school environment. Chapter 3 teaches
you how to design comprehensive school health curric-
ula, implement the National Health Education Standards,
and effectively assess students, teachers, and school
health programs. Chapter 4 describes instructional strat-
egies and technologies you might use in the classroom.
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
Health; Chapter 7, Growth and Development; ­Chapter 8,
Nutrition; Chapter 9, Personal Health and Physical
Activity; Chapter 10, Alcohol, Tobacco, and Other
Drugs; Chapter 11, Communicable and Chronic Dis-
eases; C­ hapter 12, Consumer and Community Health;
­C hapter 13, Environmental Health; and Chapter 14,
Injury Prevention and Safety.
xviii ©McGraw-Hill Education
Section 3. Totally Awesome Teaching Strategies™
explains the format and how to use Totally Awesome
Teaching Strategies™ to help students develop and
practice life skills and achieve health goals. Chapter 15
includes Totally Awesome Teaching Strategies™ for each
grade level from K to 12 for each of the ten content areas.
Section 4. The Meeks Heit K–12 Health Education Curric-
ulum Guide is a state-of-the-art curriculum guide focusing
on the National Health Education Standards using the
ten content areas. The Curriculum Guide in Chapter 16
can be used as is or can be adapted for a specific school
district.
Appendix A. National Health Education Standards:
Teaching Masters provides reproducible masters with
steps for teaching each of the National Health Education
­Standards at age-appropriate grade levels: K–2, 3–5, 6–8,
and 9–12. Appendix B includes The Teacher’s Encyclope-
dic Guide for Health Concerns of School-Age Youth . . .
from A to Z. Appendix C includes Health Resources, a
listing of the names and contact information for agencies
and organizations in the ten health content areas.
For information about the resources available to instruc-
tors online, please see page xx.
We are committed to helping teachers with the awesome
task of providing quality health education.
 Linda Meeks
 Philip Heit
 Randy Page
 Phillip Ward
 ACKNOWLEDGMENTS
The authors wish to thank the advisory board, consul- David Lohrmann, Ph.D., CHES
tants, and publisher’s reviewer panel. Their comments Professor of Applied Health Science
and suggestions helped us significantly improve the text. Indiana University
We gratefully acknowledge their expertise and assistance. Bloomington, Indiana

Deborah Miller, Ph.D., CHES

Review Panel Professor, Department of Health and Human
Judith Ausherman Performance
Cleveland State University College of Charleston
Charleston, South Carolina
Gayle Bush
Troy University Joanne Owens-Nauslar, Ed.D.
Director of Corporate and Community Development
GeoFitness, Inc.
Joanne Chopak-Foss
Orlando, Florida
Georgia Southern University
John Ray, M.S.
Matthew Flint
Education Specialist
Utah Valley University
Delaware Department of Education
Dover, Delaware
Richard Fopeano
Rowan University
Spencer Sartorius, M.S.
Temporary Staff
Brian Geiger Office of Public Instruction
University of Alabama at Birmingham Helena, Montana

Advisory Board Sherman Sowby, Ph.D., CHES

Professor, Department of Public Health
Jane Beougher, Ph.D. California State University at Fresno
Adjunct Faculty Fresno, California
Ashland University
Ashland, Ohio Deitra Wengert, Ph.D., CHES
Professor, Department of Health Science
Moon S. Chen, Ph.D., M.P.H. Towson State University
Associate Director for Disparities and Research Towson, Maryland
Professor of Public Health Sciences
School of Medicine Susan Wooley, Ph.D., CHES
University of California–Davis Executive Director
Davis, California American School Health Association
Kent, Ohio
Gary English, Ph.D., CHES
Chair, Department of Public Health
Western Kentucky University
Bowling Green, Kentucky
Consultants
Kymm Ballard, M.A.
Deborah Fortune, Ph.D., CHES Physical Education, Athletics, and Sports Medicine
Assistant Professor Consultant
Department of Public Health Education North Carolina Department of Public Instruction
North Carolina Central University Raleigh, North Carolina
Durham, North Carolina
Donna Breitenstein, Ed.D.
Elizabeth Gallun, M.A. Coordinator and Professor of Health Education
Specialist in CSHE Department of Curriculum and Instruction
Maryland Department of Education Appalachian State University
Baltimore, Maryland Boone, North Carolina
©McGraw-Hill Education xix
xx   Acknowledgments

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

Janet Henke Jess Bogli

Baltimore County Public Schools, Retired Director, Bogli Consulting
Baltimore, Maryland Portland, Oregon

Russell Henke Kim Robert Clark

Montgomery County Public Schools, Retired California State University–San Bernardino
Rockville, Maryland
Mary Connolly
Joe Leake, CHES Cambridge College
Supervisor, Office of Health Education
Baltimore County Public Schools Marilyn Jensen
Baltimore, Maryland South Dakota Department of Education

Mary C. Marks, Ph.D. Ellen Larson

School Health Consultant Northern Arizona University
California Department of Education
Sacramento, California
Mary Marks
California Department of Education
J. Leslie Oganowski, Ph.D.
Professor Emeritus of Health Education
Antoinette Meeks
University of Wisconsin–LaCrosse
Florida Department of Education
LaCrosse, Wisconsin
Linda Morse
Debra Ogden, M.A.
New Jersey Department of Education
Coordinator of Health, Physical Education, Driver
Education and Safe and Drug-Free Program
Collier County Public Schools Fred Peterson
Naples, Florida The University of Texas–Austin

Fred Peterson, Ph.D. Eric Pliner

Associate Professor of Child, Adolescent and School New York City Department of Education
Health
Department of Kinesiology and Health Education Becky Smith
University of Texas American Association for Health Education
Austin, Texas
Barbara Sullivan
Linda Wright, M.A. Baltimore County Public Schools, Retired
District of Columbia Public Schools
Washington, DC Marilyn Tappe
Minnesota State University
The authors want to acknowledge the colleagues who
served on the National Health Education Standards Revi- Mary Waters
sion Initiative Advisory Panel. The professional organiza- American Cancer Association
tions represented included the American Association for
Health Education (AAHE), the American Cancer Society Katherine Wilbur
(ACS), the American Public Health Association (APHA), Alliance for a Healthier Generation

©McGraw-Hill Education
 HIGHLIGHTS OF THIS EDITION
Highlights of This Edition
•• Information on technology and its risks has been
integrated throughout the text.
•• The health content chapters (5–14) have been
updated to include the latest research and
developments in each content area, including the
risks involved with technology and social media,
traumatic brain injury, and updated references
throughout.
•• The NHES are integrated into the Totally Awesome
Teaching Strategies™, and each strategy references
blackline Teaching Masters that assist in evaluating
students according to NHES.
•• Chapter 1 introduces the Whole School, Whole
Community, Whole Child (WSCC) model from the
CDC and ASCD that represents a child-centered
public health framework situating the child in the
school and community contexts. It is important for
teachers to understand how school health education
in the WSCC model is now tied to the educational
mission of the school and to the larger community
and public health contexts. The model is referenced
in subsequent chapters.
•• Chapters 1–14 have been updated to reflect the latest
statistics and health education practices from sources
such as the CDC, the Institute of Medicine (2013)
reports, and SHAPE America guidelines for health
education.
•• For Chapters 1–14, Web sites and references have
been updated throughout the text to reflect latest
research and developments in each content area.
•• Totally Awesome Teaching Strategies™ continues
to be aligned to the national standards for health
education and with CDC guidelines for health
education. In particular the book is aligned
with the instructional and assessment practices
for health education recommended by SHAPE
America.
Chapter 1: A Nation at Risk
•• Updated CDC risk categories
•• Increased information on traumatic brain injuries,
particularly as related to concussion in sport
•• Substantive update on bullying, focusing on verbal
and physical as well as cyber bullying including
sexting
•• New section describing the comprehensive overview
of the Whole School, Whole Community, Whole Child
(WSCC) model and its ten components
•• Updated CDC guidelines for school health
curriculums
•• The Institute of Medicine (2013) guidelines
integrated throughout this chapter
©McGraw-Hill Education
•• New section on the Comprehensive School Physical
Activity Program (CSPAP) is introduced and
discussed
Chapter 3: The Comprehensive School Health Education
Curriculum
•• Educational policies updated
•• Updated characteristics of an effective health
education curriculum
•• New section on SHAPE America
assessment practices for school-based health
education
Chapter 4: Instructional Strategies and Technologies
•• New section on online and app-based tools for
assessment
•• New section on Integration of the SHAPE America
assessment practices for school-based health
education
•• Cooperative learning resources added
•• Updated U.S. Department of Education has an
Office of Educational Technology guidelines
•• Web sites extensively updated
Chapter 5: Mental and Emotional Health
•• Comprehensive introduction and discussion of ­
socio-emotional learning (SEL) and SEL
competencies for students
•• Updated discussion of concussions, including
introduction of the consensus statement on
concussion in sport
•• Updated suicide resource web links
Chapter 6: Family and Social Health
•• Tips for Safe Social Networking for teens
•• Updated policy information from the American
Academy of Pediatrics on media use
•• New section on the learning characteristics of
Generation Z
Chapter 8: Nutrition
•• Updated MyPlate information
•• Updated food labeling information
Chapter 9: Personal Health and Physical Activity
•• Updated physical activity guidelines from the CDC
and the Institute of Medicine
•• Updated sleep guidelines and discussion on device
use and sleep
Chapter 11: Communicable and Chronic Diseases
•• Updated recommendations and profile for Type 2
Diabetes
xxi
xxii   Highlights of This Edition
Chapter 12: Consumer and Community Health
•• Revised tips for staying organized
•• Updated money management tips
•• Updated careers in health education
Chapter 13: Environmental Health
•• Updated climate change data and information
Chapter 14: Injury Prevention and Safety
•• New section on LGBT harassment
•• New section on race discrimination and violence
•• Updated web links
•• Updated distracted driving discussion and data
Chapter 15: Using the Totally Awesome Teaching
Strategies™
•• National Health Education Standards and
performance indicators included in teaching
strategies
•• Materials section for each teaching strategy
identifies one or more blackline teaching masters
of the National Health Education Strategies from
Appendix A that can be used with the evaluation
•• Evaluation sections for each teaching strategy assess
students’ mastery of the National Health Education
Standards
Chapter 16: Using the Meeks Heit K–12 Health
Education Curriculum Guide
•• National Health Education Standards listed
in introduction to the Health Education K–12
Curriculum Guide
•• National Health Education Standards and new
numbering system in the Meeks Heit Umbrella of
Comprehensive School Health Education (Figure 16-1)
•• Performance indicators included in Scope and
Sequence Chart
Appendix A: National Health Education Standards:
Teaching Masters
•• Grade-level appropriate blackline masters can be
used as teaching masters for each of the National
Health Education Standards
Appendix C: Health Resources
•• Resources fully updated and current Web sites
provided
Supplements
Online Resources
www.mhhe.com/meeks8e
Resources are available for the instructor.
©McGraw-Hill Education
For the instructor:
•• PowerPoint Slides. A complete set of PowerPoint
slides is downloadable. Keyed to the major points in
each chapter, the slides can be modified or expanded
to adjust to the instructor’s teaching style and needs.
•• Instructor’s Manual. The manual includes three
sample syllabi, course objectives, and instructor
strategies for presenting each chapter.
•• Computerized Test Bank. The test bank is available
with EZ Test computerized testing software. EZ Test
provides a powerful, easy-to-use test maker to create
printed quizzes and exams. For secure online testing,
exams created in EZ Test can be exported to WebCT,
Blackboard, and EZ Test Online. EZ Test comes with a
Quick Start Guide; once the program is installed, users
have access to a User’s Manual and Flash tutorials.
Additional help is available at www.mhhe.com/eztest.
•• Guide to First-Aid Procedures. The guide explains
how to maintain a first-aid kit, make an emergency
telephone call, obtain consent to give first aid,
follow universal precautions, and administer first-aid
procedures.
McGraw-Hill Create™
Craft your teaching resources to match the way you
teach! With McGraw-Hill Create, you can easily rear-
range chapters, combine material from other content
sources, and quickly upload content you have written like
your course syllabus or teaching notes. Find the content
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to www.mcgrawhillcreate.com today and register to expe-
rience how McGraw-Hill Create empowers you to teach
your students your way.
Electronic Textbook Option
This text is offered through CourseSmart for both
instructors and students. CourseSmart is an online
resource where students can purchase the complete text
online at almost half the cost of a traditional text. Pur-
chasing the eTextbook allows students to take advantage
of CourseSmart’s web tools for learning, which include
full text search, notes and highlighting, and email tools
for sharing notes between classmates. To learn more
about CourseSmart options, contact your sales represen-
tative or visit www.CourseSmart.com.
 ABOUT THE AUTHORS
Linda Meeks and Philip Heit are emeritus professors in
the College of Education and Human Ecology at The
Ohio State University. They have authored more than
350 health and wellness textbooks including Health
and Wellness K-12, published by Glencoe/McGraw-Hill.
Linda and Phil have helped state departments of educa-
tion and numerous school districts develop comprehen-
sive school health education curricula and implement the
National Health Education Standards. Their textbooks
and curricula have been adopted in many languages
and foreign countries and they have trained teachers in
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
health and well-­being globally and locally. Linda serves
on the Board of Directors for the International Women
Presidents’ ­Organization and is active in global educa-
tion as a member of the International Women’s Forum
and supports its Presidents’ Circle Leadership Founda-
tion. Phil initiated and directs Healthy New Albany, a
model community organization made up of residents
of a community who set goals for fitness, nutrition, dis-
ease prevention, mental health awareness, and safety
and coordinates the largest race walk (The New Albany
©McGraw-Hill Education
Walking Classic) in the world. Randy Page is a professor
of Health at Brigham Young University. He has written
more than 75 articles in professional journals, consulted
with the Centers for Disease Control and Prevention,
and conducted research on adolescent health in the
United States, Asia, Eastern Europe, and Latin America.
He is co-author of Totally Awesome Teaching Strategies for
Teaching Health™; Drugs, Alcohol, and Tobacco: Totally
Awesome Teaching Strategies™; and Violence Prevention:
Totally Awesome Teaching Strategies™ for Safe and Drug-
Free Schools.
Phillip Ward is a professor in the Department of Human
Sciences at the Ohio State University where he teaches
health and physical education to preservice and inser-
vice teachers. He is a fellow of SHAPE America and the
National Academy of Kinesiology. Ward has published
more than 100 articles and 5 books; he has been invited
to speak in Belgium, China, Cyprus, Israel, Japan, Korea,
Turkey, and throughout the United State. He is a co-­author
of the recent SHAPE America and NAKHE policy report
on health and physical education teacher recruitment in
the United States.
xxiii
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 SEC TION
1 ON E

Comprehensive School
Health Education

Chapter 1: A Nation at Risk:

The Need for Comprehensive School Health Education

Chapter 2: School Health Services and Healthful School Environment:

Promoting and Protecting Health and Safety

Chapter 3: The Comprehensive School Health Education Curriculum:

A Blueprint for Implementing the National Health Education Standards

Chapter 4: Instructional Strategies and Technologies:

Motivating Students to Learn
This page intentionally left blank
 C H A P T E R
1 O N E
A Nation at Risk
The Need for Comprehensive
School Health Education
P
erhaps no profession is more vital to the future
of this nation than teaching. Every teacher has
the potential to affect the lives of many stu-
dents. Many students are at risk in ways that
influence their ability to learn. Some students lack ade-
quate nourishment, sleep, immunizations, and proper
clothing. Others are being reared in families in which
there is domestic violence, chemical dependency, or some
other dysfunction. Still others are managing health con-
ditions such as asthma, anorexia nervosa, or depression.
Effective teachers are aware of the health status of their
students and are committed to working with their stu-
dents to maintain and improve their health status. Teach-
ers must be positive role models for healthful living.
And, of course, teachers must be motivated to create a
dynamic and challenging classroom where students can
learn and practice life skills and the National Health
Education Standards. In other words, today’s teachers
must be totally awesomeTM. A Totally Awesome ­TeacherTM
is committed to promoting health literacy, improving
health, preventing disease, reducing health-related risk
behaviors in students, and creating a dynamic and chal-
lenging classroom where students learn and practice life
skills and the National Health Education Standards.
Although this task demands training and effort, it has
many rewards—the future of this nation depends on
students being able to practice life skills for health and
achieve health goals.
©McGraw-Hill Education
This totally awesomeTM teacher resource book, Comprehen-
sive School Health Education, was written by teachers, for
teachers who want to make a difference. The style of this
resource book is teacher-friendly and interactive. This is
not a resource book to gather dust on your bookshelf; it is
a resource book you can use. This chapter begins with a
review of the six categories of risk behaviors identified by
the Centers for Disease Control and P ­ revention (CDC).
You will learn more about the risk behaviors that compro-
mise the health status of today’s students.
The purpose of the chapter is to introduce core elements
in today’s health education and to conclude by showing
how Comprehensive School Health Education: Totally Awe-
some Strategies for Teaching Health™ provides teachers
with the resources to teach health education successfully.
The ­chapter begins with an overview of health risk behav-
iors identified by the CDC. We then introduce the Whole
School, Whole Community, Whole Child (WSCC) model
that represents a child-centered public health framework,
situating the child in the school and community contexts. It
is important for teachers to understand how school health
education in the WSCC model is now tied to the educa-
tional mission of the school and to the larger community
and public health contexts. Next, we discuss the school
health education curriculum in the 21st century, and the
chapter finishes showing how the Meeks Heit Umbrella of
Comprehensive School Health Education connects core
understandings about school health education together.
4    Section 1   Comprehensive School Health Education
Six Categories of Risk
Behaviors in Today’s
Students
Four causes are responsible for most deaths of young
people: motor vehicle crashes, other unintentional inju-
ries (such as falls, fires, and drownings), homicide, and
suicide (Kann, McManus, Harris et al., 2016). Most of
these deaths are preventable and are associated with ad-
olescent behaviors such as drinking alcohol, not wearing
safety belts, carrying weapons, and engaging in physical
fights. Adolescent behaviors result in many health and
social problems, such as teen pregnancy and sexually
transmitted diseases (STDs), that cause young people to
suffer. Avoiding sexual activity can prevent high rates of
teen pregnancy and sexually transmitted diseases.
Heart disease, cancer, and stroke are prominent causes
of death in adults. Habits established in childhood and
adolescence often contribute to these diseases, typically
after which they do not show up until adulthood. Major
causes of these diseases are poor dietary habits, cigarette
smoking, alcohol use, and physical inactivity. Childhood
and adolescence are times to develop lifestyle habits that
foster good health and help prevent disease.
Many of the deaths and illnesses that occur in youths
and adults can be prevented by making healthful behav-
ior choices and avoiding risk behaviors. A risk behavior
is an action a person chooses that threatens health. Risk
behaviors can cause injury, illness, and premature death.
They also can destroy the environment. Examples of risk
behaviors are rollerblading without safety equipment, fail-
ing to use a safety belt, smoking cigarettes, using alcohol
or other drugs, and joining a gang. Most risk behaviors
• Are established during youth.
• Persist into adulthood.
• Are interrelated.
• Contribute simultaneously to poor health, education,
and social outcomes.
• Are preventable.
The Centers for Disease Control and Prevention (CDC)
has identified six categories of risk behaviors:
1. Behaviors that contribute to unintentional injuries
and violence
2. Sexual behaviors related to unintended pregnancy
and sexually transmitted diseases, including HIV
(human immunodeficiency virus) infection
3. Alcohol and other drug use
4. Tobacco use
©McGraw-Hill Education
5. Unhealthy dietary behaviors
6. Inadequate physical activity
Establishing healthy behaviors during childhood is eas-
ier and more effective than trying to change unhealthy
behaviors during adulthood (Allensworth et al., 2011).
Schools can play a critical role in helping young people
to establish healthy behaviors. The following sections
describe how the six categories of risk behaviors affect
today’s youths. You will learn what many youths are
doing in their lives and why these risk behaviors place
our nation’s youths at risk. You should know that the
CDC has implemented a surveillance system, the Youth
Risk Behavior Survey (YRBS), which every other year
assesses these six categories of risk behavior in U.S.
high school students. The CDC also provides funding to
states to modify these risk behaviors (Gieger, Fulmore, &
Werner, 2010b). The following information about youth
risk behaviors will help you understand the importance
of the comprehensive school health education program.
Unintentional Injuries
and Violence
The first category of risk behaviors is behaviors that
contribute to unintentional injuries and violence. An
unintentional injury is an injury caused by an accident.
An intentional injury is an injury resulting from interper-
sonal violence or self-directed violence. Intentional injury
includes deaths from homicide and suicide. Injuries kill
more young people than all diseases combined. Injuries
also contribute to substantial suffering and health care
costs. For every young person who dies from an injury,
many more are hospitalized and treated in emergency
rooms. Many young people are disabled by intentional
and unintentional injuries.
Motor Vehicle–Related Injuries
There are two primary ways young people sustain motor
vehicle–related injuries: being struck by a motor vehi-
cle as a pedestrian or being in a motor vehicle crash.
Children aged five to nine are the most likely of all age
groups to be struck by a motor vehicle and be killed or
injured. Unfortunately, children under the age of nine are
unable to accurately perceive the distance of oncoming
motor vehicles or the speed at which they are traveling.
­Teaching them how to cross the street safely is imperative
if this risk is to be reduced.
Motor vehicle crashes are the leading cause of death for U.S.
teens. The CDC reports that per mile driven, teen drivers
aged sixteen to nineteen are nearly three times more likely
than drivers aged twenty and older to be in a fatal crash.
 Chapter 1   A Nation at Risk    5
Each year, more than 5,000 teens (aged sixteen to twenty)
are killed in passenger vehicle crashes. This amounts to
a teen dying in a traffic crash an average of once every
hour on weekends and nearly once every two hours
during the week (National Highway Traffic Safety Admin-
istration, 2011). Teens also are involved in more than
2 million nonfatal crashes each year (National Highway
Traffic Safety Administration, 2008). Although teen-
agers between fifteen and twenty years of age make up
only 6.3 percent of all licensed drivers, 12.9 percent of all
the drivers involved in fatal crashes are in this age group.
Driver fatalities for teens fifteen to twenty years of age
increased by 3 ­percent between 1996 and 2006. For young
males, driver fatalities rose by 5 percent, compared with a
3 ­percent decrease for young females (National Highway
Traffic Safety ­Administration, 2008).
Inexperience, risk-taking behavior, immaturity, and greater
risk exposure place teens at high risk for being involved in
a motor vehicle crash. Driving a motor vehicle requires
complex skills that take time to develop. Safe driving
requires experience, technical ability, good judgment, and
the avoidance of high-risk behaviors. High-risk behaviors
such as speeding, inattention, talking on a cell phone or
text messaging, using portable entertainment devices (e.g.,
iPods), and driving under the influence of alcohol or other
drugs increase the likelihood of a crash. Peer pressure
often encourages risk taking. Driving at night and driving
with other teens in the car increase the risk of a crash.
Adolescents are much less likely to wear safety belts, com-
pared to other age groups. Alcohol consumption is often
a factor in motor vehicle crashes. Twenty-nine percent of
drivers aged fifteen to twenty who died in motor vehicle
crashes had been drinking alcohol (National Center for
Injury Prevention and ­Control, 2009). Many teens expose
themselves to the effects of drinking and driving. Accord-
ing to the Youth Risk Behavior Survey (Kann, McManus,
Harris et al., 2016), 20 percent all high school students
report that in the past month they rode with a driver
who had been drinking alcohol, and 7.8 percent report
driving after drinking alcohol (Kann, McManus, Harris
et al., 2016). Adolescents are far less likely to use safety
belts than any other group. About one in sixteen (6.1 per-
cent) high school students report that they rarely or never
wear safety belts while riding in a car (Kann, McManus,
­Harris et al., 2016). It is obvious that injury prevention
programs must focus on teaching about the dangers of
driving while talking on a cell phone or text messaging,
driving after drinking alcohol or using other drugs, riding
in a car with someone who has been drinking or using
other drugs, and failing to use safety belts.
Fires
Another leading cause of unintentional injuries in today’s
students is fire. Most fire-related deaths and injuries
occur in the home. Nearly 3,000 people die each year in
home fires (National Fire Protection Association, 2011b).
©McGraw-Hill Education
In addition, more than 17,000 people are injured in home
fires. Of the many who are hospitalized for severe burns,
some are disfigured for life. Fires in the home are the lead-
ing cause of death for children under the age of f­ ifteen.
Children who live in homes without smoke and heat detec-
tors and those who live in below-standard housing are
especially vulnerable to fire-related injuries. Smoke detec-
tors cut in half the chance of dying in a home fire. The
National Fire Protection Association (2011a) estimates
that 96 percent of homes have at least one smoke detec-
tor installed. However, many homes have smoke detectors
that do not function properly, often because batteries
are missing or not working. Injury prevention programs
should work with children and parents so that they under-
stand the importance of having smoke and heat detectors
installed in the home and checking the batteries regularly.
Smoke alarms should be installed on every level of the
home, including the basement, garage, and attic. They also
should be installed outside each sleeping area. New homes
are required to have a smoke alarm in each sleeping area
as well. Contrary to popular belief, the smell of smoke may
not awaken a person who is sleeping. Instead, the poison-
ous gases and smoke produced by a fire can numb the
senses and put a person into a deeper sleep.
Many fatal home fires are caused by improper use and
disposal of cigarettes. Children whose parents smoke
­cigarettes are at high risk of fatal fire injuries. An all-too-
common scenario is an adult who smokes falling asleep
with a lit cigarette. The risk of falling asleep is enhanced
when the person who smokes has been drinking alcohol.
Children playing with cigarette lighters and matches are
also a significant cause of fires that result in fatalities, inju-
ries, and property damage. Two of every five fires that kill
young children are started by children playing with light-
ers or matches. Injury prevention programs should teach
children how dangerous it is to play with matches and
lighters. Another important means of protection against
fire injury is having a fire escape plan. A fire escape plan
should be set up in advance, include at least two differ-
ent ways to escape from each room, and designate a place
­outside the home to meet.
Drowning
Drowning is a leading cause of death from unintentional
injury in today’s students. Drowning as a cause of death is
highest among children five and under and among males
ages fifteen to twenty-four. Many children who survive
near drownings suffer severe and permanent disability.
Many children and adolescents who drown are strong
swimmers who became tired or were pulled under by the
current. Drowning also can result from boating accidents.
Many incidents of drowning occur in swimming pools and
hot tubs. Many young children are injured or drown in
bathtubs, toilets, and sinks.
6    Section 1   Comprehensive School Health Education
Young children need to be observed closely when they
are near swimming pools and other bodies of water.
Many children who drown in swimming pools were out
of sight from adults for only five minutes or less. Adults
can improve safety and reduce the risk of childhood
drownings by installing childproof enclosures to prevent
children from entering home swimming pools and whirl-
pools. Turn-off valves for swimming pools and hot tub
suction drains should be readily accessible in case a child
is held under by a suction drain.
As children reach adolescence, they need to be educated
about the dangers of participating in boating and other
water activities under the influence of alcohol or other
drugs. Many adolescent drownings occur in remote,
unsupervised areas of lakes, rivers, canals, and the ocean.
The risks of swimming in these remote areas (e.g., rough
waters, submerged rocks, strong undertow) increase
when adolescents use alcohol or other drugs. Alcohol
use is involved in up to half of all adolescent drown-
ings (National Center for Injury Prevention and Con-
trol, 2010). Drinking alcohol impairs swimming ability,
judgment, coordination, and balance, and the ability to
recover after being submerged. Alcohol also can delay
laryngospasm, a protective reflex that closes the opening
to the lungs to prevent water from entering.
Traumatic Brain Injury
Traumatic brain injury (TBI) is a leading cause of death
and disability in the United States, contributing each
year to a substantial number of deaths, hospitalizations,
emergency room visits, and cases of permanent disability
(Coronado et al., 2011). A TBI is a bump, blow, or jolt to
the head or a penetrating head injury that disrupts the
normal functioning of the brain (National Center for
Injury Control, 2011). About three-quarters of the TBIs
that occur each year are concussions or other forms of
mild TBI. Children aged zero to four years and adoles-
cents aged fifteen to nineteen years are among the age
groups most likely to sustain a TBI (Faul et al., 2010).
The severity of a TBI can range from mild to severe. Mild
could be a brief change in mental status or consciousness,
while severe could be an extended period of unconscious-
ness or amnesia after the injury. The majority of TBIs
that occur are concussions or other forms of mild TBI.
A concussion is a type of TBI that can change the way
the brain normally works. In addition to being caused
by a bump, blow, or jolt to the head, concussions can
also occur from a blow to the body that causes the head
to move rapidly back and forth. Most concussions occur
without a loss of consciousness. A concussion is a brain
injury and all concussions should be considered serious.
Children and teens are more likely to get a concussion
and take longer to recover from them than adults. Ath-
letes who have already had a concussion are at increased
risk for another concussion (NCIJ, 2011).
©McGraw-Hill Education
TBI can affect the brain’s ability to think, perceive sensa-
tions such as taste and smell, use language, and express
and feel emotion. TBI can also cause epilepsy and increase
the risk for other brain disorders such as Alzheimer’s dis-
ease and Parkinson’s disease. Repeated mild TBIs over
time can impair thinking ability and the brain’s ability to
function normally (NCIJ, 2011).
Repetitive head impacts to children and youth playing
contact sports has become a significant public health
concern. There is increasing evidence that repetitive head
impacts with or without concussion can lead to long-
term neuropsychiatric and executive function challenges
and to degenerative chronic traumatic encephalopathy or
CTE. This has become most prominent in football, but
all sports where severe contact is possible such as basket-
ball, soccer, lacrosse, and field hockey place children and
youth at risk. Because initial engagement with the sports
occurs between ages five and fourteen, there is concern of
damage that can be done to a developing brain. Because
of the brain’s susceptibility to injury, a growing number
of scientists argue children should avoid playing sports
such as tackle football (McCrory et al., 2013).
TBIs can be minimized by wearing a seat belt when driving
or riding in a motor vehicle and buckling up children in child
safety seats and booster seats. Wearing a helmet during the
following activities is important for preventing TBI: riding a
bicycle, motorcycle, snowmobile, scooter, or all-terrain vehi-
cle; playing a contact sport such as football, ice hockey, or
boxing; using in-line skates or riding a skateboard; batting
and running bases in baseball or softball; riding a horse;
or skiing and snowboarding. Making sure that the surface
of children’s playgrounds is made of shock-absorbing mate-
rial, such as hardwood mulch or sand, is another means of
­preventing TBIs in children (NCIJ, 2011).
Other Unintentional Injuries
Other leading unintentional injuries that cause death and
injury include falls, suffocation, poisoning, and bicycling
accidents. Falls are the leading cause of injury and death
in the home. Most spinal cord injuries are the result of
falls. Young children are at particular risk of spinal cord
injuries from falls because their sense of balance is not
fully developed. Teens injured by falls often have taken
unnecessary risks and may have ignored safety precau-
tions or have been showing off. Suffocation due to chok-
ing is the leading cause of death among infants. Young
children can choke on small objects they put in their
mouths, such as small toys, coins, or food. Suffocation
also may be due to strangulation. Some children and
teens accidentally strangle themselves on material tied
around their necks, such as a scarf, that has caught on
another object, such as a car door. Children also have
been strangled on cords from window coverings, strings
on toys, ropes tied into lassoes, and pieces of clothing.
Most cases of poisoning in a home result from young
 Chapter 1   A Nation at Risk    7
children swallowing household products and over-the-
counter drugs. Poisoning deaths and injuries also occur
as a result of inhaling poisonous substances such as auto
exhaust, airplane glue, gasoline, and carbon monoxide.
Carbon monoxide is emitted from motor vehicles, stoves,
heaters, lawn mowers, and chimneys. Most deaths and
serious injuries due to bicycling involve head injuries.
Therefore, it is imperative that children and teens be
instructed to wear bicycle safety helmets. The most seri-
ous injuries occur when bikes collide with motor vehicles.
Violence
Unfortunately, many students are at risk for violence in
their own homes. An estimated 3 million children per
year are reported as victims of child abuse and neglect
to Child Protection Services (CPS) agencies. More than
1,500 children die from abuse each year (Child Welfare
Information Gateway, 2016). A family member is the
abusive person in a large proportion of child abuse cases.
Many young people who are abused later become abu-
sive when they are older and become parents if they have
not received counseling. A high proportion of violent
­offenders in prison report that they were abused during
childhood.
Other forms of violence occur between students.
Today’s students are more likely to bully one another
and to get into fights. Many teens have been bullied
at one time or another. Bullying often leads to fight-
ing. The first e­ xperience children have with fighting is
often a fistfight. According to the Youth Risk Behavior
Survey, 28.4 ­percent of male high school students and
16.4 ­percent of female high school students say that they
have been in a fight within the past year; 2.9 percent of
students say that they have received medical treatment for
injuries from a fight in the past year (Kann, M ­ cManus,
­Harris et al., 2016).
Carrying a weapon increases the risk of violence for teens.
Guns, knives, razor blades, pipe bombs, brass knuckles,
clubs, and stun guns are examples of weapons. Today, many
students carry weapons, including guns, or have access to
them. Many firearms and handguns are in circulation in this
country. Guns and handguns are present in many homes.
It is possible for students to obtain a gun from their home
without their parents or guardians knowing. Unfortunately,
students can buy guns on the street from drug dealers and
from pawnshops. Nearly one-sixth (16.2 percent) of high
school students say they carried a weapon (e.g., gun, knife,
or club) in the past month. The percentage of high school
students who said they carried a gun on one or more days
in the past month is 5.3 percent (8.7 percent of boys and
1.6 percent of girls) (Kann, McManus, Harris et al., 2016).
Guns are the weapons most likely to be used to harm
teens. Having access to guns and carrying firearms are
risk factors for homicide, suicide, and accidental injury.
©McGraw-Hill Education
Carrying a gun increases the risk of injury due to acci-
dents, the risk that a gun will be used to settle a fight, the
risk that it will be used in a crime, and the risk of it being
used for suicide. Among adolescents fifteen to nineteen
years old, one in every four deaths is caused by a firearm.
Fortunately, the rate of physical fighting and weapon
­carrying among adolescents declined during the 1990s.
The United States has an average of seventeen youth homi-
cides per day. The percentage of homicide victims fifteen
to nineteen years of age who are killed with a firearm is
82 percent. Homicide is the leading cause of death for
­African American youths and the second leading cause
for Hispanic youths fifteen to twenty-four years of age
(National Center for Injury Prevention and Control, 2009).
Suicide
Suicide is the third leading cause of death among teens
and also occurs among younger children. Young people
who commit suicide usually have experienced depression,
anger, hopelessness, alcohol and other harmful drug use,
family problems, and relationship problems for which
they might have received help. Teen males are much more
likely to commit suicide than teen females. However, teen
females attempt suicide at a much higher rate than teen
males. Suicide rates are highest among white males. Rates
among young African American males have risen in
recent years. Nationwide, 17.7 percent of high school stu-
dents (23.4 percent of females and 12.2 ­percent of males)
report considering suicide during the past twelve months
in the Youth Risk Behavior Survey (Kann, McManus,
Harris et al., 2016). The majority of youths who attempt
suicide do not receive follow-up medical or mental health
care. This places them at risk for making another suicide
attempt.
Bullying, Cyberbullying, and Other Risks
Involving the Digital World and Social Media
Between one in four and one in three students in U.S.
schools report that they have been bullied at school (Stop-
bullying.gov, 2018). In 2014, the CDC and the Department
of Education released the first federal uniform definition
of bullying (Stopbullying.gov, 2018). This definition
acknowledges two modes and four types of bullying. The
two modes of bullying include direct (e.g., bullying in
person of a targeted person) and indirect (e.g., bullying
not directly communicated to a person such as spreading
rumors). In addition to these two modes, the four types
of bullying include broad categories of physical, verbal,
relational (e.g., efforts to harm the reputation or relation-
ships of individuals), and damage to property. Stopbully-
ing.gov (2018) also notes that some bullying actions may
fall into criminal categories, such as harassment, hazing,
or assault. The definition recognizes that bullying can
happen anywhere and in many different contexts. Bully-
ing that occurs through the use of technology (e.g., cell
8    Section 1   Comprehensive School Health Education
phones, email, gaming devices, chat rooms, instant mes-
saging, and online posts such as Instagram, Snapchat, and
Twitter) is considered electronic bullying and is viewed as
a unique context. Electronic bullying or cyberbullying
involves primarily verbal aggression (e.g., threatening
or harassing electronic communications) and relational
aggression (e.g., spreading rumors electronically). Elec-
tronic bullying or cyberbullying may also involve property
damage resulting from electronic attacks that lead to the
modification, dissemination, damage, or destruction of an
individual’s privately stored electronic information.
Cyberbullying is different from physical and verbal bully-
ing in two important ways. First, in some cases, the aggres-
sor can hide his or her involvement. Second, cyberbullying
can go viral, increasing substantively the number of people
who can see the comments and in some cases participate
in the cyberbullying. Because youth spend increasingly
more time online and their online presence often rep-
resents a larger proportion of their daily interactions with
others, the effects of cyberbullying represent a greater and
more constant threat of bullying for children and youth.
Sexting is sending, receiving, or forwarding sexually
explicit messages, photographs, or images via cell phone,
computer, or other digital devices. Young people “sext”
to show off, to entice someone, to show interest in some-
one, or to prove commitment (Common Sense Media,
2011). Sexting can include sharing photos in nude, par-
tially nude, or seductive poses. Sexting is becoming a
more common practice among youth with 15 percent of
teens having sent a message, 27 percent of teens having
received a message, and one in eight teens having for-
warded a sext message without consent (Madigan, Ly,
Rash, Van Ouytsel, & Temple, 2018). Both boys and girls
are equally likely to send a sext. One large problem with
“sexting” is that highly compromising images or mes-
sages can easily be posted on a social networking site or
sent to others via email or text messages. When revealing
photos are made public, the subject is likely to feel severe
humiliation and violation. A tragic case involving sexting
was one of a teenager in Cincinnati, Ohio, named Jesse
Logan. She committed suicide after a nude photo that
she had sent to a boyfriend was circulated widely among
peers, causing harassment. It is imperative that young
people understand that once an image is sent, it can
never be retrieved and the sender may lose control of it.
One outcome tied to cyberbullying, sexting, and a sustained
online presence is depression. It develops when young peo-
ple spend a great deal of time on social media sites and
then develop symptoms of depression. Twenge, Joiner,
Rogers, and Martin (2018) found that teens who spent five
or more hours a day online were 71 percent more likely
than those who spent only one hour a day to have at least
one suicide risk factor (depression, thinking about suicide,
making a suicide plan, or attempting suicide).
©McGraw-Hill Education
A final concern for online presence are privacy risk behav-
iors. These are types of behaviors that place a person’s
privacy at risk, such as sharing too much information
(addresses, phone numbers, email addresses), posting
false information about themselves or others, and a lack
of understanding that when users visit various websites,
they leave behind evidence of which sites have been vis-
ited. Privacy threats include identity theft, home break-
ins, cyberstalkers, cyberbullies, and child predators.
Tobacco Use
The second category of risk behaviors in today’s students
is tobacco use: the use of cigarettes, pipes, cigars, or
smokeless tobacco. Tobacco use is the single most pre-
ventable cause of death in the United States. Cigarette
smoking annually causes about 480,000 people to pre-
maturely die from smoking or exposure to secondhand
smoke far more than from alcohol abuse and illegal drugs
(Centers for Disease Control and Prevention-fast facts,
2018). ­
Cigarette smoking kills more Americans each
year than the combined total deaths caused by suicide,
murder, alcohol abuse, AIDS (acquired immunodefi-
ciency syndrome), car accidents, illegal drugs, and fires.
Cigarette smoking causes nicotine dependence, several
kinds of cancer, chronic obstructive pulmonary disease,
emphysema, and numerous other serious health effects.
Using smokeless tobacco, including chewing tobacco
and snuff, also can harm health. Smokeless tobacco con-
tains many harmful chemicals that can cause nicotine
dependence, increase the risk of developing cancer, cause
problems with the gums and teeth, and dull the senses
of smell and taste. In addition, breathing environmen-
tal tobacco smoke—including sidestream and exhaled
smoke from c­ igarettes, cigars, and pipes—causes serious
health problems.
Results from the 2015 Youth Risk Behavior Survey
(Kann, McManus, Harris et al., 2016) show that 11.8
percent of male and 9.7 percent of female high school
students are current smokers (have smoked at least one
cigarette in the past thirty days). Overall, male students
(11.9 percent) were more likely than female students
(2.3 percent) to report use of smokeless tobacco in the
past month. While there has been a decrease in the use of
cigarettes by youth in grades 8, 10, and 12, the use of vap-
ing (i.e., e-cigarettes, e-pipes, and vape pens) is occurring
more often (Watkins, Glantz, & Chaffee, 2018). Youth
who use vaping are more likely later in life to use ciga-
rettes (Watkins et al., 2018). Nationwide, 10.3 percent
of students smoked cigars or cigarillos (little cigars) in
the past month (14.0 percent of males and 6.3 percent
of females).
 Chapter 1   A Nation at Risk    9
Alcohol and Other
Drug Use
The third category of risk behaviors in today’s students is
alcohol and other drug use. Alcohol and other drug use
is dangerous to health and causes numerous family and
social problems. Every year, the use of alcohol and other
drugs is a factor in numerous traffic fatalities, drownings,
fire fatalities, murders, rapes, assaults, child abuse cases,
suicides, and deaths from chronic diseases, such as can-
cer and cirrhosis.
Alcohol
Alcohol depresses the central nervous system, dulls the
mind, impairs thinking and judgment, lessens coordina-
tion, and interferes with the ability to respond quickly to
dangerous situations. The effects of alcohol increase as
blood alcohol level increases. This has especially dan-
gerous implications for young people—a smaller body
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
drink of alcohol is between twelve and thirteen. Almost
three-fourths (63.2 percent) of high school students have
had at least one drink of alcohol during their lifetime,
and 32.8 percent have had a drink of alcohol in the past
month. Nationwide, 17.7 percent of students report epi-
sodic heavy drinking in the past month. ­Episodic heavy
drinking is having five or more drinks on a single occa-
sion (Kann, McManus, Harris et al., 2016). Episodic
heavy drinking, or binge drinking, is associated with
injuries, fights and arguments, rapes and other forms of
sexual assault, reckless driving, infection with sexually
transmitted diseases (STDs, including HIV), unplanned
pregnancy, and other problems among youth.
Other Drugs
Illicit drug abuse accounts for numerous problems in
our society including drug abuse and addiction, family
disintegration, loss of employment, failure in school,
domestic violence, child abuse, and increased risk of
HIV infection.
According to the Youth Risk Behavior Survey, 38.6 ­percent
of high school students report having tried marijuana and
21.7 percent report having used marijuana in the past
thirty days (Kann, McManus, Harris et al., 2016). The
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-
ing use also is associated with increased perception of the
availability of marijuana (Johnston et al., 2011).
©McGraw-Hill Education
Adolescents who drink alcohol or smoke cigarettes are
at increased likelihood of smoking marijuana and using
other illicit drugs. Popular illicit drugs used by some
adolescents include marijuana, opiods, methamphet-
amine, ice, cocaine, crack, heroin, LSD, PCP, MDMA
(Ecstasy), ketamine (Special K), and methcathinone
(“cat”). Some adolescents also abuse anabolic steroids,
methylphenidate (Ritalin), rohypnol (roofies), GHB,
and inhalants.
Teachers, principals, administrators, and parents must
work together to prevent the use of illegal drugs by stu-
dents. Illegal drug use is having a devastating effect on
our students and on society.
Sexual Behaviors That
Contribute to Unintended
Pregnancy, HIV Infection,
and Other STDs
The fourth category of risk behaviors is sexual behaviors
that contribute to unintended pregnancy, HIV infection,
and other sexually transmitted diseases (STDs). Fewer
than half (41.2 percent) of all high school students report
having had sexual intercourse, and about one-third (30.1
percent) report having had intercourse in the past three
months. The percentage of students who have had sexual
intercourse with four or more sex partners is 11.5 percent
(Kann, McManus, Harris et al., 2016). Youth Risk Behav-
ior Surveys (YRBS) show that the proportion of high
school students engaging in sexual activity has decreased
since 1991.
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-
tion with STDs. Youths who begin having sex at younger
ages are exposed to these risks over a longer period of
time. Sexual intercourse during the teen years, especially
first intercourse, usually is unplanned. As a result, teens
do not take measures to prevent pregnancy or infection
with STDs, including HIV. Youths who have early sexual
experience are more likely at later ages to have more sex-
ual partners and more frequent intercourse. The greater
the number of sexual partners a person has, the greater
the risk of contracting sexually transmitted diseases,
including HIV.
HIV Infection
Human immunodeficiency virus (HIV) is the pathogen
that destroys the body’s immune system, allowing the
10    Section 1   Comprehensive School Health Education
development of AIDS. Currently, there is no cure for
AIDS, and AIDS is fatal. During sexual contact, HIV
from an infected partner may enter the body of an unin-
fected partner through exposed blood vessels in small
cuts or tiny cracks in mucous membranes. HIV can spread
from male to male, male to female, female to male, or
female to female. Unprotected sexual intercourse (sexual
intercourse without a latex condom) is a risk behavior for
HIV infection, yet many students engage in unprotected
sexual intercourse. A significant proportion of young
adults who currently have AIDS were infected with HIV
during their adolescent years as a result of risk behaviors
they practiced.
Infection with Other Sexually
Transmitted Diseases
Common STDs reported in students include chlamydia,
gonorrhea, syphilis, chancroid, genital herpes, human
papilloma virus (HPV), and genital warts. Chlamydia
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
in newborns, and severe discomfort. Some sexually trans-
mitted diseases, such as genital herpes, are recurring. For
example, a person who is infected with genital herpes
always will be infected.
Teenagers are at high risk for becoming infected with an
STD because they are more likely to have multiple sex part-
ners, they are more likely to have unprotected intercourse,
and their sex partners are likely to be other teens (there
is a higher prevalence of STDs among teens than among
adults). Compared to older adult females, teen females
are more susceptible to cervical infections, such as gon-
orrhea and chlamydia, due to having an immature cervix.
Chlamydia is more common among teenagers than among
adults.
Unintended Pregnancies
Students who choose to be sexually active are at increased
risk for having unintended pregnancies. The United
States has one of the highest adolescent birthrates among
developed nations with approximately 730,000 teens
becoming pregnant each year. These pregnancies result
in more than 350,000 teen births annually. Since peaking
in the early 1990s, the teen birthrate has fallen 67 percent
overall (CDC, 2016).
Most pregnant teens are unmarried, and most are not
ready for the emotional, psychological, and financial
responsibilities and challenges of parenthood. Teen moth-
ers are likely to have a second birth relatively soon—a high
proportion of teen mothers have a second child within
twenty-four months of the first.
©McGraw-Hill Education
Most teens giving birth prior to 1980 were married,
whereas most teens giving birth in recent years were
unmarried. Also, pregnant teens are much less likely than
older pregnant females to receive timely prenatal care and
are more likely to receive no care at all. Pregnant teens
also are more likely to smoke and less likely to gain ade-
quate weight during pregnancy. Babies born to these teens
are at greatly elevated risk of low birthweight (less than
2,500 grams, or 5 pounds 8 ounces), of serious and long-
term disability, and of dying during the first year of life.
Clearly, student sexual behavior is risky and can have
serious consequences. Much effort must be directed at
encouraging students to choose abstinence from sex and
delay the onset of sexual intercourse.
Dietary Patterns That
Contribute to Disease
The fifth category of risk behaviors in today’s students is
dietary patterns that contribute to disease. Seven of the
ten leading causes of death are related to nutritional and
dietary choices. Unhealthful eating patterns increase the
risk of diet-related chronic diseases. Unhealthful eating
habits are established early in life, and young people tend
to maintain these eating habits as they age. An unhealth-
ful diet is a known risk factor for the three leading causes
of death in the United States: coronary heart disease, can-
cer, and stroke. Other health problems associated with an
unhealthful diet are diabetes, high blood pressure, over-
weight, and osteoporosis. An unhealthful diet accounts
for many deaths and substantial chronic illnesses in the
United States each year.
Most young people do not meet recommendations for
healthful eating. Unhealthful eating habits can have
immediate and lasting effects on their health status. On
average, young people consume too much fat, saturated
fat, cholesterol, and sodium and not enough fruits, vege-
tables, and calcium. Approximately three-fourths of the
student population has an eating pattern that is low in
vegetables, fruits, dairy, and oils. Failure to obtain ade-
quate nutrients can result in deficiency diseases such as
iron deficiency anemia, which is the most common cause
of anemia in the United States. Preventing iron defi-
ciency anemia requires adequate intake of foods high in
iron. Vitamin C intake also is important, in part because
it helps the body efficiently absorb iron.
Excess consumption of calories and fats can lead to a
person being overweight or obese. The prevalence of
overweight and obesity are increasing among children,
adolescents, and adults in the United States (Flegal et al.,
 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

The Whole School,

eating disorders are among the highest for any mental
health disorder.

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

The Whole School, Whole Community, Whole Child Model

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-
edges learning, health, and the school as being situated in
a community. A key assumption of which is that students
do not learn in isolation but rather in their various com-
munities of friends, class, school, family, and neighbor-
hood. The final layer of the model illustrates situatedness
of the other layers within a community.
The School Health Index (SHI) is a self-assessment
and planning tool that helps individual schools identify
the strengths and weaknesses of their health policies
and programs (Brener, Pejavara, & McManus, 2011;
National Center for Chronic Disease Prevention and
Health Promotion, 2010). The SHI is based on CDC’s
research-based guidelines for school health programs,
which identify the policies and practices most likely to
be effective in reducing youth health risk behaviors, and
it is available at https://www.cdc.gov/healthyschools/shi/
index.htm as an online or paper version.
Comprehensive School
Health Education
School health education helps students develop the
knowledge and skills they need to avoid or modify
behaviors that contribute to the leading causes of
death, illness, and injury during both youth and adult-
hood. Studies have demonstrated that health education
in schools can reduce the prevalence of health-related
risk behaviors among young people and have a positive
effect on academic performance (CDC, 2018a). The
comprehensive school health education curriculum is an
organized, sequential K–12 plan for teaching students
information and helping them develop life skills that pro-
mote health literacy and maintain and improve health,
prevent disease, and reduce health-related risk behaviors.
The comprehensive school health education curriculum
addresses the physical, mental, emotional, and social
dimensions of health and is tailored to each age level.
The curriculum is designed to motivate students and help
them maintain and improve their health, prevent disease,
and reduce their health-related risk behaviors. It helps
students develop and demonstrate increasingly sophis-
ticated health-related knowledge, skills, and practices.
Skilled health education teachers teach students health
concepts and skills through a variety of methods that
engage students in active manner (Geiger, Fulmore, &
Werner, 2010a). School health education programs are
most effective when they are developmentally appro-
priate (Inman et al., 2011). Therefore, health problems
and issues are addressed at developmentally appropriate
grade levels.
©McGraw-Hill Education
The CDC (2018b) describes the National Health Educa-
tion Standards as written expectations for what students
should know and be able to do by grades 2, 5, 8, and 12
to promote personal, family, and community health. The
standards provide a framework for curriculum develop-
ment and selection, instruction, and student assessment
in health education. The standards are also organized
in a developmentally appropriate manner by grade level
with each grade level serving as prior knowledge for the
next.
Standard 1 Students will comprehend concepts
­related to health promotion and disease
prevention to enhance health.
Standard 2 Students will analyze the influence of fam-
ily, peers, culture, media, technology, and
other factors on health behaviors.
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
to enhance health and avoid or reduce
health risks.
Standard 5 Students will demonstrate the ability to
use decision-making skills to enhance
health.
Standard 6 Students will demonstrate the ability to
use goal-setting skills to enhance health.
Standard 7 Students will demonstrate the ability to
practice health-enhancing behaviors and
avoid or reduce health risks.
Standard 8 Students will demonstrate the ability
to advocate for personal, family, and
­community health.
Joint Committee on National Health
Education Standards. (2007). National
Health Education Standards, Second Edi-
tion: Achieving Excellence. Washington,
DC: The American Cancer Society.
The school health education curriculum includes a vari-
ety of topics:
1. Health education
2. Physical education and physical activity
3. Nutrition environment and services
4. Health services
5. Counseling, psychological, and social services
6. Social and emotional climate
7. Physical environment
8. Employee wellness
9. Family engagement
10. Community involvement
14    Section 1   Comprehensive School Health Education
One of the objectives of Healthy People 2020 is to
increase the proportion of elementary, middle, and high
schools that provide comprehensive school health edu-
cation to prevent health problems in the following areas:
unintentional injury; violence; suicide; tobacco use and
addiction; alcohol or other drug use; unintended preg-
nancy, HIV/AIDS, and STD; unhealthy dietary pat-
terns; and inadequate physical activity (Inman et al.,
2011). The Health Education Curriculum Analysis
Tool (HECAT), available on the Centers for Disease
Control and Prevention Web site (see www.cdc.gov/
healthyyouth/hecat/index.htm), can help schools select
or develop appropriate and effective health education
curricula, enhance existing curricula, and improve the
delivery of health education. The HECAT is an assess-
ment tool that helps to provide an analysis of health
education curricula based on the National Health Edu-
cation Standards and Characteristics of Health Effective
Health Education Curricula. These standards and char-
acteristics are presented in this chapter and can also be
found at www.cdc.gove/healthyyouth. The HECAT also
helps to determine if a curriculum is based on properties
determined to be effective based on research and from
suggestions from health education experts (Herbert &
Lohrmann, 2011). The HECAT includes all the needed
guidance and appraisal tools for carrying out a thor-
ough assessment of a health education curriculum. The
HECAT can be customized to meet local community
needs and to conform to the curriculum requirements of
the state or school district.
Modules are available to help analyze curricula that
address healthy eating, mental and emotional health, per-
sonal health and wellness, physical activity, alcohol and
other drugs, tobacco, safety, sexual health, and violence
prevention.
Included in specific HECAT modules are guidance, anal-
ysis tools, scoring rubrics, and resources for carrying out
a clear, complete, and consistent examination of health
education curricula. These tools and resources can help
schools to determine whether health education curric-
ula provide students with opportunities to acquire the
attitudes, knowledge, and skills necessary for making
health-promoting decisions, achieving health literacy,
adopting health-enhancing behaviors, and promoting the
health of others. It also helps to determine if curricula
includes a set of intended learning outcomes or learning
objectives that are directly related to students’ acquisi-
tion of health-related knowledge, skills, and attitudes; a
planned progression of developmentally appropriate les-
sons or learning experiences that lead to these objectives;
continuity between lessons or learning experiences that
clearly reinforce the adoption and maintenance of spe-
cific health-enhancing behaviors; accompanying content
or materials that correspond with the sequence of learn-
ing materials and help teachers and students meet the
©McGraw-Hill Education
learning objectives; and assessment strategies to deter-
mine if students achieved the desired learning.
HECAT recommends that schools establish a process for
ensuring that key stakeholders from the school and com-
munity review curricular materials through the forma-
tion of a health education curriculum review committee.
The organization of this committee will differ between
communities but may include key school policymakers
and staff (including school board members, principals,
curriculum directors, administrators); teachers responsi-
ble for implementing health education curricula; repre-
sentatives from other school health program components
such as physical education and school health services;
representatives from relevant community agencies and
organizations such as the health department, health
care providers, and youth-serving organizations; repre-
sentatives from other groups within the community with
interest in the positive health and development of stu-
dents; parents and caregivers of students who receive the
curriculum; and students. This representation helps to
increase the relevance and acceptability within a com-
munity and to reflect local school and community health
interests, priorities, and values. The assessment results
obtained from using these HECAT tools and resources
can help schools select or develop appropriate and effec-
tive health education curricula, strengthen the delivery of
health education, and improve the ability of health educa-
tors to influence healthy behaviors and healthy outcomes
among school-age youth.
Physical Education
and Physical Activity
Physical education is an important part of the WSCC
model and can improve the health of students, staff, and
community members (CDC, 2010). Physical education is
an academic subject, and all fifty states have standards
for physical education. SHAPE America (2013) describes
the goal of physical education as to develop physically
literate individuals who have the knowledge, skills, and
confidence to enjoy a lifetime of healthful physical activ-
ity. To pursue a lifetime of healthful physical activity, a
physically literate individual:
• Has learned the skills necessary to participate in a
variety of physical activities.
• Knows the implications and the benefits of involve-
ment in various types of physical activities.
• Participates regularly in physical activity.
• Is physically fit.
• Values physical activity and its contributions to a
healthful lifestyle.
 Chapter 1   A Nation at Risk    15
The national standards for physical education reflect
these values:
Standard 1. The physically literate individual demon-
strates competency in a variety of motor skills and
movement patterns.
Standard 2. The physically literate individual applies
knowledge of concepts, principles, strategies, and
tactics related to movement and performance.
Standard 3. The physically literate individual demon-
strates the knowledge and skills to achieve and main-
tain a health-enhancing level of physical activity and
fitness.
Standard 4. The physically literate individual exhib-
its responsible personal and social behavior that
respects self and others.
Standard 5. The physically literate individual recognizes
the value of physical activity for health, enjoyment,
challenge, self-expression, and/or social interaction.
(SHAPE America, 2013)
Physical education is enacted as a planned, sequential K–12
curriculum that provides cognitive content and learning
experiences in a variety of activity areas including basic
movement skills; physical fitness; rhythms and dance;
games; team, dual, and individual sports; tumbling and
gymnastics; and aquatics. One of the main goals of the
physical education curriculum should be to help students
develop a physically active lifestyle that will persist into
and throughout adulthood. Therefore, quality physical edu-
cation should help students develop the attitudes, motor
skills, behavioral skills, and confidence they need to engage
in lifelong physical activity (Institute of Medicine, 2013).
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-
cents who participate in daily physical education has
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
students’ knowledge about ways to be physically active.
Physical education also can be instrumental in increasing
the amount of time that school-age youth are physically
active in physical education classes. Physical education
interventions are important strategies for obesity preven-
tion in school children (Budd & Volpe, 2006).
The Institute of Medicine (2013) recommended that
schools in their district policies and supported by admin-
istrators and parents should provide access to at least
60 minutes per day of moderate-to-vigorous physical activ-
ity (MVPA) for children in schools. They note that more
than half of the MVPA should be accomplished during
regular school hours. To meet this challenge, SHAPE
©McGraw-Hill Education
America and the CDC developed the ­ Comprehensive
School Physical Activity Program (CSPAP). CSPAP is
a multicomponent approach where school districts and
schools are encouraged to use all opportunities for stu-
dents to be physically active, meet the nationally recom-
mended 60 minutes of physical activity each day, and
develop the knowledge, skills, and confidence to be phys-
ically active for a lifetime (see https://www.shapeamer-
ica.org/cspap/what.aspx for more details).
Physical educators in schools should coordinate with the
other components of the WSCC model. Physical edu-
cators can help school nutrition services staff to plan
weight loss and weight management programs for stu-
dents and staff who need and would like to participate.
Physical educators can contribute to a healthful school
environment by ensuring that facilities at the school are
safe and free of hazards, and they can increase family and
community involvement by offering activities for families
that include physical activity and by encouraging com-
munity organizations to use school facilities for physical
activity during nonschool hours.
Classroom health education also can complement physi-
cal education. Health education can help students acquire
the knowledge and self-management skills they need to
maintain a physically active lifestyle and to reduce the
time they spend in sedentary activities such as watching
television. Health and physical educators can collaborate
to reinforce the link between sound dietary practices and
regular physical activity for weight management. Col-
laboration also helps these educators to focus on other
behaviors that can limit student participation in physical
activity, such as using tobacco or other drugs.
Nutrition Environment
and Services
The nutrition environment and the services that support
it is part of the WSCC model and can help shape lifelong
healthy eating behaviors. The nutrition environment and
its services should provide students with nutritionally
balanced, appealing, and varied meals and snacks in
settings that promote social interaction and relaxation.
Those who plan meals and snacks should take into con-
sideration the health and nutrition needs of all students.
School nutrition programs should reflect the U.S. Dietary
Guidelines for Americans and other quality criteria to
achieve nutrition integrity. School nutrition programs
should offer an opportunity for students to experience a
learning laboratory for applying classroom nutrition and
health education and serve as a resource for links with
nutrition-related community services. Food service staff
16    Section 1   Comprehensive School Health Education
have the primary responsibility for providing adequate
and appropriate foods. However, the effective operation
of school nutrition services requires coordination and
cooperation from school administrators, school health
coordinators, teachers, families, school nurses, coun-
selors, and other school staff. Food service personnel
should play an active role on school health committees.
School nutrition services are aided when supported by
community resources and professionals. In addition to the
nutrition services provided onsite by school personnel,
schools should establish links with qualified public health
and nutrition professionals in the community. These
professionals can inform families and school staff about
nutritional services available in the community, such as
the Special Supplemental Program for Women, Infants,
and Children (WIC), the Food Stamp Program, the Sum-
mer Food Program, and local food and nutrition pro-
grams. Qualified public health and nutrition professionals
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
nutrition education. The American Diabetic Associa-
tion (ADA), School Nutrition Association (SNA), and
­Society for Nutrition Education (SNE) jointly recognize
the importance of nutrition services integrated with coor-
dinated school health programs for the nation’s students
(Briggs, Fleischhacker, & Mueller, 2010).
Health Services
School health services are services designed to appraise,
protect, and promote the health of students. Health ser-
vices differ widely among individual school systems,
depending on the resources in the school and community
as well as students’ health needs. Examples of health ser-
vices that are offered in schools are
• Urgent and emergency care.
• Timely identification of and appropriate intervention
for health problems (e.g., infections, injuries, asthma,
emotional difficulties).
• Mandated and necessary screenings for all students
(e.g., vision, hearing).
• Assistance with medication during the school day.
• Health services for children with special health needs.
• Health counseling.
• Health promotion for students and staff.
• Preventive health services (e.g., immunizations, den-
tal sealants).
• Referrals and links with other community providers.
©McGraw-Hill Education
Schools are an ideal place for providing health services
as most children over age five attend school. Schools
provide a favorable setting for preventive health services
(e.g., health screening for vision and hearing) and health
services that are limited or unavailable to many students.
Services and settings vary widely, ranging from traditional
core services, such as vision and hearing screenings, to
comprehensive primary care in school-based health cen-
ters or in off-campus health centers (Story et al., 2006).
School health services are provided mainly by qualified
professionals such as physicians, nurses, dentists, social
workers, speech pathologists, and other allied health per-
sonnel. Teachers also play an important role in school
health services. For example, teachers might be called
on to participate in various health screenings (e.g., visual
testing, scoliosis screening) and to provide emergency
care for students involved in sudden illness or accident.
Chapter 2 in this book discusses school health services.
Counseling, Psychological,
and Social Services
Counseling, psychological, and social services provide
broad-based individual and group assessments, interven-
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
environment. Services are provided by professionals such
as trained/certified school counselors, psychologists, and
social workers. The need for these professionals is par-
ticularly highlighted by tragedies, as when schools need
to provide services to students when a student or teacher
has died. Professionals can provide invaluable services in
helping students, staff, and families deal with the shock
and grieving process. Personnel such as physicians,
nurses, speech and language therapists, special education
school staff, and classroom teachers also provide ser-
vices that contribute to the mental, emotional, and social
health of students.
Counseling, psychological, and social services can prevent
and address problems, enhance student learning, encour-
age healthy behavior, and promote a positive school cli-
mate. These services are especially needed because of the
emotional challenges many students face owing to paren-
tal divorce or death, family or peer conflicts, alcoholism,
and drug abuse. School counseling and psychological ser-
vices are capable of intervening in areas of assertiveness
training, life skills training, peer interaction, self-esteem,
problem solving, and conflict resolution.
 Chapter 1   A Nation at Risk    17
It is impossible for schools to offer or fund direct services
to meet all of the mental, emotional, and social needs
of children. Schools have to develop linkages with com-
munity resources so that services can be extended to a
greater number of children in need of services. Collab-
orations between school and community resources help
improve school-age youth’s access to services. The school
health council plays a vital role in this collaboration and
in advocating for increased resources for counseling, psy-
chological, and social services.
Social and Emotional Climate
The inclusion of social and emotional school climate into
the WSCC model reflects the need to address the high
occurrence of social, emotional, mental, and behavioral
challenges that increasingly confront students (CDC,
2013). It also reflects research showing that the social
and emotional climate of a school can impact student
engagement in school activities; relationships with other
students, staff, family, and community; and academic
performance (CDC, 2013; Humphrey, 2013).
The relationship between student engagement in schools
and the social–emotional climate is important to recog-
nize. Students who are engaged interact in classrooms
with their teachers and peers, with the content being
taught, and do so in ways that lead to academic achieve-
ment (Reyes, Brackett, Rivers, White, & Salvey, 2012).
In these classrooms, students share and collaborate in
their learning through the connections they have with
their teacher, peers, and the content. In contrast, disen-
gaged students become disruptive, typically do poorly in
school, and are more likely to drop out of school (Reyes
et al., 2012). In such classrooms, there is little connec-
tion to teachers, peers, or the content to be learned.
The social and emotional climate in schools should be
one where students, teachers, and staff feel comfortable,
safe, and supported. Such a milieu is essential for stu-
dents’ sense of safety and as a foundation for their aca-
demic achievement and for teacher and staff health and
well-being. A strong social and emotional school climate
also creates protective factors such as prosocial behaviors
that can disrupt potential challenges (Humphrey, 2013).
Similarly, the quality of social and emotional interactions
in the community, between and among students, peers,
family, neighbors, and friends defines the social and
emotional climate that children grow up in.
A social and emotional climate is in part a function of
the teaching practices that teachers use in their day-to-
day lessons where they should teach and reinforce skills
©McGraw-Hill Education
such as self-awareness, self-management, social aware-
ness, relationship skills, and responsible decision mak-
ing. A social and emotional climate is also in part the
responsibility of everyone in the school. A school-wide
culture should focus on a consistent message to students
from teachers and staff that reinforces these skills before
and after school, on the playgrounds, in the hallways, in
study halls, and in sports and extra-curricular activities.
The Physical Environment
A healthful and safe school physical environment is a
school environment that attends to the physical and aes-
thetic surroundings and the psychosocial climate and
culture that maximize the health and safety of students
and staff. Factors involved in the physical environment
include the school building and the area surrounding it;
any biological agents that might be detrimental to health;
and physical conditions such as temperature, noise, and
lighting. The psychological environment includes the
interrelated physical, emotional, and social conditions
that affect the well-being and productivity of students
and staff. This includes physical and psychological safety,
positive interpersonal relationships, recognition of needs
and successes of the individual, and support for building
self-esteem in students and staff. In addition to enhanc-
ing student health, a healthful and supportive environ-
ment fosters learning and academic growth. Chapter 2
also covers the school health environment.
Employee Wellness
Schools are one of the nation’s largest employers, with
approximately 4 percent of the total U.S. workforce, com-
prising nearly 6 million teachers and staff who work in
the public school system (Story et al., 2006). CDC (2010)
recommends that schools implement quality health pro-
motion programs for staff. Health promotion for staff
includes health assessments, health education, health-­
related physical-fitness activities, and other programs
that protect and promote the health of school staff. These
programs encourage and motivate school staff to pursue
a healthful lifestyle, thus promoting better health and
improved morale. This commitment can transfer into
greater commitment to the health of students and help
staff become positive role models for students. Health
promotion programs for staff also can improve produc-
tivity, decrease absenteeism, and reduce health insurance
costs (Council of Chief State School Officers, 2004).
For these reasons, health promotion programs for staff
18    Section 1   Comprehensive School Health Education
make good sense. The 2016 School Health Policy and
Practices Study reports that 54 percent of school districts
require schools to have an employee wellness program.
Importantly, 40.7 percent of districts provided funding or
offered health risk appraisals for employees, 27.8 percent
of districts provided incentives for employee’s participa-
tion in wellness programs, and 60.8 percent of districts
provided funding or offered immunizations such as influ-
enza injections for employees. The good news regarding
these data is that they have been trending upward since
1994 (School Health Policy and Practices Study, 2016).
It is critical that school staff be offered regular opportu-
nities to cultivate their own physical, mental, and emo-
tional well-being. Health promotion can include health
education, employee-assistance programs, health care,
and other activities. Activities that might be offered to
school staff include fitness classes, fitness testing and
assessment, health screening for early signs of disease
(e.g., blood pressure measurements, blood cholesterol
testing), smoking cessation classes, nutrition or healthy
cooking classes, walking or exercise groups, yoga or
meditation classes, conflict resolution training, finan-
cial planning sessions, and support groups for various
stressful life situations. Various personnel throughout the
school and community can lend their skills and resources
to providing health promotion activities for staff. For
example, physical education teachers can help plan and
provide fitness activities. School food service personnel
can teach healthy cooking classes. School psychologists
and counselors can offer stress management and conflict
resolution to school staff. School health services person-
nel, such as nurses, can conduct medical screenings and
give immunizations for influenza and other infectious
illnesses. Public health and health care professionals in
the community are often willing to provide services that
would promote the health and well-being of school staff.
Family Engagement
Families and schools share a reciprocal and collaborative
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
the context of the other. Parents should be active in their
child’s engagement in school beyond parent–teacher
­conferences, and schools should solicit parent involve-
ment. However, what is seen as family engagement with
the school varies by parent, and it can be affected by the
level of education of the parent, the family unit (e.g., single
or dual parenting, guardians), the socioeconomic status of
the parents, the life history of the parent(s) with schools
and authorities, and the mobility of the family. At its best,
©McGraw-Hill Education
family engagement consists of robust, trusting relation-
ships between teachers, families, and community that
place the child at the center of the engagement. There is
no fixed model for family engagement and because of the
factors that influence engagement it can take many forms.
In their review of the benefits of family engagement, the
New Hampshire Department of Education (2018) notes
that research shows that students whose parents are
involved in their education are more likely to:
• Adapt well to school
• Attend school more regularly
• Complete homework more consistently
• Earn higher grades and test scores
• Graduate and go on to college
• Have better social skills
• Show improved behavior
• Have better relationships with their parents
• Have higher self-esteem
Schools can encourage family involvement in projects
that improve the community environment (e.g., recy-
cling programs, providing safe bicycle paths). School
staff can invite interested parents to participate in health
promotion activities such as exercise or smoking cessa-
tion classes. Parents can serve on school health advisory
boards and school committees.
Health education teachers can send home with students
health information for families that reinforces health
education lessons. Families can be invited to health fairs
held at schools and to participate in health fair promo-
tion and activities. School food service personnel can
provide information to families about school nutrition
programs and recipes for nutritious meals. School facil-
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.
Community Involvement
Schools are situated in communities, and communities are
filled with resources that can support the school. It does
take a village to raise a child, and the more involved the
village is, the better likelihood of raising a child in a good
environment. When schools actively involve parents and
engage community resources, they are able to respond
more effectively to the health-related needs of students.
Linking community activities to the classroom (a) improves
school-related behaviors, (b) positively impacts academic
achievement, and (c) reduces school suspension rates
 Chapter 1   A Nation at Risk    19
(New Hampshire Department of Education, 2018). Health
education curricula implemented in classrooms with exten-
sion activities to engage parents and community agencies
helps students to assume responsibility for their personal
health and well-being (Gieger, Fulmore, & Werner, 2010a).
In their influential chapter on “School and Family Part-
nerships,” Epstein and Salinas (1992) describe six types
of community involvement:
• Parenting. Where the intent is to assist families with
parenting skills, provide knowledge relative to child
and adolescent development, helping families under-
stand the expectations of the school. Schools need to
understand their families’ backgrounds, cultures, and
goals.
• Communicating. Families and schools represent a
two-way communication model, and schools and fam-
ilies are each obligated to find the best ways for this
to happen.
• Volunteering. Schools require engagement from the
community, but they are responsible for creating
mechanisms for such engagement, including the
recruitment of families as volunteers, meaningful
work, and flexible scheduling.
• Learning at Home. Many parents do not have a strong
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-
ities. As such there is an important need for family
education on these issues.
• Decision Making. If families and schools are to
engage in democratic governance of schools, then
families should be involved in school decisions, gov-
ernance, and advocacy activities such as school coun-
cils or improvement teams and permanent and ad hoc
committees.
• Collaborating with the Community. Schools have the
responsibility to share in the coordination of support
services for families with community groups, includ-
ing businesses, agencies, cultural and civic organiza-
tions, and colleges or universities.
Comprehensive School
Health Education
This teacher resource book has been designed to focus on
one component of the coordinated school health program:
comprehensive school health education. The comprehen-
sive school health education curriculum is an organized,
sequential K–12 plan for teaching students information
and helping them develop life skills that promote health lit-
eracy and maintain and improve health, prevent disease,
©McGraw-Hill Education
and reduce health-related risk behaviors. The comprehen-
sive school health education curriculum addresses the
physical, mental, emotional, family, and social dimen-
sions of health and is tailored to each age level.
Each of the fifty states in the United States has its own
set of health education standards. In some cases, these
are exactly the same national health education standards,
and in other cases, a state’s standards for health educa-
tion have been shaped to serve state-specific needs. The
curriculums that serve each state vary greatly across states
and within each state by district. As such, while the gen-
eral focus in the United States is for the most part on a
common set of standards and on a skills-based, decision-­
making curriculum, the approaches vary. This teaching
resource book has been designed to focus on one compo-
nent of the WSCC model: comprehensive school health
education. The book is organized around the Meeks Heit
Umbrella of Comprehensive School Health Education.
The Meeks Heit Umbrella
of Comprehensive School
Health Education
The Meeks Heit Umbrella of Comprehensive School
Health Education illustrates how a curriculum can be
designed to protect young people from the six categories
of risk behaviors identified by the Centers for Disease
Control and Prevention by teaching them to comprehend
health concepts; analyze influences on health; access
valid health information and products and services; use
communication skills; use resistance skills; use conflict
resolution skills; make responsible decisions; set health
goals; practice healthful behaviors; manage stress; be
health advocates; and demonstrate good character.
Figure 1-2 shows the Meeks Heit Umbrella of Compre-
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
indeed be drenched in troubles! The six categories of risk
behaviors from which young people need protection are
these:
1. Behaviors that contribute to intentional injuries
2. Tobacco use
3. Alcohol and other drug use
4. Sexual behaviors that contribute to unintended preg-
nancy, HIV (human immunodeficiency virus) infec-
tion, and other sexually transmitted diseases
5. Dietary patterns that contribute to disease
6. Insufficient physical inactivity
20    Section 1   Comprehensive School Health Education

FIGURE 1-2

The Meeks Heit

Umbrella of Comprehensive
School Health Education
Insufficient Dietary
Tobacco
Alcohol Physical Patterns
Use That Sexual
and Activity
Other Contribute Behaviors
Health Literacy to Disease That Result
Drug
Use National Health in Unintended
Unintentional Education Standards Pregnancy,
Injuries
Performance Indicators HIV, and
and
Violence Other STDs
Com nic Dise

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)

Health & Wellness

©Copyright
by the McGraw-Hill Companies, Inc.
©McGraw-Hill Education
Another random document with
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 Transcriber’s Notes
Several minor punctuation errors have been fixed.
Page vi: changed “Fusi San” to “Fuji-San”.
Page vii: changed “Murdock” to “Murdoch”.
Page 44: changed “Rhone” to “Rhône”.
Page 50: changed “distined” to “destined”.
Page 107: changed “vendure” to “verdure”.
Page 142: changed “destoy” to “destroy”.
Page 144: moved the second Gibraltar illustration to the appropriate chapter.
Page 148: “Oxeraa” left in place; modern spelling is Öxará.
Page 152: changed “obsure” to “obscure”.
Pages 160 and 168: Both Tindafjall and Tindfjall have been retained as printed
in the original publication.
Page 166: changed “aneriod” to “aneroid”.
Page 205: changed “verdue” to “verdure”.
Page 208: changed “guage” to “gauge”.
Page 216: The open quotation mark before “There was a roaring ... has been
left unmatched as published.
Page 255: “Etna may be is” retained per original publication.
Page 269: changed “Gramnaticus” to “Grammaticus”.
Page 271: changed “quiescient” to “quiescent”.
Page 358: changed “preclude” to “prelude”.
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