Building Health Skills: Analyzing Influences

Building Health Skills: Analyzing Influences

By Suzanne Schrag | February 7, 2019
Editor/Project Manager, ETR

What makes young people do the things they do? And how does this affect their choices about health and risk?

Young people’s health behaviors can be influenced by a number of different factors, including family, friends, entertainment and social media, fads and trends, and their own internal attitudes and beliefs. One particularly powerful area of influence is the family, peer and social norms they see reflected in the actions and values of those around them. The things they see—and, sometimes even more important, the things they think they see (the perceived norms)—can either support or discourage healthy behaviors.

We are offering a series of blog posts about the ways HealthSmart addresses the seven key skills for health literacy addressed in the National Health Education Standards. Other posts in this series:

Shaping Healthy Peer Norms

One of the key Characteristics of an Effective Health Education Curriculum is that a program “addresses individual and group norms that support health-enhancing behaviors.HealthSmart is designed to build a personal value for health as students explore health beliefs and the potential outcomes of health choices. It shapes healthy peer norms as students understand the healthy actions their family and friends support and expect.

Lessons cover current youth norms around a variety of health behaviors, such as injury, sexual activity and substance use, both to reinforce positive norms and to help students understand how misperceptions of those norms—e.g., a false belief that “everyone is doing it”—can negatively affect their health-related choices and behaviors.

"Analyzing Influences" is the skill addressed by the second of the National Health Education Standards. This key skill for health literacy is particularly critical today, when children and adolescents not only witness and absorb the beliefs, behaviors and norms reflected within their families, groups of friends, schools and local communities, but also are exposed to the much wider, and not always health affirming, world of the Internet and social media.

The 7 Health Skills

In addition to outlining performance indicators for comprehending concepts, the National Health Education Standards (NHES) also set performance criteria for these seven critical health skills:

  • Analyzing Influences
  • Accessing Resources
  • Interpersonal Communication
  • Decision Making
  • Goal Setting
  • Practicing Health-Enhancing Behaviors
  • Advocacy

Accessing Information and Support, K through 12

How does this skill look at different grade levels? What is developmentally appropriate for children in the primary grades? young adolescents? high school students?  What does it mean to access valid resources when you’re 6 versus when you’re 17?

The standards offer guidance through the performance indicators outlined at each grade span. As students grow in knowledge, capacity and independence, what it means to practice a particular health skill also evolves, including where they look for information and support, and the means they use to evaluate the resources they find.

For children in grades pre-K though 2, it is most appropriate to focus on adult help as the main resource.  The two NHES performance indicators for the skill of accessing resources guide students toward locating trusted adults at home, school and in the community who can provide information and support:  (1) identify trusted adults and professionals who can help promote health, and (2) identify ways to locate school and community health helpers. For these youngest students, identifying support people and being able to access adult help is key.

By the upper elementary grades, the focus in the standards begins to shift toward the wider world of information and services. The NHES performance indicators for grades 3–5 reflect that students are now connecting with and exposed to more sources of information, including the Internet. Students at these grades are expected to: (1) identify characteristics of valid health information, products and services, and (2) locate resources from home, school, and community that provide valid health information.

As students move through middle school and high school, they continue to hone their information gathering skills and need to understand and practice how to access health products and services. Middle and high school students should be able to analyze and evaluate the validity of the information, products and services they find, as well as determine when professional health services may be needed.

Of course, within the health lessons, these standards need to translate into language that makes sense to children and teens at their different grade levels and stages of development.

Some HealthSmart Examples

ETR’s HealthSmart program includes the skill of accessing resources at all grade levels K–12, closely following the guidance of the NHES.

In the primary grades (K–2), there are numerous opportunities for students to identify the trusted adults at home and at school who can offer them advice and support for various health issues. For example, students identify adults who care and who can help them with troublesome feelings, illness or injury. They learn rules about only using medicines with the help of a trusted adult. They identify family members and other adults who can support them to make healthy food choices and stay tobacco free.  They identify adults who help them feel safe and to whom they can go for help with bullying or inappropriate touch, and practice calling 9-1-1 for help in an emergency.

Grades 3 and 4 continue to encourage students to access caring adults by identifying emotional health role models or deciding on the best person to ask for help with a variety of different feelings. At grades 4 and 5, students also begin to explore how to find accurate information online and are introduced to key questions they can ask to help them evaluate whether they can trust a website to give them correct information:

  1. Who made the website? Was the website created by an individual person or company (.com), a government agency (.gov), a college or other school (.edu), or a nonprofit organization (.org)?
  2. What’s the website’s point of view? Is it based on one person’s opinion, or is it backed up by facts? Is there data from studies or statements from experts? Are there links to and from these sources?
  3. When was the website created or updated?  Is the date easy to find? Do the links on the website still work? 
  4. Whom is the website for? Is the information meant for kids? teens? adults? experts? people who work in health care? everyone?
  5. Is the website trying to get you to buy, do or believe something? 

An increasingly sophisticated evaluation of resources continues throughout middle school and high school, as students identify sources of accurate information about personal and sexual health; explain the importance of seeking help for physical and mental health issues, including eating disorders, substance use and suicide thoughts; research information about tobacco, alcohol and other drugs; and identify and access community health resources.

At each of these grade levels, students are able to practice skills that make sense developmentally and help them meet the objectives from the NHES.

Check It Out

If you’re intrigued and would like to learn more about ETR’s comprehensive, skills-based, standards-aligned K–12 health education program, visit the HealthSmart website. You can also email or call ETR at 1-888-220-9455 to set up review access to the digital edition of the program.


Suzanne Schrag is the series editor of the second edition of the HealthSmart program, and a co-author of the newly revised K–5 grade levels. She can be reached at

Sign up for the ETR Health Newsletter.

Social Media :

  • YouTube
  • LinkedIn
  • Twitter
  • Facebook