K–12 Health Education That Works!


To connect with Customer Service regarding a HealthSmart order, or if you have questions about the HealthSmart program, call 1-800-321-4407 or email us at

See below for some of the most frequently asked questions.


Please click on a topic below to view the related FAQs.

Using the Curriculum

Who can teach HealthSmart?

You don’t have to be an expert to provide learning experiences that will help students practice healthy behaviors. Both new and experienced teachers will appreciate the teacher-friendly design, and the program supplies everything needed to teach the lessons. Teacher preparation is minimal, and teaching steps are clearly defined. Because the program is designed to incorporate the characteristics of effective health education curricula and adheres to both the National Health Education Standards and the CDC's Health Education Curriculum Analysis Tool (HECAT) teachers can be sure they are providing the knowledge and skills their students need to become health literate, reduce their health risks and achieve key healthy behavior outcomes.

Do I have to teach the units in a particular order?

No. HealthSmart allows school districts and/or teachers to determine the order in which units will be taught. However, the Grade K through 5 Teacher Guides are designed to start with Emotional & Mental Health followed by Personal Health & Wellness, and we recommend starting with the Emotional & Mental Health unit in Middle and High School, because these lessons provide an opportunity to establish a supportive classroom atmosphere and help students become comfortable with the teacher and their classmates before moving into other health content areas.

How many lessons are there?

There are 375 HealthSmart Lessons across grades K–12. The total number of lessons at each grade level are shown in the table below:

Level Lessons
Grade K 30
Grade 1 29
Grade 2 26
Grade 3 29
Grade 4 28
Grade 5 38
Middle School 96
High School 99

How long does it take to teach the program? Is it a semester or year-long course?

This depends on how often health classes are taught. The elementary grades are designed to be taught over the course of the school year for each grade, depending on how often teachers address health. At the middle and high school levels, most content units can be taught over a semester, if health is taught only once per week. If health is a daily class, it might be possible to cover three or four of the content units in a semester, and all of the units over the course of a year. Teachers can use the online Lesson Planning Tool to help design a course of study that will cover desired content in the time they have available.

What is the materials duplication policy?

No part of the Teacher Guides or Student Workbooks and other materials may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without prior written consent of ETR.

For the Print Edition, all teacher resources, including the slides, teacher masters, images, student journals, rubrics and answer keys may be copied and distributed for use within a single classroom. Student Workbooks for Grades 3–5, Middle School and High School are available for purchase in sets of 5 or 30, and larger quantity discounts are available.

For the Digital Edition, the teacher license grants a teacher access to all of the lessons and related teacher resources. A separate student license (for a set number of students per year) is required to print and/or distribute the activity sheets that comprise the Student Workbooks. Note that the online access to the program is for teachers, not students.

Contact us at for more information.

Do I have to buy Student Workbooks?

Student Workbooks (or Student Licenses for Digital Edition users) are required for the program for Grade 3 through High School. Student participation is an essential part of any research-based or evidence-informed intervention. The student workbooks provide students with all of the activity sheets used in the program. Having their own workbooks helps ensure student engagement, and also provides educators with a completed portfolio of student work for review and assessment.

Digital Edition users purchase a Student License that allows them to print a predetermined number of copies of the student activity sheets. Users of the Print Edition also have the option to purchase a license to print student materials, rather than using the printed and bound student workbooks. Many schools or agencies also purchase the Digital Edition for their teachers, but provide the printed workbooks for students.

Workbooks can save time and money over duplication costs (see cost comparison chart) and are an easy and complete way to ensure all students have the requisite reading assignments, worksheets, roleplays and other activity sheets.

Cost Comparison for 48-page Student Workbook

HealthSmart Student Workbooks Typical Copy Prices
Single workbook = $3.00 @ 0.11 per page = $5.28 for single workbook
Classroom set of 30 = $90.00 ($3.00 each) Price for set of 30 = $100.80 ($3.36 each)
Saddle stitched Add stapling = $102.30 ($3.41 each)
Full-color heavyweight cover Add color cover = additional $35.40 for 30 ($4.59 each)

What does the program cost?

Grades K through 2 are $129.99 per grade. Grades 3–5 include a classroom set of 30 student workbooks and are $149.99 per grade.

Middle and High School prices are $189.99 per subject unit, which includes the teacher guide and 30 student workbooks. The price of a complete Middle School or High School set is $999.99, which includes the teacher guides and 30 student workbooks for each of the 6 units. Additional student workbooks are available in sets of 5 ($15) or 30 ($90).

With the digital edition of HealthSmart, users purchase a teacher license that grants a single educator online access to the program, plus a student license fee based on the number of students taught per year. The student license grants the teacher access to the program for a set number of students (a minimum number of students is required). Price breaks are given based on the total number of students, length of the license and special use considerations. Please call to discuss your needs.

For more information about HealthSmart pricing, contact John Henry Ledwith at or at 1-888-220-9455 x204.

How do I make decisions about what to leave out, if I don’t have time to teach the entire program?

Many health education programs throughout the country don’t allow enough time for all HealthSmart units and lessons to be taught. If there isn’t enough time to teach the entire HealthSmart curriculum, school districts should choose those units and lessons that are aligned with their scope and sequence and/or examine existing local health behavior data to determine the greatest needs for the students in their district.

Our online Lesson Planning Tool enables educators to select particular content areas, skills and healthy behavior outcomes outlined by CDC’s Health Education Curriculum Analysis Tool (HECAT) to generate a personal lesson plan that contains the lessons most relevant to their needs and desired outcomes.

Reviewing the HealthSmart Scope & Sequence charts for each grade level can assist schools with deciding on a focus. Which healthy behaviors need to be reinforced at your school? Have you identified areas of problem behavior or risk taking? The Scope & Sequence charts identify core concepts, lesson objectives, National Health Education Standards met and healthy behaviors supported by each lesson. They can be found on the Lessons page for each grade level.

If you must omit some of the lessons in the program, using the Lesson Planning Tool and Scope & Sequence charts will allow you to make an informed decision.

I absolutely love the online lesson planning tool. It will be such a valuable tool to advocate for health time within our program.

Catherine Corkery,
Oregon Education Program


Using the Website

What do I need in order to use this website?

Your computer must meet these requirements, or you may not be able to successfully use the HealthSmart Digital Edition website.

Hardware Minimum Specifications

Operating System

Windows 8, Windows 7, Windows XP, MAC OS 10.6.X

Internet Connection

256 kbps as minimum, 512 kbps recommended


PC – Chrome, Firefox or Internet Explorer 8 or 9 (with Chrome extension enabled)
Mac – Safari 5.1, Chrome


You may use other browsers however the lesson eReader may have display issues.


Using the Teacher Resources

Images and Slides

Images and slides are provided as a set of PDFs and as a PowerPoint slide show.

  • Slides in PDF format: The PDFs can serve as the slide deck for teaching the lessons. Images can be projected on to a screen or whiteboard. The Show Image or Show Slide cue in the Teacher Guide prompts you to show the image and the teaching steps include instructions on when to advance to the next slide to bring up discussion summaries, additional instructions and key talking points.
  • PowerPoint Slide Show: The PowerPoint slide show can be used for presenting the lesson. Notes are provided in the PowerPoint that mirror the teaching steps in the Teacher Guide. This enables the educator to teach the lesson directly from the PowerPoint. Using presenter mode allows you to view the notes and a preview of the slides on your monitor, while the full image is projected to a second screen. Presenter mode can be selected under the Monitors icon in the PowerPoint Slide Show toolbar. Later versions of PowerPoint will automatically open in Presenter mode if you have two monitors set up. If you have only one screen on which to show the images, the Show Slide cue in the Teacher Guide prompts you to show the slide and the teaching steps include instructions on when to advance to the next slide to bring up discussion summaries, additional instructions and key talking points.
    Timesaving Tip: We recommend opening the PowerPoint program before you start the lesson so you can quickly pull up the first slide and assign the Journal entry or Transition assignment.


The PDF masters files can be printed and copied, as well as displayed on screen. It may be useful to display each master when giving directions or reviewing content so you can visually highlight or point out specific areas on the page.

Health Terms Glossary

A copy of the Health Terms Glossary is provided in the Student Workbook. Teachers using the digital edition may find it helpful to give each student a printed copy or access to the full glossary file to review before lessons begin, or as a reference tool for researching unknown terms.

Teacher Keys

Digital copies of each teacher key can be displayed on screen when reviewing answers with the class, or handed out for use by students as they correct their own or others’ work.

Scoring Rubrics

Rubrics are used to assess student work on activity sheets and performance tasks. The rubric for each activity may be displayed for review with the class or printed and handed out to establish clear expectations before students begin work.


Using HealthSmart Digital in an LMS

Google Classroom: How do I use HealthSmart student resource PDFs in an assignment?

Schoology: How do I use HealthSmart student resource PDFs in an assignment?

This video has a good description of the process: Attaching a Fillable PDF to a Schoology Assignment

  • Download the HealthSmart student PDFs to a folder on your desktop or other location.
  • Go to your course on Schoology. Click Add Materials. Then click Add Assignment.
  • Name the assignment. Then go to File and select the PDF from the folder on your desktop and attach to the assignment. (You can click on edit details if you want to rename the file to something more student friendly.)
  • Add instructions to the description if you want to further clarify the assignment for students. Let them know they can Upload their work to submissions on the right.
  • Click Create. Then your students will see the assignment in the list.
  • You will be able to seesee student submissions of the assignment in the Submissions list from your teacher view.


Using the Lesson Planning Tool

What is the Lesson Planning Tool?

The HealthSmart Lesson Planning Tool allows teachers to select HealthSmart lessons in particular content areas that address specific skills and support desired healthy behavior outcomes.

It is based on two powerful documents that define key content, skills and outcomes for health education.

  1. The National Health Education Standards set performance indicators around the essential knowledge (Standard 1, Comprehending Concepts) and skills (Standards 2 -8) required for adopting and maintaining healthy behaviors. The Lesson Planning Tool shows you the particular skills covered within your selected content area(s) and lets you choose the ones you wish to address.
  2. The CDC’s Health Education Curriculum Analysis Tool (HECAT) was designed to guide curriculum selection and development. It builds on the characteristics of effective health education curricula and the National Health Education Standards by identifying the knowledge and skill expectations that will support healthy behavior outcomes (HBOs) for students at various grade levels. The Lesson Planning Tool groups the HealthSmart lessons according to the content areas defined by the HECAT, and allows you to choose which HBOs you wish to address within your selected content area(s).

The Lesson Planning Tool:

  • Eliminates hours of lesson planning.
  • Combines healthy behavior outcomes and skills to achieve real, measurable success.
  • Creates a flexible, responsive plan tailored to the number of health class periods available.
  • Generates results that correlate to the CDC’s Health Education Curriculum Analysis Tool (HECAT) and the National Health Education Standards (NHES).

Try the Lesson Planning Tool >>

I have my lesson plans hanging at my desk for all three grade levels. They are my checklist of everything. My life is so much easier because of you. I LOVE it!

Audra Deli-Hoofnagle, PE and Health Teacher,
Elkhorn Middle School, Franklin, Kentucky

How do I use the Lesson Planning Tool?

  1. Select the grade level you are teaching.
  2. Enter the number of lessons or class periods you have available for teaching health.
  3. Select the content area(s) you wish the health lessons to address. These content areas are based on the CDC’s Health Education Curriculum Analysis Tool (HECAT). Selecting a content area will give you all of the lessons that cover that health topic.
  4. Select specific skills covered in the content area(s) that you want to teach. This will ensure that the specific lessons that teach these skills will be included in the Lesson Plan, regardless of which healthy behavior outcomes (HBOs) you select.
  5. Select the HBOs defined by the HECAT that you wish to achieve. Then only the lessons that teach key concepts related to the selected HBOs will be included in the plan. (Note: Some HBOs are very broad, such as, “Avoid experimentation with alcohol and other drugs,” and will select more lessons than narrower, more specific HBOs, such as, “Avoid riding in a motor vehicle with a driver who is under the influence of alcohol or other drugs.” Choosing broader coverage HBOs will result in a lengthier Lesson Plan.)
  6. Review your customized Lesson Plan. The list of lessons will identify both the HECAT HBOs and the NHES skills addressed by each lesson. You can then choose the lessons you want to save under My Lesson Plan.
  • If you have additional time for teaching health, you can go back and select additional skills and/or HBOs to bring up additional lessons that can be added to the plan.
  • If the generated Lesson Plan contains more lessons than you have time for teaching, try the following strategies:
    • If possible, add more time for teaching.
    • Review the lesson Overviews to determine which you can eliminate. Click on the grey More Details button under each lesson to read the Overview.
    • Restart the tool and eliminate a content area, if you have selected more than one.
    • Restart the tool and reduce the number of skills or HBOs you select.


Print vs Digital

HealthSmart Theory & Practice

What learning theory is HealthSmart based on?

HealthSmart is grounded in sound educational and behavioral theory. The Theory of Planned Behavior provides the framework for lessons and activities. Concepts from Social Learning Theory are strategically woven throughout the program. The Transtheoretical or Stages of Change Model serves as the foundation for activities designed to support student change of unhealthy behaviors.

In addition, HealthSmart was developed to meet the 15 Characteristics of Effective Health Education Curricula as identified by the CDC Division of Adolescent and School Health.

How does HealthSmart involve families?

HealthSmart recognizes that parents and family are essential in the health education of children and adolescents. Opportunities for families to be involved are woven throughout the program. Each grade level includes take-home family sheets throughout the lessons that encourage family talks about key health topics. Other take-home activities such as surveys or requests for advice give parents and other family members ways to actively participate in their children and teens' health instruction. At the Middle and High School levels, the program includes family letters that can be sent home at the start of each content area unit, to inform parents and guardians about the topics to be addressed.

Does HealthSmart support ESL/Spanish speakers?

All of the family letters and take-home family materials for grades K through 12 are available in both English and Spanish. Currently, student workbooks and teacher guides are available in English only.

How does HealthSmart relate to asset building?

Developmental Assets represent the relationships, opportunities, and personal qualities that young people need to avoid risks and to thrive. HealthSmart focuses on helping students adopt or maintain targeted health behaviors, which will help them avoid risks and thrive both emotionally and physically.

How does HealthSmart support media literacy?

Media Literacy is the ability to access, analyze, evaluate and create media in a variety of forms. The elementary grades include lessons that ask students to apply what they see on television and in other media to the content they are learning in the lesson and to analyze the influence of media in their lives. At the middle school and high school levels, HealthSmart provides opportunities for students to access, analyze and evaluate the influence of media (including websites, television, movies, music and commercials) on a variety of health behaviors. Students also have opportunities to use a variety of media and technology to complete in-class and take-home assignments.

How does HealthSmart support academic achievement?

HealthSmart supports and reinforces many skills that help ensure academic achievement, particularly in the area of English and Language Arts.

Reading: Student workbooks for Grade 3 through High School include reading sheets that make the health topic interesting and relevant. Students apply what they've read to the health concepts and skills they are learning. Within the middle and high school lessons, students read and analyze informational text on various health topics, and integrate and apply what they have read to draw conclusions or teach others. They read case studies and make logical inferences about health risks based on what they’ve learned. They are asked to integrate and evaluate content presented through slides, reading assignments, quizzes and self-assessments, and occasional graphs.

Writing: HealthSmart encourages effective writing by having students express their personal knowledge, ideas and opinions. For example, most middle and high school lessons begin with short writing assignments, and the optional Student Journal provides an ongoing record of these assignments as well as supporting note-taking skills. Assessment activities that promote competency in writing include writing coherent explanations of concepts learned, short narratives or case studies, public service announcements, advice columns and, at the high school level, opinion pieces and fact sheets to share with peers. Through these assignments, students gain practice in writing explanatory texts to examine a topic and convey ideas based on the content they have learned in the lesson, as well as expressing their opinions and supporting claims with logical reasoning and relevant evidence to demonstrate their understanding of the topic.

Speaking & Listening: Students gain mastery of speaking and listening skills when they engage in collaborative discussions in pairs, triads, small groups and as a class, which gives them experience in expressing their thoughts clearly and building on the ideas of others. At the middle and high school levels, they also conduct short research projects and then present their claims and findings with relevant evidence and valid reasoning. Refusal, negotiation and other communication skills practice helps them learn to use appropriate eye contact, adequate volume and clear speech.

Language: Writing assignments throughout the lessons provide students with practice and teachers with opportunities to assess students' command of grammar and usage conventions, capitalization, punctuation and spelling. Language is developed at middle and high school through the introduction of relevant Health Terms, which are explained by the teacher during the lesson. A comprehensive Glossary is also provided, which may be shared with students.


School Health Guidelines

How many hours of health education do kids need?

The National Health Education Standards recommend that students in Pre-K to grade 2 receive a minimum of 40 hours and students in grades 3 to 12 receive a minimum of 80 hours of instruction in health education per academic year.

How does HealthSmart fit into a Coordinated School Health Program (CSHP)?

The HealthSmart program provides a comprehensive curriculum to provide Health Education, one of the essential components of a Coordinated School Health Program. The effectiveness of school health education is enhanced when it is implemented as part of a larger school health program and when health education outcomes are reinforced by the other 7 components in the CSHP model. HealthSmart lessons offer opportunities to involve other components of the CSHP, particularly those activities that engage students as health advocates and allow them to share their learning with the wider school community.

How does HealthSmart align with the National Health Education Standards?

The National Health Education Standards (NHES) detail what students need to know and be able to do in order to achieve health literacy, by setting performance indicators around the functional knowledge and essential skills required for adopting and maintaining healthy behaviors. All lessons in the K–12 curriculum are aligned with NHES, and great emphasis is placed on students having opportunities to become proficient in and master the concepts and skills outlined at each grade level. The specific performance indicators met within each lesson are clearly identified in the lesson overviews.

Click here to learn more.

How does HealthSmart align with the Health Education Curriculum Analysis Tool (HECAT)?

The Health Education Curriculum Analysis Tool (HECAT) was developed by the CDC to provide guidance to improve curriculum selection and development. The HECAT identifies the healthy behavior outcomes considered to be the most important behaviors to promote in a K–12 health education curriculum, and the corresponding knowledge and skill expectations that must be met at various grade levels in order to achieve these outcomes. The HECAT builds on the characteristics of effective health education curricula and reflects the National Health Education Standards.

HealthSmart was developed to support healthy behavior outcomes for children and youth. The HECAT played a primary role in the development of the second edition of the HealthSmart program for Grades K–12. Key concepts and skills required by the HECAT were a driving force in the development of the lesson objectives and assessments in all grades and content areas.

Click here for charts that show the full HECAT alignment for Grades K–5, Middle School and High School.

How does HealthSmart align with the National Sexuality Education Standards (NSES)?

The goal of the National Sexuality Education Standards is to provide clear, consistent and straightforward guidance on the essential minimum, core content for sexuality education that is age-appropriate for students in grades K–12. HealthSmart lessons related to sexual health have been aligned with the NSES for Grades K through 12.

Click here to learn more.

Does HealthSmart meet state standards for health education?

Yes, HealthSmart aligns well with many state standards in health education.

Click here to learn more.

Does HealthSmart align with the Danielson Framework for Teaching?

Yes, HealthSmart can support teachers in meeting the competencies outlined in the Danielson Framework for Teaching in many ways. You can download a document showing how here.


Teacher Support

Does HealthSmart include assessment tools to use with students?

Yes. Each unit in the Teacher Guides for Grades K–2 includes a Portfolio Checklist that lists evidence of student progress, and Grades 3–5 include individual Student Workbooks that serve as a record of student achievement. The Assessment Evidence provided for each lesson links the lesson objectives to specific activities, practice sessions, activity sheets and projects completed within the lesson.

In Middle and High School, objectives for each lesson are linked to clearly identified teaching steps and the corresponding student activity sheets and other performance tasks. New assessment rubrics at these upper grade levels provide scoring guidance to ensure that student mastery can be assessed for every lesson objective. In addition, each subject module in Middle and High School culminates with two overall assessment activities: a written assessment of content and concepts, and a performance task that provides authentic assessment of content and skills through a creative individual or group project.

Are the lessons the same between the print and digital editions?

The print and digital editions of HealthSmart teach all of the same content and skills. Lessons are identical, except for differences in formatting for print and online.

Will HealthSmart be relevant to my students?

One of the key characteristics of effective health education curricula identified by the CDC is that these programs “use strategies designed to personalize information and engage students.” HealthSmart includes many student-centered activities and questions that allow students to apply the content and skills to their lives.

What I like most about the lesson plans is that they really relate to kids, so I've had really good buy-in from the students. The sequence and pacing of the lessons are super teacher-friendly as well.

Cassidy Greif, MSEd, CHES, Classroom Instructor, Denver, Colorado

How does HealthSmart help me teach tough issues?

HealthSmart has detailed lesson plans and support materials for teachers. If there is a difficult or controversial topic to teach, the Teacher Guides include additional guidance for discussing and handling the topic in the classroom, including how to answer questions about sexuality and sexual health.

Professional development resources for Grades K–5 are available to purchasers of both the print and digital editions of the program on the HealthSmart website under Resources for Teachers. These free full-length books cover the important content areas of Nutrition & Physical Activity, Tobacco, Safety & Injury, and Sexuality and include guidance on answering difficult questions.

Is training available for teachers?

Yes, HealthSmart training is available. ETR offers a 2-day HealthSmart training with a 1-day follow-up booster session. This comprehensive professional development opportunity for educators covers both the characteristics of effective health education curricula and how to use the HealthSmart curriculum, with an implementation booster session offered several months later. A shorter, less formal day-long orientation to the program is also available.

For questions about training, contact John Henry Ledwith at to discuss the best options for your program. If you are interested in scheduling the formal 2-day training, please complete a Training & TA Request Form >>

Is there technical support for HealthSmart?

Yes. For questions or assistance please contact us at


What's New in the Third Edition of Middle and High School?

Released for the 2020/21 school year, the new third edition for the middle and high school levels continues to focus on the essential concepts and skills students need to know and practice to adopt healthy behaviors, with lessons and activities tailored to the developmental capabilities of students at each grade level.

  • Updated content. All lessons were reviewed for medical accuracy and up-to-date content. Lessons continue to reflect the recommendations of the National Health Education Standards (NHES) and the CDC’s Health Education Curriculum Analysis Tool (HECAT)to align the teaching more closely with what research has shown to be effective.
  • New lessons. New lessons have been added on social media and emotional health, opioids, affirmative consent and sexual abuse prevention. Tobacco lessons have been revised to include and emphasize risks of vaping.
  • PowerPoint slides for every lesson. Engaging PowerPoint slides are now provided for every lesson to convey key concepts, enhance discussions and guide group activities.
  • Enhanced workbooks. Student journal pages have been incorporated into the Student Workbooks for personal reflection, guided lecture notes and group activities. Journal pages list important health terms for each lesson, and the Student Workbook now includes a full Health Terms Glossary.
  • Inclusivity. Language has been reviewed to reflect and promote inclusivity and support a trauma-informed approach.

The third edition of HealthSmart continues to be teacher friendly, with clearly defined teaching steps that require only minimal preparation. The website gives HealthSmart teachers free access to digital versions of the teacher guide resources, content updates, current articles about school health, and professional development materials. The HealthSmart program continues to be committed to providing learning activities that build a personal value for health, shape healthy peer norms, and enhance students’ power to make healthy choices that contribute to a better future.


Specific Topics

Does HealthSmart address gun violence?

Grades K and 3 include specific mention of basic safety around firearms (e.g., never touch a gun or bullets, tell an adult if you find a gun). The High School Violence & Injury Prevention unit includes specific discussion of how the presence of guns or other weapons increases the risk of violent injury. Students examine factors that contribute to violence in a school setting, including the presence of weapons. They work in small groups to brainstorm and discuss how strong emotions, a need for personal power, lack of respect, use of alcohol or other drugs, gang involvement and access to weapons can increase the risk of violence. They practice identifying crisis situations and asking for adult help if there are people who are in danger of hurting themselves or others.

Gun safety is also addressed in the context of injury prevention at both the middle and high school levels. Students propose specific safety strategies for preventing injuries related to the leading causes of death among teens, including firearm injuries. Lessons emphasize the importance of training in the proper use of firearms for sport or hunting, as well as correct cleaning and transportation. There are also lessons that review and practice established school and district procedures to follow in the event of school emergencies, such as lockdowns or intruders, in the Violence & Injury Prevention units at both middle and high school.

In general, the K-12 HealthSmart program builds an overall foundation for preventing violence and injury from many sources. Lessons teach students the skills needed to make safe decisions and identify and deal with unsafe events. For example, students establish guidelines for respect and trust that will help make their classroom a safe place to be. They learn to express strong feelings in healthy ways, manage anger and get help for troublesome feelings. They practice specific skills to change risky or unhealthy behaviors, and learn how to get help from adults if they or others are in danger.

Does HealthSmart address eating disorders?

Disordered eating is covered at both the middle and high school levels. Lessons in Nutrition & Physical Activity also cover body image issues and dangers of fad diets or other unhealthy weight-loss methods.

In addition, eating disorders are examined in the context of mental health in the High School Emotional & Mental Health unit. Anorexia and bulimia nervosa are among the common mental health issues that students research and teach each other about.

Does HealthSmart address cyberbullying?

Young people today often are immersed in online interactions with their peers and others. Bullying lessons in Grades 3–5 provide information about cyberbullying and example scenarios include stories about students who are bullied online. The middle and high school levels of HealthSmart give special attention to students' online activities in the context of violence prevention and sexual health, as well as in terms of accessing reliable online resources across all subject areas.

For example, the Middle School and High School Violence & Injury Prevention lessons on bullying include cyberbullying as one of the types of bullying students may experience. Students examine ways cyberbullying is similar to and different from traditional bullying, and look at how using communcation technology affects how they interact with and express conflicts with peers.

Lessons at the upper grade levels also help students understand the risks and consequences of sexting, both in the context of cyberbullying, and, in the sexual health units, in terms of behaviors that can contribute or lead to sexual activity or pressures to have sex.

Does HealthSmart address sexual abuse prevention?

Each grade span includes at least one lesson on sexual abuse prevention. At the K–2 grade level, Lesson 20 in Grade 1 helps students identify appropriate (safe) and inappropriate (unsafe) touch, understand that they are not at fault if someone touches them in inappropriate ways, and seek help if this happens. At the 3–5 grade level, Lesson 16 in Grade 3 helps students identify caring adults they could go to for help with problems, then introduces the concept of different kinds of touch and contrasts safe touches with two types of touch that can be problems: unsafe and secret touches (sexual abuse). Again, as in all HealthSmart lessons on sexual abuse, the teacher emphasizes that students are never at fault if they receive unsafe or secret touches. These lessons can be taught up or down a grade level depending on when sexual abuse prevention education is mandated by the district or state.

At the secondary grade spans, lessons on sexual abuse prevention can be found in the Violence & Injury Prevention units. The first of two lessons in middle school has students participate in an exercise that helps them identify personal boundaries and practice steps they can take to protect themselves using assertive communication to defend their personal space. The second lesson helps students understand, recognize and seek help for sexual abuse through responding to scenarios in which young people are in danger of being sexually abused, identifying resources, and practicing how to ask for help for themselves or a friend.

High School has three lessons on the topic. The first focuses specifically on sexual exploitation and helps students learn how to recognize a potentially exploitive situation or relationship, both in person and online. The second explores the definition of abuse; examines myths and facts, with an emphasis on understanding that sexual abuse is never a victim’s fault; and discusses why it is important for survivors of abuse to get help. The third focuses on skills and steps students can take to help protect themselves from sexual abuse or sexual exploitation, including practicing assertive refusals for a variety of risky situations.

Does HealthSmart address human trafficking?

The Middle School Violence & Injury Prevention lesson on sexual abuse includes some information about this topic. It defines trafficking as a form of abuse, and one of the scenarios students discuss presents a situation in which a student’s friend is being drawn into a trafficking-type situation. But the lesson doesn’t go into particulars of human trafficking. Educators might need to add some information to the lesson, such as being sure to list trafficking hotlines among the resources discussed at the end of the lesson, to fully meet legislative mandates or state standards around this subject at the middle school level.

The High School Violence & Injury Prevention unit has a separate lesson (Lesson 17) on sexual exploitation, that covers many points about trafficking. Here, too, the educator might want to supplement discussion to be sure the particular points required by legislation or district policies are being covered (e.g., How did the exploiter try to win Lee’s trust? What needs was Riley’s exploiter trying to fill? How was Tallulah targeted? What might have happened if she had gone with the man?). Resources specific to trafficking are shared at the end of that lesson, and can also be included at the end of the next lesson, which focuses on sexual abuse.

In including information about trafficking in HealthSmart, we chose to cover situations that a larger percentage of students might encounter in the scenarios at both upper grade levels. As a result, the lesson focus is more on understanding that trafficking exists and recognizing early warning signs. The high school lesson also defines and includes examples of peer-to-peer exploitation, because an ETR research study found this to be an issue for a surprising number of youth.

An exploration of commercial sex trafficking is really outside of the scope of the program, because the primary goal of HealthSmart is always to empower the practice of healthy behaviors and address the Healthy Behavior Outcomes (HBOs) defined by the CDC. Students can’t do anything about commercial sex trafficking, but they can understand what trafficking is, recognize warning signs, and access resources for help for themselves or a friend if they see those warning signs. That’s the content that’s going to help them “Get help to stop being subjected to violence or physical abuse” (the HBO). Legislation intended to address social problems and health issues doesn’t usually approach it from that behavior standpoint, so is often written around required content to include rather than the functional knowledge and skills that will help youth protect themselves.

Does HealthSmart address LGBTQ+ issues?

Lessons in the Emotional & Mental Health content area at Grades K–5 help build a foundation for respecting self and others as well as accepting and celebrating differences. Grade 5 includes a lesson on gender roles and gender expression. At the middle and high school levels, language around dating relationships and feelings of attraction has been carefully chosen to avoid making assumptions about sexual orientation or gender identity. In addition, roleplays involving relationships and many of the relationship case study examples use gender-neutral names to avoid assigning a specific sexual orientation to the characters, so that all students can feel represented. Teacher notes alert teachers to places they can model respect for differences around aspects of sexuality.

The sexual health units at middle and high school in particular help address the needs of LGBTQ+ students in the following ways:

  • The Abstinence, Puberty & Personal Health unit for middle school, and the Abstinence, Personal & Sexual Health unit for high school both include discussion of different aspects of sexuality, including sexual orientation and gender identity.
  • The lessons on reproductive anatomy are now presented in a non-binary way to allow all students to feel represented.
  • HIV, STI & Pregnancy Prevention unit at middle school includes a lesson on Stopping Sexual Stereotypes, which teaches about different aspects of sexuality, and how to recognize and challenge stereotypes based on gender roles or sexual identity.
  • HIV, STI & Pregnancy Prevention unit at high school includes a lesson on Respecting Sexual Differences, which teaches about different aspects of sexuality and promotes understanding and respect for those differences.
  • Throughout the program, language around dating relationships and feelings of attraction has been carefully chosen. Roleplays and relationship case study examples use gender-neutral names and include some same-sex couple examples.
  • Teacher notes alert teachers to places they can model respect for differences around aspects of sexuality.

Why do the HealthSmart middle and high school programs have a separate lesson on HIV rather than just including it in the lesson on STIs?

ETR has much expertise and a long history of providing materials around HIV prevention, and we believe the topic of HIV is important enough to merit its own lesson. Most of ETR's evidence-based prevention programs devote separate lessons to HIV and to other STIs.

Although there are some STIs that can become life threatening if left untreated, HIV is unique in having been widely publicized and devastating in the earlier years of the epidemic. Even though that is changing, it is likely students may have heard of HIV apart from the context of other STIs, and have encountered myths or misinformation about its transmission or whom it affects. Having the separate lesson allows us to correct misconceptions and present important information that applies to HIV in particular, such as the newer treatment options that allow people living with HIV to stay healthy and greatly reduce their risk of transmitting it to others.

There is naturally some overlap across the two lessons—for example, in Lesson 7 of the Middle School HIV, STI & Prevention unit, the “handshake” activity could be used to model transmission of other types of STI as well. However, we believe there are enough unique things about HIV to justify a separate lesson that can also reinforce what students have learned about STIs in general in the previous lesson.