Assemblymember Scott Stringer is a native New Yorker who was first elected to the New York State Assembly in 1992 after more than a decade of political involvement and neighborhood advocacy. Stringer represents the 67th Assembly District on Manhattan's West Side.

Stringer is the Chair of the New York State Assembly Committee on Cities and serves on the Education, Higher Education, Housing, Judiciary and Health Committees. Stringer is also a former Chair of the Real Property Taxation Committee, the Assembly Oversight, Analysis and Investigation Committee and the Task Force on People with Disabilities. Stringer is also a member of the Assembly Task Force on Women's Issues.

Stringer has released the following research reports since 2002:

• "Faces of the Budget Crisis: How Much Pataki's Budget Really Costs NYC Families", February 2003
• "Total Collapse: How NYC Department of Buildings Failed Policies Contribute to Crumbling Buildings", November 2002
• "Report on Assessor Practices and Assessment Administration in New York City", May 2002
• "Reading is Fundamental: The Textbook Shortage in New York City's Public Schools", April 2002 (with an update issued in April 2003)

Assemblymember Scott Stringer prepared this report with the help of his staff:

Alaina Colon, Policy & Communications Director
Debbie Roth-Rogoff, Chief of Staff
Erin Nazarowitz, Graduate Student Intern
Felicia Feinerman, Legislative Director
Jason Haber, District Coordinator
John Simpson, Director of Constituent Services
Susannah Vickers, Special Assistant
Shraddha Patel, Graduate Student Intern

For additional copies of this report, please contact Assemblymember Stringer's office by phone: (212) 873-6368 or email: strings@assembly.state.ny.us.

Executive Summary

1. Poor Health: The Case of New York City Youth
2. Health Education in New York City
3. Diagnosing a Sick Health Education Program
4. 5 Steps to a Cure
5. Conclusion

Appendix A: Current NYC and NYS Health Education Mandates for Grades K through 8

Appendix B: Responses of New York City District Health Coordinators to Assemblymember Stringer's Survey Questions

Appendix C: Benefits of Health Education to Youth Health Status and Awareness and Academic Performance

Good health among our schoolchildren is the fundamental building block to their overall well-being. Schools play an essential role in imparting to our youth the importance of eating healthy and exercising, steering clear of drugs and alcohol, avoiding teenage pregnancy and STDs, developing a positive self-image, and remaining free of life-threatening diseases such as AIDS. Children do not adopt these healthy behaviors in a vacuum. Therefore, we must pay close attention to the quality of our children's health education in school.

This report documents the enormous discrepancy between State and City health education mandates for grades K-8 and actual practice in public school districts. New York State legally requires all public schools to teach lessons on HIV/AIDS from grades K-8, as well as alcohol and substance abuse prevention. New York City's policy on health education, although never codified through City regulations, mandates instruction of the "Family Living, including Sex Education" (FL/SE) curriculum for grades K-8. For both HIV/AIDS and FL/SE mandated curricula, the State and City require specific levels of teacher training. For the HIV/AIDS curriculum, there are also separate State mandates and City policies for the number of lessons provided per year, as well as the corresponding oversight procedures to track such lessons. For middle schools, the State also requires a separate half unit on health, which may include any health-related topics.

Through in-depth interviews of district health coordinators, or the most senior staff members responsible for health education, our investigation sought to determine the status of health education in New York City's public schools.¹ Specifically, we examined each official's knowledge of government health mandates, as well as compliance and oversight regarding these requirements. At the conclusion of our research, we were able to interview administrators at 27 out of 32 districts throughout New York City, with 5 districts either unwilling or unable to respond to our inquiries. Broken down by borough, we interviewed 5 out of 6 districts in the Bronx, 11 out of 12 districts in Brooklyn, 5 out of 6 districts in Manhattan, 5 out of 7 districts in Queens and the 1 district in Staten Island.

Our study reveals that districts are overwhelmingly unaware of, and unable to comply with, even New York State and City's minimal mandates on health education. Our key findings include:

• 75% of districts violate at least one of the government mandates for health education;
• 63% of districts specifically violate the mandate requiring a sufficient number of properly trained teachers for instruction of either HIV/AIDS or FL/SE curricula;
• 70% of districts inaccurately describe one or more of the health education mandates;
• 70% of districts do not actively oversee how or whether all mandated health instruction occurs in individual schools; and
• 63% of districts compensate for the gaps in the State and City mandates.

These statistics clearly illustrate the utter disarray of health education in the New York City school system. Unfortunately, those districts that want to strengthen health education programs in their schools are seriously limited by resource constraints and lack of support from State and City government.

This report is drafted at a time when New York's teenage pregnancy rate currently ranks 9th in the United States¹, and young people under the age of 25 comprise approximately one-half of all new HIV cases in the nation.² Despite these risks, close to 40% of New York's adolescents failed to use a condom the last time they engaged in sexual intercourse.³ Other recent health trends among our youth are equally disturbing:

• New York's youth tops the list of obesity in the nation,⁴ and the number of overweight teens in the United States has tripled in the past two decades;⁵
• During a typical month, over 40% of New York City students consume at least one alcoholic drink;⁶
• Over 40% of New York City students were involved in a fight at least once in the past year, a statistically significant increase from years past;⁷
• Suicide is responsible for 9% of childhood deaths reported each year among young people in New York;⁸ and
• Almost 33% of New York City students have experienced such extreme levels of depression in the past year that they began to disengage from their usual activities.⁹

These risky health behaviors endanger our children through lowered academic performance, diminished potential earnings, compromised self-image and relationships, and a greater risk of disease and death.

Given such serious health problems confronting today's youth, there is no excuse for the current widespread neglect of health education in schools revealed by this report. Addressing the health needs of youth to combat these poor health trends will not only enhance their lives, but also significantly lower long-term health costs. In fact, recent estimates indicate a $13 dollar savings in reduced medical costs alone for every $1 spent on high-quality, broad-based school health education.¹⁰

This report uncovers a New York City health education crisis that has been ignored and allowed to worsen for over a decade. To reverse the abandonment of health education in New York City and to preserve and enhance the future of our children, we propose a multi-step plan that will strengthen existing mandates and institute a far-reaching, comprehensive health education curriculum in New York's schools. Features of our plan include:

• Conducting a full-scale evaluation of health education in New York City's public schools;
• Designing cutting-edge curricula;
• Providing adequate funding;
• Enhancing and supporting teacher training; and
• Instituting regional implementation panels to oversee health education in New York City schools.

While there are varying causes for the dilapidated state of health education in New York City, our investigation clearly points to the need for a more comprehensive and accountable health education program. Funded by a recently-obtained CDC grant, New York State is beginning to revisit its health education mandates, as well as improve the collaboration between different government agencies to reduce overlap in services. The City is also in the process of reorganizing its school system. If there ever was a time to address the breakdown in public school health education, it is now. The State and City must take immediate action on this crucial issue for the sake of the future of our youth.

We have an obligation to assure parents and the community that every child in the system is receiving current, coherent and comprehensive instruction on health issues. We urge our education leaders to bring New York's system back to life and take the first, essential step by giving our children the gift of good health. When it comes to our children's survival, there simply is no room for complacency.

"[Children]…who face violence, hunger, substance abuse, unintended pregnancy, and despair cannot possibly focus on academic excellence. There is no curriculum brilliant enough to compensate for a hungry stomach or a distracted mind."

-National Action Plan for Comprehensive School Health Education, Centers for Disease Control and Prevention (CDC), 1992

Alarming Health Challenges Confronting New York's Children

New York's youth traverse a minefield of health-related risks that can have a devastating impact on their lives if they are unequipped to handle them. Students face enormous risks from unprotected sexual activity, including: teenage pregnancy, sexually-transmitted diseases (STDs), and HIV/AIDS. Every day, children also encounter perils such as poor physical condition, obesity, substance abuse, eating disorders, low self-esteem and depression, physical violence and unsafe schools.

Over half of New York City adolescents have had sexual intercourse at least once.¹¹ Students are continuing to experiment with sex at earlier ages, and younger students are less likely to practice safe sex.¹² Despite the risks of pregnancy, STDs and HIV/AIDS, 40% of sexually active New York City teens failed to use a condom when they last engaged in sexual intercourse.¹³ New York ranks 9th in the nation in teenage pregnancy, and 1 in 20 New York City students will become pregnant or will cause someone to become pregnant during high school.¹⁴ Our nation's teens contract nearly 4 million STDs each year, and half of the 40,000 new HIV cases in the United States each year occur in young people under the age of 25.¹⁵

Alarming numbers of our children are overweight, eat poorly and do not get enough exercise. Almost 40% of New York City students are currently trying to lose weight, and over 10% do not eat at all for 24 hours in an average month because of weight concerns.¹⁶

New York's youth tops the list of obesity at a national level.¹⁷ According to the American Medical Association, the number of overweight teens nationally has tripled in the past two decades, increasing their risk of diabetes, heart problems, and other debilitating diseases.¹⁸ The percentage of New York City students engaging in strenuous physical activity has also decreased in recent years, as has the level of voluntary physical activity undertaken by adolescents between the ages of 10 and 18.¹⁹

Substance abuse has plagued our youth for decades. During a typical month, over 40% of New York City students consume at least one alcoholic drink and almost 18% smoke cigarettes at least once. At least 34% of our City's teenagers have tried marijuana. Almost one-quarter of New York City students have been approached about buying or otherwise acquiring illegal drugs on school property.²⁰

Many children in New York suffer from bouts of depression or low self-esteem. Distressingly, almost 33% of New York City students have experienced such extreme levels of depression in the past year that they began to disengage from their usual activities.²¹ Suicide is responsible for 9% of childhood deaths each year among young people in New York.²²

Much of childhood depression and suicide stems from low self-esteem. Particularly in light of the tragic events of September 11th and the most recent war against Iraq, students are prematurely confronted with serious global issues and the implications of such issues in their daily lives. These worries can compromise a child's self-image and sense of world safety.

Violence is a serious problem in our City's schools. Over 40% of New York City students were involved in a fight at least once in the past year, a statistically significant increase from years past.²³ Thousands of crimes occur in New York City public schools each academic year.²⁴ According to the School Health Policies and Programs Study (SHPPS) 2000, New York State does not have a specific policy to prohibit gangs, physical fighting, and harassment by students.²⁵

The Damaging Effects of Poor Health on Youth Well-Being

Risky health behaviors have devastating short- and long-term consequences for our children. The following statistics speak for themselves:

• Less than one-third of girls who have a child before age 18 earn a high school diploma, and many experience lower status employment and income. ^{26 27}
• Low levels of physical activity and poor nutritional habits contribute to low self-esteem and hamper academic success.²⁸
• Poor eating, low fitness levels and tobacco use, all known to start at young ages, are associated with diseases that kill over 70% of United States residents.²⁹
• Drug users are absent from school more frequently, are more likely to take sexual risks and experience depression, rebelliousness and a lack of motivation.³⁰
• Suicide and AIDS combined are to blame for 10% of the deaths among our nation's children.³¹

It is just common sense that youth who face health-related risks without the knowledge to combat them will be unable to concentrate on planning for their futures, much less learning at school, engaging in after-school activities or developing healthy habits.

Despite today's acute health challenges, neither New York State nor New York City has ever instituted a far-reaching, comprehensive school health curriculum. However, in response to the risks posed by teenage pregnancy, the HIV/AIDS epidemic and substance abuse, the government mandates a scattering of programs.

New York State legally requires all public schools to teach a series of yearly HIV/AIDS lessons from grades K-8, as well as instruction in the dangers of alcohol and substance abuse.³² New York City's policy on health education, although never codified through City regulations, mandates instruction of the "Family Living, including Sex Education" (FL/SE) curriculum for grades K-8. For HIV/AIDS and FL/SE, the State and City mandate specific levels of teacher training. For the HIV/AIDS curriculum, there are also separate State mandates and City policies for the number of lessons provided per year, as well as oversight procedures to track such lessons. For middle schools, the State also requires a separate half unit on health, which may include any health-related topics.

(Please see Appendix A for detailed tables on New York State and City health education requirements for grades K-8.)

The "Family Living/Sex Education" Curriculum

The focus of the New York City Department of Education (DOE) initially turned to health education in the 1970s with the design of the FL/SE curriculum. Developed in response to skyrocketing teen pregnancy rates, this program teaches age-appropriate topics on family structures and relationships, as well as selected topics in sex education for grades K-8. The City mandates that the FL/SE instruction must be performed by a teacher who has completed a 30-hour training course.

The FL/SE mandate presents a number of problems regarding curriculum content and effective implementation. First, the curriculum has not been updated since 1986. With the fast pace of developing new knowledge in this area, this lack of attention to what is being taught in schools is irresponsible at best, dangerous at worst. Second, according to a high-ranking DOE official, the DOE is often aware that many schools do not have certified FL/SE teachers and that there is not 100% certification among instructors who teach the FL/SE curriculum.³³

In the absence of resources and programming to perform emergency training in these areas, many needy schools have no choice but to knowingly violate City law by failing to teach this curriculum, or by allowing uncertified teachers to educate children in this area.

Lastly, outside of the requirements concerning teacher training, there are no guidelines for the number of classes or oversight of this curriculum.³⁴

HIV/AIDS Education

In 1988, a few years after New York City implemented FL/SE mandates, New York State stepped up and enacted a law requiring age-appropriate instruction on HIV/AIDS in grades K-12.

New York City follows the State's requirements on HIV/AIDS education such that the curriculum must include accurate information about the nature of the disease, methods of transmission, methods of prevention, and also stress abstinence as the most appropriate and effective method of protection.³⁵ However, there is much concern among community health groups that there has not been an update to the HIV/AIDS curriculum since 1991.

The State mandates the submission of a HIV/AIDS class schedule as an enforcement tool. On the City level, principals often hold this responsibility. Optional forms of oversight utilized by education officials include random site visits or self-reporting at district-wide conferences among support staff. However, these efforts have been scattered and implemented inconsistently.

Notwithstanding the adoption of State law in this area, HIV/AIDS education did not make its way to the classroom so easily. In 1989, a BOE survey of 300 schools indicated that most were not in compliance with the New York State HIV/AIDS mandate.³⁶ Exacerbated by the fear of political backlash, lack of teacher training and embarrassment among educators, the substantive content of the HIV/AIDS instruction varied greatly from school to school, especially in the elementary and secondary levels.

In response to this study, the City established an HIV/AIDS directive in the early 1990s that requires at least five lessons per year for elementary schools and at least six lessons per year for middle schools as an additional enforcement measure.

Despite this directive, our investigation reveals that many of the same problems that beset HIV/AIDS instruction in New York City public schools more than a decade ago remain just as intractable today. School officials interested in fostering health education continue to confront a lack of trained teachers, embarrassment and discomfort among the available teachers and inconsistent use of curricula in the schools, all of which prevent instruction of the mandated curriculum in a comprehensive and coherent manner.

Alcohol, Substance Abuse & Violence Prevention

New York State mandates some form of instruction in public schools to discourage alcohol and substance abuse for grades K-8. At the elementary school level, either a regular classroom teacher or a teacher certified in health can provide this instruction. At the middle school level, this instruction must be part of a separate unit on health taught by a certified health teacher. Each district may develop its own curriculum for this instruction.

New York City requires a drug director in each district to oversee alcohol and substance abuse prevention education. The City also provides Substance Abuse Prevention Intervention Specialists (SAPIS) to teach prevention topics in needy schools. Each superintendent assigns SAPIS personnel based on specific district needs. Outside of the SAPIS position, there are no City or State mandates for teacher training or oversight concerning this instruction.

State regulations on school instruction for alcohol and substance abuse prevention also specify requirements for violence prevention education. Specifically, the State requires schools to make violence prevention packets available for students in grades K-8. However, this material is not part of a mandated curriculum.

The Future of Health Education in New York

With so many gaps and weaknesses in the limited government health education mandates, New York City's education system is clearly in need of reform.

Funded by a recently-obtained CDC grant, New York State is beginning to revisit its health education mandates, as well as improve the collaboration between different government agencies to reduce overlap in services. The State plans to focus these reforms in the areas of physical activity, tobacco use, and nutrition.

The DOE recently created the Office of Youth Development and School Community Services under its purview to oversee public school health education. Through the reorganization of the City's education system, Mayor Bloomberg hopes to connect the DOE with the Department of Mental Health and Hygiene, which is part of the Department of Health, to provide health services to students more effectively. It is also planning to reach out to community partnerships.

While promising, these reforms are still in their infancy and do not address the rampant neglect of health education in New York City schools that our investigation uncovers. Despite current efforts toward reform, the future of health education in New York City still hangs in the balance.

Given the pressing need for health education among New York's children, we undertook a groundbreaking investigation of the New York City education system. We focused on health education for grades K-8 because of the tremendous promise in teaching younger children about good health, as most health habits tend do develop at earlier ages.

To assess the status of health education in grades K-8 in New York City public schools, we conducted interviews of health coordinators, or the most senior staff member responsible for health education, at the district level.⁰²

We posed a series of questions to health coordinators to determine the following:

• Whether the districts could identify the State and City health education mandates;
• Whether the districts actually follow such mandates; and
• Which, if any, oversight procedures exist to track implementation and effectiveness at the district level.

(Please see Appendix B for a summary of survey responses. In order for the district health coordinators to cooperate with our survey, we promised to keep specific names confidential.)

At the conclusion of our research, we were able to interview personnel responsible for health education at 27 out of 32 districts throughout New York City, with 5 districts either unwilling or unable to respond to our inquiries.³⁷ Broken down by borough, we interviewed 5 out of 6 districts in the Bronx, 11 out of 12 districts in Brooklyn, 5 out of 6 districts in Manhattan, 5 out of 7 districts in Queens and the 1 district in Staten Island.

Our Findings

Our investigation reveals that districts are overwhelmingly unaware of, and unable to comply with, even the minimal New York State and City's current mandates on health education. This distressing problem stems from enormous obstacles facing school districts, most notably a severe lack of trained teachers, time, money and centralized direction from State and local government. The findings below uncover for the first time the appalling state of health education that is available to New York's children.⁰³

FINDING #1 a-
-75% OF DISTRICTS VIOLATE AT LEAST ONE OF THE GOVERNMENT REQUIREMENTS FOR HEALTH EDUCATION

FINDING #1 b-
-63% OF DISTRICTS SPECIFICALLY VIOLATE THE MANDATE TO HAVE A SUFFICIENT NUMBER OF PROPERLY TRAINED TEACHERS FOR INSTRUCTION OF EITHER HIV/AIDS OR FL/SE CURRICULA

Upon analyzing the data captured from our interviews, we discovered that at least 75% of districts in New York City are violating at least one of the State and City mandates for health education. With such a large percentage of districts out of compliance with some portion of curriculum and teacher training guidelines, one has to wonder what purpose the health education mandates really serve. As the budget crisis continues to deplete available funds for education, problems will inevitably worsen.

In many instances, districts are simply incapable of meeting these mandates because they lack an adequate number of trained teachers. In fact, our survey finds that at least 63% of districts admit to not having enough trained or certified teachers to fulfill the requirements for health instruction. Several district administrators voice frustration at the lack of support provided by the City in fulfilling teacher training mandates, as exemplified by one official's concerns, "The Board of Ed used to pay for training, but now it comes out of the district's budget . . . we have to pay for a substitute for each day the teacher is away, which costs us like $150 to $200 per day."

Echoing the problems encountered decades ago, some districts cite teacher embarrassment and discomfort as a major barrier in presenting health education material. As one district coordinator explains, "teachers aren't trained well enough and are scared to [teach sex education and] offend someone."

Schools also have difficulty complying with health education requirements because such little time is available during the already overscheduled school day. After teaching core subjects, such as math and reading, educators only have a small portion of each day to devote to art, music, health and physical education. As one administrator reports, "So much time [in the school day] is blocked out . . . there are only 20 minutes before lunch and 40 minutes in the afternoon [for other areas, such as health] and there is a lot of competition among different mandates." The administrator succinctly sums up the main point: "Anyone saying that health ed. is fine in the districts is telling you a story."

According to many district coordinators, health takes such a backseat to core subjects because of pressures to increase math and reading scores. The lack of performance measures on health education compel teachers to push aside health instruction in favor of other lessons more directly linked to higher test scores. In light of these factors, the high rate of non-compliance with State and City mandates is not surprising. One health coordinator sums it up, by stating, "I guess the Board figures some things are more expendable in terms of testing needs."

To counter these time constraints, the DOE encourages districts to incorporate their health lessons into literacy blocks, such as bringing up health statistics in math class or teaching children how to read from passages concerning health issues.

As one DOE employee explains, "[H]ealth has always been second rate because the pressure is on for improved reading scores. In fact, in some schools that is all they prepare for." He continues, "The selling point for health programs is 'health literacy' - it links health content to other academic skills." This approach currently receives neither coordinated oversight by the districts nor any assessment by the City.

FINDING #2 - 70% OF DISTRICTS INACCURATELY DESCRIBE ONE OR MORE OF THE HEALTH EDUCATION MANDATES

Poor communication between the district health coordinators and DOE personnel about what is actually mandated compounds this health education crisis in New York City schools. An astonishing 70% of school districts cannot accurately describe all of the State and City government mandates for health education, and strikingly some are unaware that such mandates even exist.

A veteran district health coordinator expresses her concerns about this gap in information: "This is not a unified discipline. We are all over the place and it is hard to focus in any one area. When I first started, it was really hard to find someone at the top to explain to me how things worked." Other administrators do not even seem to be aware of their lack of knowledge. As one administrator states, "[T]here are no mandates. Health ed is based on budget constraints and up to each principal's discretion."

A handful of districts do not have the required health coordinator position and charge alternative administrators to oversee the instruction. However, most of the alternative or temporary appointments are either severely under-qualified or under-trained for the position. One such appointee states, "[T]here is no health education required on the elementary level . . . but, I don't know for sure." This temporary health administrator continues, "Schools may be [required] to have a certified health teacher, but I am unsure of what the credentials are." Sadly, there is no one else in this district to fill in the holes in the appointee's knowledge.

FINDING #3 - 70% OF DISTRICTS DO NOT ACTIVELY OVERSEE HEALTH INSTRUCTION IN INDIVIDUAL SCHOOLS

We discovered a shocking 70% of districts do not actively monitor health instruction, but instead merely rely upon principals to track compliance at their discretion. This deficiency in district level oversight highlights the overwhelming lack of incentives in place to motivate schools to comply with health requirements. Perhaps one coordinator states the realities faced by districts best in observing, "Look, we have over 20 schools in our district. It would be near impossible to know what is going on in each one." Another district coordinator laughs while saying, "I serve a total of five positions on the district level. As an army of one, I am spread so thin that to monitor the schools would be impossible." Without adequate oversight, it is impossible to guarantee that our students receive the health education to which they are entitled.

These problems are hardly unique to New York City. Health program officials across the country have difficulty verifying the instruction of required health classes, and many administrators and educators are deprived of the support they need to make health a priority for our nation's children. As noted in a recent article in the Journal of School Health, "Except in response to specific crises, administrators and school health advocates receive limited support for programs which, by their very existence, confirm that local children and youth face risks for negative health consequences."³⁸

FINDING #4 - 63% OF DISTRICTS COMPENSATE FOR GAPS IN STATE & CITY MANDATES

Our most encouraging finding is that school districts want to provide effective health education. In fact, 63% of districts report launching their own initiatives to fill the substantial gaps in the State and the City mandates. For instance, some districts and many individual schools adopt health topics and curricula that go well beyond the State and City's requirements. One district health coordinator elects to supplement the HIV/AIDS curriculum by teaching about other commonly-contracted STDs.

Despite the promise of such programs, this discretionary instruction raises several concerns, such as how to confirm that qualified educators are performing this instruction, as well as how to ensure the material is accurate and appropriate for the students. Without a system of oversight and assessment over the instruction afforded to our students, we cannot provide the appropriate assurances for parents and the community at large regarding these issues.

The DOE does provide some extra support for districts in delivering health education to New York City schoolchildren through its collaboration with the New York Academy of Medicine (NYAM). Contingent upon a contract with the City, the NYAM provides comprehensive curricula and teacher training for schools on a voluntary basis.³⁹

Districts also have access to other community resources to assist them in developing more comprehensive health education, such as those provided by Planned Parenthood and other non-profits and community organizations. The CDC and the State Department of Health also provide grants for specialized instruction, a resource that a few New York City school districts have utilized over the years. Districts have also made laudable attempts to increase knowledge of health in their schools by organizing health fairs for students and parents, as well as coordinating workshops presented by outside providers on topics such as violence and drug abuse.

While most of these ad hoc programs are short-lived due to budgetary constraints and personnel turnover, they demonstrate the desperate need of New York City's districts and schools to have more and better health information for their students. In fact, when asked to comment on the sufficiency of the State and City curricula mandates, one district health coordinator states, "I just hope teachers are putting forth the effort to do more than just the mandated curriculum. This is my hope."

Our empirical and anecdotal findings illustrate the utter disarray of health education in New York City public schools. There is no accountability among any person or entity at the State, City or district level regarding the status of health instruction in schools. While the reasons for this neglect vary, ranging from the interference of political and cultural agendas to poor communication between the DOE and the individual districts to insufficient funding for teacher training and health programs in schools, the need for a more comprehensive and accountable health education program is abundantly clear.

The sobering statistics presented in Section I above illustrate that the health of our youth is deteriorating, disadvantaging our children in terms of academic performance, potential earnings, self-image and relationships with others, and risk of disease and death.

Despite these alarming trends, our study shows that public school health education is in shambles. Misinformation and rampant neglect of mandates and laughable oversight - these are the horrific conditions our investigation documents in New York City schools.

Fortunately, there is a solution - the institution of a clear and accountable comprehensive health education program in our schools. By comprehensive health education, we refer to a health curriculum that addresses a wide range of topics, from physical activity and nutrition to substance abuse, STDs, and pregnancy prevention.

A comprehensive health program is an essential investment in our children. It more than pays for itself by reversing the tremendous costs associated with poor health.

Research clearly confirms the efficacy of comprehensive health education in improving youth health status and awareness, as well as bolstering academic performance.

(Please see Appendix C for highlights of this research.)

Nationwide Momentum for Health Education

In 1992, the CDC created a coordinated school health program to promote healthy behaviors. Comprehensive health education is one of eight components of this program.⁴¹ Today, nationwide coalitions are forming to confront the health problems plaguing our youth. New York State must immediately join this campaign to give our youth the healthy start that they need to succeed in life.

Recommendations for Instituting Comprehensive Health Education in New York

To address the deplorable state of health education in New York, we hereby propose a multi-step plan that will strengthen existing mandates and institute a comprehensive health education curriculum in New York's schools. State and City leaders must take immediate and aggressive action on this crucial issue. We should begin by implementing the following:

STEP #1 - CONDUCT A FULL-SCALE EVALUATION OF HEALTH EDUCATION IN NEW YORK PUBLIC SCHOOLS

To successfully reorganize public school health education, the New York City DOE must conduct an official full-scale evaluation of the current status of health instruction in our public schools. Our investigation serves as a necessary first step in understanding this situation at the district level, allowing us to design a number of valuable recommendations for improving the state of existing health education requirements.

The DOE must follow-up on this report with a full-blown study of each public school in this City to obtain a comprehensive picture detailing exactly what is occurring and what is not regarding each area of health education. The DOE must also interview district drug directors to obtain a full picture of what is happening in the districts. An evaluation of this kind is essential for developing a complete set of recommendations for revamping New York's health education program that fully addresses the weaknesses in the current system.

STEP #2 - DESIGN CUTTING-EDGE CURRICULA

While the DOE is currently assessing the accuracy and relevancy of topics taught as part of the FL/SE curriculum, we must go beyond these efforts to create a comprehensive program that integrates a full range of cutting-edge health topics. Chancellor Klein must update the HIV/AIDS curriculum, and must design a comprehensive curriculum based on new trends and data constantly emerging in the health education field. It is dangerous to use decades-old health education materials in the New York City school system.

Health experts recommend numerous innovations that are pivotal to developing a comprehensive health curriculum in New York. Two particularly promising recent trends include skills-based health and comprehensive sex education:

Skills-based health - Skills-based health emphasizes the development of skills, such as decision-making and goal setting, over a simple presentation of materials. As a CDC official notes, an optimal health education curriculum "must push past cognitive approach (memorizing facts) to skills-based learning, which promotes behavior change." New York State is currently revisiting its health standards to incorporate skills-based learning and should expedite this effort.

Comprehensive sex education curriculum - Growing numbers of educators, academics, parents and advocacy groups support a comprehensive sex education curriculum to help youth think critically about the consequences before engaging in sex. Polls indicate that voters strongly support comprehensive sex education on issues ranging from contraception to decision-making skills.⁴²

STEP #3 - PROVIDE ADEQUATE FUNDING

The State must give schools a fighting chance to teach health to New York's youth by providing adequate funding for comprehensive health education. To date, the State and City rules imposing the FL/SE and HIV/AIDS curricula are not accompanied by sufficient funds to hire and train teachers, to purchase necessary materials, or to conduct effective oversight and evaluation.

A coalition led by Family Planning Advocates and Planned Parenthood of America is already advocating Assembly Health Chair Richard Gottfried's bill (A.8599) to earmark funding for an age-appropriate and medically-accurate sex education curriculum in New York City public schools. This legislation would also provide monies for rigorous evaluations to identify effective sex education programs. The State must extend this effort to encompass a full range of health concerns.

New York State has recently obtained a grant from the CDC (Capacity Building B Funding 2003-2008) to improve current health education mandates.⁴³ We must continue to find similar sources of funding to implement a full-scale comprehensive health education program in New York.

STEP #4 - ENHANCE TEACHER TRAINING

It is outrageous that almost 63% of New York City's school districts lack sufficiently-trained staff to teach the mandated health curriculum. In our interviews, officials repeatedly expressed a desire for consistent and current training for teachers on health topics relevant to New York City youth.

New York State and City should increase the health education training requirement for students to graduate from teachers' colleges. The government must also collaborate with institutions of higher education to enhance training for potential health education teachers.

STEP #5 - INSTITUTE REGIONAL IMPLEMENTATION PANELS

Adequate implementation of comprehensive health education requires oversight conducted by a lasting partnership between local organizations with knowledge of different pieces of the health curriculum. Unfortunately, our investigation, along with nationwide studies such as the School Health Policies and Programs Study, show that such collaborations rarely exist at a local level.⁴⁴

The designation of ten regional health coordinators (one for each region) has been one of Chancellor Klein's only acknowledgements of health education during his reform efforts. Since 32 district health coordinators failed so dramatically to ensure compliance with the limited mandates currently in effect, it is difficult to see how the reorganization will be helpful rather than harmful to monitoring comprehensive health education in New York City.

The City must support and fund robust panels of informed community members, such as parent and student representatives, to work with the ten regional health coordinators in overseeing health education curriculum in City schools.⁴⁵ This structure will contain the necessary expertise and will facilitate greater levels of parental and community involvement in comprehensive health education. Such panels will also remedy the current separation of oversight in New York City regarding the different areas of health education, such as HIV/AIDS, sex education, alcohol and substance abuse and physical education.

For far too long, the pendulum of health education in New York has swung between ideological grandstanding and political squabbling over highly-charged topics, such as condom distribution or the Rainbow Curriculum, and complete abandonment or neglect in between cultural skirmishes. These failures by adults have deprived our children of the basic, well-rounded health education they need to live healthy and productive lives.

While proficiency in reading and math skills is certainly important, good health is the one indispensable ingredient for a successful life. This report documents our children's need for a school-based comprehensive health education to survive and thrive, an opportunity currently being denied to them.

State and City education officials must not hesitate, waiver or become distracted in meeting the health needs so critical for the survival of New York's students. If we fail to act, given the portrait painted here, we will only have ourselves to blame for the continued incidences and rising costs of childhood obesity, substance abuse, teenage pregnancy, depression, and death from suicide, AIDS, or violence. Our education leaders must bring our system back to life and take the first, essential step to give our children the gift of good health.

[Note: Because our investigation did not focus on alcohol and substance abuse, this appendix does not summarize State and City mandates on this topic.]

New York requires no full-scale, comprehensive health curriculum in its schools. For grades K-8, New York State mandates HIV/AIDS education, and it details general health education standards for schools. The State allows local school boards to revise and submit alternative HIV/AIDS curricula for approval by the State. The DOE created three different HIV/AIDS curricula from which the districts can choose, and it allows individual districts to make changes contingent upon DOE approval. State regulations mandate that local school boards provide HIV/AIDS curriculum materials and training for the instructors.

New York City goes a little further than New York State by mandating FL/SE education, but this program falls far short of a full-scale health curriculum designed to address the broad range of health problems among New York City's youth today. Furthermore, New York State and New York City provide limited oversight of program implementation, a particularly troubling omission given the historical difficulties of New York schools in delivering health education to their students.

Please see the tables below for more details on the current New York State and City mandates for public school health education, grades K-8.

Research clearly confirms the efficacy of comprehensive health education in improving youth health status and awareness and bolstering academic performance. Highlights of this research include:

Health Status and Awareness-

• A recent evaluation of Teenage Health Teaching Modules, a comprehensive school health curriculum for grades 6 to 12 developed by the nationally-renowned Education Development Center, found that the program produces significant improvements in students' health knowledge, attitudes and behaviors.⁵⁰
• Comprehensive sex education helps youth think more critically about engaging in sex and preventing unwanted pregnancy and STDs, thereby combating one of the key precursors of risky sexual behavior among youth.⁵¹ For example, a study recently published in the American Journal of Public Health and a 2001 report by The National Campaign to Prevent Teen Pregnancy both find that providing students with free condoms results in greater protection during sexual intercourse without resulting in more episodes of sexual encounters.⁵²
• According to the CDC, recent evaluations of health education programs substantiate the effectiveness of health education in preventing obesity among middle school girls participating in such programs.⁵³

Academic Performance-

• A CDC-collaborated School Health Education Evaluation of 20 states reports that "children exposed to health education show increased knowledge, healthier attitudes, and better health skills and practices than those who do not receive health education."⁵⁴
• Increased physical activity is clearly linked with a range of positive attitudes, behaviors and outcomes for youth. For example, more active students tend to engage in other healthy behaviors, focus better in school, create healthy relationships and feel better about themselves. A recent study ties school-based physical activity programs to improved test scores, enhanced concentration levels and less disruptive behavior.⁵⁵
• Students participating in school breakfast and lunch programs geared toward good nutrition are able to attend school and participate in class more frequently, and they exhibit enhanced levels of academic achievement and emotional stability.⁵⁶