Leigh Szucs (00:00):
Welcome to our video titled CDCs health education curriculum analysis tool HECAT sexual health module updates. In 2021, CDC released an updated version of the HECAT to help translate research into practice and support schools in delivering quality health, and sexual health education. Today, we're excited to provide an overview of key updates for sexual health. My name is Leigh Szucs and I am a health scientist in CDCs division of adolescent and school health also known as DASH. In this role, I work primarily on DASHÕs health and sexual health education portfolio, supporting research and programmatic activities with school districts and schools across the United States. In today's presentation, we will begin by exploring data about adolescent sexual behaviors and experiences and talk about practices and strategies for schools to address sexual health, including STI, HIV, and unintended pregnancy prevention. Specifically, we will talk about recent updates to CDCs HECAT and do a deep dive into the chapter six sexual health module.
Leigh Szucs (01:04):
Recent updates include new and revised examples of student level knowledge and skill expectations important for universal primary prevention schools. The last section of this video will include several tools and resources to help schools working to address sexual health, including STI HIV and unintended pregnancy prevention. Let's begin by looking at CDC youth risk behavior survey data. In 2019 CDCs nationwide youth risk behavior survey, or YRBS was administered to high school students across the United States, measuring several items related to sexual health, including questions about sexual activity, number of sexual partners, and use of condoms and effective hormonal birth control. Overall fewer students engaged in sexual behaviors that increase their risks for HIV, STIs, and unintended pregnancy from 2009 to 2019. However, these trends data highlights some behaviors that need improvements. Over the last 10 years fewer high school students engaged in sexual activity. Students in all racial and ethnic groups were less likely to have had four or more sexual partners between 2009 and 2019.
Leigh Szucs (02:17):
The percentage of black, white, and Hispanic students who had ever had sex or were sexually active, decreased from 2009 to 2019. Notably fewer sexually active high school students used condoms between this time period and fewer students got tested for HIV in 2019. About 54% of sexually active high school students had used a condom the last time they had sexual intercourse. As you can see more male students used a condom at last intercourse than female students and more white students and Hispanic students used a condom at last sex than black students. About 9% of sexually active high school students used dual methods of protection the last time they had sex. Dual methods of prevention include using both a condom and effective hormonal birth control defined as birth control pills, an I U D or implant, a shot, a patch or a birth control ring. 
Leigh Szucs (03:18):
More white students use dual methods of prevention than black students or Hispanic students and the percentage of all students using the recommended dual method to prevent against both STIs and HIV and unintended pregnancy was low. Lastly, about 9% of high school students had been tested for sexually transmitted diseases during the past year. As you can see more female students have been tested for STDs during the past year than male students and more black students have been tested than compared with white students. The tested for sexually transmitted diseases, variable was only added to the national YRBS in 2019, and thus trends are not currently available. Collectively fewer students engaged in sexual behaviors that increase their risks for STI HIV and unintended pregnancy between 2009 and 2019. However, this data highlights important areas for improvement and present opportunities for school-based education and prevention. Given the prevalence of such behaviors and experiences, public health and education professionals have to identify opportunities to effectively reach students and increase their knowledge, skills, services, and support to enhance their sexual health.
Leigh Szucs (04:25):
Luckily, schools are uniquely positioned to improve the health outcomes for adolescents, including addressing STIs, HIV, and unintended pregnancy. Many factors contribute to the sexual health of young people as the data just discussed and research shows that well designed and implemented sexual health education can provide youth with the knowledge and skills they need to protect their health, reduce sexual risks, and become successful learners. In helping promote sexual health, schools are uniquely positioned to build staff capacity, specifically core knowledge and skills for delivering sexual health education, teach functional health information and skills that address STI HIV and unintended pregnancy, and offer or link students to sexual and reproductive health services. Schools that provide quality health education are using a formal structured combination of planned learning experiences that provide opportunities for youth to acquire the knowledge and skills needed to make health enhancing decisions, achieve health literacy, adopt healthy behaviors, and promote the health of self and others.
Leigh Szucs (05:32):
Curriculum is the primary organizing framework for delivering such quality health information and skills through schools. So what exactly is a health education curriculum? According to CDC, health education curriculum includes five core elements. One, they include a set of intended learning outcomes or objectives that directly relate to studentÕs acquisition of health, knowledge, attitudes, and skills. Two, curriculum have a planned progression of developmentally appropriate lessons and learning experiences that lead to achieving healthy behaviors or objectives. There's continuity between lessons or learning experiences that clearly reinforce the adoption and maintenance of health enhancing behaviors. Curricula, content, and materials correspond with a sequence of learning events and help the teacher and students meet learning objectives. And lastly, health education curricula include assessment strategies to determine if students have achieved the desired learning. In order to strengthen school health and sexual health education CDC created the health education curriculum analysis tool.
Leigh Szucs (06:39):
As I said, HECAT, is CDCs primary evidence informed tool for advancing health education through schools. The HECAT contains process guidance, appraisal tools, and resources for carrying out a clear, complete, and consistent examination of commercially packaged or locally developed health education curricula. Analysis results can help school and community leaders select or develop appropriate and effective health education curricula, revise, and improve locally developed materials, strengthen the delivery of health and sexual health education, and improve educator's ability to support healthy behaviors and outcomes among youth. The HECAT aligns with the national health education standards and CDCs characteristics of effective health education curriculum. HECAT was designed for use by several groups, including state, local, territorial, or tribal health and education agency staff, curriculum committees, teams, or educators at schools and school districts, youth serving community organizations, institutions of higher education and other pre-service teacher training programs and commercial curriculum developers. As was mentioned in the beginning, CDC recently updated the contents of HECAT based on emerging research in adolescent and school health, as well as practices from the field.
Leigh Szucs (08:01):
As part of that key update HECAT is now offered in two formats. As you can see here, users can access the tool via the PDF manual on CDCs healthy youth webpage or through the interactive online application called HECAT online. Together these multiple user formats help to improve the accessibility and reach of the HECAT. Where we will spend the majority of our time today is talking about HECATÕs chapter six. Chapter six includes 10 modules to address single topic curricula or comprehensive health curricula. Each module contains a description of the health topic includes the healthy behavior outcomes relevant for that curriculum in the specified topic area. All modules use the national health education standards, core concept standard one as the framework for analysis. This framework helps determine the extent to which the curriculum is likely to enable students to master the essential knowledge and skills that promote healthy behavior outcomes. Because school curriculum must meet local community needs and often align with state or local curriculum requirements HECAT users are encouraged to review the full list of HBOS knowledge and skill expectations, and other HECAT information before completing any analysis.
Leigh Szucs (09:09):
HECAT users can add, delete, or revise items to meet school youth and community needs. Now we will dive into the sexual health module highlighting new and revised student level knowledge and skill expectations. As part of the recent update, let's begin by talking about the healthy behavior outcomes or as I said, HBOs. A pre-K through grade 12, sexual health curriculum should enable students to achieve 10 healthy behavior outcomes. As you can see these range from establishing and maintaining healthy relationships to using appropriate sexual and reproductive health services. During updates two new HBOs were added to this module. HBO number one, recognized developmental changes experienced by self and others during childhood and adolescent and HBO four, give and receive consent in all situations. Before we talk more about specific knowledge expectation updates, I want to take a moment to connect the healthy behavior outcomes and how HECAT uses knowledge and skill expectations to help schools analyze, select, and create sexual health education curricula. When using HECAT to analyze curricula, the first step is to identify the desired HBO, as you can see, they're in orange. So in this example, let's say that the sexual health education curricula is designed for middle school students grade six through eight and one of the desired outcomes is for students to give and receive consent in all situations.
Leigh Szucs (10:55):
So what information might be important for students to have in reaching that goal? The HECAT identifies what knowledge expectations shown in green are aligned to help students achieve that behavioral outcome. Knowledge expectations, such as defining consent and its importance for decisions about sexual behaviors, as well as describing how consent cannot be fully present when there is an imbalance of power may lead students toward the desired health behavior outcome. Every knowledge expectation found in HECAT is aligned or mapped with the healthy behavior outcome of interest. As you can see there in yellow HECAT users may also be interested in what skills are important for students as they build knowledge in order to reach the desired health behavior outcome. In the blue boxes, you can see skill expectation, examples that include examining how social expectations influence healthy and unhealthy sexual relationships, practices, and behaviors, as well as how to demonstrate effective negotiation skills to avoid or reduce sexual risk behaviors, a skill related to interpersonal communication.
Leigh Szucs (11:52):
Both may be critical as students develop mastery of information in that green column, leading them toward increased likelihood of the health behavior outcome of interest, giving and receiving consent. This process of identifying the HBO, selecting relevant knowledge and skill expectations will be driven by local priorities and needs. However, HECAT users can use this tool and this process to systematically inform their decisions about sexual health education curricula across all grade levels. In HECATs recent update in the fall of 2021, a number of new revisions were made to the sexual health module and I'd like to draw your attention to six key updates, including improvements in inclusive anatomy and puberty language, interpersonal relationship dynamics and personal safety, STI HIV and pregnancy prevention and treatment strengthening concepts related to sexual and gender identity development and new and updated knowledge expectations across all grade spans pre-K through 2, 3 - 5, 6 - 8 and grades nine through 12, as well as additional specificity to the skill expectations across all grade groups.
Leigh Szucs (13:09):
Let's talk about each of these key update areas. So related to inclusive anatomy and puberty language, new items across all grade spans included knowledge expectations, such as using medically accurate terms for body parts including genitals for older students, new knowledge expectations, such as explaining how puberty and development can vary greatly and be normal, as well as describe the human sexual response cycle, including the role of hormones and pleasure are now included. Related to interpersonal relationships and safety, several new items were included across multiple grade levels. As you can see, for example in grades three pre-K to 2, 3 to 5, 6 to 8, and 9 to 12 new knowledge expectations such as recognize the range of different family and peer relationships, as well as identify characteristics of healthy relationships can be found in this module. Related to STI and HIV and pregnancy prevention and treatment, several new items were updated across secondary grades. For example, new items such as describe the importance of using a condom for STI HIV prevention at the same time as using a more effective contraceptive method for pregnancy prevention and explain what to expect from youth friendly sexual health services and providers can now be found. Related to the strengthen strengthening concepts around identity development several new items were updated.
Leigh Szucs (14:50):
Beginning in grades three through five, for example, knowledge expectations, including describe personal characteristics related to sexual identity, orientation, and gender that make people different from one another, as well as defining sexual orientation, including a sense of identity attraction and related behaviors can be found in this module. Lastly, important updates to the sexual health module include a strengthening on the role of technology and impacts on sexual health and relationships. For example, in grades nine through 12, in new knowledge, expectations states explain how viewing sexually explicit pictures, messages or media can influence perceptions of and expectations for relationships is now included. Also in this module, new consent based language is included that draws attention to the content and skills for giving and receiving consent while also maintaining developmentally appropriate content across grade spans. Notably within HECATÕs mental and emotional health and violence prevention modules, users can find complimentary knowledge expectations for promoting sexual health.
Leigh Szucs (16:03):
HECAT users should consult these additional modules when developing, revising, or analyzing sexual health curricula where relevant knowledge expectations might be found. That concludes the deep dive into the knowledge expectations found in HECATÕs sexual health module. We encourage users to review the module in full before any systematic analysis of new or locally developed sexual health education curricula. In the final section of this video, we will highlight key resources and tools to help schools promote sexual health and address STI HIV and unintended pregnancy prevention. To accompany the HECAT, CDC created a frequently asked questions page that talks all about HECATÕs features, forms, updated content, and how to use HECAT online. There's also a new HECAT fact sheets series that again, details HECATÕs core features for intended audiences and provides in depth guidance on how to use HECAT online. Other resources that might be helpful to schools that are promoting or working in sexual health education include CDCs characteristics of effective health education. This resource highlights the 15 characteristics of effective health education curricula based on a growing body of research and evaluation, developing a scope, and sequence for health education. This resource provides a step by step process for creating or revising a scope and sequence for sexual health education and the health education pacing guide and unit planner. This tool provides templates and considerations for schools and classroom teachers who are creating pacing guides and unit plans in sexual health education.
Leigh Szucs (17:49):
Lastly, everything presented in this video can be found on CDCs healthy use webpage. Additionally, CDCs tools for healthy schools offers an e-learning training series about HECAT that overviews key features of the tool and how it can be used. Both webpages and training series offer more detailed information than what we covered today. Check them out. This concludes our overview of CDCs HECAT sexual health module updates. If you have questions or need additional assistance, please reach out to CDC. Thank you for spending time with us today.