HealthTeacher

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Standard 2 - Analyzing Internal and External Influences

Analyzing influences means knowing what influences you and how your are influenced when you make certain health choices. A student demonstrates appropriate application of this skill when he / she can show different ways that health choices are affected, including internal feelings and external things that influence health choices, and that he / she has considered why different things affect health choices. Some examples of activities that help to build this skill include re-working an advertisement, doing a skit on peer pressure, re-writing a tale that helps explain influences. (from: Assessing Health Literacy: A Guide to Portfolios).

Influences on Decisions

The skill category of Analyzing Internal and External Influences helps develop students' ability to analyze the influence of internal and external elements on health behavior. Unfortunately, many young people do not recognize the role internal and external factors play in their decisions regarding personal, family and community health. These decisions are more likely to result in risky behavior. Students must learn to appreciate the complexity of these influences and be able to determine how these factors can positively or negatively affect health decisions.

There are two major types of influences-internal and external.

Internal Influences:

knowledge/factual information/what I know
curiosity
interests, likes/dislikes
desires (to feel accepted, loved, powerful, competent, etc.)
fears

External Influences:

media/advertising
legal restrictions (speed limit, drinking age laws, driver's license, no smoking signs)
setting/location
culture
parents/family/relatives
peers/friends/other teens
role models outside the family (celebrities, athletes, singers, leaders)

Media Literacy

Media literacy is defined as the ability to access, analyze, evaluate, and communicate information in a variety of formats including print and non-print. It is an expanded information and communication skill that is responsive to the changing nature of information in our society. It addresses the skills students need to be taught in school, the competencies citizens must have as we consume information in our homes and living rooms, the abilities workers must have as we move toward the 21st century and the challenges of a global economy. (Appalachian State University)

Standard 3 - Accessing Information

Accessing information is a basic skill. It means knowing how to find correct information about health and knowing how to choose a health-related product or service. A student demonstrates appropriate application of this skill when he / she identifies the information source and can defend it as a reliable way to get correct information; uses a variety of sources and shows them to be reliable, and when the student demonstrates knowing where to go to get help to solve problems. Some examples of activities that help to build this skill include research projects, surveys, and reports. (from: Assessing Health Literacy: A Guide to Portfolios).

Identifying Valid Sources for Information

To make wise decisions about health, students must be able to access valid sources of information-sources that will provide accurate information about health and health-promoting products and services. Students may have had practice in evaluating printed sources of information, where publication dates, authors and place of publication are clearly listed. However, the vastness and accessibility of the Internet requires some additional criteria. Anyone can post anything on the Net, so the ability to access information and evaluate sources becomes even more critical.

Internet Information

The URL, or address, of a Website provides some information about the host of the site. Commercial organizations have URLs that end in ".com." Community organizations, such as the American Heart Association and the American Cancer Society, usually have URLs that end in ".org." The URLs for government agencies end in ".gov," and the URLs for educational organizations, such as colleges, end in ".edu."

These designations can provide an initial clue to the value of the site. Commercial sites are usually trying to sell a product. Depending on the product they're selling, they may or may not be trustworthy. For example, sites hosted by tobacco companies are unlikely to provide the real truth about tobacco. If the site is hosted by an organization, what is the organization's purpose? Sources such as the Encyclopedia of Associations (which can be found in the library) may provide more information about the organization that sponsors a Website.

The dates the site was created and revised offer clues about how current the information is likely to be. If no dates are posted, clicking on any listed links may indicate how current the site is. If the links have expired, the site probably has not been updated in a while. Up-to-date information may not be important for all research. For example, current information is important when researching new tobacco laws, but less crucial to a report on the history of tobacco use.

Information about the author of the content of the site also provides clues about the validity of the information. Do the author's credentials suggest that he or she is qualified to provide information on the topic? Does the Website include contact information for the author? If not, you may be able to contact the Webmaster by e-mail to check the author's credentials. If an author or Webmaster is not listed, look for another site for information. Knowing who is providing the information is a vital component in evaluating its validity.

Standard 4 - Interpersonal Communication

Interpersonal communication "means showing appropriate ways to exchange your ideas and needs." A student demonstrates appropriate application of this skill when he / she can do a good job of presenting both sides of an issue, showing how both sides feel and interact, showing respect, using appropriate language, not using "put downs", and using strategies such as "I messages" and refusal techniques. Some examples of activities that help to build this skill includes role plays, dialog, and puppet shows. (from: Assessing Health Literacy: A Guide to Portfolios).

Interpersonal Communication Primer
Most people want to be understood and accepted more than anything else in the world. Knowing this is the first step toward good communication. Good communication has two basic components:

You listen to and acknowledge other people's thoughts and feelings: Rather than showing that you only care about broadcasting your feelings and insisting that others agree with you, you encourage others to express what they are thinking and feeling. You listen and try to understand.
You express your own thoughts and feelings openly and directly: If you only listen to what other people are thinking or feeling and you don't express your own thoughts or feelings, you end up feeling shortchanged or "dumped on."

To communicate effectively, practice using these interpersonal communication skills.

I-statements help you express the way you feel and what you want with great clarity. Sometimes people use "you" statements, such as "You never call when you are going to be late." This type of statement can make others feel angry and defensive immediately. When you use I-statements, such as, "I really need to know when you're going to be here so I can make plans," you express the concern in terms of you.
A respectful tone of voice conveys that you are taking others seriously and that you also expect to be taken seriously. In addition, people with good communication skills are assertive without being aggressive or manipulative.
Eye contact is vital for good communication. For example, how would you feel if the person you were talking to kept looking around the hallway or out the window?
Appropriate body language encourages conversation. Nodding your head, smiling, laughing, using words such as "uh-huh" and "yeah" and asking questions at appropriate times assure the person that you are really listening.
Clear, organized ideas help you accurately and honestly describe your feelings and contribute to conversations and to decisions that need to be made. Good communicators are also specific. For example, a good communicator would say, "I need to use the computer from 7-9," as opposed to "I'll need the computer tonight."

Refusal Techniques

Saying No!
Skill Practice
Young people may find themselves in a variety of pressure situations, so no single refusal strategy can be adequate for safeguarding their health. Students must be equipped with a repertoire of strategies to choose from, depending on the setting. Effective skill practice has the following components:

1. Introduce the skill.
2. Present steps for developing the skill (if applicable).
3. Model the skill correctly.
4. Allow learners to practice and rehearse the skill.
5. Provide feedback and reinforcement.

Ways to Say No

1. Say no firmly.
When you are asked or pressured to do something you don't want to do, say no firmly and convincingly. Sometimes it's best to say no and physically turn away.

2. Repeat the word no over and over.
If teased or called a name, don't counter with your own "put downs"; just continue to repeat the word no. Usually, the other person eventually gets tired and leaves.

3. Give an excuse (an honest one).
Examples:

I tried it once, and when I got home, my folks could smell smoke on my clothes, and I was grounded for a week.
I tried smoking a couple of times and always got sick. The doctor said I'm probably allergic to tobacco smoke.
I gotta go home and babysit my kid sister.
I've got a cold sore in my mouth, and everything hurts.

4. Give reasons.
Similar to the "Give an excuse" refusal strategy, this technique stresses the use of a rationale to explain why one is not participating in a certain behavior. Knowing the facts about tobacco can help. Examples:

Tobacco would be one more thing to worry about. Besides, I need the money for other things.
Diabetes runs in my family, so I don't want to risk my health with nicotine.
My dad just quit smoking, so he could smell cigarette smoke on me a mile away.

5. Avoid or leave the situation.
When in an unfamiliar setting such as a party, scan the room to see what different people are doing. Many times the tobacco users hang out by themselves. Avoid these people while looking for those who share your values to talk to. If you find yourself getting pressured or just feel uncomfortable with what is going on around you, say that you have to meet someone (or will be back later) and then leave immediately.

6. Change the subject.
If the conversation begins to drift to the topic of drug use, subtly change the subject. Example:
"Hey, let me tell you how wasted I got last week."
"Speaking of wasted, did you see how Stone Cold Steve Austin "wasted" the Undertaker on WWF last night?"

7. Suggest an alternative activity.
Invite your friends to do something else, which leaves the door to the friendship open. Examples:

I'm going to my house to play Nintendo, want to come?
No thanks, Dude, let's go to the video arcade.
I'm starving; I want to get a taco. Who wants to go with me?

8. Ignore the problem/act dumb.
Remind students of the tone of voice they employ when they try to convince you that they just can't remember that you said they were going to have a quiz today.
Examples:

Huh?
Yeah, right?
Say what?
Duh, I don't know what you're talking about.

9. Find friends who feel the same way you do.
There really is safety in numbers, especially if the "numbers" (your friends) share your beliefs and values about not smoking or not using drugs. For example, at a party, you and your friends can watch out for each other. If pressured to use a drug by someone, you could turn to your friends and say, "Do the rest of you go along with this?" or "Are they crazy or what?"

10. Reverse the pressure.
Shift the focus away from the tobacco and onto your friendship. People who are really your friend will usually back off at this point. If friends keep pressuring you, rather than argue with them, simply say, "Why are you hassling me on this?" or "Why are you on my case so much today?" People who are really your friends will usually back off at this point. This skill is effective only if a friendship already exists. A person who doesn't really care for the other isn't going to be put off by these questions.

Another version of this if the Fairness Argument. For example, you could say, "Look, I'm not telling you not to smoke, so why are you telling me I have to smoke?" or "I'm not telling you what to do with your life, so why are you trying to tell me what to do with mine?"

11. Delay your decision.
If you're being pressured, this skill buys you time and temporarily, at least, gets you off the hook. Responses include: In a minute; catch me later; not yet.
Another version is to combine this strategy with Number 6, Change the Subject. For example, you could say, "Not now, I'm getting ready to dance/talk to, check out that person over there."

Be aware that using this strategy may give the impression that you are a person who sometimes uses tobacco. If you want to get the word out that you are tobacco free, this strategy may send mixed messages. It may be more appropriate to use when you are with a group of people you don't expect to see again.

12. Tell your friends, "I have made a decision."
The best decision for your health is to be tobacco free. If you're clear about your decision, your friends may stop pressuring you.

Web-Links

Resisting Peer Pressure. DHHS.

"I" Statements/ Assertiveness Skills

Communication Styles
Without adequate communication skills, adolescents may be unable to release their feelings. This lack of communication can increase stress and lower self-esteem.
There are three styles of communication:

passive
assertive
aggressive

Passive communication involves the inability or unwillingness to express thoughts and feelings. Passive people will do something they don't want to do or make up an excuse rather than say how they feel.

Assertive behavior involves standing up for oneself. Assertive people will say what they think and stand up for their beliefs without hurting others.
The aggressive style of communication involves overreaction, blaming and criticizing. Aggressive people try to get their way through bullying, intimidating or even physical violence. They do not or will not consider the rights of others.

Types of Messages
There are two types of messages that accompany each style of communication: nonverbal and verbal. Signs, symbols, posture, body movements, dress, facial expressions and gestures are examples of nonverbal messages. The nonverbal messages reinforce what the speaker is saying. For example, passive communicators often have slumped posture and a lack of eye contact. Assertive people exhibit erect posture and direct eye contact. Forward-leaning posture, pointing and a glaring look are nonverbal signals of aggressive communication.

The verbal messages for each communication style are very different. People who are passive will often ask questions to determine what others want, or they may say, "I don't care." Assertive communicators use I-messages to say what they want or need. They use refusal skills to say no while maintaining important relationships. People who are aggressive often use you-statements to blame or criticize.

Components of Assertive Communication
The components of verbal messages for assertive communication include I-messages and refusals. I-messages state what the sender thinks, feels, needs, wants or believes. They begin with the word I.

Examples of I-messages:

I want to see Star Wars.
I feel angry about the game.

There are a variety of refusal strategies, including:

Say the word no firmly.
Repeat no (if needed).
Let the other person know you want to stay friends.

Examples of refusals:

No, I can't sleep over on Friday, but I would like to another time.
No, thanks. I'm allergic to peanuts. The cookies look really delicious, and I'm sorry I can't have one.

Assertiveness Skills

What is the difference between assertiveness (confrontation) and aggressiveness?
Assertiveness, or confrontation, means taking the initiative or first steps to deal with a problem in a constructive, self-protective manner. Assertiveness attacks the problem, not the person.

Aggressiveness attacks the other person rather than the problem. It is a destructive desire to dominate another person or to force a position or viewpoint on another person; it starts fights or quarrels.

When do you use assertiveness skills?
These skills can be used when another's behavior is not acceptable or when continued "listening and accepting" isn't appropriate. People often avoid confronting others about their behavior because they don't want to hurt the relationship. However, avoiding problems may cause bad feelings to build and may result in an explosion or withdrawal from the relationship. Using I-messages to be assertive is constructive, rather than destructive. It helps people deal with problem behavior in a way that allows the other person to agree to change while not damaging the relationship.

How do you use this skill?
The goal is to get other people to change their behavior without putting them down or making them feel badly toward you. You may like the person; it's a particular behavior of the person that you don't like. Your purpose is to address the behavior, not to "dress down" the person.

The Importance of I-messages
I-messages are designed to deal with problems. The purpose of an I-message is to express your needs. It expresses the attitude "I am not going to give up my needs and I'm willing to help you meet your needs," creating a win-win situation.
I-messages attempt to deal with the problem situation by talking about it in terms of what is happening to me-I've got a problem. An I-message is disarming. It's hard for someone to say something nasty in response to a good I-message. On the other hand, a "you" message blames others and puts them on the defensive. Then they want to retaliate, to get even.

Steps in Using I-Messages
There are three parts to delivering an I-message, although sometimes not all three parts are used.

A description of the behavior. What is it the other person is doing that gives you a problem? You are describing something to the other person, not blaming her or him for something. I-messages tell others that their behavior is interfering with something you need (not just something that you want). Give the other person a clear idea of what he has done without extra blame or guilt added.

A description of the feeling this behavior causes you. How does what the other person is doing affect you?

A description of the effects produced by the behavior. What concrete problem is the behavior causing you? If you can help other people see how their behavior affects you, then they are more likely to change the behavior.

Examples
Mother to teenage son:

"You" message: You just tracked mud all over my clean floor! I just mopped that floor! You are such a slob.
I-message: When I see mud tracked into my clean kitchen, I get irritated, because I have to clean it up again.

Description of Behavior	Description of Feeling	Description of Effects
What's the behavior that bothers you?	What are you feeling as a result of this behavior?	How does this behavior affect you?
Mud tracked on the clean floor	Irritated	I have to do more work

One friend to another:

"You" message: You don't care about anyone but your own fat self!
I-message: I feel hurt when you only call me to come over to visit when none of your other friends are available. I get left out.

Description of Behavior	Description of Feeling	Description of Effects
What's the behavior that bothers you?	What are you feeling as a result of this behavior?	How does this behavior affect you?
You only call me when you don't have anyone else to visit	Hurt	Left out of things

Dad yelling at child.

"You" message: You're late again! I told you to be home by 9:00 and it's 10:00. You have no consideration at all and care for no one but yourself."
I-message: When you come home late, I get really upset because I worry that something bad has happened to you.

Description of Behavior	Description of Feeling	Description of Effects
What's the behavior that bothers you?	What are you feeling as a result of this behavior?	How does this behavior affect you?
Coming home late	Upset	Worried that something bad has happened

Hints for Successful I-messages

Be specific in describing the problem behavior
Make eye contact
Use a respectful tone of voice, not an aggressive or confrontational tone
Be aware of what your body language is saying-that it is reinforcing what your words say.

When an I-message Doesn't Work
If an I-message isn't working, it may be a lousy message. Yes, the words may be OK, but the tone may be full of blame or rage or disrespect. Pay attention to the non-verbal message. Is your face red; are your eyes bulging; are you yelling to the top of your voice? Or are you cool, calm and collected?

There is little to be gained by sending an anger message. Try to stop and think about why you are so angry. You will likely find other feelings underneath the anger: frustration, embarrassment, rejection, fear, hurt and loneliness.

Sometimes, an I-message may not work if the other person has a strong need to continue her or his behavior. If the other person is upset and out of control, shift gears. Try active listening, change the environment, or let him or her blow off steam.

I-messages also may not work if the other person doesn't agree that the "effect" on you is a real problem. This is a values collision, which occurs often in families.

If there is a conflict of needs, an I-message won't be enough. You'll need to give up on the I-message and work out the conflict with some other techniques.

Standard 5 - Decision Making

Development of decision-making skills is needed by students to help them make health-enhancing choices, to choose behaviors that promote health and reduce the risk of illness and injury. These skills include the recognition of need and understanding of how to make a decision. Decision-making skills are needed to improve health status in each of the ten content areas.

Decision-making "means showing steps in a process to make a decision.” Students demonstrate appropriate application of this skill when they can show the steps of making a good decision, can demonstrate that alternative actions were considered and that they considered whether or not they were making a good decision. An activity that can help build this skill includes role-playing scenarios using the decision-making process. (from: Assessing Health Literacy: A Guide to Portfolios).

Decision Making

Decision making involves choosing between alternative courses of action to deal with a problem. Steps in the decision-making process:

1. Analyze the situation. Define what is happening. Get input from others. Be objective rather than emotional.

2. Define the problem. Don't deal with symptoms, but focus on the actual problem.

3. Consider options / Develop solution alternatives. Each alternative must solve the problem.

4. Evaluate the solution alternatives. Look at both the positive and the negative consequences of each alternative. Some alternatives will have fewer "side effects", or unintended consequences. Get input from others if needed.

5. Make a choice / decision. Make the choice that has the least negative consequences and that solves the problem, accomplishes the purpose, and meets the goal.

6. Implement the plan and evaluate the decision. Make changes in the plan if needed, again using the steps of the decision-making process.

Web-Links

Provides a "Conflict Resolution Kit" containing twelve skills. Skills 8 and 9 apply to this area.

Teaching Decision Making

Many students are not accustomed to breaking down the decision making process. To make this process relevant, remind students that decision making and problem solving are things they do several times a day.

Some students may resist employing a structured decision-making process, because they think it takes too much time or is too "mechanical" and does not allow spontaneity. For most minor decisions, a formal decision-making process is not necessary. However, using a decision-making model in complex situations can help people avoid serious negative consequences. Becoming a good decision-maker doesn't mean people lose the ability to have fun or to do things "on a whim." Rather, it means they look before they leap and are fully aware of their options.

There are many types of decision-making/problem-solving models, and they are all more alike than different. If students have already been exposed to decision-making or problem-solving models, this one is similar and contains the same important ideas. These models provide only a framework for making decisions. It is appropriate at times to skip certain steps or to compress others. Steps may vary slightly at different grade levels.

§ Step One: Define the problem to be solved. This includes thinking about the facts of the situation as well as the feelings of people directly involved.

§ Step Two: Generate at least three options or alternative courses of action. We often feel stressed about major decisions because we are only thinking of two solutions. In fact, there may be ten ways to solve that problem effectively. This is why it is so important to spend some time gathering information related to the problem.

§ Step Three: Think about the positive and negative consequences of each option. This may include answering questions such as: What are my responsibilities to my parents? What are my feelings and fears about each option? In addition to the positive and negative consequences of decisions, we often have to consider the questions of short-term and long-term consequences. For example: If Sam saw his buddy purchase steroids from a high school student, Sam might decide not to confront his friend. Sam might believe that this is a positive consequence, because he did not jeopardize the friendship. However, this is a short-term positive consequence, and Sam might not feel positive about his decision later.

§ Step Four: List others affected by these options and describe any feelings, emotions, or values that may be in conflict with the options you have named. This step allows time to think about the other "key players" involved. Major decisions usually involve others in a meaningful way.

§ Step Five: After weighing all the options, choose the best one.

§ Step Six: Design a plan of action to carry out this decision. For example: Sam has chosen a drug free lifestyle, but still wants to hang out with his friends. There is a party in his neighborhood next week. Sam should get as much information about the upcoming party as possible, so he could have fun and be safe. Knowing drugs might be there, he could plan to practice refusal skills and also plan to have several drug-free friends meet him at the party.

§ Step Seven: Evaluate your decision. How did it work out? Were there any consequences you had not thought about before? What would you do differently next time?

Problem-Solving/Conflict Resolution

Problem solving is the process of determining a discrepancy between how things are and how they are desired to be and then taking action to resolve this discrepancy. There are three primary conflict resolution problem-solving processes:

§ Negotiation

§ Mediation

§ Consensus Decision Making

Each of these processes has similar characteristics, including:

§ Parties identify their own needs and interests.

§ Parties work cooperatively to find solutions to meet those needs and interests.

§ Parties stay focused on the problem.

§ Parties work cooperatively to find a mutually acceptable solution.

Each problem-solving process has similar steps:

§ Agree that you disagree (agree to negotiate; set the stage).

§ Take turns talking (gather perspectives/identify interests).

§ Restate what you think you heard (explain the other's viewpoint).

§ Come up with a solution that works for both parties (create and evaluate options/generate agreement).

Negotiation

Negotiation is a problem-solving process in which there are face to face efforts by those involved to resolve the dispute or problem. Representatives of those involved may also meet face to face to negotiate on behalf of the disputing parties.

Steps in Negotiation

1. Agree that you disagree and you will try to negotiate.

2. Take turns talking; look at things from the viewpoint of the other party.

3. Describe what you want, how you feel, and the reasons for your wants and feelings.

4. Take the other person's point of view and then summarize your understanding of what he or she wants and feels and the reasons for his or her wants and feelings.

5. Think of several ways to solve the conflict in a way that works for both parties (create win-win options).

6. Choose the best way and make an agreement to do it.

7. Get outside help if unable to resolve the conflict.

Mediation

Mediation is a problem-solving process in which the two parties in the dispute are assisted by a neutral third party known as the "mediator". Face to face meetings of the parties involved, or their representatives, occur during the mediation process.

Consensus Decision Making

Consensus decision making is a group problem-solving process in which all of the parties in the dispute, or representatives of each party, work together to resolve the dispute. A plan of action is created that all parties can and will support. Consensus decision making may or may not be facilitated by a neutral party.