Elementary, middle school, high school, and university education provide an opportunity to promote health literacy, to reduce health-risk behaviors, and to prepare children to navigate the health-care system. Effective health education programs should begin in early childhood and continually build on previous knowledge (NRC, 1999). Achieving health literacy in students is hindered by a lack of continuity in health education programs across the many age groups.
The School Health Policies and Programs Study 2000, conducted by the Centers for Disease Control and Prevention (CDC), indicated that most elementary, middle, and high schools require health education classes as a part of the curriculum (Kann et al., 2001). The majority of these states (75 percent) use the National Health Education Standards (NHES) as a framework to develop these programs (Kann et al., 2001). Box 5-1 displays the NHES and some background about these standards. Some states have made significant progress in establishing guidelines in accordance with the NHES.
A lack of consistent, cross-grade health curriculums may reduce student health literacy. Although most elementary, middle, and high schools require students to take health education, classes in different grades tend not to build upon previous grades. The absence of a coordinated health education program across grade levels may impede student learning. Kann et al. (2001) report an increase in the percentage of elementary schools that require health education from 33 percent in kindergarten to 44 percent in grade 5. However, only 27 percent of schools require health education in grade 6, 20 percent in grade 8, 10 percent in grade 9, and 2 percent in grade 12.
Teacher education may affect teacher effectiveness in implementing health and health literacy curriculums. National and international strategies developed to help schools implement effective policies and programs (e.g., Kolbe et al., 1997, 2001) are complicated by the fact that few health education teachers majored in health education (Collins et al., 1995; Hausman and Ruzek, 1995; Kann et al., 2001; Patterson et al., 1996; Ubbes et al., 1999). Only 10 percent of health education classes or courses have a teacher who majored in health education, or in health and physical education combined (Kann et al., 2001). Peterson and colleagues (2001) suggest that inadequate attention to teacher health literacy has impeded student health literacy. Many teachers feel that they are not prepared to teach specific health topics (Peterson et al., 2001). For example, a sample of 156