Chapter One: Introduction
Background
In 2006, over half of elementary schools taught health at every grade, and nearly
half of secondary schools required at least one health course to graduate (Brener, et al.,
2011). In 2018, the national median was 40.8% of secondary schools requiring one health
course to graduate, and 30.1% required two or more courses to graduate (Centers for
Disease Control and Prevention [CDC], 2019d). A median of 93.7% of secondary schools
required some form of health education instruction across the United States in 2018,
although not all of this instruction was delivered as a part of a health education course. In
2006, more than half of schools used a sequential, standards-based curriculum and
onethird of secondary health teachers had credentials to teach health education (Brener et
al., 2011). Approximately one-third of secondary schools provided professional
development in health education. As of 2014, less than half of schools had professional
preparation requirements for school health education, and over one-third of schools
required health education professional development for health educators (Lee et al.,
2019).
Unfortunately, all of these numbers remain relatively unchanged.
As of July 1, 2018, the Minnesota Professional Educator Licensing and Standards
Board (PELSB) began to utilize a tiered system for teaching licenses (PELSB, 2018). All
four tiers required a minimum of a bachelor’s degree in the subject taught. Tier 2 added
the requirement for an approved education program, master’s degree, or multiple other
criteria. Tier 3 added the requirement for teachers to pass knowledge and skills exams,
whereas Tier 4 required a three-year teaching experience minimum within the state.
New requirements went into effect for teaching license renewal on January 1,
2019 for the state of Minnesota, which required training to meet the needs of English
language learners (PELSB, 2019). Cultural competency training started with licenses that
expired in 2020. Licenses range in length of validity from one to five years, with Tier 2
valid for two years and Tier 3 valid for three years (PELBS, 2018). The requirements
applied to all teaching licenses, and were not content specific (PELBS, 2019). Sexual
health is a topic that requires specialized knowledge and skills, which may not be a
comfortable subject for all people. Continuing education time has shown to have a
positive relationship with the sexual health topics taught at the secondary level (Clayton
et al., 2018). Although teaching licenses currently require a minimum of a content area
degree, some health teachers in Minnesota do not possess a degree in health education.
Most school districts required elementary, middle, and high schools to teach
health education (Kann et al., 2001). Researchers found, however, that health education is
often not taught by someone who was trained to teach health education (Kann et al.,
2001; Rhodes et al., 2013). With respect to health education, some districts requested or
required licensure in physical education, developmental adapted physical education, and
health education. Meanwhile, secondary health teachers reported less administrative
support for professional development than other subject areas (Cardina, 2018). Health
education has evolved with new information, health-related concerns, and the
development of empirically tested health behavior theory.
Human sexuality can be a sensitive topic, and among the schools where sexual
health content was taught, 91% of elementary schools, 79% of middle schools, and 57%
of high schools required guardian notification in advance of the instruction (Kann et al.,
2001). Professionally trained health education teachers were more likely to teach sexual
health topics (Rhodes et al., 2013). Elementary teachers were less likely to experience
pre-service health education training than secondary teachers were; however, fifth and
sixth grade students have questions about sexual health, about which they ask their
teachers (Price et al., 2003). Elementary teachers reported, however, that at times they
chose not to respond to student sexual health questions. They did not respond because it
was not appropriate to answer the questions in front of the whole class, they elected to
refer the questions to someone else, or simply refused to answer the questions.
Statement of the Problem
Health education content, health-related skills, and health behavior theory
continuously evolve. These changes lead to a need for continuing education for teachers.
The state of Minnesota, however, does not require continuing education for content areas.
Some continuing education criteria for license renewal relates to content areas, such as
reading preparation related to language content. Although the state of Minnesota requires
on-going professional development for all teachers in mental illness and suicide
prevention, which are content areas for school health education, they are the only aspects
of school health content required for health education teachers. Once a teacher earns a
license for health education, the teacher does not need to receive professional
development for the other topic areas. Although continuing education is an important part
of professional development, it may not occur for a variety of reasons (Eisenberg et al.,
2013). Thus, many health teachers may not be adequately prepared to teach sexual health
content and skills due to gaps in their pre-service training, and/or professional development.
One goal for sexual health education is to prevent pregnancy and sexually
transmitted diseases among adolescents. According to the researchers conducting the
2014 School Health Policies and Practices Study, however, health teachers without
preservice health education training teach fewer sexual health topics and health-related
skills than teachers who have health education training (Clayton et al., 2018). If the
results reported on that study regarding teacher preparation accurately represent the health
teachers currently in Minnesota, then many are inadequately prepared to teach sexual
health education, and they may not receive the professional development necessary to
prepare them for this task. It is unknown, however, whether the results reflect the status of
Minnesota teachers.
According to Eisenberg et al. (2013), as of 2010, not all Minnesota health
education teachers were fully trained to teach health education. Some teachers faced
barriers to instruction based on content, policy, and community members. Additionally,
teachers did not necessarily teach what they believed should be taught in a specific class
or grade level. Structural barriers were negatively associated with instruction about
communication, abortion, and teen parenting. Policies were negatively associated with
instruction about sexual orientation and abortion (Eisenberg et al., 2013). If Minnesota
teachers are not fully prepared to teacher health education, face barriers to instruction, or
have not received professional development in the various topics, then students may not
receive the best education they could receive.
Significance of the Problem
Adolescents who initiate sex at an early age are more likely to have multiple sex
partners and not use condoms, and therefore, are at a greater risk for HIV, sexually
transmitted diseases, and pregnancy (CDC, 2018b). Researchers conducting a large
national study of male high school students and adults reported initiation of sex prior to
age 13 at a rate approximately double the rate reported by female high school students
and adults (Lindberg et al., 2019). In 2016, adolescents and young adults 13-24 were
diagnosed with 21% of all new HIV infections in the United States, and approximately 10
million new cases of sexually transmitted diseases are reported each year among 15-24
year olds (CDC, 2018b). Although the trend from 2007-2017 was a decrease among high
school students who had ever had sex, the rate was 40% in 2017. The trend among those
who had sex using a condom, or who used condom plus hormonal birth control, also
decreased. An additional downward trend in adolescent sexual risk behavior includes a
decrease to ten percent among high school students that reported four or more sexual
partners (CDC, 2018b).
Content, and time spent on both content and skills, varies by district, course, level
of teacher comfort, and teacher training (Kann et al., 2001). If students do not receive
quality sexual health education, they are at risk of not being able to make responsible
sexual health decisions, or use skills to manage their health behavior. Professionally
prepared health education teachers provide more opportunities to practice health skills
than health teachers who are not professionally prepared (Rhodes et al., 2013).
This study may be important to other education disciplines because professional
development requirements for teacher license renewal do not focus on content and skills.
This may be neglected by some districts’ professional development plans. The absence of
content-based professional development forces teachers to seek ongoing content training
independently. Although some teachers may seek professional development, others may
face barriers to this training. This study may also benefit other disciplines because all
employees need ongoing training to update their knowledge and skills that effectively
contribute to their work and occupations. The tiered licensing system for Minnesota
requires content and skills training to obtain a license, but not afterwards. Students
benefit from enhanced health education by qualified teachers who help students develop
knowledge, skills, and attitudes for healthy living. The students deserve the best
education possible.
This study helps determine whether Minnesota health teachers are currently
qualified and prepared to teach sexual health content and skills, and whether they are
teaching it within their classrooms. Teacher preparation programs for health education
may not examine standards or requirements for completion. Districts and administrators
may continue to hire teachers who are underqualified or ill prepared to teach health
education. Consequently, students may experience unqualified teachers who are not able
to promote health to the highest level, or help them develop health-enhancing skills.
Purpose Statement and Research Questions
The purpose of this study is to analyze the School Health Profiles data set to
determine the preparation of health teachers and their practice of teaching sexual health
topics and skills.
Research Question One
What pre-service training did Minnesota health teachers receive for health
education?
Research Question Two
How much professional development have Minnesota health teachers received on
teaching sexual health education, including content, skills and teaching methods?
Research Question Three
What professional development do Minnesota health teachers want related to
sexual health education content, skills, and teaching methods?
Research Question Four
Are there differences in the sexual health teaching practices among teachers with
and without pre-service health education preparation?
Research Question Five
Are there differences in the sexual health teaching practices among teachers who
have and have not received professional development on sexual health content?
Research Question Six
Are there differences in the sexual health teaching practices among teachers who
have and have not received professional development on teaching sexual health
education?
Limitations
There are multiple limitations of this study. Although the participant selection was
random, it is possible that those who chose not to complete the survey were in one or
more ways different from those who chose to complete it. The survey forms did not offer
an opportunity for participants to provide additional information, or to clarify their
responses. The data did not include observations of instructional quality, only
participants’ self-report of their instructional practices. Some of the participants may not
have completed a sexual health education course regardless of their degree emphasis.
Teachers who responded may have received professional development outside the
twoyear period, which continues to affect their teaching practice. Additionally, the School
Health Profiles surveillance system does not investigate all parts of comprehensive sexual
health curricula. This study does not examine program policies, or utilize the principal
questionnaire.
Delimitations
There are multiple delimitations of this study. One delimitation of this study is the
inability to add additional items to obtain more information regarding the perspectives of
the participants related to their responses. The sample was a random sample of districts
and schools from all 50 states in the United States, as well as, Washington, D.C. Another
delimitation is that the study focused on courses taught in Minnesota. Finally, this study
focused on the demographic and sexual health sections of the survey, and not on other
content areas, or coordinated school health program services.
Assumptions
This study is predicated on three assumptions. One assumption related to this
study is that participants were honest in their responses. Another assumption is that the
data accurately reflects health teachers in Minnesota. A final assumption is that the
weighted data accurately represents health teachers in Minnesota.
Definition of Terms
There are multiple terms that are relevant to this study. These terms include:
Abstinence-only sexual health education. An educational program that emphasizes
abstinence for teens outside of marriage (Alford, 2001).
Comprehensive health education. The school health portion of a coordinated
program that addresses the content and skills for multiple health topic areas (Allensworth
et al., 1997; CDC, 2012 p. G-1).
Comprehensive sex education. Content instruction on abstinence, condoms, and
contraception to decrease the risk for sexually transmitted diseases or pregnancies, and
promotes effectiveness of abstinence; and skills instruction on accessing information,
evaluating personal perspectives, making decisions, and developing social relationships
(Alford, 2001).
Coordinated school health education. An overarching and integrated program that
meets students’ needs through the collaboration of the schools and community members
(CDC, 2012, p. G-1).
Developmentally appropriate. The curriculum and resources match students’ needs
and stages of growth (CDC, 2012, p. G-2).
Functional knowledge. The key information and essential concepts students need to
develop the skills to improve health behavior (CDC, 2012, p. G-2).
Health education curriculum. A planned, cohesive scope and sequence with
objectives, content, instruction, and assessments to meet students’ developmental needs
for health decision-making, behavior, and literacy (CDC, 2012, p. G-2).
Health literacy. The ability to access, understand, and use health information resources,
and the ability to access and use health services, to improve one’s health (CDC, 2012, p.
G-3).
National Health Education Standards. “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 assessment of student knowledge and skills in health education” (CDC, 2012,
p. G-3).
Research-based. “Strategies, programs, and policies with evidence from the scientific
literature that they have demonstrated effectiveness in accomplishing intended learner and
program outcomes” (CDC, 2012, p. G-4).
School health education. The curriculum, instruction, and assessment activities that
occur between pre-school and twelfth grade to meet the goals of improving health and
reducing risk behavior (CDC, 2012, p. G-4).
School Health Policies and Practices Study. A CDC survey that examines policy and
practice of the Whole School Whole Community Whole Child model among school
health programs at the state, district, school and classroom levels (CDC, 2017). This
survey has been conducted six times: 1994, 2000, 2006, 2012, 2014, and 2016.
School Health Profiles. A CDC system to examine the policies and practices of
states, large urban districts, and United States territories during even numbered years by
surveying lead health education teachers and administrators throughout each community
(CDC, 2019d).
Sexual health education. The instruction of information on puberty, relationships, sex
and sexuality, which includes content, decision-making skills, and communication skills
(Bridges & Hauser, 2014).
Skill expectations. “Derived from and predicated on the performance indicators of the
National Health Education Standards, Standards 2–8, these identify the developmentally
appropriate skills (learning) students should perform in each topic and by the end of grades 2,
5, 8, and 12” (CDC, 2012, p.G-4).
Summary
The amount of health education required for graduation is relatively low.
Minnesota recently changed licensing requirements for all teachers to include additional
preparation and on-going professional development. Nationally, and in Minnesota, many
health teachers have not received training in health education. Minnesota does not require
preparation or professional development about sexual health for teachers who teach
sexual health education. The teachers who received training in sexual health content and
skills are more likely to teach comprehensive sex education compared to those who have
not received training on it. Researchers have shown that some teachers do not teach what
they believe they should teach about sexual health. This could leave students without
teachers prepared to address their concerns, or help them learn.
One goal of sexual health education is to help students make healthy decisions for
themselves about their sexual behavior. Considering the high rates of adolescent
pregnancy and sexually transmitted diseases in the United States, students deserve to
receive the best education possible. The School Health Profiles surveys what teachers
teach, how they were trained to teach, and what professional development they desire for
the future. This study examines who is teaching sexual health education in Minnesota,
what they are teaching, and what professional development they desire for the future.
Chapter Two: Review of Related Literature
The purpose of this study is to compare the pre-service preparation of health
teachers with their sexual health education teaching practices to determine whether
differences exist among health educators and examine their professional development
needs. This encompasses pre-service health education teacher training, current health
education practices, sexual health education practices, and professional development.
Research on comprehensive health education, sexual health education, barriers to health
education, teacher training, and professional development will be reviewed in this
chapter.
Comprehensive Health Education
The Whole School Whole Community Whole Child model focuses on
improvements in student health and education (Chiang et al., 2015). It promotes
collaboration among health and education organizations, parents, and communities to
maximize resources to meet students’ needs, interests, and academic success (Chiang et
al., 2015; Hunt et al., 2015). Health education is one aspect of the Whole School Whole
Community Whole Child model. The other aspects include 1) physical activity, 2)
nutrition and food services, 3) social and emotional climate, 4) physical environment, 5)
health services, 6) mental and social services, 7) employee wellness, 8) community
involvement, and 9) family engagement (Chiang et al., 2015). One purpose of health
education is to help students learn and develop skills to make healthy decisions (Hunt et
al., 2015).
The authors of the Institute of Medicine report Schools and Health: Our Nation’s
Investment (Allensworth et al., 1997) noted that the foundation of school health education
is the National Health Education Standards (Joint Committee on National Health
Education Standards, 1997). These standards promote health literacy. A health literate
student can learn independently; access, use, and evaluate the quality of health
information and services; use critical thinking skills to make responsible choices; and
communicate effectively. Health education, as a part of comprehensive school health
programs (now the Whole School Whole Community Whole Child model), provide
students with knowledge, promote positive health attitudes, and strengthen skills to
practice health-enhancing behaviors. Health education, as a component of Whole School
Whole Community Whole Child model, includes a variety of content areas and
healthrelated skills (CDC, 2012). The content areas include avoidance of tobacco,
alcohol, and other drugs; sexual health; physical activity; nutrition; preventing violence;
mental/emotional health; safety; and personal health and wellness. Health-related skills
include influence analysis, resource access, decision-making, goal-setting, interpersonal
communication, self-management, and advocacy (Joint Committee on National Health
Education Standards, 1997).
Comprehensive health education provides curriculum and instruction from early
childhood through K-12 education (Hunt et al., 2015; Joint Committee on National
Health Standards, 2007). The curriculum encompasses nutrition, physical activity,
personal wellness, mental health, sexual health, tobacco/alcohol and other drug use
prevention, violence prevention, and safety (Hunt et al., 2015). The curriculum also
encompasses the health-related skills of influence analysis, resource access,
decisionmaking, goal-setting, interpersonal communication, self-management, and
advocacy (Joint Committee on National Health Education Standards, 1997). The scope
and sequence outline the entire content and skills throughout the health education
experience, and should be developed through a collaborative process utilizing school and
community resources (CDC, 2012).
The Institute of Medicine The Committee on Comprehensive School Health
Programs in Grades K-12 emphasized health education prior to high school to promote
health-enhancing behaviors and attitudes (Allensworth et al., 1997). The recommendation
was for age-appropriate, sequential health education every year until high school, and
some form of health education throughout high school, with a minimum of one semester.
According to the authors of School Health Profiles 2018: Characteristics of health
programs among secondary schools (CDC, 2019d), the median percentage of schools in a
given state that require health instruction for any grade 6 through 12 is 93.7% (67.6% -
99.4%). This finding clearly indicates that United States schools do not meet health
education recommendations.
Sexual Health Education
Sexual health education is one content area of health education that can be
controversial among families and communities (Russo & Thro, 2012). Although schools
have the legal right to educate students about a variety of sexual health topics, parents
have concerns about the sexual health education their children receive (Russo & Thro,
2012). Children and adolescents have the right to understand their bodies, relationships,
and sexuality; thus, sexuality education is recognized internationally as a human right
(Parry & Wilentz, 2015). This content area may be taught in a variety of forms, two of
which are abstinence-only and comprehensive sex education.
Abstinence-only Education
In the late part of the 20th century, abstinence-only sex education began to increase
in the United States (Grunbaum et al., 2000; Lindberg et al., 2015). Abstinenceonly sex
education focuses on the concept that abstinence from sexual activity until marriage is the
only accepted standard to prevent pregnancy and sexually transmitted diseases, and thus
does not address contraception (Trenholm et al., 2007). The Adolescent Family Life Act
was part of the Public Health Service Act of 1981, that provided support for pregnant and
parenting teens while promoting abstinence through 2010 (Sexuality Information and
Education Council of the United States [SIECUS],
2018). Title V, Section 510 of the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996 promoted abstinence education for adolescence, and it
connected federal funding to its implementation from 1998 to 2009 (SIECUS, 2018;
Trenholm et al., 2007). Under this law, sex education was to promote 1) the benefits of
abstinence, 2) abstinence-only until marriage, 3) the consequences of not practicing
abstinence outside marriage, 4) how to say no to sex, 5) how chemical use increases the
risk of sexual activity, and 6) being self-sufficient prior to engaging in sexual activity
(Trenholm et al., 2007). Thus, two different laws influenced sex education in the United
States at the end of the twentieth century by promoting abstinence-only sex education.
Community-based Abstinence Education provided grants to local organizations
beginning in October 2000 (SIECUS, 2018). After a report that 11 of 13 abstinence-only
programs included myths and deceptive information, beginning in 2007 grantees needed
to provide a written guarantee that their information was accurate. After congressional
hearings on abstinence-only programs, funding for Community-based Abstinence
Education ended in 2010. The Patient Protection and Affordable Care Act added
abstinence education from 2010 to 2014. In 2012, grants tied to Title V funded programs
for abstinence education through 2015. Sexual Risk Avoidance Education was a revised
version of abstinence-only programs to replace Community-based Abstinence Education
beginning in 2016. Sexual Risk Avoidance Education utilized the terminology of
evidence-based programs to promote abstinence as effective at reducing poverty, and the
funding continued into 2018 and beyond. Congress did not provide money for abstinence-
only education tied to Title V between 2010 and 2012. The educational focus on
abstinence-only education continued into the 21st century (Lindberg et al., 2006; Lindberg
et al., 2015).
According to the authors of School Health Profiles 2018: Characteristics of health
programs among secondary schools (CDC, 2019d), the median percentage of schools in a
state that taught the benefits of sexual abstinence was 73.3% (28.9% - 93.4%), the
importance of correct condom use was 44.0% (11.3% - 72.6%), and the importance of
combining a condom with another form of contraception to prevent STD and pregnancy
was 45.0% (6.3% - 73.2%). Students who received abstinence education received it at an
earlier age than the students who received education about birth control (Lindberg et al.,
2006; 2015). The rates of skill instruction regarding how to say no to sex increased for
male adolescents, but decreased for female adolescents between 1995 and 2013 (Lindberg
et al., 2006; 2015). The authors of School Health Profiles 2018: Characteristics of health
programs among secondary schools (CDC, 2019d) found the median percentage of
schools who taught communication and negotiation skills to reduce risk for pregnancy
and sexually transmitted diseases was 66.9% (31.8% - 90.7%). There was an increase in
the percentage of adolescents who received abstinence education prior to sexual
initiation, and a decrease in receipt of birth control education (Lindberg et al., 2006;
2015). According to authors of the School Health Policies and Program Study 1998, the
percentage of schools that taught reasons for abstinence from sexual activity decreased
from 1996 to 1998 (Grunbaum et al., 2000). In 2000, among secondary schools that
required human sexuality and HIV prevention, most taught abstinence as the most
effective method, whereas less than half taught correct condom use (Kolbe et al., 2001).
In 2018, most taught abstinence and less than half taught the importance of correct
condom use or combining it with another form of contraception (CDC, 2019d).
Abstinence-only sex education has not effectively reduced unwanted pregnancy or
sexually transmitted diseases among adolescents and teens (Chin et al., 2012; Wingo et
al., 2011).
Parents who prefer abstinence-only sex education often have religious or moral
reasons for that preference (Constantine et al., 2007). Some parents argued that sex
education was the families’ responsibility, and not the schools (Russo & Thro, 2012). The
courts have upheld that states and districts are able to determine age-appropriate sex
education for students. Birth control education continued to decline between 2006 and
2010, yet the communication between parents and adolescents about sexuality topics did
not increase (Lindberg et al., 2015). One strategy to promote abstinence until, and only
within the context of marriage, is the virginity or abstinence pledge. Adolescents who
signed a virginity pledge in either middle school or high school were less likely to have
used condoms or contraceptives during the previous year, measured in a five-year
followup (Rosenbaum, 2009). Among adolescents who signed a virginity pledge in
middle school or high school, 82% denied they had made that commitment. Most of the
adolescents who pledged virginity reported vaginal and anal sex prior to marriage.
Approximately 40% of high school students report having sex on the Youth Risk
Behavior Survey, and approximately 10% report having four or more sexual partners
(CDC, 2018b). Abstinence-only education is not associated with delayed sexual activity,
reduced occurrence of teen pregnancy, or a lower incidence of sexually transmitted
diseases (Kohler et al., 2008).
Comprehensive Sexuality Education
Comprehensive sex education includes education about abstinence and
contraceptive use, including barrier methods to decrease incidence of sexually transmitted
diseases and pregnancy (Chin et al., 2012). International benchmarks for comprehensive
sexuality education include life skills training, sexual and reproductive health education,
and HIV transmission and prevention (Parry & Wilentz, 2015). Future of Sex Education
Initiative (2020) published the National Sexuality Education Standards to outline and
provide rationale for research-based scope and sequence for content and skills in K-12
sex education, with the ultimate goal to meet students’ needs, improve student health and
success, and respect student diversity. The content addresses biology, sexual
development, sexual health, gender identity and expression, sexual orientation and
identity, healthy relationships and consent, and interpersonal violence (Future of Sex
Education Initiative, 2020). Effective implementation of these standards means that
students will be able to connect the content and skills to their own lives, understand their
own risks based on their individual behaviors, believe they can change their risk through
their behavior, and accurately perceive social norms. This education scaffolds learning to
be appropriate for all developmental stages to prepare students for the future (Parry &
Wilentz, 2015).
Controversy may occur when parents do not perceive the education to be
ageappropriate, or to match their families’ values (Russo & Thro, 2012). A logical,
sequential progression would help alleviate concerns, and support adolescent
development (Parry & Wilentz, 2015; Russo & Thro, 2012). The Minnesota Department
of Education (2019) established a purpose for health education that promotes positive
health behavior and environmental conditions to improve health status. Local school
districts develop their own curriculum, assessment, and standards with benchmarks.
Therefore, curriculum, assessment, and standards may vary greatly from one Minnesota
school district to another. Instruction during K-8 is required for all students, and at least
once during high school, with the districts determining credit requirements for
graduation. The Minnesota Department of Education supports the use of the National
Health Education Standards K-12, and provides a benchmark guide for school districts.
States vary in their requirements for sexual health and HIV education, as do local
district content requirements (Brener et al., 2011; Hamilton et al., 2013; Kann et al.,
2001). According to the Office of the Revisor of Statutes for Minnesota (2019b), the state
requires programs to prevent and reduce the risk of sexually transmitted diseases, and
each district must provide technically accurate materials and resources with guidelines for
these programs to support students in practicing abstinence until marriage. Districts must
establish procedures to provide parents and guardians the opportunity to preview
instructional content with associated materials, and if the parent or guardian opts out of
the instruction, a reasonable alternative can be arranged, or provided by the parent or
guardian (Office of the Revisor of Statutes, 2019a). The school cannot penalize the
student for the choice of alternate instruction, and the student’s work quality may be
evaluated by the school.
Skill-based programs are more effective at leading to behavior change than
knowledge-based education programs (Allensworth et al., 1997; CDC, 2019a; Kirby, et
al., 2007). Kirby et al. (2007) found that development of sex education curricula requires
multiple people with backgrounds in sexual health education theory and research.
Curriculum development should assess student and community needs, delineate goals,
and develop activities to address both risk and protective factors (Allensworth et al.,
1997; Kirby et al., 2007). Sexual health curriculum should utilize local resources and
reflect community values. It should have clear goals for preventing sexually transmitted
diseases and pregnancy, focus specifically on those goals, address both the cognitive and
affective domains, and address perceptions of risk (Kirby et al., 2007). Teaching
strategies should create a safe environment; utilize multiple methods with active
engagement; personalize the information; reflect age, culture, and experience; and have a
logical scope and sequence (CDC, 2019a; Kirby et al., 2007). Quality curriculum, with a
skills-based instructional approach, enhances sexual health education.
The United States already has the highest rate of teen pregnancy among developed
countries, so a concern is that sexual health education could lead to increases in the teen
pregnancy rate (Sedgh et al., 2015). However, sex education is not associated with earlier
initiation of sexual activity, sexual risk behavior, or poor sexual health outcomes, though
it is associated with delays in sexual initiation (Kirby et al., 2007; Lindberg & Maddow-
Zimmet, 2012). Unlike abstinence-only education, some sexual health education
programs postpone sexual activity, reduce sexual activity, and increase condom and
contraceptive use (Chin et al., 2012; Kirby et al., 2007). Of 54 studies in a literature
review that measured the impact of sexual health education on condom use, 48%
increased condom use, whereas none of the researchers conducting these studies found a
decrease in condom use (Kirby et al., 2007). Sexual risk-taking, described as sexual
activity without condom use, measured in a literature review of 28 studies found that
none of the sexual education programs increased sexual risk-taking behavior. Many
programs positively influenced sexual health knowledge, risk awareness, beliefs,
perspectives, self-confidence, and goals for the future.
Benefits of Comprehensive Sex Education
Sex education is associated with delays in sexual initiation, and not associated
with earlier initiation of sexual activity, sexual risk behavior, or poor sexual health
outcomes (Lindberg & Maddow-Zimmet, 2012). Comprehensive sex education is
significantly associated with reductions in teen pregnancy (Kohler et al., 2008). Sexual
health education that includes instruction about contraception is not associated with an
increased risk of sexually transmitted diseases or sexual activity. When teens receive
comprehensive sex education, they have a lower risk of teen pregnancy.
Comprehensive sexuality education supports the mental/emotional and social
growth and development of adolescents, and reduces risks for sexually transmitted
diseases and unintended pregnancy (Parry & Wilentz, 2015). Chin et al. (2012) found that
intermediate outcomes include change in knowledge and attitudes, improved skills and
intentions, and increased condom use. It reduces sexual activity, the number of sex
partners, occurrences of unprotected sexual activity, pregnancy rates, and HIV/STI rates.
Health education with condom use skills training increases knowledge, attitudes and use
of condoms at community health clinics (Choi et al., 2008). Comprehensive-risk
reduction activities are effective at delaying and reducing sexual activity, increasing
protective sexual behaviors among adolescents, and increasing future condom use (Chin
et al., 2012; Kirby et al., 2007; Parry & Wilentz, 2015). Comprehensive sexuality
education reduces the risk of sexually transmitted diseases and unintended pregnancy
(Parry & Wilentz, 2015). At three and six months after condom instruction in a clinical
setting, women were more likely to use internal condoms compared to women who did
not receive instruction about condom use, without negatively impacting the frequency of
external condom use (Choi et al., 2008). Female adolescents are more likely to use
condoms or other forms of contraception, and more likely to have a sexual partner of a
similar age, if they received education about contraceptives as opposed to only education
about abstinence (Lindberg & Maddow-Zimmet, 2012).
Many elementary students do not learn about puberty until fifth grade, but they
may already be experiencing it, and they talk about it outside of the classroom; they want
to know about puberty because they believe it could make it less frightening and
confusing (Hurwitz et al., 2017). Elementary-aged students also have questions about
gender and identity, pregnancy, and infections (Price et al., 2003). Adolescents want to
know about the physical, emotional, and social aspects of romantic relationships (Adams
& Williams, 2011; Canan & Jozkowski, 2017). They want to know how to prevent
sexually transmitted diseases, and they believe these topics should be taught throughout
their education (Canan & Jozkowski, 2017). The National Sex Education Standards
(Future of Sex Education Initiative, 2020) delineate clear guidelines for sex education
scope and sequence at the elementary level for teachers to address content, skills, and
student questions.
Support for Sex Education
Despite the concerns, there is overwhelming support for comprehensive sexual
health education. Adults believed that the sexual health course they took in high school
had both immediate and long-term impacts on their lives (McCaffree & Matlack, 2001).
They believed that it was important to have their opinions valued, and for the teacher to
respect everyone in sexual health education. Students believed they experienced higher
quality sexual health education when it matched their interests, level of development, and
more thoroughly covered sexual health topics (Byers et al., 2013). Middle school students
evaluate the quality of their sexual health education based on a combination of topics and
instructional strategies. First-year university students who are unsatisfied with their high
school courses are more likely to seek out a college level sexual health course (Rye et al.,
2014). Their primary motivation for taking a sexual health course was a desire for valid,
reliable, and unbiased sexual health information. When they reported that their prior sex
education did not connect with their lives, and they did not agree with the negative
approach it took, they were more likely to seek out additional sexuality education.
Most California parents prefer comprehensive sex education over abstinence-only
education because it focuses on consequences, accurate information, and it recognizes
that adolescents will eventually have sex, whether that time occurs as a teenager or as an
adult (Constantine et al., 2007). Texas parents with strong religious convictions want the
informative portion of sex education to occur at school, whereas the norms come from
home because some perceive abstinence-only sex education to portray sex in a negative
light (Dent & Maloney, 2017). Hmong parents believe lack of knowledge about
contraception and desire for loving relationships lead to teen pregnancy, and most (90%)
believe it is important for teens to learn about sexual health both at school and at home
(Meschke & Peter, 2014). The authors of the Florida Child Health Survey found that most
parents support education about reproductive health, sexually transmitted diseases,
gender, abstinence, and communication skills during elementary school with additional
topics and skills as they develop (Barr, Moore et al., 2014). They support ageappropriate,
evidence-based sexual health education. The majority of adults in South
Carolina support comprehensive sexuality education, plus access to birth control and
condoms in school (Kershner et al., 2017). The majority of people who identify as
Catholic, Born Again Christian, and very politically conservative still support
comprehensive sex education (Eisenberg et al., 2008). The majority of Minnesota parents
(89%) support teaching both abstinence and contraception, and they believe most sexual
health topics should be taught at the middle level or earlier.
Barriers to Sexual Health Education
In 1996, Haignere et al., found that the three biggest barriers to teaching sexual
health using non-traditional teaching strategies included a lack of materials, lack of time,
and the challenge of facilitating group activities in a classroom setting. Some teachers do
not use small group activities or decision-making activities. Most teachers reported that
they were comfortable with skill development activities, but that they need more time and
strategies to implement them. Multiple barriers influence the sexual health content
provided for students in Minnesota (Eisenberg et al., 2013). Minnesota teachers reported
lack of time, finances, and curricula as barriers to teaching what they believe should be
taught. The lack of time for instruction, combined with a lack of resources and confidence
in skills, creates a need for professional development and strategies to address
instructional barriers.
State policies, which vary significantly, influence sexual health education (Hall et
al., 2019). Approximately three-fourths of states endorse abstinence outside of marriage,
and less than half require education about contraceptives and barrier methods. Most state
policies focus on abstinence, though approximately half require information about
relationships, and a few address contraceptives beyond their potential to prevent
pregnancy and sexually transmitted diseases. State policies do not always address the
needs of people who identify as LGBTQ, and some specifically oppose diverse sexuality
topics. Policies may also influence the time and resources devoted to sexual health
education (Cohen, et al., 2012). In Minnesota, some district policies serve as barriers to
teaching specific sexual health topics (e.g., decision-making related to pregnancy, sexual
orientation, and sexual violence) more so than other topics (Eisenberg et al., 2013).
Additionally, most high school health teachers are influenced to teach HIV
prevention by their personal learning experiences, level of education, training, and
policies (Herr et al., 2012). Teachers who previously received HIV prevention education
training are significantly more likely to teach HIV prevention, perceive fewer barriers to
teaching it, and increase self-efficacy regarding HIV prevention education. In Canada,
middle school teachers were more willing to teach sexual health education topics,
especially if they received training to teach it, felt more knowledgeable about it, and
viewed it as important (Cohen et al., 2012). Their perceptions of their sexual knowledge,
and their values for sexual health education, influence how they implement sexual health
curriculum. Most teachers felt sexual health education should begin in elementary school.
Multiple factors influence health teachers’ willingness to teach curricula for sexual health
education.
The greatest reported barrier to teaching HIV prevention was lack of materials and
curriculum, which could reflect a lack of effective training because if the teachers
received pre-service training, they should have the skills to develop effective prevention
lessons (Herr et al., 2012). When Eisenberg et al. (2013) surveyed Minnesota teachers,
they found that for all 14 common sexual health topics, more teachers felt the topics
should be taught compared to what they actually taught. They also taught fewer skills
than they believed their students need. Students have the right to accurate sexual health
information and schools should provide this for students to ensure healthy development.
Health Education Training
In Minnesota, teachers are required to obtain a degree in the content area or field
for which they teach. Participation in a pre-service education program is necessary to
maintain a license indefinitely (PELSB, 2018). Variations exist among teacher
preparation programs. Fisher et al. (2015) found that most school health education
methods courses focused on alignment of objectives, instruction, and assessment (79%);
lesson plan development (73%); use of instructional engagement strategies (72%);
National Health Education Standards application and use of performance indicators
(69%); and unit plan development (60%). However, less than one-third (32%) of the
preservice teaching programs taught strategies for sexual health education.
Accredited programs are more likely to address how to stay current in teaching
practices, accommodation strategies, and various learning styles (Fisher et al., 2015).
College instructors who previously taught K-12 health education are significantly more
likely to address the CDC’s (2019a) Characteristics of an Effective Health Education
Curriculum, and how to accommodate students with special needs. Instructors who
possess a degree in health education are significantly more likely to address application
of behavioral theory, lesson plan development, use of instructional technology, and use of
engaging instructional methods. Instructors without a doctoral degree, and those who
were not full professors, are significantly more likely to address classroom management,
whereas instructors with full professor rank were more likely to address the use of Health
Education Curriculum Analysis Tool (2012). Each state has different standards for
preservice teachers to obtain an initial teaching license, thus one state’s programs may not
address licensure requirements for other states.
The Minnesota legislature established standards for teachers to obtain an initial
license. The primary method is through completion of an accredited teacher preparation
program (Office of the Revisor of Statutes, 2016). The detailed standards related to
content, communication, and instructional skills went into effect September 1, 2010.
Teacher candidates must be able to utilize a variety of instructional strategies to address
diverse student learning needs, create a positive learning environment, plan instruction
and assessment, reflect on teaching and collaborate with others to enhance student
learning and wellbeing. Pre-service teachers must be able to follow professional ethics
and seek out professional development to continue developing as a teacher.
Although pre-service teacher programs and licensing requirements vary, the need
for quality health education remains. The license renewal process in Minnesota, effective
January 2020, required cultural competency training (PELSB, 2019). This is especially
important considering Luquis and colleagues (2006) found that most health education
preparation programs did not offer courses specific to cultural competence (27% offered
it), but most addressed it as part of various courses (88%), or referred students to other
departments (87%) (Luquis et al., 2006). This means that the majority of pre-service
teachers did not receive training in cultural competence specific to health education. One
part of the National Health Education Standards expects students to analyze the influence
of culture on health behavior (Joint Committee on National Health Standards, 2007). In
2018, the median percentage of schools across states that assess students on their ability
to analyze influences on sexual risk behaviors was a median of 70.8% (CDC, 2019d). If
they did not receive this training prior to teaching, what they receive as teachers will
likely to be broad enough to apply to all staff members, and all content areas.
Recommendations for Sex Education Preparation
In order to prepare for the future, sexual health education must begin prior to the
respective developmental stage (e.g., students learn about menstruation prior to
menarche) (Parry & Wilentz, 2015). Critical pedagogy includes relevant information,
development of values, skill development, and peer interaction. Examples of primary
level sexuality education include good touch and bad touch, how to report a problem and
positive body image. Despite all of the guidelines, program quality still depends upon
teacher training for knowledge, confidence and skills.
The National Teacher Preparation Standards for Sexuality Education guide higher
education program preparation of pre-service educators to provide sexuality education
(Future of Sex Education Initiative, n.d.). The primary focus is for K-12 health and
physical education teachers since that is the most common pre-service training emphasis
for health education. The standards emphasize seven professional characteristics and
competencies, policies, ethics, planning, implementation, and assessment. According to
Eisenberg et al. (2010), less than two-thirds of Minnesota health teachers received pre-
service sexuality education training, and almost one-third reported not receiving any
training prior to teach sexuality education. Barr, Goldfarb et al. (2014) recommend the
use of the National Teacher-Preparation Standards of Sexuality Education by university
programs to improve the preparation of pre-service health teachers.
The focus of sexual health education should be health motivation to improve
personal health and the mastery of health behavior skills (Hamilton et al., 2013). Mastery
of skills and content should be demonstrated through application of role-plays and
discussions, with an emphasis on growth and development. An evaluation of teaching
methods in comprehensive sexual health education suggest that teachers need training in
how to implement interactive techniques and promote a respectful learning environment
(McCaffree & Matlack, 2001).
Instruction on Sexual Health
Middle school students evaluate the quality of their sexual health education based
on a combination of topics and instructional strategies (Byers et al., 2013). When they
perceive their teachers as comfortable with sexual health topics, using effective teaching
techniques, and responding to questions, they rate the quality of their sexual health
education high. When students are taught in a skills-based way, they are motivated to
learn because it benefits them and they relate to the information (Anderman et al., 2011).
They demonstrate higher levels of skills to negotiate condom use, belief in their abilities
to use condoms, choose abstinence, and lowered rates of plans to have sex. The structure
of the class to promote learning to master skills, as opposed to simply earning points
towards a grade, has shown to improve student knowledge, attitudes, self-efficacy, and
intentions to have sex (Anderman et al., 2011). Adults looking back on high school sexual
health education believed that open discussion and interactive learning improved their
learning (McCaffree & Matlack, 2001).
When students received education from either a school nurse or their regular
education teacher for sexual health education, they rated the teachers higher in comfort
with the material and challenges to their thinking compared to school nurses, and those
who had their teachers demonstrated higher knowledge levels about condoms (Borawski
et al. 2015). However, students taught by the nurses reported higher self-efficacy with
condom use immediately after the intervention (Borawski et al., 2015). Health teachers
were not as effective as the school nurses at promoting skill development among students
(Borawski et al., 2015). The teachers in this study were trained in health or health and
physical education, whereas the nurses were trained in nursing (Borawski et al., 2015).
Some health education teachers may need more training in health education.
Professional Development
The demographics of the majority of secondary health teachers in Minnesota do
not match the make-up of secondary health classrooms (Eisenberg et al., 2013). Teachers
need professional development on cultural competence, English language learners, and
strategies for teaching students with special needs to meet the needs of their diverse
student population (Cardina, 2018). Professional development was positively related to
the topics taught in sexual health courses at the middle and high school levels (Clayton et
al., 2018). Secondary health education teachers receive less professional development and
support for professional development than other subject areas (Cardina, 2018).
According to School Health Profiles 2018: Characteristics of health programs among
secondary schools, the median percentage of schools’ lead health education teachers who
received professional development in the previous two years for human sexuality was
33.3%, HIV prevention was 31.2%, STD prevention was 30.5% and pregnancy
prevention 26.6% (CDC, 2019d). However, more than 54% wanted to receive
professional development on at least one of these sexual health topics.
Current Health Education Practice
According to the Results from the School Health Policies and Practices Study
2016 (CDC, 2017), approximately 40% of school districts require health teachers to earn
continuing education credit in health content or instruction. Among district participants in
the School Health Policies and Practices Study, 59% reported requiring new middle
school health teachers, and 69% reported requiring new high school health teachers to
possess an undergraduate or graduate degree in health education. In the previous two
years, 63% reviewed or updated their health education curricula, but only 15% of school
districts provided funding or professional development opportunities to use Health
Education Curriculum Analysis Tool, 2012 to assess the curricula (CDC, 2017). Although
48% of districts provided funding or professional development opportunities for health
education teachers to use data to plan or evaluate their health education practices (CDC,
2017).
In 2010, Eisenberg et al. (2013) found that approximately 79% of health teachers
in Minnesota were certified to teach health, and 29% identified something other than
health or combined health and physical education as the focus of their teacher
preparation. If this is still the case, then professional development for health educators
throughout the state is critical. Approximately one-third of the new health teachers felt
inadequately prepared to vary their instructional methods or to differentiate instruction,
and they reported feeling ill-prepared to manage classroom discipline or use assessment
data (Cardina, 2018).
Description of the School Health Profiles
Purposes
The School Health Profiles survey monitors 1) health education content and
requirements, 2) physical education, 3) bullying and harassment practices, 4) tobacco
policies, 5) nutrition policies, 6) health services, 7) family connections, 8) community
involvement, and 9) health coordination (CDC, 2019d). The data describe health
education throughout schools across the country.
Sampling
Local health and education agencies administered the survey, and utilized the
same standard methods for each sample, which applied to secondary schools with
students in at least one grade six or above. The states utilized systematic, equalprobability
sampling. Administrators selected the health teachers at their respective buildings who
knew the most about the health curriculum to be designated as the lead health education
teacher. The CDC (2019d) reports the sampling procedures in detail. Local health and
education agencies conducted The School Health Profiles 2018 survey in the spring
(CDC, 2019d). Each agency used its own sampling frame, chose its format, and collected
its own survey data. These agencies may grant the CDC permission to distribute the data
upon request. Those agencies who did not grant that permission to the
CDC may be contacted individually to request their data.
Years of Data Collected
The CDC began to collect data through the School Health Profiles survey in 1996
(Grunbaum et al., 1998). The survey repeats every two years, during the spring of even
numbered years. Some years the states that participate vary, and the data for various
communities do not reach the 70% threshold for weighted data. For the purpose of this
study, data collection occurred during the spring on 2018 (CDC, 2019d).
Instrumentation
The survey has a variety of items and questions to gather information about the
health education practices and materials in schools across the country (CDC, 2018a). The
items inquire about access to resources and the resource components. The questions
inquire about required course prevalence, course topics, teacher actions, plus professional
development experiences and interests. Four items relate to the existence of required
health courses, and the final three items request participant demographics. Several items
refer to teacher behavior asking whether they tried to teach about specific topics. This
specifically reflects attempted teacher actions within the classroom, but it does not assess
the extent or quality of instruction.
Eighteen survey items have sub-parts, ranging from four to 20 sub-parts (CDC,
2018a). These items are yes/no format, and three have Not Applicable as an option,
forcing the participant to make a choice or leave it blank. Although the items do not use
scientific terms, some are specific to health education, and teachers not professionally
trained in health education may not know them. Considering that health may be taught by
someone who lacks professional health education training, this could make some items
more challenging for some participants as they may interpret questions and responses
differently (Kann et al., 2001; Rhodes et al., 2013).
Validity for the survey was obtained through input from various experts in
education and health (Grunbaum et al., 2005). Data is weighted, which support reliability
as it can be generalized to United States 6-12 public schools when participation exceeds
70% (Grunbaum et al., 1998). Brener et al. (2003) documented the reliability of the
School Health Policies and Practices Study survey through expert evaluation and pilot
testing. Although the School Health Profiles survey and the School Health Policies and
Programs Study vary in sample size and survey methodology, they exhibited concurrent
validity (exception of rates of topics taught) when the data was initially reported from the
1996 studies (Grunbaum et al., 1998; Grunbaum et al., 2000).
Summary
Comprehensive health education requires teachers to personalize learning, use
interactive strategies, and promote skill development along with the core content.
Effective sexual health education can reduce sexual risk behavior. Each state sets its
standards and practices for teachers independently; however, many health teachers across
the United States lack professional training in health education. Thus, professional
development is necessary to meet the needs of teachers and students.
Chapter Three: Methodology
The purpose of this study is to analyze the School Health Profiles survey data set
to determine the preparation of health teachers and their practice of teaching sexual health
topics.
Research Questions
Research Question One
What pre-service training did Minnesota health teachers receive for health
education?
Research Question Two
How much professional development have Minnesota health teachers received on
teaching sexual health education, including content, skills and teaching methods?
Research Question Three
What professional development do Minnesota health teachers want related to
sexual health education content, skills, and teaching methods?
Research Question Four
Are there differences in the sexual health teaching practices among teachers with
and without pre-service health education preparation?
Research Question Five
Are there differences in the sexual health teaching practices among teachers who
have and have not received professional development on sexual health content?
Research Question Six
Are there differences in the sexual health teaching practices among teachers who
have and have not received professional development on teaching sexual health
education?
This chapter will describe the School Health Profiles survey, the variables chosen
for this study, and how the data will be analyzed. The section describing the School
Health Profiles survey includes its purpose, sampling, years collected, a description of the
instrument, variables used, and the size of the sample.
Research Design
This study utilized the 2018 School Health Profiles data from lead health
education teachers (CDC, 2019b). The research is descriptive in nature and includes
secondary data analysis. The 2018 School Health Profiles surveyed a cross-section of
teachers from schools across Minnesota regarding the health policies and practices they
have in place (CDC, 2019d). This study focused on the Minnesota state data, and
compared subgroups based on self-reported levels of training and experience.
Description of the School Health Profiles
The Centers for Disease Control and Prevention’s School Health Profiles began
surveying lead health education teachers and school administrators in 1996, and has
continued the surveys every two years since that time. The purpose of the surveillance
system is to monitor school health policies and practices.
Description of Instrument
The researcher chose to analyze one of the two surveys for this study, the Lead
Health Education Teacher Questionnaire, obtained from the CDC website (CDC, 2018a).
The survey was 15 pages long, and contained 27 items, with one new item compared to
the 2016 survey (CDC, 2018a; CDC, 2019d). The new item inquired about skills practice
opportunities for students (CDC, 2018a). The survey items were primarily yes/no
questions, with only four multiple-choice questions. The instrument format was via paper
and pencil, or online, determined at the discretion of the administering agency (CDC,
2019d). Responses were self-reported.
Variables for this Study
The independent variables included area of professional preparation, and topics of
professional development received. Health teachers with pre-service training in either
health education, or health/physical education were placed in the group that had
preservice health education training. Teachers who had all other pre-service training were
placed into the group without pre-service health education training. The dependent
variables were content, skills and instruction topics. This study used four nominal data
items from the required health education section, which represent the content and skills
taught in health education, the practices teachers use to teach them, and whether they are
assessed. This study used six items under the professional development section, which
include both professional development received during the past two years, and the
professional development desired. This study used three items from the professional
preparation section. The researcher selected these items to represent the practices,
experiences, and interests of Minnesota health education teachers related to sexual health
education. The chart in Appendix B outlines the instrument items, their variable type, and
type of measurement.
Minnesota was one of the 43 states that participated in the 2018 School Health
Profiles, and had weighted data. The weighted data indicate that at least 70% of
participants responded. This study focused on the school health education programs
taught in Minnesota, based on teacher perspectives. The literature research was limited to
teacher training and standards, professional development, and health education with an
emphasis on sexual risk behaviors, sexual health content, and skills taught.
Sample Size
The sample size for the state of Minnesota was 306 lead health education teachers
for 2018 (CDC, 2019d). The data were weighted, and had an 86% response rate from
participants.
Institutional Review Board
This study was submitted for approval through Minnesota State University
Mankato on January 22, 2020. The Institutional Review Board determined the project to
be exempt from review on January 23, 2020 (Appendix A).
Analysis
Data analysis for this study used descriptive statistics, Chi-square tests, Phi, and
Cramer’s V. Chi-square tests show how well the results match what is expected. Phi is
used to show the effect size of a chi-square test result in a two-by-two comparison table,
and Cramer’s V is used to show the effect size of chi-square tests that compare more than
two dichotomous variables. Table 1 is the outlines the study specifications. It display the
research questions, matched with the instrument items, identifies the type of data, and the
data analyses used for this study. The data describe the pre-service training of Minnesota
health teachers, and compares the sexual health teaching practices among health teachers
with, and without, a health education preparation emphasis. The analyses help determine
whether a relationship exists between professional development and instructional practice
among health teachers. The frequency of professional development for sexual health
education was during the two years prior to the survey, and teachers’ interest in future
professional development was determined using this analysis.
Table 1
Table of Specifications
Instrument Data
Research Questions Items Type Statistical Analyses
RQ1
What pre-service training did
Minnesota health teachers receive
for health education?
Item 25
Nominal
Descriptive
statistics
RQ2
How much professional
development have Minnesota
health teacher received regarding
sexual health education, including
content, skills, and teaching
methods?
Items 19-21
Nominal
Descriptive
statistics
RQ3
What professional development do
Minnesota health teachers want
related to sexual health education
content, skills, and teaching
methods?
Items 22-24
Nominal
Descriptive
statistics
RQ4
Are there differences in the sexual
health teaching practices among
teachers with and without preservice
health education preparation?
Item 25
Items 9, 11-13
Nominal
Chi-square tests
Phi
Cramer's V
RQ5
Are there differences in the sexual
health teaching practices among
teachers who have and have not
received professional development
on sexual health content?
Item 19
Items 9, 11-13
Nominal
Chi-square tests
Phi
Cramer's V
RQ6
Are there differences in the sexual
health teaching practices among
teachers who have and have not
received professional development
on teaching sexual health
education?
Items 20-21
Items 9, 11-13
Nominal
Chi-square tests
Phi
Cramer's V
Summary
The broad scope of the School Health Profiles survey allows for analysis of many
aspects of school health education programs with both national and local application. The
purpose of this study is to analyze the survey data set to determine the preparation of
health teachers and their practice of teaching sexual health topics. The survey separates
various health content topics and sections by page to help distinguish them. It examines
teaching practices to uncover program strengths and limitations for teachers and school
districts. The professional development data reveals areas for professional and program
growth. Overall, the survey yields important program information for school health
education programs and professionals.
Chapter Four: Results and Discussion
This chapter includes the results of the statistical analyses of the data from the
Minnesota portion of the CDC’s (2018a) School Health Profiles: Lead Health Education
Teacher Questionnaire, 2018. The analyses used descriptive frequencies, Chi-square, Phi,
and Cramer’s V. The results include the pre-service training Minnesota health teachers
received for health education, how much professional development they have received on
sexual health education and content, and how much they desire for the future. Differences
were found in the sexual health teaching practices between teachers with and without
preservice health education preparation or professional development.
The state of Minnesota distributed surveys to 353 randomly-selected Minnesota
secondary schools that had at least one of grades 6 through 12 in the spring of 2018. An
administrator selected the lead health education teacher who was most knowledgeable
about the school health curriculum. Lead health education teachers responded to the
survey (N=306) with an 86% response rate (CDC, 2019b). Therefore, the data for
Minnesota were weighted to represent the population of health teachers in the state (CDC,
2019d). The results follow according to research questions and include tables of data and
charts of the results.
Pre-service Training
This first research question inquired about the pre-service training Minnesota
health teachers received for health education. The survey instrument used the professional
preparation items for demographics (CDC, 2018a). The CDC collects data on
participants’ 1) major emphasis of training, 2) health education licensure status, and 3)
experience teaching health education. The data from the 2018 School Health Profiles
survey indicate that the majority of health teachers in Minnesota (73.9%) received a
combination of health and physical education as their pre-service training. The second
largest training emphasis was health education alone (12.7%), which was much smaller
than the combined health and physical education emphasis. For detailed information
about the various preparation areas, see Table 2.
The School Health Profiles 2018: Characteristics of health programs among
secondary schools (CDC, 2019d) reported a median of 48.6% (11.5% - 80.5%) of health
teachers with a preparation emphasis in health and physical education among the 43
participating states. Across states, a median of 6.3% (1.0% - 28.1%) received health
education only training (CDC, 2019d). Compared to other states, Minnesota had a much
higher level of training with the combination health and physical education, and health
education alone. New teaching licenses in Minnesota require a minimum of an
undergraduate degree in the content area (PELSB, 2018).
More than 95% of the lead health education teachers were certified by the state of
Minnesota to teach health (CDC, 2019b). Across the United States a median of 82.2%
(36.8% - 99.4%) of lead health teachers were authorized by their states (CDC, 2019d).
Although states vary in their requirements for teacher licensure, Minnesota was close to
the top of the range for state authorization to teach health (Goldhaber et al., 2015;
Podgursky et al., 2016). Multiple criteria determine eligibility for a health education
license in Minnesota, and as the new tiered licenses vary, so do the knowledge, skills, and
experience requirements (PELSB, 2018).
Table 2
Pre-service Training Emphasis
N
Health and Physical Education
456
73.9%
Health Education
78
12.7%
Physical Education
55
8.8%
Weighted Percentage of Professional Preparation Emphasis
The largest portion of Minnesota health teachers (44.7%) reported at least 15 years
teaching experience. See Table 3 for details of teacher experience teaching health.
Researchers who reported School Health Profiles 2018: Characteristics of health
programs among secondary school (CDC, 2019d) found that across the states, a median
of 35.4% (21.5% - 55.8%) of health teachers have 15 or more years of experience
Other Education
6
1.0%
Exercise Science
6
1.0%
Family and Consumer Science
4
0.7%
Biology or Other Science
6
0.9%
Nursing or Counseling
2
0.3%
Other (includes public health and nutrition)
4
0.7%
Total
617
100.0%
%
teaching health (CDC, 2019d). Compared to that data, Minnesota skews higher in years
of experience teaching health. Most Minnesota lead health education teachers have more
than 10 years of experience as health teachers, possess a license to teach health, and
received a combination of health and physical education for their pre-service training.
Table 3
Weighted Percentage of Health Education Teaching Experience
Years of Experience
N
%
15 or more years
276
44.7%
10 to 14 years
113
18.3%
6 to 9 years
89
14.4%
2 to 5 years
112
18.1%
1 year
28
4.5%
Total
616
100.0%
Professional Development Received and Desired
This study focused on teacher preparation for sexual health education. The survey
measured the professional development teachers received in the previous two years, and
that they want for the future. This section answers two research questions. How much
professional development have Minnesota health teachers received on teaching sexual
health education, including content, skills and teaching methods? What professional
development do Minnesota health teachers want related to sexual health education
content, skills, and teaching methods? The School Health Profiles Lead Health Education
Teacher Questionnaire addressed professional development received and desired by
Minnesota health teachers related to sexual health education content (CDC, 2018a).
Sexual Health Content Professional Development Received and Desired
Minnesota heath teachers reported primarily receiving professional development
on mental and emotional health (78.9%), suicide prevention (66.6%), and violence
prevention (56.3%) during the two years prior to survey administration in the spring of
2018 (CDC, 2019b). The median for receipt of professional development on the 20 health
topics in the previous two years was 24.2% (13.1% - 78.9%). Specific to sexual health
education, human sexuality (27.1%) was above the median percentage; however, HIV
prevention (23.7%), STD prevention (19.6%), and pregnancy prevention (17.7%) were
lower than the median percentage of professional development received. The data
indicate that Minnesota teachers also received professional development at rates lower
than other states. The authors of School Health Profiles 2018: Characteristics of Health
Programs Among Secondary Schools (CDC, 2019d) reported the medians for content
professional development received of HIV prevention (31.2%), human sexuality (33.3%),
pregnancy prevention (26.6%), and STD prevention (30.5%) across states. All of the
professional development reported for sexual health education by Minnesota teachers
were lower than the rates reported across states.
The results from this study indicate that most health teachers want professional
development on the four sexual health education content areas. Minnesota teachers
reported interest in professional development about HIV prevention (57.5%), human
sexuality (73.0%), pregnancy prevention (58.4%), and STD prevention (64.1%). School
Health Profiles 2018: Characteristics of Health Programs Among Secondary Schools
(CDC, 2019d) reported similar medians for the same four content areas across states. In
Minnesota, higher rates of professional development desired were found when compared
to the rates reported for receipt of sexual health content in the previous two years.
Although Minnesota health teachers report low levels of professional development related
to sexual health content, they want the professional development in the future.
Sexual Health Education Professional Development Received and Desired
The professional development investigated represent both effective health
education pedagogy and sexual health education. The rates of professional development
received, and the rates of professional development desired for topics related to sexual
health education appear in Table 4. The two areas of professional development with the
highest reported frequency for receipt in the previous two years were use of interactive
teaching methods (58.6%) and teaching behavior change skills (52.3%). All other types of
professional development included in this study had reported frequencies up to 38% by
health teachers in Minnesota. The medians reported by the authors of School Health
Profiles 2018: Characteristics of Health Programs Among Secondary Schools (CDC,
2019d) for receipt of professional development ranged from 25.4% to connect students
with sexual health services to 58.2% to use interacting teaching methods. However,
teachers reported a desire for professional development on these topics across the country
ranged from a median of 58.3% to align lessons with scope and sequence, to a median of
71.7% to teach behavior change skills (CDC, 2019d).
The results of this study suggest most teachers want professional development to
teach behavior change skills, even though it was one of the most reported topics of
professional development received over the past two years. Most health teachers reported
that they want to receive professional development on sexual health education in the
future, with more than 70% of teachers reporting an interest in teaching behavior change
skills, using interactive teaching methods, and teaching students of different sexual
orientations or gender identities. Less than one-third received professional development
in the previous two years regarding 11 of the 16 professional development topics.
Although Minnesota health teachers may meet the requirements to renew their licenses,
they reported low levels of sexual health education professional development. This
supports the findings of Cardina (2018), who reported lower rates of professional
development for health education teachers, and less administrative support for health
education professional development. Health teachers want professional development to
help them meet students’ needs.
Table 4
Professional Development
Received
Desired
HIV prevention
23.7%
57.5%
Human sexuality
27.1%
73.0%
Pregnancy prevention
17.7%
58.4%
STD prevention
19.6%
64.1%
Teach students of different sexual orientations/gender identities
30.8%
70.8%
Use interactive teaching methods
58.6%
72.6%
Encourage community involvement
37.6%
69.5%
Teach behavior change skills
52.3%
73.6%
Assess students in health education
36.6%
69.0%
Professional Development Received and Desired
N=616
Sexual Health Teaching Practices by Health Education Preparation
The comparison of pre-service preparation with attempts to increase knowledge,
teach content, assess skills, and provide opportunities for practice, explores differences
among teachers based on their pre-service training. This section examines the research
question as to whether there are differences in the sexual health teaching practices among
teaches with and without pre-service health education preparation.
Sexual Health Content Examined by Pre-service Training
The comparison of pre-service training and teacher attempts to increase
knowledge of four sexual health content areas examines a relationship between teacher
preparation and instruction. When teacher pre-service training emphasis was compared
with the four sexual health content areas, this study found no statistically significant
differences among pre-service health education training and teacher attempts to increase
knowledge on HIV. The comparison of pre-service training with human sexuality,
pregnancy prevention, and STD prevention yielded statistically significant results, though
Align lessons with scope and sequence
33.7%
58.9%
Create a safe learning environment
31.6%
62.2%
Connect students with health services
22.0%
58.5%
Use a variety of instructional strategies
29.1%
69.0%
Build prevention skills among students
24.7%
65.6%
Assess student knowledge and skills
24.5%
67.7%
Understand district policies and guidelines
25.8%
54.7%
the relationship with pregnancy prevention was small 2(1, N=594)=6.279, p<0.05,
Ф=0.103) (Table 5). The analyses indicate a relationship between pre-service training and
teacher attempts to increase knowledge about sexual health content. When pre-service
training was compared to instruction of 20 specific sexual health concepts and skills, the
results of the crosstabs analyses were not statistically significant.
Table 5
Comparison of Pre-service Training and Sexual Health Content
Knowledge
N
2
Ф
HIV prevention
593
1.147
0.044
Human sexuality
594
3.922*
0.081
Pregnancy prevention
594
6.279*
0.103
STD prevention
594
5.750*
0.098
*p<0.05
Assessment of Sexual Health Concepts and Skills Examined by Pre-service Training
Statistically significant results were found for assessment of all seven concepts
and skills at the middle school level when compared to teacher preparation (p<0.001) (see
Table 6). The results indicate statistically significant results for two of the seven standards
at the high school level, though the strength of the relationship was small (p<0.05).
Cross-tabs analyses also showed significant relationships between pre-service training
and assessment of communication and goal-setting skills, though the relationship strength
was small (p<0.05). Thus, there is a relationship between pre-service training and
assessment of standards in sexual health education in grades six through eight.
Table 6
Comparison of Preparation Emphasis and Standards Assessment
Sexual Health Topic
Middle School
High School
2
Cramer’s V
2
Cramer’s V
Comprehend concepts
important to prevent HIV, other
STDs, and pregnancy
18.731***
0.197
5.551
0.105
Analyze the influence of family,
peers, culture, media,
technology, and other factors
on sexual risk behaviors
20.389***
0.206
2.382
0.069
Access valid information,
products, and services to
prevent HIV, other STDs, and
pregnancy
16.412***
0.185
1.835
0.060
Use interpersonal
communication skills to avoid
or reduce sexual risk behaviors
16.086***
0.183
7.727*
0.124
Use decision-making skills to
prevent HIV, other STDs, and
pregnancy
15.635***
0.180
2.981
0.077
Set personal goals that enhance
health, take steps to achieve
these goals, and monitor
progress in achieving them
17.202***
0.189
7.874*
0.125
Influence and support others to
avoid or reduce sexual risk
behaviors
18.640***
0.197
2.277
0.067
df = 2
*p < 0.05. **p < 0.01. ***p < 0.001.
Provision of Practice Opportunities Examined by Pre-service Training
Less than two-thirds of health teachers reported providing students with the
opportunity to practice skills related to sexual health education (CDC, 2019b). When
teacher provision of practice opportunities was compared with the health teacher
preservice training emphases 2(1, N=616)=2.626, Ф=0.065, p > 0.05), the relationship
was not significant. The comparison of pre-service training with sexual health education
teaching practices for content, concepts, skills, and practice opportunities examined
whether differences exist among Minnesota secondary school health educators with
different training emphases. There was not a significant difference among health teachers
with and without pre-service health education training when compared to content
instruction or skill practice opportunities. This study found significant differences among
assessment of concepts and skills by middle school teachers with health education
preservice training. Overall, it was found that pre-service training relates to standards
assessment at the middle school level.
Sexual Health Teaching Practices and Content Professional Development
The comparison of sexual health content professional development with attempts
to increase knowledge, teach content, assess skills, and provide opportunities for practice
examines variations among teacher practices based on their professional development
experience in the previous two years. This section examines the research question
whether there are differences in the sexual health teaching practices among teachers who
have and have not received sexual health content professional development.
Sexual Health Knowledge Examined by Content Professional Development
Table 7 displays each of the four sexual health content professional development
topics compared to instruction to increase knowledge about the same topics to examine
any relationships between them. The relationship between HIV, STD, and pregnancy
prevention professional development and increased knowledge for sexual health content
was statistically significant (p<0.05). The relationship between human sexuality
professional development and attempts to increase sexual health knowledge were
significant (p<0.01). Professional development for all four content areas showed the
strongest relationship with increasing human sexuality knowledge (p<0.001). There were
statistically significant relationships between recent receipt of sexual health content
professional development and sexual health content instruction (p<0.05).
Table 7
Comparison of Content Professional Development and Instruction
Professional
Development
Content Instruction
HIV
prevention
Human
sexuality
Pregnancy
prevention
STD
prevention
HIV prevention
N
594
594
594
594
5.477*
15.157***
7.938**
3.995*
Ф
0.096
0.160
0.116
0.082
Human sexuality
N
594
594
594
594
7.061**
24.357***
13.285***
9.802**
Ф
0.109
0.202
0.150
0.128
Pregnancy prevention
N
595
594
595
594
7.171**
14.393***
9.205**
4.469*
Ф
0.110
0.156
0.124
0.087
STD prevention
N
595
594
595
594
8.176**
16.411***
11.004**
5.529*
Ф
0.117
0.166
0.136
0.096
*p<0.05, **p<0.01, ***p<0.001.
Sexual Health Concepts and Skills Examined by Content Professional Development
The receipt of content area professional development was compared with teachers’
responses of yes to instruction of all 20 specific sexual health concepts and skills for
either middle school (sixth, seventh, and eighth grades), or high school (ninth, tenth,
eleventh, and twelfth grades). Professional development about HIV prevention, human
sexuality, pregnancy prevention, and STD prevention significantly relate to teaching all
20 sexual health topics at the middle school and high school levels (p<0.001). Human
sexuality professional development has a moderate relationship with high school content
instruction. See Table 8 for analysis details and Appendix C for a list of the 20 concept
and skills.
Table 8
Professional Development with Concepts and Skills Instruction
Middle
School
High
School
n
2
Ф
n
2
Ф
HIV prevention
399
13.713***
0.185
358
19.206***
0.232
Human sexuality
400
14.817***
0.192
358
34.467***
0.310
Pregnancy prevention
399
33.481***
0.290
358
25.684***
0.268
STD prevention
398
26.866***
0.260
358
31.167***
0.295
*p < 0.05. **p < 0.01. ***p < 0.001.
Assessment of Applied Standards Examined by Content Professional Development
The results of the analysis between content professional development and
standards assessment appear in Table 9. A comparison of recent receipt of HIV prevention
professional development and assessment of concepts and skills standards shows small,
but significant relationships with assessment of all seven standards at the middle level,
and five of the seven standards at the high school level (p<0.05). The strongest
relationships at the middle level are assessment of student ability to access reliable
information, resources, and services; and to make decisions. HIV professional
development relates to assessment of concepts and skills at the middle school level.
Human sexuality professional development was significantly related to assessment
of student ability to access resources at both the middle school and high school levels
(p<0.01) (Table 9). At the high school level, human sexuality professional development
was also associated with assessment of interpersonal communication, goalsetting, and
advocacy skills. Human sexuality professional development is significantly associated
with assessment of one standard at the middle school level and four standards at the high
school level (p<0.05).
When comparing pregnancy prevention professional development to concept and
skill standards assessment, there was a significant relationship with all seven standards at
the middle school level, and six of the seven standards at the high school level (p<0.05)
(Table 9). A moderate relationship exists between pregnancy prevention professional
development and assessment of resource access at the middle level. At the high school
level, the strongest relationship was between professional development and assessment of
advocacy skills. Recent receipt of pregnancy prevention professional development relates
to assessment of concept and skills.
Professional development about STD prevention significantly relates to
assessment of all seven standards at the middle school level, and five of the seven
standards at the high school level (p<0.05) (Table 9). The strongest professional
development relationship at the middle school level is with resource access skills. At the
high school level, the strongest relationship is with advocacy skills. HIV, pregnancy, and
STD prevention professional development all significantly relate to assessment of the
seven standards at the middle school level (p<0.05). Assessment of resource access skills
relates to the professional development topics at both the middle school and high school
levels. All of the relationships were positive, which indicates that teachers who received
sexual health content professional development were more likely to assess students’
concept and skills in sexual health education.
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Skill Practice Opportunities Examined by Content Professional Development
The results of the comparison between sexual health content professional
development and opportunities to practice skills appear in Table 10. Professional
development about HIV prevention, human sexuality, and pregnancy prevention
significantly relate to teachers providing opportunities for students to practice
decisionmaking, goal-setting, interpersonal communication, or refusal skills related to
sexual health (p<0.05). The results indicate a small relationship between skills practice
opportunities for students and professional development about pregnancy prevention and
human sexuality (p<0.01).
The examination of sexual health teaching practices was based on teachers’ recent
professional development about HIV prevention, human sexuality, pregnancy prevention,
and STD prevention. Statistically significant relationships were found between recent
receipt of sexual health content professional development and attempts to increase
knowledge about HIV prevention, human sexuality, pregnancy prevention, and STD
prevention, and teach all 20 specific sexual health concepts and skills (p<0.05). Teachers
who received professional development about sexual health content were more likely to
assess students about sexual health concepts and skills standards, and to provide
opportunities to practice skills related to sexual health. Content professional development
about HIV prevention, human sexuality, pregnancy prevention, and STD prevention relate
to teacher instructional practices in sexual health education.
Table 10
Professional Development Received and Skill Practice Opportunities
Professional Development Topic
n
2
Ф
HIV prevention
617
4.676*
0.087
Human sexuality
617
9.579**
0.125
Pregnancy prevention
616
15.057***
0.156
STD prevention
616
2.752
0.067
*p < 0.05. **p < 0.01. ***p < 0.001.
Sexual Health Education Teaching Practices and Professional Development
The comparison of the professional development independent variables with the
instructional practices for teaching sexual health education dependent variables help
determine whether differences in teaching practices exist among teachers who received
and did not receive professional development.
Sexual Health Knowledge Examined by Education Professional Development
The results of the comparison of professional development with trying to increase
knowledge on HIV prevention, human sexuality, pregnancy prevention, and STD
prevention appear in Table 11. The results suggest a significant relationship between ten
of the twelve professional development topics and teacher attempts to increase HIV
prevention knowledge (p<0.05). Ten of the twelve professional development topics relate
significantly with teacher attempts to increase knowledge about human sexuality
(p<0.05). Professional development on eight of the twelve topics was associated with
increasing knowledge about pregnancy prevention (p<0.05). Six of the twelve
professional development topics are significantly related with attempts to increase
knowledge about STD prevention (p<0.05). The strongest relationship occurred between
professional development to use various effective instructional strategies and increasing
human sexuality knowledge (n=594, 2=27.805, Ф=0.216, p<0.001). Sexual health
education professional development is associated with teacher attempts to increase
knowledge about HIV prevention, human sexuality, pregnancy prevention, and STD
prevention.
Table 11
Sexual Health Education Professional Development with Content Instruction
Professional
Development
Content Instruction
HIV
prevention
Human
sexuality
Pregnancy
prevention
STD
prevention
Teach students of
N
595
594
594
594
different sexual
9.367**
18.332***
5.918*
1.987
orientations Use
interactive
Ф
N
0.125
0.176
0.100
0.058
594
594
595
595
instructional methods
2.761
0.088
2.405
1.168
Encourage community
Ф
N
0.068
0.012
0.064
0.044
594
594
594
594
involvement
5.334*
9.643**
2.258
1.743
Teach behavior change
Ф
N
0.095
0.127
0.062
0.054
594
594
594
595
skills
5.666*
6.517*
0.237
2.378
Assess students in
Ф
N
0.098
0.105
0.020
0.063
595
594
594
594
health education
4.208*
1.754
0.888
0.458
Align lessons with
Ф
N
0.084
0.054
0.039
0.028
594
594
594
594
scope and sequence
11.505**
5.947*
8.629**
1.254
Create safe learning
Ф
N
0.139
0.100
0.121
0.046
594
594
594
594
environment
10.111**
10.704**
10.246**
5.163*
Connect students with
Ф
N
0.130
0.134
0.131
0.093
594
594
594
594
sexual health services
4.857*
9.336**
13.437***
6.952**
Use various effective
Ф
N
0.090
0.125
0.150
0.108
594
594
595
594
instructional strategies
4.463*
27.805***
11.740**
3.888*
Build student
Ф
N
0.087
0.216
0.140
0.081
595
594
595
594
prevention skills
6.021*
11.517**
15.964***
8.487**
Assess student
Ф
N
0.101
0.139
0.164
0.120
594
594
594
594
knowledge and skills
6.042*
16.406***
16.011***
8.487**
Understand curriculum
Ф
N
0.101
0.166
0.164
0.120
594
594
594
594
policies
3.078
13.009***
12.614***
9.355**
Ф
0.072
0.148
0.146
0.125
*p<0.05, **0.01, ***p<0.001.
Instruction of Sexual Health Topics Examined by Sexual Health Education
Professional Development
Analyses that compare health education professional development with instruction
of all 20 specific sexual health concept and skill topics, at both the middle school and
high school levels, show whether differences exist among instructional practices (see
Table 12). Nine of the twelve professional development topics were significantly
associated with instruction of all 20 sexual health concepts and skills at the middle school
level (p<0.001). All of the professional development topics were significantly associated
with instructing all 20 sexual health topics at the high school level (p<0.01). This
suggests that sexual health education professional development relates to instruction of
sexual health topics at the middle school and high school levels.
Table 12
Sexual Health Education Professional Development and Teaching All 20 Sexual Health
Content and Skills Topics
Middle
School
High
School
n
2
Cramer's
V
n
2
Cramer's
V
Teach students of different gender
identities or sexual orientations
398
27.840***
0.264
359
24.306***
0.260
Use interactive instructional
methods
399
0.128
0.018
358
10.365**
0.170
Encourage community
involvement
398
1.930
0.070
359
30.978***
0.294
Teach behavior change skills
399
1.242
0.056
358
13.127***
0.191
Assess students in health
education
399
22.598***
0.238
358
26.974***
0.274
Align lessons and materials with
scope and sequence
398
13.217***
0.182
359
33.211***
0.304
Create safe learning environment
for students
398
14.246***
0.189
358
26.278***
0.271
Connect students with sexual
health services
399
45.046***
0.336
358
47.528***
0.364
Use a variety of effective
instructional strategies
398
28.452***
0.267
358
37.644***
0.324
Build student skills in HIV,
pregnancy, and STD prevention
399
31.253***
0.280
358
35.904***
0.317
Assess student knowledge and
skills
399
35.604***
0.299
358
31.661***
0.297
Understand policies or curriculum
guidance
399
22.772***
0.239
358
26.334***
0.271
*p < 0.05. **p < 0.01. ***p <0.001.
Assessment of Concepts and Skills Standards Examined by Sexual Health Education
Professional Development
The teachers’ sexual health education professional development experiences were
compared with their assessment practices for concepts and skills in sexual health
education to determine whether a relationship exists between professional development
and assessment practices. The results of the comparison appear in Table 13 for middle
school and Table 14 for high school. At the middle school level, nine of the 12
professional development topics significantly relate to teacher assessment of concepts
(p<0.05). At the high school level, ten professional development topics relate to concept
assessment (p<0.05).
The comparison of sexual health education professional development and
assessment of skills for sexual health education shows whether a relationship exists
between the two. Eight professional development topics at the middle school level, and
nine topics at the high school level were significantly associated with assessment of
influence analysis (p<0.05). Middle school teacher assessment of student ability to access
resources is significantly related to three-fourths of the sexual health education
professional development topics (p<0.05). High school assessment of resource access was
significantly associated with all twelve professional development topics (p<0.01). The
assessment of student communication skills was significantly associated with six
professional development topics at the middle school level and seven of the 12 topics at
the high school level (p<0.05).
Teacher assessment of student decision-making skills compared with sexual health
education professional development found nine of 12 significant relationships at the
middle school level, and 11 of 12 significant relationships at the high school level
(p<0.05). Eight significant relationships exist between professional development topics
and assessment of goal-setting skills at the middle school level, and 11 significant
relationships exist at the high school level (p<0.05). The results of the comparison
between sexual health education professional development and assessment of advocacy
skills found nine significant relationships at the middle school level, and 11 of the 12
professional development topics at the high school level (p<0.05).
Professional development to connect students with sexual health services was
associated with teacher assessment of all skill standards for both the middle school and
high school levels. At the middle school level, professional development to teach students
of different sexual orientations or gender identities, use a variety of effective strategies,
and assess knowledge and skills in sexual health education were significantly associated
with teacher assessment of concept and skill standards. At the high school level, the
professional development topics are associated with teacher assessment of resource
access skills. Professional development to teach behavior change skills had the strongest
relationship with assessment of concepts and skills related to sexual health education
(p<0.001). Professional development to encourage of community involvement, assess
health education, and understand policies and guidelines were significantly associated
with teacher assessment of skill standards. This means that professional development for
sexual health education relates to teacher assessment of concepts and skills standards.
Table 13
Professional Development and Middle School Standards Assessment
Middle School Assessment of Standards
Standards Assessment
Concepts
Influences
Communi-
Resources cation Decisions Goals Advocacy
Teach students
N
481
481
481 481
482 482 481
of different sexual
2
14.555**
16.970***
16.137*** 14.502**
18.352*** 20.810*** 15.923***
orientations
V
0.174
0.188
0.183
0.174
0.195 0.208 0.182
Use interactive
N
482
482
481
482
482 481 482
instructional
2
6.140*
2.815
4.227
1.077
1.969 2.112 3.041
methods
V
0.113
0.076
0.094
0.047
0.064 0.066 0.079
Encourage
N
482
481
482
482
481 481 481
community
2
0.868
6.247*
1.392
2.495
6.353* 5.573 0.834
involvement
V
0.042
0.114
0.054
0.072
0.115 0.108 0.042
Teach behavior
N
482
482
481
482
482 482 482
change skills
2
0.840
2.604
5.820
6.303*
6.776* 20.678*** 6.162*
V
0.042
0.073
0.110
0.114
0.119 0.207
0.113
Assess students
N
482
482
481
481
481 482
482
in health
2
1.676
1.772
13.099**
2.756
5.682 3.465
1.898
education
V
0.059
0.061
0.165
0.076
0.109 0.085
0.063
Align lessons
N
482
481
482
482
482 482
482
with scope
2
12.873**
20.230***
13.829**
4.439
17.765*** 11.395**
22.825***
and sequence
V
0.163
0.205
0.169
0.096
0.192
0.154
0.218
Create safe
N
481
482
482
480
482
482
482
learning
2
6.730*
5.777
7.884*
3.299
4.749
10.162**
11.579**
environment
V
0.118
0.109
0.128
0.083
0.099
0.145
0.155
Connect students
N
482
482
482
483
483
482
482
with sexual health
2
18.418*** 15.396***
23.310*** 6.194*
13.540**
7.905*
17.645***
services
V
0.195 0.179
0.220 0.133
0.167
0.128
0.191
Use a variety of
N
482 483
482 483
481
483
481
instructional
2
10.587** 12.927**
14.950** 7.861*
7.534*
11.828**
11.644**
strategies
V
0.148 0.164
0.176 0.128
0.125
0.156
0.156
Build student
N
482 482
482 483
482
482
483
prevention skills
2
13.182** 18.751***
26.077*** 5.475
11.524**
11.021**
14.963**
V
0.165 0.197
0.233 0.106
0.155
0.151
0.176
Assess student
N
482 482
482 482
482
482
481
knowledge and
2
15.222*** 16.900***
23.224*** 10.587**
7.081*
12.759**
13.402**
skills
V
0.178 0.187
0.220 0.148
0.121
0.163
0.167
Understand
N
481 482
481 482
482
481
482
curriculum
2
18.282*** 25.674***
18.378*** 9.860**
21.029*** 5.894
17.287***
policies
V
0.195 0.231
0.195 0.143
0.209 0.111
0.189
df=2
*p<0.05, **p<0.01, ***p<0.001.
Table 14
Professional Development and High School Standards Assessment
High School Assessment of Standards
Communi-
Standards Assessment Concepts Influences Resources cation Decisions Goals Advocacy
Teach students N 503 503 502 502 503 503 502
of different sexual 2 7.569* 4.330 12.515** 5.612 2.967 9.513** 7.880* orientations V 0.123 0.093
0.158 0.106 0.077 0.138 0.125
Use interactive N 503 503 504 504 504 504 503
instructional 2 3.274 8.692* 9.769** 4.481 7.842* 8.325* 26.439*** methods V 0.081 0.131 0.139
0.094 0.125 0.129 0.229
Encourage N 502 502 503 503 503 503 504
community 2 8.345* 9.330** 11.903** 6.736* 6.139* 18.146***16.038*** involvement V 0.129
0.136 0.154 0.116 0.110 0.190 0.178
Teach behavior N 502 503 502 503 502 504 502
change skills 2 20.265***26.978***35.144***27.580***18.510***33.595***49.001***
V 0.201 0.232 0.265 0.234 0.192 0.258 0.312
Assess students N 502 503 503 503 504 504 502
in health 2 6.423* 9.226* 14.061** 9.975** 14.319** 9.309* 23.598*** education V 0.113 0.135
0.167 0.141 0.169 0.136 0.217
Align lessons N 503 504 503 503 503 503 504
with scope 2 4.765 6.378* 9.988** 2.065 7.853* 11.861** 17.609*** and sequence V 0.097 0.112
0.141 0.064 0.125 0.154 0.187
Create safe N 503 503 504 504 503 504 502
learning 2 8.965* 1.308 16.640***8.978* 11.237** 14.150** 0.107 environment V 0.134 0.051 0.182
0.133 0.149 0.168 0.167
Connect students N 504 504 503 504 503 504 504
with sexual health 2 8.998* 10.815** 13.221** 8.978* 11.237** 14.150** 17.609*** services V
0.134 0.146 0.162 0.133 0.149 0.168 0.187
Use a variety of N 503 503 503 503 503 503 502
instructional 2 8.024* 4.935 13.221** 6.178* 11.525** 14.386** 28.388*** strategies V 0.126 0.099
0.162 0.111 0.151 0.169 0.238
Build student N 503 502 503 503 503 502 503
prevention skills 2 10.303** 8.161* 19.020***3.205 12.806** 4.924 20.726***
V 0.143 0.128 0.194 0.080 0.160 0.099 0.203
Assess student N 503 503 503 503 502 503 502
knowledge and 2 9.871** 7.695* 12.619** 5.936 12.309** 9.859** 25.793***
skills V 0.140 0.124 0.158 0.109 0.157 0.140 0.227
Understand N 503 503 503 502 502 503 503
curriculum 2 11.167** 13.071** 13.443** 11.254** 13.331** 16.468***19.787*** policies V 0.149
0.161 0.163 0.150 0.163 0.181 0.198
df=2
*p<0.05, **p<0.01, ***p<0.001.
Sexual Health Education Professional Development and Skill Practice Opportunities
The comparison of professional development with the provision of opportunities
for students to practice communication, decision-making, goal-setting, or refusal skills
related to sexual health shows differences among teacher practices based on professional
development. This comparison is displayed in Table 15. All of the professional
development topics significantly relate to teacher provision of opportunities to practice
skills related to sexual health (p<0.05). A moderate association occurs between
professional development to assess students in health education, and the provision of
opportunities for students to practice skills related to sexual health education. The data
analysis shows that Minnesota health teachers are more likely to report that they provide
opportunities for students to practice communication, decision-making, goal setting, or
refusal skills related to sexual health when they also report receipt of professional
development on sexual health education in the past two years. Sexual health education
professional development is associated with attempts to increase knowledge about HIV
prevention, human sexuality, and pregnancy prevention; teach all 20 sexual health
concepts and skills; assess concepts and skills; and provide opportunities for students to
practice skills related to sexual health.
Table 15
Sexual Health Education Professional Development and Skill Practice Opportunities
Professional Development
Practice
Opportunities
n
2
Ф
Teach students of different gender identities or
sexual orientations
617
8.661**
0.118
Use interactive instructional methods
617
18.141***
0.171
Encourage community involvement
616
6.899**
0.106
Teach behavior change skills
617
19.406***
0.177
Assess students in health education
617
35.017***
0.238
Align lessons and materials with scope and
sequence
617
4.191*
0.082
Create safe learning environment for students
617
11.719**
0.138
Connect students with sexual health services
615
16.023***
0.161
Use a variety of effective instructional strategies
616
10.364**
0.130
Build student skills in HIV, pregnancy, and STD
prevention
616
10.771**
0.132
Assess student knowledge and skills
616
14.497***
0.153
Understand policies or curriculum guidance
617
5.500*
0.094
*p < 0.05. **p < 0.01. ***p < 0.001.
Summary
This chapter included the pre-service training Minnesota health teachers received
for health education; how much recent professional development they received on
teaching sexual health; and how much they want in the future. This study considered two
forms of health education preparation, pre-service training and professional development,
to examine teacher instructional practices for sexual health education. Differences were
found in the sexual health teaching practices between teachers with and without
preservice health education preparation or professional development.
Chapter Five: Summary and Discussion, Implications, and Recommendations
The purpose of this study was to analyze a portion of the Minnesota Lead Health
Education Teacher Questionnaire from the School Health Profiles data set to determine
the preparation of health teachers and their sexual health education practices. Both
preservice and professional development forms of teacher preparation were examined in
this study. Teachers’ instruction of sexual health topics, provision of practice
opportunities, and assessment of skills were also examined in this study. This chapter
includes a summary and discussion, the implications for health education, and
recommendations for future research.
Summary of Results and Discussion
This study examined the preparation of health educators to teach sexual health
education. It considered both pre-service health education preparation and professional
development, and compared them to sexual health education teaching practices. The
preservice preparation and professional development were compared to teacher attempts
to increase content knowledge, teach 20 specific sexual health topics, provide
opportunities for students to practice skills related to sexual health, and teacher
assessment of content and skills applied to sexual health education. Professional
development represented content areas and educational methods. In addition, teacher
responses for professional development received was compared to teacher responses for
interest in future professional development about those topics.
Summary of Results and Discussion Related to Pre-service Health Education Training
According to the results of this study, most Minnesota health teachers received
pre-service preparation to teach health through either health education or a combination
of health and physical education, and the state licensed them to teach health. Considering
both health education training and the combination health and physical education training
emphases, 86.6% of teachers received pre-service training in health education. More than
95% of teachers were licensed by the state to teach health education. Researchers who
conducted studies across states found that health education may be taught by someone
who was not trained to teach health (CDC, 2019d; Eisenberg et al, 2013; Kann et al.,
2001). In 2010, Eisenberg et al. (2013) found that approximately 71% of Minnesota
health teachers received pre-service health education training, and 79% were certified to
teach health. The results of this study contrast with the lower rates of pre-service
preparation and licensure found for Minnesota by other researchers.
Pre-service training was significantly related to increasing knowledge about STD
prevention and the assessment of standards in sexual health education. Middle school
teachers who received pre-service health or health and physical education training were
significantly more likely to report assessment of concepts and skills than teachers who
received other pre-service training. Although Rhodes et al. (2013) found that
professionally trained health education teachers were more likely to teach sexual health
topics, the results of this study are different. Eisenberg et al. (2013) found that multiple
factors influence the sexual health content taught by Minnesota health teachers, and that
teachers do not always teach what they believed students should learn.
Education, professional development, and years of experience influence most high
school health teachers to teach HIV prevention (Herr et al, 2012). In Minnesota,
participation in a pre-service education program, but not content professional
development, may maintain a license indefinitely (PELSB, 2018). Each state
independently sets teacher standards and practices; however, many health teachers in the
United States lack health education professional training (Goldhaber et al., 2015).
Comprehensive health education requires teachers to personalize learning, use interactive
strategies, and promote skill development related to core content (CDC, 2019a). Effective
sexual health education can reduce sexual risk behavior (Kirby et al., 2007; Chin et al.,
2012). Thus, professional development is necessary to meet the needs of students.
Summary of Results and Discussion Related to Professional Development
Most health teachers in Minnesota did not receive professional development
related to sexual health education in the previous two years. Teachers reported a
professional development frequency range between 17.7% and 27.1% for sexual health
content, and a range between 22.0% and 58.6% for health education instruction during
the previous two years. They reported a range of interest in professional development
between 54.7% and 73.0% for the same topics. More than half of teachers want
professional development about sexual health education content and instruction. The low
frequency of professional development about human sexuality and pregnancy prevention
are consistent with the findings of Brener et al. (2013). The low rate of professional
development is consistent with findings that school practices changed very little between
2008 and 2014 (Demissie et al., 2018). One avenue to explore in future research is
whether the same teachers receive the majority of the sexual health professional
development and many teachers receive nothing, or whether most teachers received some
professional development. The data indicate that health teachers want professional
development to effectively meet the needs of all students. Although most health teachers
in Minnesota want professional development on the content, skills and methods for
teaching sexual health education, most have not received it in the previous two years.
Less than one-third received professional development about teaching students
with different sexual orientations or gender identities, but more than 70% reported that
they want to receive it. The low rate of professional development about different sexual
orientations and gender identities is consistent with findings that school practices changed
very little between 2008 and 2014 (Demissie et al., 2018). This low rate, combined with
the significant relationship to increase content knowledge, teacher concepts, and teach
skills suggests that health teachers need to receive this professional development.
Human sexuality had the highest frequency of professional development interest
for content areas, which may simply be due to its lack of a definition. The CDC website
references a World Health Organization (WHO) definition of sexuality on its Sexual
Health website (CDC, 2019c). The World Health Organization website has a working
definition of sexuality, which broadly encompasses sexual activity and reproduction,
gender identities and roles, sexual orientation and expression, intimacy and relationships,
beliefs and attitudes, values, behaviors, and its influences, but it does not have an official
definition or position (WHO, 2020). The absence of a definition was made clear by a
bold-print disclaimer above the definitions which indicated that it was a working
definition for the purposes of discussion. The lack of a clear definition of sexuality may
be a reason for the need for more professional development about human sexuality.
Teaching behavior change skills, using interactive teaching methods, and teaching
students with different sexual orientations or gender identities were the highest reported
interest areas for educational professional development.
The results of this study indicate that receipt of sexual health content professional
development was significantly associated with instructional practices. Teacher attempts to
increase content knowledge and teach sexual health concepts and skills, relates to
professional development to teach students of different sexual orientations or gender
identities, and to teach behavior change skills. Minnesota health teachers were more
likely to teach human sexuality and pregnancy prevention, teach all 20 specific sexual
health concepts and skills, provide opportunities for students to practice skills, and assess
standards during sexual health education when they received professional development
about sexual health education in the previous two years. Other researchers have found
that continuing education time has a positive relationship with the sexual health topics
taught at the secondary level (Barr et al., 2014; Clayton et al., 2018; Jones et al., 2004;
Kann et al., 2007). This study adds to the literature that sexual health education
professional development relates to teacher provision of skill practice opportunities in
sexual health education, and to assessment of content and skills.
Sexual health education professional development is significantly associated with
instruction to increase knowledge about HIV prevention, human sexuality, and pregnancy
prevention, and instruction of sexual health concepts and skills. The professional
development also relates to the provision of opportunities for students to practice skills
related to sexual health, and assessment of content and skills in sexual health education.
Minnesota health teachers were more likely to teach sexual health content, concepts, and
skills; provide opportunities for students to practice skills in sexual health education, and
assess standards during sexual health education when they received professional
development about sexual health education in the previous two years. The results are
consistent with Clayton et al. (2018), who found that sexual health education instructional
professional development has a positive relationship with instruction of sexual health
education. The results of this study add to the professional literature surrounding the
relationship between sexual health professional development and teacher practices in
sexual health education.
Implications for Health Education
There are multiple implications for health education relevant to this study. Some
implications are specific to pre-service health education training, and others specifically
relate to professional development throughout a teacher’s career.
Implications for Pre-service Teacher Preparation
This study is important for health education because not all health teachers in
Minnesota received pre-service training to teach health education. The results of this
study indicate that not all teachers received pre-service health education training, and that
the training is associated with increasing knowledge about STD prevention and
assessment of concepts and skills at the middle school level. Effective health education
provides the background necessary to personalize learning, use interactive strategies, and
promote skill development for students (CDC, 2019a). Herr et al. (2012) recommends
pre-service training to ensure teachers can meet student needs. Pre-service training
provides the foundation for effective health education.
Pre-service health education training was found in this study to relate to the
assessment of skills in sexual health education. Researchers have found that pre-service
programs may not require sexual health education training (Eisenberg et al., 2010). Skills-
based programs are more effective at leading to behavior change (Allensworth et al,
1997; CDC, 2019a; Kirby et al, 2007). Students who learn through skills-based
instruction negotiate condom use, choose abstinence more frequently, and have lower
rates of plans for sexual activity (Anderman et al., 2011). Skills-based instruction helps
students develop skills to reduce sexual risk behavior. Herr et al. (2012) recommend
preservice training to ensure teachers are prepared to meet student needs. The association
of pre-service training with skills assessment found in this study, and the literature
support for pre-service training to reflect effective teaching, suggest that health education
teachers need pre-service training to reduce sexual risk behavior through health
education.
In Minnesota, teachers are required to obtain a degree in the content area or field
for which they teach. Teacher candidates must show evidence that they know health
education content, methods, and student learning processes as part of the state standards
for teaching (Office of the Revisor of Statutes, 2016). They must also show that they can
plan and differentiate instruction, create a safe learning environment, communicate
effectively for instruction and with the school and community, conduct assessments, and
reflect upon instruction. Most health education methods courses focus on objectives,
instruction, and assessment; lesson plan development; use of instructional engagement
strategies; National Health Education Standards use; and unit plan development (Fisher et
al., 2015). Methods course instructors with a degree in health education were more likely
to share how to apply behavior theory (Fisher et al, 2015). Pre-service training does not
provide ongoing support for health teachers already in the field, so they need professional
development to prepare them to teach it now and in the future.
Implications for Professional Development
Content and time spent on content and skills, varies by district, course, teacher
comfort, and teacher training (Kann et al, 2001). Given that some health teachers do not
possess a license or pre-service training in health education, professional development
opportunities for health teachers are critical for teacher preparation and student learning.
This study highlights both the need and interest in sexual health education professional
development for Minnesota health teachers. Although continuing education is an
important part of professional development, it may not occur for a variety of reasons
(Eisenberg et al, 2013). Professions use ongoing training to support employees in their
jobs, but it needs to be relevant to their positions. Minnesota teachers need more
continuing education hours to renew a teaching license than are designated to specific
topics. This suggests that teachers should receive content professional development, but
have not received as much as they need for sexual health education.
The results suggest that professional development on sexual health education
content topics were not a priority in Minnesota school districts during the previous two
years. The new Minnesota teaching license renewal professional development
requirements apply to all teaching licenses, and are not content specific (PELBS, 2019).
The lack of sexual health education professional development received in the previous
two years, coupled with the difference in sexual health education practices based on
receipt of professional development, suggest the need to provide sexual health education
professional development for all teachers on a recurring basis.
The results of this study indicate that health teachers were more likely to teach
sexual health content, provide practice opportunities, and assess skills related to sexual
health when they also received professional development related to sexual health
education. Ongoing professional development about sexual health education would help
teachers meet their students’ needs. Students have the right to accurate sexual health
information and schools should provide this for students to ensure healthy development
(Parry & Wilentz, 2015). However, teacher knowledge and skills may not be up-to-date if
they do not receive professional development. Professional development related to
teaching students of different sexual orientations or gender identities support meeting
student needs. The lack of this professional development influences future physical,
mental, and social health of students (Russell et al., 2011).
In Minnesota, this study suggests that receipt of professional development in the
past two years is associated with sexual health knowledge, concepts, and skills
instruction; opportunities to practice skills; and the assessment of concepts and skills.
Skills-based health education programs support behavior change (Allensworth et al,
1997; CDC, 2019a; Kirby et al, 2007). Students who learn through skills-based
instruction negotiate condom use, choose abstinence more frequently, and have lower
rates of plans for sexual activity (Anderman et al., 2011). Skills-based instruction helps
students develop skills to reduce sexual risk behavior, which can lead to unplanned
pregnancies or sexually transmitted diseases. Effective sexual health education reduces
sexual risk behaviors and improves knowledge and attitudes related to sexual behavior
(Chin et al., 2012). Teaching knowledge, concepts and skills is insufficient if students do
not have opportunities to practice those skills prior to assessment. More than one-third of
health teachers did not provide opportunities for students to practice skills related to
sexual health, but most teachers assessed students’ skills. This study supports professional
development opportunities for health teachers in Minnesota, especially related to
assessment in health education.
Recommendations for Health Education and Future Research
Effective health education utilizes the characteristics of health education,
represents all students, is skills-based and standards-based, provides opportunities to
practice skills, and teaches behavior change skills. Using the School Health Profiles and
Health Education Curriculum Analysis Tool to monitor the programs locally, and Profiles
to examine programs more broadly. The two instruments evaluate and monitor programs
for all aspects of school health. The Profiles data can compare states and examine
programs and policies throughout the country. This may be the first study to examine any
association between the provision of skill practice opportunities for students and
preservice training; thus, further research is necessary. Given low rates of practice
opportunities, stakeholders must continue to monitor and promote skills practice prior to
assessment. Practice for a skill should occur prior to assessment of the skill, but whether
this occurs in practice is unknown.
At both the middle school and high school levels, professional development to
connect students with sexual health services relates significantly to assessment of
concepts and skills. The sexual health services could be school-based or part of the larger
community. Condom availability programs in schools, and school-based sexual health
services, are not associated with increased sexual risk behavior, increased sexual activity,
or earlier sexual initiation (Andrzejewski et al., 2019; Owen et al., 2010). Over the past
couple of decades, the number of school-based health centers has doubled in the United
States, and they serve to fill community health care gaps (Love et al., 2019). (CDC,
2017). The authors of School Health Profiles 2018: Characteristics of health programs
among secondary schools reported that school health services may refer students to
community sexual health services to reduce risks associated with sexual behaviors (CDC,
2019d). Collaboration between health education and health services staff ranges between
44% and 87% across states, and most schools did not refer for sexual health services.
Collaboration between health education and school health services require further
investigation, as well as, school and community health services.
Future research about health education should examine pre-service training.
Although most Minnesota teachers have pre-service training and possess a health
education teaching license, what factors have led to some teachers not possessing the
training and/or license? The data from this study compared to Eisenberg et al. (2013)
suggest that Minnesota could be trending towards increased health education pre-service
training, but further research into trends is necessary for confirmation. Most health
teachers in Minnesota are qualified or prepared to teach health education. Eisenberg et al.
(2013) found that multiple factors and barriers may influence sexual health education in
Minnesota, and more research is necessary to examine the influences and ways to
overcome them. With respect to the pre-service training, Minnesota must promote
licensing for health teachers, especially among new hires, and ensure that sexual health
education is required for pre-service health education programs.
Researchers of other studies have found that health teachers do not receive the
sexual health training necessary to teach sexual health education confidently in the K-12
setting (Barr, Goldfarb et al., 2014; Eisenberg et al., 2013; Herr et al., 2012). The School
Health Profiles survey does not investigate pre-service sexual health education training.
Future studies should examine the pre-service training for sexual health education as it is
possible teachers in other fields (e.g. elementary education, family and consumer
sciences, biology) received sexual health education training. University programs may
use the National Sexual Health Education Teacher Preparation Standards (Barr et al.,
2012), but without the requirement for sexual health education training, teachers may
miss these standards. In the future, research should examine the provision of
opportunities for pre-service health education teachers to learn sexual health education
content and skills, and meet the standards to teach sexual health education.
This study did not examine any relationships between years of experience or
course requirements for graduation and sexual health education. Possible relationships
between teachers or programs and educational practices should be considered. Future
research should investigate whether the low credit requirements for graduation set by the
state and districts leads to a lack of full-time positions for which qualified teachers would
apply. Other possible factors in teacher pre-service preparation could be a lack of district
emphasis on licensure, pre-service training, or professional development, which should
be investigated in the future. Given the frequency of teachers reporting more than 10
years of experience teaching health education, turnover is an area for future investigation.
The state requires teachers who teach outside their licensure area to apply for a variance
to teach in another field, valid for one year, which has restrictions and requirements.
Licensure variances, and reasons for teaching outside of one’s license area, should also be
investigated for potential teacher shortages in areas of the state, or lack of viable positions
for teachers.
One step towards uncovering this this information is to examine the School Health
Profiles School Principal Questionnaire (CDC, 2018c). The second question on the
survey inquires whether health education is included in a district’s school improvement
plan. A district that does not have all health education teachers licensed and trained to
teach health education should include that as part of its plan. The survey also inquires
about coordinated review of health education. A program that has gaps in topics, content
areas, or skills, should include professional development training to assist with
implementing the necessary activities into the curriculum. The data from School Health
Profiles may be used in a variety of ways. States use School Health Profiles data to
examine and support policies and practices, professional development, and to monitor
and evaluate programs (CDC, 2019d; Foti et al., 2011). Then, states disseminate the
results to various stakeholders to improve health education.
The broad scope of the School Health Profiles survey allows for analysis of many
aspects of school health education programs with both national and local application. The
survey examines teaching practices to uncover program strengths and limitations for
teachers and school districts. The professional development data reveals areas for
professional and program growth. Future research should examine the principal survey,
teacher survey, and data from the Minnesota Student Survey (or YRBS in other states) to
examine additional data about sexual health education to meet student and teacher needs.
School Health Profiles data (2019b) for Minnesota suggests a need for sexual health
education professional development and pre-service training for future health educators to
improve sexual health education.
This study examined relationships using all 20 sexual health concepts and skills as
one variable to reflect teachers who taught all of them. Researchers should examine the
specific concepts and skills within the 20 topics to determine whether gaps exist for a few
topics, and whether some topics relate to training, provision of materials, or curriculum
policies. Multiple factors influence sexual health education content (Eisenberg et al.,
2013; Herr et al., 2012). The School Health Profiles surveys examine multiple areas of
health education, and all of these areas should be explored for data to support curriculum,
policies, and training needs. Data from other states can create a more clear picture of
sexual health education throughout the country. Also, the administrative perspective,
policy guidance, and available materials cannot be ignored as factors in health education.
Content-area professional development not a requirement for re-licensure in
Minnesota, but the reasons are unclear. Due to the lack of literature surrounding
assessment practices and sexual health education, additional research is important to
examine relationships with pre-service training, professional development, and
instructional practices. Some health teachers have not received professional development
related to sexual health content and teaching. Differences among the sexual health
education practices for teachers who have and have not received recent professional
development were found in this study. Also, Minnesota health teachers need and want
professional development related to sexual health education. Future research should
examine any barriers to access for sexual health education professional development.
Eisenberg et al. (2013) found that Minnesota teachers face a variety of barriers to
professional development about sexual health education. The barriers to teaching sexual
health education content in Minnesota need to be continuously monitored to ensure
teachers are prepared to provide the best possible education for students. If teachers are
unable to access sexual health education professional development, their teaching
practices may be different. Additional research on the current barriers facing Minnesota
teachers, along with strategies to overcome those barriers, will improve access to sexual
health education professional development and influence sexual health education quality.
Overall, teachers need professional development related to sexual health education to
maintain their knowledge and skills related to pedagogy and trends.
Summary
Minnesota health teachers reported that most of them received pre-service training
in a combination of health education and physical education. They received low levels of
professional development related to sexual health education in the two years prior to the
study, though most of them want professional development on all of the sexual health
education topics investigated. The highest reported topics of interest were to teach
behavior change skills, human sexuality, students with different sexual orientations or
gender identities, and using interactive methods. Teachers want and need professional
development about sexual health education.
The teaching practices for knowledge about STD prevention, and assessment of
concepts and skills at the middle school level, were both associated with pre-service
training. Professional development about human sexuality related to teaching all of the
sexual health content, and professional development about all of the sexual health topics
related to teaching human sexuality. Content professional development about HIV
prevention, human sexuality, pregnancy prevention, and STD prevention relates to
instruction of all 20 sexual health concepts and skills. Professional development about
sexual health content, especially pregnancy prevention, related to assessment of concepts
and skills. Human sexuality and pregnancy prevention professional development relate to
opportunities for students to practice skills in sexual health education. Sexual health
education professional development related to instruction to increase knowledge,
especially HIV prevention and human sexuality content. Receipt of professional
development about sexual health education relates to assessment of all 20 specific
concepts and skills at both the middle school and high school levels. Assessment of
concepts and skills relates to most of the sexual health education professional
development topics at both the middle school and high school levels. Teaching behavior
change skills was especially noticeable at the high school level, and connecting students
with sexual health resources was significant for concept and skill assessment at both
middle school and high school levels. Sexual health education professional development
relates to practice opportunities. Professional development for sexual health education
relates to teacher attempts to increase content knowledge, teach concepts and skills,
provide opportunities for skill practice, and assessment of concepts and skills in sexual
health education.
