Listening to Youth Perspectives to Support School Health Education

Starting at a young age, children acquire knowledge and develop skills and habits that can impact their overall health and well-being. Schools play an integral role in helping children develop that knowledge base, and today, several states are exploring policies that will support or restrict schools’ roles in school health education. As U.S. education policy gives state and local authorities control over education, these state policy considerations are incredibly important. In a review of policy levers and youth perspectives, it’s clear that policy informing school health education varies considerably and as a result health education, while important to youth, does not always meet their needs. 

A few states have already chosen to bolster health education for youth. For example, between March 2020 and December 2021, 13 states passed laws requiring mental health education at some point during a student’s school career. There is also an active national campaign for states to ensure all grade levels receive mental health education. Expanding mental health education in the school setting is important as it builds mental health knowledge and awareness, contributes to reducing stigma and promotes accessing care when needed. 

But we are also seeing moves toward restrictive state policies, such as recently signed legislation in Florida, which would prohibit teachers of kindergarten through third grade from discussing gender identity and sexual orientation—creating a massive barrier in fostering an inclusive classroom and delivering comprehensive health education. 

I’ve been following these trends around school health education in my role as a Policy and Strategy Senior Associate at PolicyLab. I work collaboratively with researchers and faculty members in the Adolescent Health and Well-being Portfolio to ensure their work and expertise is informing policy. While the portfolio members’ work spans many issue areas, in their research or clinical encounters with adolescents, many experienced that adolescents were insufficiently equipped with the knowledge or skill sets to be able to make informed decisions about their health, habits or behavior. School health education presents an opportunity to address these gaps and better prepare youth in their development. This led us to set out to better understand: how is health education implemented in schools? What shapes school health education? What do adolescents think about school health education? 

Most students receive some school health education, presenting a consistent opportunity to support youth in their development into healthy, productive adults. However, there is a great deal of variation in school health education, including what is taught, when it is taught and how much time is devoted to the subject. State, local, and school policy shape health education, and there are national resources that educators and decision-makers can consult and reference in their work. 

While there are many voices on school health education, we found a number of qualitative research studies from across Children’s Hospital of Philadelphia (CHOP) that allowed us to consider youth perspectives on school health education. Reviewing this work and looking to youth themselves, we found they are interested in school health education, but it does not always meet their needs. More specifically, youth seek information from trusted sources. They turn to social media for answers, but it’s not always their preferred source. Youth can find health education to be alienating or supportive depending on the context and the educator, and when incomplete, health education can be harmful. And, finally, when and how information is shared does not always meet youth needs.  The following quotes come from a series of qualitative interviews between CHOP researchers and youth.* 

“Personally, in my life, like a lot of the things I went through, I had to like, look up on the internet. A lot of my education came from the internet.”

“There are different relationship norms and boundaries depending on the genders involved. The curriculum is heavily geared toward cishet relationships.”

“When I got my period, I wasn’t thinking about that. I still was playing with dolls and stuff. Who wants to think about sex when they get their period? That’s not the first thing that comes to your mind.”

There are multiple efforts underway to support the advancement of school health education more broadly. A 2020 National Academy of Medicine discussion paper called for strategic efforts to link school health education and health literacy. And several leading education groups formed the National Consensus on School Health Education, seeking to develop more contemporary resources for school health education. 

We hope to add to the dialogue. In our recently released issue brief, we share themes that emerged from youth perspectives that led us to highlight six priorities for school health education. We place importance on ensuring equitable access to school health education that is comprehensive, medically accurate, and age appropriate and which emphasizes health literacy. 

There are many groups who are involved in school health education, and we hope that health care providers and systems can be helpful partners. Through this brief and our subsequent conversations, we very much hope to meaningfully support and strengthen school health education. We invite you to join us in this conversation and share your perspectives with us on social media. What challenges do you see arising in implementing these priorities? What resources are needed by school districts and educators? What research is needed to inform school health education? 

Stay tuned as we continue this conversation.   

*All participants consented to the use of these quotes in a way that does not identify them. Scientific research projects were conducted with Institutional Review Board (IRB) approval. The youth advisory group for city planning purposes was conducted in accordance with local guidelines. You can find more quotes, and more information about these interviews, in our issue brief.