Educational and Evidence Base for Health for Life Overview The Centers for Disease Control and Prevention (CDC, 2013) has described 4 essential qualities and 15 characteristics of an effective health education program, including the need for an evidence base and a basis in sound educational theory. Health for Life (McConnell, Corbin, Corbin, & Farrar, 2014) and its accompanying instructional materials conform to those qualities and characteristics set forth by the CDC. A foundation in domain-specific educational standards is also essential for high-quality programs. Health for Life (McConnell, Corbin, Corbin, & Farrar, 2014) is based on current standards for Health Education (SHAPE America, 2007). In addition Health for Life meets standards for physical education and fitness education for specific topics such as physical activity and fitness, nutrition, stress management, and consumerism (SHAPE America: Physical Education, 2014; SHAPE America: Fitness Education Framework, 2012). Healthy People 2020 health goals for the nation (USDHHS, 2010) and Career and College Readiness Standards (CCSSI, 2015) also provided guidance in content selection. Finally, Health for Life was prepared using a formula that has been successful for several award-winning theory-driven evidencebased programs. CDC Essential Qualities of an Effective Health Education Curriculum The Centers for Disease Control and Prevention (CDC) identified four qualities that are essential to an effective health education curriculum. Each of these is reflected in the Health for Life program: 1. Teaching functional health information (essential knowledge). Health for Life focuses on knowledge that addresses all essential health education topics, including the prevention of alcohol, drug, and tobacco use; the promotion of priority lifestyles (physical activity, nutrition, and stress management); the promotion of mental, emotional, personal, and sexual health and wellness; the promotion of safety; and the prevention of violence. 2. Shaping personal values and beliefs that support healthy behaviors. Health for Life challenges students to explore their values and beliefs and provides them with repeated opportunities to examine what influences their values and beliefs and how their behaviors are changed as a result. 3. Shaping group norms that value a healthy lifestyle. Throughout the Health for Life program, students are given opportunities for peer-to-peer interactions that affirm healthpromoting beliefs; counter perceptions about peer behaviors in relation to risky health behaviors; and promote healthy choices in their school, family, and community. 4. Developing the essential health skills for adopting, practicing, and maintaining healthenhancing behaviors. In every chapter of Health for Life, students engage in self-assessing their health status and behaviors, setting health behavior goals, and creating action plans for behavior change. In addition, each chapter provides opportunities for skill development in relation to skills for healthy living such as goal setting, time management, changing attitudes, building refusal skills, and providing social support. Characteristics of an Effective Health Education Curriculum The CDC (CDC, 2013) states that less effective curricula often overemphasize teaching scientific facts and increasing students’ knowledge. While it is important to learn basic health knowledge and to gain health literacy, an effective curriculum must translate that knowledge into skills that promote long-term behavior change. As such, experts in the field of health education have identified a set of characteristics that are associated with an effective overall curriculum that promotes long-term behavior change: 1. Focuses on clear health goals and related behavioral outcomes. Health for Life demonstrates this characteristic in several ways. First, each unit of the text identifies the Healthy People 2020 behavioral objectives that are reinforced in the associated chapters. In addition, the first unit of the book teaches students the foundations of behavior change, and each subsequent chapter provides opportunities for developing behavior change and skills for healthy living. Through features such as Self-Assessment and Planning for Healthy Living, students are given opportunities to develop relevant behavioral outcomes and to set their own health goals. 2. Is research based and theory driven. Health for Life relies on several key theories that inform the text’s content as well as the learning opportunities provided for students: Social learning theory. Also referred to as social cognitive theory, this theory emphasizes the importance of self-efficacy and positive expectations in making behavior changes. It also emphasizes the importance of trying ability-appropriate tasks to gradually enhance self-efficacy for a specific task. The theory suggests that a person must value the outcomes of a behavior if a change in behavior is the goal. Self-determination theory. Central to self-determination theory is personal autonomy. Autonomy refers to the ability of a person to make his or her own decisions. Feelings of competence at mastering skills or tasks are also critical to the theory. Making personal choices is emphasized rather than making choices based on external pressures to comply. Intrinsic (internal) motivation is considered to be more important than extrinsic (external) motivation (e.g., rewards, payments). In self-determination theory, intrinsic motivation is a major factor in making choices to adopt a behavior because it makes them fulfilling rather than coerced. Theory of reasoned action. This theory suggests that a person’s behavior is most associated with the person’s stated intention to carry out the behavior. According to this theory, a person’s intentions are influenced by attitudes (beliefs) and the social environment (opinions of others). Theory of planned behavior. This theory has many of the tenets of the theory of reasoned action but includes the concept of perceived control over the environment. If a person is to change a behavior, she must believe that she has some control over the factors that influence the behavior. Perceived control is in many ways similar to selfefficacy in social cognitive theory. Health belief model. A model is similar to a theory in that it provides a blueprint for behavior change. This model suggests that a person’s health behavior is related to five factors: the belief that a health problem will have harmful effects, the belief that a person is susceptible to the problem, the belief that the perceived benefits of changing a lifestyle will prevent the problem, the belief that overcoming barriers to the problem will solve the problem, and confidence that the person can do what is necessary to prevent or solve a problem. Social ecological model. This model is based on the idea that health behavior change is influenced by the interaction of factors from the cultural, social (intrapersonal), and physical environment. For example, when people practice a negative behavior such as smoking, they affect the environment. Others in the environment are then exposed to a health risk. Unlike the other theories and models, the social ecological model emphasizes the importance of a multitude of social and environmental factors rather than personal health behavior change. Transtheoretical model. This model is also referred to as the stages of change. The model uses elements of all of the previously described theories and models. As noted in the student text, the model suggests that health behavior change does not occur all at once. Rather, five stages exist and behavior change occurs when people move from one stage to another. The model also emphasizes the importance of the process of change, including factors such as goal setting, self-monitoring, self-assessment, and planning. All of the Skills for Healthy Living features (see table 1 below) in the text are derived from these theories and models. These are skills for healthy living that help students change, or enhance, their lifestyle. There are three kinds: those that help with beginning to change, those that help in making a change, and those that help in maintaining a change. These skills are presented in the student text, and activities that help in developing the skills are supported by the lesson plans. Skills for Healthy Living provide the basis for adopting healthy lifestyles. Students not only learn about these skills for healthy living, but they also get the opportunity to practice them. As with any skill, practice is critical to the effective use of skills for healthy living. Table 1: Skills for Healthy Living Skill Selfassessment Description This skill allows you to evaluate your current status for markers of health and wellness or particular health behaviors. Examples include assessing personal fitness, nutrition, and stress level. Goal setting This skill helps you set goals that are SMART (specific, measurable, attainable, realistic, and timely) for changing health behaviors. Benefits Helps you objectively determine your current status. Helps you set goals and plan a program to change your health behavior. Provides a road map for change. Helps you prepare a plan for changing your health behavior. Self-planning This skill has five steps that serve as an outline for planning a personal program for health behavior change. Selfmonitoring This skill helps you keep records (logs or a journal) to see whether you’re actually doing what you think you’re doing—whether you’re meeting personal goals and complying with your planned program for changing your health behavior. Overcoming barriers Time management This skill helps you find ways to stick with a behavior change despite obstacles such as lack of time, lack of safe places to be active, and difficulty selecting healthy foods. This skill helps you schedule time efficiently so that you have more time for the important things in life. This skill helps you stick with healthy behaviors even when you have problems getting motivated or when other people or situations tempt you to make unhealthy decisions. Finding This skill helps you stick with healthy social support behaviors by getting support from friends and family members. Providing Being a healthy citizen includes being social support able to help others when they are at risk for injury, illness, or death. This skill involves identifying risks, communicating effectively, and finding Relapse prevention Helps you commit in writing to goals and changing your behavior. Provides a measuring stick for evaluating whether you’ve accomplished your goals. Helps you evaluate your progress in meeting goals and adhering to your program. Helps you stay motivated to stick with your program. Helps you keep useful records. Helps you begin making changes. Helps you stick with your changes. Helps you eliminate excuses and succeed. Helps you see how you use your time. Helps you take care of priorities. Helps you reduce stress. Helps you adhere to healthy behaviors. Helps you persist and meet your goals. Helps you adhere to healthy behaviors. Helps you prevent relapse. Helps you build selfconfidence and social wellness. Helps you develop social responsibility. Saying no Conflict resolution Critical thinking Performance Self-help appropriate resources. This skill helps you avoid doing things you don’t want to do, especially when you’re under pressure from friends or other people. This skill helps you resolve problems that arise at school, at home, or in other circumstances. This skill enables you to find and interpret information that helps you make good decisions and solve problems related to your health. One critical thinking skill that you will address in this book is evaluating nutrition information. This type of skill involves performing tasks of daily living (e.g., typing, cooking) and tasks that make your leisure time enjoyable (e.g., playing a sport). This type of skill helps you be safe and healthy and able to help others as well. Examples are: knowing first aid and CPR, using safety equipment (e.g., helmet and pads for in-line skating), and practicing good personal health habits (e.g., tooth brushing and flossing). Helps you adhere to healthy behaviors. Helps you stay on track to meet your goals. Helps you reduce stress. Helps you maintain friendships and other good relationships. Helps you set goals. Helps you plan your program. Helps you be a wise health consumer. Helps you enjoy life. Contributes to healthy living. Helps you be healthy and well. Helps you be safe and avoid injury. Allows you to contribute to the health and safety of others. 3. Addresses individual values, attitudes, and beliefs. Health for Life provides multiple opportunities for students to examine personal attitudes, values, and beliefs through discussions, debates, and consensus-building activities as part of the Healthy Communication and Connect features in the text. In addition, the lessons associated with each chapter provide opportunities for exploration of how individual and societal values, attitudes, and beliefs influence health behaviors. 4. Addresses individual and group norms that support health-enhancing behaviors. Throughout the Health for Life text, students are provided with points of reference about positive and negative norms and trends related to specific health behaviors. In addition, many of the lesson plans provide opportunities for students to analyze, role-play, and identify how norms affect health decisions and health behaviors among individuals, groups, and society at large. 5. Focuses on reinforcing protective factors and increasing perceptions of personal risk and harmfulness of engaging in specific unhealthy practices and behaviors. According to the CDC, this characteristic means that an effective curriculum provides opportunities for students to validate positive health-promoting beliefs, intentions, and behaviors. It provides opportunities for students to assess their vulnerability to health problems, actual risk of engaging in harmful health behaviors, and exposure to unhealthy situations. Every chapter of Health for Life contains an individual self-assessment and asks students to evaluate their personal risks related to a variety of health behaviors and choices and provides them with opportunities to define goals to change unhealthy behaviors or maintain healthy ones. 6. Addresses social pressures and influences. This characteristic is well supported throughout Health for Life and the associated lesson plans. In addition, the Connect feature questions, which provide opportunities for students to focus on the analysis of social pressures, media influences, and peer pressures to engage in unhealthy and healthy behaviors, are a central feature of each chapter. 7. Builds personal competence, social competence, and self-efficacy by addressing skills. Essential skills such as communication, refusal, information literacy, decision making, planning and goal setting, self-control, and self-management are critical elements of the Health for Life program. Each chapter in the text contains a Making Healthy Decisions feature and a Skills for Healthy Living feature (see table 1), which are also the focus of a dedicated lesson plan each week. For each lesson plan that focuses on skill development related to the Skills for Healthy Living, students are guided through a series of developmental steps: a. Identifying the importance and relevance of the skill through a designated case study and discussion questions (presented in the text) b. Specific steps for skill development (presented in the text) c. Opportunities to model and practice or rehearse the skill (presented in the lesson plans) d. Opportunities for feedback and further practice and reinforcement (presented in the lesson plans) 8. Provides functional health knowledge that is basic and accurate and directly contributes to health-promoting decisions and behaviors. The content in Health for Life supports healthy decision making and healthy behavior change. Each lesson plan contains a Lesson Application where student knowledge is used to support health-promoting decisions and behaviors. In addition, while Health for Life provides a full range of health education topics, special emphasis is placed on the healthy lifestyle choices of physical activity, nutrition, and stress management. 9. Uses strategies that personalize information and engage students. The lesson plans in Health for Life each have five elements: Bell Ringer, Lesson Focus, Lesson Application, Reflection and Summary, and Evaluate. Students are given multiple opportunities to engage with the content. Each chapter review in the text contains a critical thinking question as well as a project opportunity. Key health concepts, creative expression, personal reflection, diverse perspectives, and critical thinking skills are developed through the instructional strategies used in the lesson plans. 10. Provides age-appropriate and developmentally appropriate information, learning strategies, teaching methods, and materials. Students have the opportunity to understand, develop, and apply skills in behavior change, self-management, self-assessment, peer interaction, program planning, critical health information, and goal setting in relation to health-enhancing behaviors. In addition, the Health Technology and Health Science features bring age-appropriate topics of interest to high school students (e.g., Internet safety, use of computer applications to assist behavior change, and evaluating web information). Together, these opportunities empower students to make healthy choices now and throughout their lives. 11. Incorporates learning strategies, teaching methods, and materials that are culturally inclusive. Health for Life reinforces cultural diversity through its presentation (i.e., illustrations and photographs), examples used (i.e., Making Healthy Decisions and Diverse Perspective features), information provided (i.e., cultural influences on specific health behaviors, cultural differences in health and health behaviors), and learning opportunities and assignments (i.e., analyzing one’s own cultural influences on health decisions and behaviors). 12. Provides adequate time for instruction and learning. This comprehensive semester-long program encompasses five daily lesson plans for each of 20 textbook chapters plus one supplemental chapter. Lesson plans focus on understanding and applying content knowledge to health problems and decisions, self-assessment of health behaviors, self-management of skill development, and development of critical thinking skills. 13. Provides opportunities to reinforce skills and positive health behaviors. Students are encouraged to consider their current health status as well as their lifelong health needs and goals. They are also given opportunities to learn, apply, and revisit health goals and plans throughout the term. Connections to other academic areas are made in both the text (i.e., communication skills, technology and science) and in the lesson plans (i.e., reading comprehension and mathematics). 14. Provides opportunities to make positive connections with influential others. Every Health for Life lesson provides an opportunity to connect with family and community in the Take It Home feature. Students are encouraged to share their health knowledge with others, explore shared and divergent values with friends and family members, use experts and others in decision-making processes, explore norms that influence their choices and actions, and directly influence others’ health behaviors. Advocacy in Action features in each unit also provide opportunities to work with others to influence health behaviors. 15. Includes teacher information and plans for professional development and training that enhance effectiveness of instruction and student learning. The lesson plans provide aligned instruction (learning outcomes, lesson focus and application activities, and assessment and evaluation activities all support one another) and specific tips to enhance instruction. All materials can be modified or enhanced as instructors gain knowledge through professional development opportunities. Standards for Health for Life As noted in the overview, Health for Life (McConnell, Corbin, Corbin, & Farrar, 2014) is based on current standards for health education (SHAPE America, 2007) as well as standards for physical education and fitness education (SHAPE America: Physical Education, 2014; SHAPE America: Fitness Education Framework, 2012 in specific chapters on physical activity and fitness, nutrition, and consumerism. In addition, Health for Life meets state-specific educational standards as well as selected standards for College and Career Readiness. Correlation tables for state specific standards are available at www.healthforlifetextbook.org/correlations-to-statestandards. Health education standards. The Health for Life program is based on the Health Education Standards as published by the Society for Health and Physical Educators (formerly AAHPERD). Go to www.shapeamerica.org/standards/health to access a list of all of the standards described in table 2, including specific performance outcomes and benchmarks. In addition, all Health for Life lesson plans indicate which SHAPE health education benchmarks are met. Specific lesson objectives and academic connections are also indicated. Table 2: Established Standards Form the Basis of the Health for Life Program Name and organization National standards and grade-level outcomes for K-12 health education (2007) SHAPE America, formerly AAHPERD (the standards were from AAHE, formerly an association within AAHPERD). Purpose The standards provide a basis for planning quality health education programs. Eight primary standards describe the healthliterate person. Primary standards The NHES are 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 development and selection, instruction, and student assessment in health education. Following are the eight national standards: Standard 1: Students will comprehend concepts related to health promotion and disease prevention to enhance health. Standard 2: Students will analyze the influence of family, 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 National Standards & Grade-Level Outcomes for K-12 Physical Education (2014) Instructional Framework for Fitness Education, 2012. Other health education standards Each state typically adopts its own standards based on national 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. The standards provide a Standard 1 - The physically literate basis for planning individual demonstrates competency in a quality physical variety of motor skills and movement education programs. patterns. Five primary standards Standard 2 - The physically literate describe the physically individual applies knowledge of literate person. concepts, principles, strategies and tactics related to movement and performance. Standard 3 - The physically literate individual demonstrates the knowledge and skills to achieve and maintain a health-enhancing level of physical activity and fitness. Standard 4 - The physically literate individual exhibits 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. The framework 1. Technique provides a basis for 2. Knowledge planning quality fitness 3. Physical Activity education programs. 4. Health-Related Fitness Eight primary standards 5. Responsible Personal and Social describe the physically Behavior literate person 6. Values and Advocates. 7. Nutrition 8. Consumerism State standards See the State-Specific Materials section typically focus on of the textbook website for your state’s specific courses or standards. classes. standards. Standards from other academic areas www.corestandards.org Academic areas other than health education have their own standards. While the primary purpose of Health for Life is to meet health education standards, academic standards in math, language arts, and science were also considered. College and career readiness standards. To ensure a smooth transition from high school to the workforce or college, students need knowledge, skills, attitudes, and academic preparation. Most states have college and career readiness standards or use common core standards (www.corestandards.org). Important to these standards is the development of higher-order critical thinking skills, particularly in language arts (reading and writing) and math. While the program focuses on health education standards, it emphasizes critical thinking and higher-order learning and reinforces critical concepts of college and career readiness. Reading, writing, and math skills are used throughout the program, and special sections in the lesson plans designate where academic connections can be made. National health objectives. Healthy People 2020 (www.healthypeople.gov) identifies nationwide health priorities and encourages action to change public policy to improve the nation’s health. Health for Life reinforces these guidelines. Following are some of the overarching goals of Healthy People 2020: Attain high-quality, longer lives free of preventable disease, disability, injury, and premature death. Achieve health equity, eliminate disparities, and improve the health of all groups. Create social and physical environments that promote good health for all. Promote quality of life, healthy development, and healthy behaviors across all life stages. At the beginning of each unit, specific Healthy People 2020 goals are identified. Content in the chapters of the units address each of the identified goals. Fitness Education and Physical Education Standards. Some of the topics (chapters) deal with topics covered in health-based physical education programs and fitness education programs. Examples include physical activity and fitness, nutrition, stress management, and consumerism. For these topics SHAPE America standards for fitness education and physical education were considered (see Table 2). Evidence in Support of Programs Like Health for Life Health for Life and its accompanying instructional materials are new. The evidence base for the effectiveness of the program has yet to be established. However, the formula used in developing Health for Life was used in building the award-winning texts (Fitness for Life, 2014; Fitness for Life: Middle School, 2007; Concepts of Fitness and Wellness, 2013) as well as two successful K8 health series: Choosing Good Health, (Thompson, Althaus, Corbin, Gray, Sroka, & Thompson, 1983) and Health for Life (Richmond, Pounds, & Corbin, 1986; Richmond, Pounds, & Corbin, 1990). That formula includes a foundation in domain specific standards, and content based on sound theory. Specific theory driven self-management skills have been identified and are central to program development. Evidence at the college level. The first programs that focused on theory-driven self-management skills and conceptual health based learning were started at the college level in the late 1960s. For example, the first edition of the text that evolved into the current text Concepts of Fitness and Wellness (Corbin, Welk, Corbin, & Welk, 2013) was published in 1968 (Corbin, Dowell, Landiss & Tolson, 1968). Since then college programs using the Concepts text, and other similar texts have been shown to be effective in building knowledge, attitudes, and healthy behaviors (Adams & Brynteson, 1992, 1995; Bjerke, 2013; Brynteson & Adams, 1993; Calfas et al., 2000; Ferkel et al., 2014; Hager et al., 2012; Pearman et al., 1997; Saelens et al., 2000; Slava, Laurie, & Corbin, 1984; Cardinal & Spaziani, 2007; DeVoe et al., 1998; Quinn & Wilson, 1987). Research by Kruger and colleagues (2014) provides evidence that college students have significant risk factors for cardiovascular disease. In this study, 73% of the participants were found to have at least one risk factor, and 15% had multiple risk factors. The authors concluded that their research has “important implications for future prevention and educational initiatives. Specifically, this knowledge will assist in providing effective programming and curriculum to support behavior change in college students considering the window of opportunity available at the college setting” (p. 581). A key element of successful programs is the development of self-management skills that aid students in changing health behaviors and adopting healthy lifestyles (Cardinal, Cardinal, & Burger, 2005; Cardinal, Jacques, & Levy, 2002). One study showed that within three years after health-based programs were dropped, activity decreased and nutrition habits deteriorated among students (Ansuini, 2001). Several researchers have pointed out the importance of reaching students while they are in school and before they become self-supporting adults (Ferrara, 2009; Keating, Guan, Pinero, & Bridges, 2005; Nelson et al., 2008; Wengreen & Moncur, 2009). Higgins and colleagues (2009) found that students valued their health-based courses for three reasons: finding balance in all aspects of wellness, learning to recognize the value of social support, and learning skills to address challenges. Jenkins and colleagues (2006) found that fitness testing, wellness assignments, and meeting new people were perceived as positive outcomes. Qualitative research has shown that programs “create awareness through providing factual information and practical strategies for health behavior changes at a transitional time to adulthood” (Woekel et al., 2013, p. 375). In addition, Kupchella (2009) and Sparling (2003) summarized the value of classes in promoting lifelong physical activity and other healthy behaviors. Evidence at the high school level. In 1979 Corbin and Lindsey wrote the first health-based physical education text, Fitness for Life. They did this because many students do not go to college and can benefit from the information commonly taught in college classes. The book, now in its sixth edition (Corbin & Le Masurier, 2014), uses the same formula that was successful at the college level. This award-winning program covers health topics such as nutrition, stress management, and personal health as well as topics now referred to as personal fitness or fitness education. It uses the same theory-driven base and emphasizes the teaching of self-management skills. The section that follows presents evidence of effectiveness for theory-driven health-based programs at the secondary school level. Several published studies provide evidence of the effectiveness of high school health-based programs such as Fitness for Life (Dale, Corbin, & Cuddihy, 1998; Dale & Corbin, 2000; Wallhead & Buckworth, 2004). The research shows that high school students who take these health-based classes make health behavior changes that persist later in high school and in the years after graduation. One study that used a knowledge test from Fitness for Life indicated “…secondary students have many misconceptions, or incomplete knowledge, regarding healthy behavior content…” (Teatro et al., 2013, p. A-30). A study by Thompson and Harmon (2012) indicates that high school students who lack knowledge of fitness are less likely to be physically active than students with better knowledge of fitness. Summary Health for Life is a new health education program (text and instructional materials) specifically for high school students. The program meets SHAPE America and state health education standards and conforms to CDC essential qualities and characteristics for health education curricula. It considers HP 2020 Health Objectives and Career and College Readiness standards. The program is by authors who have used a successful formula in creating other evidence-based, theory-driven, and award-winning health-based texts and instructional materials. Considerable evidence is available to support this approach. References Adams, P., & Brynteson, T.M. (1992). A comparison of attitudes and exercise behaviors of alumni from universities with varying degrees of physical education activity programs. Research Quarterly for Exercise and Sport, 63,148-152. Adams, T.M. II, & Brynteson, P. (1995). The effects of two types of required physical education programs on attitudes and exercise habits of college alumni. The Physical Educator, 52, 203210. Ansuini, C.G. (2001). 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