Skip Navigation LinksSkip Navigation Links
Centers for Disease Control and Prevention
Safer Healthier People
Blue White
Blue White
bottom curve
CDC Home Search Health Topics A-Z spacer spacer
Blue curve MMWR spacer

Current Trends The Effectiveness of School Health Education

The School Health Education Evaluation (SHEE), conducted in collaboration with CDC, from 1982 through 1984, suggests that exposure to health education curricula in schools can result in substantial changes in students' knowledge, attitude, and self-reported practices.

More than 30,000 fourth- through seventh-grade students representing 1,071 classrooms in 20 states were included in an experimental study comparing the effectiveness of four curricula. Details of the statistical analyses are described elsewhere (2). Overall, children exposed to health education showed increased knowledge, healthier attitudes, and better health skills and practices than those who did not receive health education. Comparisons of the curricula showed each to be most effective in the areas emphasized by developers and believed by teachers to be most important.

One of the four curricula evaluated, the School Health Curriculum Project (SHCP, now called "Growing Healthy"), may delay the onset of smoking among youth. In the fourth through the sixth grades, where the prevalence of smoking is low, the rate of self-reported smoking did not differ between classes that received the curriculum and classes that did not. However, among seventh graders, the data showed a 55% increase in smoking (from 8% to 13%) among students who did not participate in SHCP, compared with a 24% increase (from 6% to 8%) among students who did (1).

The amount of exposure time to the curricula needed to produce change can be seen in Figure 1. "Effect size" reflects the educational importance (vs. mere statistical significance) of levels reached (3,4). Large effects on specific program knowledge were achieved in relatively few classroom hours, while more than 50 hours were required to achieve large effects in general knowledge. Medium effects for self-reported practices were first achieved within 30 hours of instruction, but 50 hours were needed to reach a stable level. Only small effects on attitudes were demonstrated, even after 50 hours of instruction. Reported by DB Connell, RR Turner, Abt Associates, Inc, Cambridge, Massachusetts; EF Mason, Morehouse School of Medicine, Atlanta, Georgia; Office of Disease Prevention and Health Promotion, Office of the Assistant Secretary for Health; Office of Program Planning and Evaluation, Office of the Director, Behavioral Epidemiology and Evaluation Br, Div of Health Education, Center for Health Promotion and Education, CDC.

Editorial Note

Editorial Note: The SHEE has provided evidence that school health education curricula can effect changes in health-related knowledge, practices, and attitudes, and that such changes increase with amount of instruction. The potential impact of these changes is large. For example, the data from the SHEE suggest that in 1984, if all students in U.S. schools had been exposed to the SHCP, 146,000 students would not have begun to smoke in the seventh grade (Figure 2).

Since nearly one-third (67) of the 1990 Objectives for the Nation may be influenced directly in the school setting, use of health education curricula in schools may substantially contribute to the nation's health. The SHEE "demonstrates that school health education is an effective means of helping children improve their health knowledge and develop healthy attitudes" and "can decrease the likelihood that children will adopt behavior that is hazardous to health, such as cigarette smoking" (5). Detailed information regarding the specific and general effects of the various curricula evaluated--as well as the factors affecting their adoption, use, and effectiveness--has been published (2).


  1. Christenson GM, Gold RS, Katz M, Kreuter MW. Preface. J School Health 1985;55:295-6.

  2. J School Health 1985;55.

  3. Walberg HJ. Improving the productivity of America's schools. Educational Leadership 1984;41:19-27.

  4. Stebbins L, St.Pierre R, Proper E, Anderson R, Cerva T. Education as experimentation: final report of the national follow through evaluation. Abt Associates Inc, 1977.

  5. Mason JO, McGinnis JM. The role of school health. J School Health 1985;55:299.

Disclaimer   All MMWR HTML documents published before January 1993 are electronic conversions from ASCII text into HTML. This conversion may have resulted in character translation or format errors in the HTML version. Users should not rely on this HTML document, but are referred to the original MMWR paper copy for the official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices.

**Questions or messages regarding errors in formatting should be addressed to

Page converted: 08/05/98


Safer, Healthier People

Morbidity and Mortality Weekly Report
Centers for Disease Control and Prevention
1600 Clifton Rd, MailStop E-90, Atlanta, GA 30333, U.S.A


Department of Health
and Human Services

This page last reviewed 5/2/01