Academic journal article Journal of School Health

Design of the Teenage Health Teaching Modules Evaluation

Academic journal article Journal of School Health

Design of the Teenage Health Teaching Modules Evaluation

Article excerpt

The School Health Education Evaluation (SHEE) published in 1985 provided evidence about the effectiveness of health education at the elementary school level. (1) Based on evaluation of four curricula, the SHEE showed using gain score analysis that exposure to health education curricula administered by classroom teachers resulted in significant increases in children's health knowledge (K), with more limited effects on health attitudes (A) and self-reported practices (p). (l) The SHEE also provided evidence that exposure to comprehensive health instruction (Growing Healthy) delayed onset of self-reported smoking by children. (2)

The KAP gains detected in the SHEE were associated with the amount of inservice training that teachers received in a specific curriculum, the amount of time students were exposed to the curriculum, the fidelity with which teachers implemented the curriculum, and other factors. (1,3) The KAP gains also cumulated over four semesters. (2)

In response to the SHEE, many recommendations were made for further research. Gilbert and Gold (4) recommended examining the success of health instruction at the secondary level, where health instruction is typically provided by subject area specialists (though not necessarily by health educators). Howell, Frye, and Bibeau (5) argued that "... the next step should be a large-scale study of implementation issues not included in the SHEE . . . Too often, very good programs fail not because of the program, but because the problems of implementation were not thoughtfully considered." Basch (6) stressed that, as we develop more and better school health education innovations, "the need for research that will allow us to efficiently transport [them] ... becomes increasingly important." By studying how programs are implemented and how variations in implementation affect outcomes, we can improve prospects of transporting programs in their most effective form. Though an extensive literature on diffusion of educational innovations exists, until recently few diffusion research methods and findings had been applied formally to school health education. (6-9)

Partially in response to these recommendations, in 1986 the Centers for Disease Control (CDC) funded an evaluation of the Teenage Health Teaching Modules (THTM), a comprehensive, secondary school health education curriculum. This article describes the objectives of the THTM evaluation, the THTM curriculum, the research design, the participating sample of schools, students, and teachers, and the student and teacher questionnaires.


The four primary objectives of the THTM evaluation in priority order were to:

1) Assess the effectiveness of a comprehensive secondary school health education curriculum in producing desired changes in student knowledge (K), attitudes (A), general health practices (P), and priority health behaviors (B) (Relationship #1 in Figure 1).


2) Determine effects of pre-implementation teacher training in THTM on curriculum implementation (Relationship #2) and student outcomes (Relationship #3) under controlled conditions.

3) Determine effects of the teacher's preparation and personal characteristics and other aspects of school and classroom environments on curriculum implementation (Relationship #4).

4) Determine effects of variations in curriculum implementation on student outcomes (Relationship #5).

In summary, the evaluation assessed the effectiveness of this secondary school health education curriculum and identified factors that influence successful curriculum implementation and student outcomes.


THTM was developed between 1979 and 1983 by the Education Development Center, with support from the Office of School Health and Special Projects (now the Division of Adolescent and School Health) at CDC. The curriculum was developed because many school systems using Growing Healthy (10) in the elementary grades asked for a compatible curriculum at the secondary level. …

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