Leigh Szucs (00:01):
Welcome to today's webinar titled CDCs health education, curriculum analysis tool HECAT preventing alcohol and other drugs 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 education. Today, we're excited to provide an overview of key updates to alcohol and other drug prevention. My name is Leigh Szucs and I am a health scientist in CDC's division of adolescent and school health known as DASH. In this role, I work primarily with DASH's health and sexual health education portfolio, supporting programmatic and research activities across schools in the United States. I'm joined today by my colleague, Marcy Hertz, also from CDC DASH. Marcy.
Marcy Hertz (00:49):
Thank you so much, Leigh. IÕm Marcy, a senior health scientist also in DASH and I serve as the subject matter expert on our work related to mental health promotion and substance use prevention in schools. In today's presentation, we'll be talking about alcohol and other drug use prevention and share practices and strategies for schools to prevent use among youth. We are so excited to share an overview and recent updates to CDCs health education curriculum analysis tool or HECAT and we'll take a deep dive into chapter six, the alcohol and other drug use prevention module. We'll be highlighting examples of student knowledge expectations that are essential for universal alcohol and drug prevention and we will end our session by sharing helpful tools and resources for schools.
Marcy Hertz (01:48):
Substance use during adolescence is related to a wide variety of negative outcomes, including increased risk for sexually transmitted infections. And according to the Surgeon General's report facing addiction in America, the misuse of substances, such as alcohol and other drugs is a growing problem in the United States. Although substance misuse can occur at any age, the adolescent years are particularly critical at risk periods. Let's begin by looking at recent data on substance use among today's youth. The data shown here were collected through CDCs youth risk behavior survey or YRBS, a nationally representative survey administered to U.S. students in grades 9 through 12 in public and private schools every other year and are presented here as 10 year trends from 2009 to 2019. For the purposes of addressing HIV and sexually transmitted infection prevention, high risk substance use is any use by adolescents of substances with a high risk of adverse outcomes, including injury, criminal justice involvement, school dropout, or loss of life. This includes use of illicit drugs, such as cocaine, heroin, methamphetamines, inhalants, hallucinogens, or ecstasy, or use of injection drugs and misuse of prescription drugs. Fewer students engaged in some high risk substance use related behaviors from 2009 through 2019. However, approximately one in seven students are still reporting lifetime use of any illicit drug or misuse of prescription medication.
Marcy Hertz (03:37):
Illicit drug use varied by adolescent race and ethnicity, fewer white and Hispanic students had ever used illicit drugs from 2009 through 2019. The percentage of Hispanic students who ever used illicit drugs, steeply declined. And there was no change in the percentage of black students who had ever used illicit drugs from 2009 through 2019. Further in 2019, the percentage of high school students who had ever used select illicit drugs varied by sexual identity and sex of sexual contacts. Lesbian, gay, or bisexual students and students who were not sure of their sexual identity were more likely to have used illicit drugs than heterosexual students in 2019. Students who had sexual contact with people of the same sex were more likely to have used select illicit drugs than students who had sexual contact with only the opposite sex. CDCs YRBS in 2019 estimates also highlight about 14% of high school students had ever misused prescription opioids, such as Codeine, Vicodin, Oxycontin, hydrocodone, or Percocet. More female students than male students had ever misused prescription opioids. Note here that ever misused prescription opioids variable was only added to the national YRBS in 2017. Therefore trend data is not available.
Marcy Hertz (05:14):
Data collected through CDCs 2021 adolescent behaviors and experiences survey, or ABES, an online survey of a probability based nationally representative sample of us public and private students in grades nine through 12 assessed U.S. high school students use of six substances, electronic vape products, cigarettes, cigars, smokeless tobacco, alcohol, and marijuana plus current use of prescription opioids during January through June 2021. During January through June 2021, 31.6% of high school students reported current use of any tobacco product, alcohol or marijuana or current misuse of prescription opioids. Current alcohol use 19.5%, electronic vape use 15.4%, and marijuana use 12.8% were more prevalent among high school students than prescription opioid misuse at 4.3%, current cigarette smoking at 3.3%, cigar smoking at 2.3% and smokeless tobacco use at 1.9%.
Marcy Hertz (06:34):
In addition, among students who had ever drunk alcohol or used drugs, nearly one in three reported drinking more alcohol or using more drugs during the pandemic. Among students who currently use electronic vaping products or drink alcohol use on month use on multiple days each month was prevalent as was binge drinking. This slide highlights data from two studies that both found that adolescents facing mental health challenges, including depression and stress were more significantly likely to also endorse using substances and to endorse using substances by themselves. In the Canadian studies shown here, respondents were asked about the number of days in the past three weeks before the COVID crisis and since the COVID 19 crisis began, meaning the past three weeks in which they engaged in various substance use behaviors. Of those who used substances with their parents, 93.3% of these reported alcohol use, 25.8 reported binge drinking, 19.1% use cannabis, and 14.6% vaped. In terms of the Adolescent Brain Cognitive Development study, or ABCD, substance use was measured in a nationwide socio-demographically diverse sample of youth in early adolescence and followed up for approximately six months after the COVID stay at home orders were first issued in the United States, a total of 7,842 adolescent at 21 different study states across the United States completed a three wave survey measuring substance use between May and August of 2020.
Marcy Hertz (08:23):
Youth's worry about the virus itself was not associated with youth substance use while youth's general anxiety and stress were strongly associated. Recent data from my colleagues at SAMHSA, from the national survey on drug use in health found that among adolescents age 12 to 17 in 2020, nearly 21% had either a substance use disorder or a major depressive episode in the past year. Having a major depressive episode was associated with an increased risk for substance use. Adolescents who had a past year major depressive episode were more likely than adolescents without such a past episode to report past year illicit drug use 28.6% versus 10.7% or past year marijuana use 22% versus 7.9%. Those with a past year major depressive episode were also more likely to report past month binge alcohol use 6.2% versus 3.8%, use of tobacco products or vape nicotine in the past month 12.9% versus 5.1%. Overall, nearly 3% or 644,000 adolescents had both a major depressive episode and a substance use disorder in the past year. As we've learned nationally during the COVID 19 pandemic schools are critical for supporting children and families. While the expectation is that schools provide education, they also provide opportunities for youth to engage in social, emotional, and mental health services and supports all of which can protect against negative outcomes and risks associated with alcohol and drug other drug use. Now, I will turn it over to Leigh to talk more about educational strategies for schools in addressing youth substance use. Leigh.
Leigh Szucs (10:29):
Thanks, Marcy. State and local education agencies are often guided by student learning standards across many health topic areas, including substance use prevention. Research by Bruckner et all in 2014, highlight results from an analysis of state education standards related to alcohol, tobacco, and other drugs and coverage of five key content areas, knowledge of biology and behavior, knowledge of context, affective skills, refusal skills, and generic social skills. The graph on the left shows a steady increase between 1970 and 2010 regarding state's adoption of alcohol, tobacco, and other drug instructional standards over time. While on the right data suggests that the intensity of alcohol, tobacco, and other drug language from a developmental perspective increases by grade level. As students age, the volume of standards, content and skill building increases. For example, refusal skills gradually rise from third grade until ninth grade, although refusal skill standards are rarer than knowledge of biology and behavior standards. In sum, very few states scored a high value on their inclusion of key standards based content for in school prevention programming and thus more work on state education standards related to alcohol tobacco, and other drug prevention may be helpful.
Leigh Szucs (12:05):
This, this slide shows the percentage of secondary schools that try to increase student knowledge on alcohol and other drug use prevention in a required course. According to CDCs 2018 school health profiles. Profiles is a system of surveys assessing school, health policies and practices in states, territories and large urban school districts conducted bi-annually by education and health agencies with middle and high school principals and lead health education teachers. These findings highlight the range in this percentage of secondary schools from 76% to 98% that included such educational programming to address youth substance use prevention. There is a role for everyone in preventing alcohol and other drug use among youth and supports education and services provided by schools must be comprehensive. Schools are uniquely positioned to build staff capacity, especially core knowledge and skills for delivering prevention education, teach functional health information and skills for preventing alcohol and other drug use and related outcomes (for example, sexually transmitted infections, HIV and unintended pregnancy) and offer or link students to health services. Most easily schools can provide quality health education. Health education is the formal and planned learning experiences that provide the opportunity to acquire information and skills needed to make health promoting decisions, achieve health literacy, adopt health enhancing behaviors, and promote the health of others.
Leigh Szucs (13:51):
Let's talk more about school health education and how CDCs HECAT can help. Curriculum is the primary organizing framework for delivering health information and skills through schools. So what is a health education curriculum? CDC defines a health education curriculum as a planned structured set of learning experiences to provide students with opportunities to acquire the attitudes, knowledge, beliefs, and skills needed to support health. Health education includes five key elements. One curriculum include a set of intended learning outcomes or objectives that directly relate to students' acquisition of health, knowledge, attitudes, and skills. Two, a curriculum includes a planned progression of developmentally appropriate lessons or learning experiences that lead to achieving health outcomes or objectives. Curriculum include continuity between lessons or learning experiences that clearly reinforce the adoption and maintenance of specific health enhancing behaviors. Content and materials that correspond with a scope of learning event and help the teacher and student meet learning objectives.
Leigh Szucs (15:08):
And five curricula include assessment strategies to determine if and to what extent students have achieved the desired learning. In order to strengthen school health education, CDC created the health education curriculum analysis tool. It 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 curricula, strengthen the delivery of health education and improve the ability of school health educators to support healthy behavior outcomes among youth. The HECAT is aligned with the national health education standards and CDCs 15 characteristics of effective health education curriculum resource. The tool addresses a comprehensive array of health topics, including alcohol and drug prevention. HECAT is designed for use by state or local territorial or tribal health and education agency staff, curriculum committees, teams, or educators at school districts and schools, community organizations serving or working with youth, institutes of higher education and pre-service teacher training programs and, commercial curriculum developers. As was mentioned in the beginning, CDC recently updated the contents of the HECAT based on emerging research in adolescent and school health.
Leigh Szucs (17:01):
As part of that update HCAT is now available in two formats as displayed on the screen. Users can access the tool using the PDF manual available for download on CDCs healthy youth webpage or through the interactive online application called HECAT online. Together these multiple user formats help improve the accessibility of the HECAT tool.
Leigh Szucs (17:29):
HECAT's chapter six includes 10 modules to address specific health topic curricula and comprehensive health education curricula. Each module contains a description of the health topic to be addressed, including the healthy behavior outcomes or HBOS relevant for the curriculum in that 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' mastery of the essential knowledge and skills that promote healthy behavior outcomes. Because school curricula must meet local community needs and priorities and also address curriculum requirements from the state or local districts, users are encouraged to review the HBO's knowledge, expectations, and skill expectations in full before using any modules from chapter six to conduct an analysis. HECAT users can add, delete, or revise items again, to meet community needs and be in the line with curriculum requirements.
Leigh Szucs (18:42):
Now that we've learned a little bit about HECAT broadly, let's jump into the alcohol and other drug use prevention module highlighting new and revised student level knowledge expectations. We'll begin by talking about healthy behavior outcomes or HBOS Pre-K through grade 12. Alcohol and other drug use prevention curricula should enable students to achieve eight healthy behavior outcomes. As you can see these range from avoiding misuse or abusive drugs to seeking support for self and others in leading an alcohol and drug-free lifestyle. During the content update project one new HBO was added to this module, HBO number one, use prescription and over the counter medications correctly. Let's explore the connection between healthy behavior outcomes and how the knowledge and skill expectations found in HECAT can help schools analyze alcohol and other drug use prevention curricula. So, when using HECAT to assess curricula, the first step is to identify the desired health behavior outcome. In our example, it's shown here in orange. So, let's say that we have a substance use prevention curricula designed for high school students in grades nine through 12 and one of the desired outcomes is for students to avoid misuse and abuse of over the counter and prescription drugs.
Leigh Szucs (20:11):
The HECAT identifies what knowledge expectations are important shown here in green that are in alignment and can help students achieve the desired health behavior outcome. So for example, analyze short and long term benefits of remaining alcohol and drug free, as well as differentiate between proper use and abuse of prescription medications are mapped to the HBO number two, which is avoid misuse and abuse of over the counter and prescription drugs. Every knowledge expectation found in the tool is aligned or mapped to the health behavior outcome of interest. As you can see, highlighted in yellow as a final piece, the HECAT user may also be interested in what skills can help students build knowledge in order to reach the desired health behavior outcome presented in the blue boxes. You can see skill examples, such as analyze how personal attitudes, values and beliefs. As the final piece, HECAT users may also want to understand what skills can help students build knowledge in order to reach the desired health behavior outcomes in the blue box. You can see skill examples, such as analyze how personal attitudes, values, and beliefs influence health, and unhealthy alcohol and other drug use behaviors, or the skill of analyzing influences as well as evaluate the validity of information for alcohol and other drug use prevention, or the skill of accessing valid and reliable information.
Leigh Szucs (21:47):
The process of identifying the HBO, selecting relevant knowledge and skill expectations based on local priorities and needs is how HECAT users can apply the tool for a systematic review revision or development of substance use prevention, programming and curricula across any grades pre-K through 12. In HECATÕs recent update a number of key revisions were made including additional focus on use and misuse of prescription drugs in grades six through eight and nine through 12, strengthening language on the relationship between substance use and co-occurrence with other health topic areas such as sexual health, violence, and mental health, additional details on the short- and long-term effects of substance use and misuse are also recorded in this new update as well as new and updated knowledge expectations across all grade spans pre-K through 12 and additional specificity to the skill expectations aligned with the national health education standards two through eight in all grade spans.
Leigh Szucs (23:00):
Let's take a look at some specific examples of knowledge expectations related to updates around use and misuse of prescription drugs. New updates include HBOS and knowledge expectations around describing the importance of adult supervision of medication use, as well as in older grades explaining the dangers of sharing medication. The recent update also strengthened language on the intersection or overlap between alcohol and other drug use and co-occurring health outcomes. New items, for example, included student's ability to describe the relationship between using alcohol and other drugs and other health risks, such as unintentional injuries, violence, suicide, sexual risk behaviors, and tobacco use. Notably within CDCs mental health, mental and emotional health, sexual health, safety, and violence prevention modules there are complimentary knowledge expectations for understanding the impacts of alcohol and other drug use on related health behaviors. HECAT users that have sought out the alcohol and other drug use prevention module are also encouraged to look at these complimentary modules for knowledge and skill expectations that might overlap and inform curriculum analysis. Related to the short and long-term effects of substance use and misuse several new items were added during updates. For example, knowledge expectations around explaining the potential effects of mixing any type of medication and other drugs with another sometimes called polydrug use, and summarizing the harmful, short and long term physical, psychological, and social effects of using alcohol and illicit drugs and misusing prescription medications are also reflected in the 2021 update.
Leigh Szucs (24:57):
That concludes the high level overview of the knowledge expectations found within HECATÕs updated alcohol and other drug use prevention module. All content shared in this video are accessible in both HECATÕs PDF version on the healthy youth web webpage and accessible through HECATÕs online interactive application. We encourage users to review the full module before beginning systematic analysis of commercially developed or locally developed substance use in alcohol and other drug prevention curricula. In the final section, we'll highlight a few key resources and tools to help inform school's efforts to prevent alcohol and other drug use among young people. To accompany the HECAT CDC created a series of new fact sheets detailing the tools core features and forms intended audiences and guidance on how to access and use HECAT online.
Leigh Szucs (25:55):
Interested users can also reference the, HECATs frequently asked questions page shown here to learn more about common questions asked and important information for using both the PDF and the online versions. Other resources that might be helpful to schools working in the alcohol and other drug use prevention space include CDCs characteristics of effective health education curricula. This resource highlights 15 characteristics of effective curricula based on a synthesis of research and evaluation in adolescent and primary prevention programming. Developing a scope and sequence for health education is another key resource that provides users with a step by step process for creating or revising a scope and sequence across any topic area, including alcohol and other drug use prevention. And lastly users may be interested in a health education, pacing guide and unit planner. This tool provides a template and considerations for schools and really classroom teachers or those delivering curriculum directly to students to help with pacing, planning, and ensuring that their curriculum material aligns with the scope and sequence and curriculum requirements. All of these resources can be found on the health education tools and resources page of CDCs website. Everything presented in today's webinar can be found either on CDCs healthy youth webpage so check that out. Also, CDCs tools for healthy schools offers a e-learning training series that provides a lot more information about HECAT overviewing, the key features of the tool, how to use it and is available for free and linked on the slide. Now we'll turn it back over to Marcy to close us out.
Marcy Hertz (27:44):
Thanks so much, Leigh. The final resource we would like to highlight is CDC DASH's website for substance use prevention. This page includes information and links to recent research on youth substance use and tools and resources to help schools, parents, and families prevent high risk drug use and protect youth. Check it out today. This concludes our video overviewing updates to CDCs HECAT alcohol and other drug use prevention module and supporting resources for schools. If you have questions or need additional assistance, please reach out to CDC. Thank you so much.