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Health Education (HE) and Physical Education (PE)'''

1.0 Introduction'''

Physical and health education form critical components of today’s high school curriculum, whereby learners are expected to excel in the areas as much as they do in other aspects of learning. The combined PE and HE curriculum seeks to address five main health risks for young learners, including unhealthy dietary habits, physical inactivity, drug and substance use and abuse, irresponsible sexual behavior, and risky behaviors that may lead to bodily injuries. The curriculum aims to equip learners with balanced and planned programs to develop the capabilities, attitudes, skills, and knowledge crucial for maintaining healthy and physically active lifestyles. The underlying principle behind the curriculum is that PE and HE learning activities help learners make informed decisions regarding their physical, emotional, and social well-being, experience challenge and fun, experience positive impacts of physical activity and healthy living, and successfully transition into higher education or career. In this context, Health and physical education and general education share similar characteristics, including helping learners adapt to the changing needs of the highly evolving world and preparing them for lifelong learning and careers.

Ensuring learners understand the relationship between nutrition, physical activity, and lifestyle diseases is one of the major goals of the physical and health education curriculum. It seeks to address the increase of costly and life-threatening lifestyle diseases by teaching learners measures through which they can leverage nutrition and physical activity to lead a healthier lifestyle free from chronic illnesses. These include obesity, which also contributes to other related conditions such as type 2 diabetes, stroke, heart disease, and cancers of the pancreas, colorectal, and kidney. In the United States, obesity prevalence has increased significantly for all population needs over the past two decades, particularly rising from 30.5% in 1999 to 41.9% in 2017 (CDC, 2022). Presently, about 42% and 30.7% of American adults are estimated to be obese and overweight, respectively, which translates to about two-thirds of the total U.S. population (CDC, 2022). Statistics also indicate that adults aged between 40 and 59 years are at a higher risk of obesity, with 44% of adults within the age bracket being obese (CDC, 2022). The disease also affects about 41.5% of adults above 60 years and 39.8% between 20 and 39 years (NIIDK, 2021). Moreover, the prevalence in children has also increased, with recent reports indicating that approximately 14.7 million children (20%) of children aged between 2 and 19 years in the U.S. are obese (NIIDK, 2021). As a result, the annual medical cost of managing the condition in the U.S. has risen significantly, estimated at $173 billion in 2019 (CDC, 2022).

Moreover, the curriculum seeks to equip children and adolescents with the knowledge and skills to manage mental health issues. According to Hines et al. (2020), mental health and substance abuse are interconnected concepts, whereby issues such as trauma and mental disorders are critical predictors of substance use and abuse later in life. Mental health disorders pose a significant problem among adolescents in the U.S., whereby at least one out of five children aged between 9 and 17 years presently is suffering from a diagnosable mental problem (Tkacz & Brady, 2021). Common illnesses within the age group include depression, eating disorders, and mood, anxiety, and attention disorders. In 2021, one out of five adolescents was diagnosed with a major depressive episode (MDE) (Hhs.gov, 2023). Currently, suicide is ranked as the second leading cause of death among adolescents and young adults between the ages of 15 and 24 years (Spiller et al., 2019).

On the other hand, drug use and substance abuse in the U.S. have increased over the years, with studies conducted in 2020 indicating that about 21.9% (61.2 million people) of the population from the age of 12 years consumed illicit drugs within the year. Marijuana was the most commonly used drug within the stated population (52.5 million people), while about 9.2 million abused opioids. A study by the National Center for Drug Abuse Statistics (2023) also indicates that approximately 47% of young people in the U.S. consume an illegal drug or substance before graduating from high school.

Understanding the fundamental concepts of nutrition and mental health through PE and HE is critical in enhancing overall health among adolescents. Notably, the subjects equip learners with the critical knowledge required to prevent lifestyle problems such as obesity and drug abuse by making intelligent decisions regarding their health. For instance, it empowers them to recognize physical activity as a crucial weight and stress management tool. It also exposes them to the leading risk factors for problems such as addiction and obesity-related conditions such as type 2 diabetes in adulthood. It guides them to make better lifestyle choices at an early age.

Additionally, they obtain essential knowledge that prepares them for future careers and higher education. Particularly, PE and HE prepare learners for careers as athletic coaches, personal fitness trainers, kinesiologists, physical education teachers, health educators, nutritionists, and sports managers. In this context, schools are increasingly emphasizing the importance of health and physical education, particularly in response to the rising cases of mental health problems, drug abuse, and lifestyle diseases. Notably, more high schools require learners to score more than one credit for PE and HE to qualify for graduation, a trend that has attracted extensive debates and scrutiny in recent years. Based on this background information, this capstone project aims to answer the question, ‘Should high schools require more than one credit for Health Education (HE) and Physical Education (PE)?’

2.0 Research Strategies

The project takes a qualitative approach to establish the importance of physical and health education and make recommendations on whether high schools should demand learners to attain more credits to qualify for graduation. The strategy comprises an extensive literature review, particularly focusing on the identified benefits of HE and PE among children and adolescents. The review also examines the impact of physical and health education in high school on mental wellness and disease prevention in adulthood. Notably, the researcher uses a wide range of sources to gather crucial insights regarding the benefits of PE and HE, including peer-reviewed journals, academic papers, and reports from recognized institutions such as the CDC.

The project also critically analyzes the information presented in the reviewed academic sources to identify trends in physical and health education requirements and their connection to mental health and nutrition. Notably, the analysis seeks to determine whether credit requirements motivate learners to focus more on gaining the identified benefits of PE and HE. Particularly, the analysis focuses on establishing the relationship between physical and health education credits and improved academic performance, long-term well-being measured by factors such as weight loss and higher interest in physical activity, and better mental and physical health outcomes. The analysis also incorporates a comparative approach to evaluate the impact of HE and PE on learner’s academic and health outcomes. Particularly, the comparative analysis compares PE and HE credit requirements in high schools from different regions and examines how health and academic outcomes differ. Comparing the different requirements is crucial to determining whether institutions should require more credits or not, whereby lower attainment of the intended goals demonstrates a need to require more credits and vice versa. On the other hand, higher goal attainment could indicate that schools need to demand higher credits to ensure that learners incorporate healthy habits into their lifestyles. Finally, the discussion and conclusion part provides a summary of the study findings and presents comprehensive recommendations based on the facts obtained from the literature review, as well as data and comparative analysis. These recommendations seek to give insight into the best practices for HE and PE in high schools, including the most effective requirements to promote healthy behavior in the form of mindful eating and exercising.

3.0 A Review of the Literature

A critical analysis of past studies on health and physical education forms a crucial part of this project. Notably, the review primarily aims at examining past knowledge to gain insight into how the PE and HE curriculum contributes towards achieving improved outcomes in the management of chronic illness and mental health. 3.1 Significance of Health Education for High School Learners

Learners in high school are at a higher risk of adopting unhealthy behavior that can result in undesirable lifelong consequences, including drug addiction, mental disorders, and lifestyle diseases. To a great extent, they face these risks because, at the teenage stage, individuals are likely to be influenced by factors such as peer pressure to indulge in habits such as drug use and unhealthy eating. Therefore, the high school health education curriculum is broad, covering topics such as mental health, nutrition intake, physical growth and development, prevention of alcohol and drug abuse, and reproductive health. Given that experiences and behaviors during adolescence form a critical part of preparing for adulthood, particularly in the context of health, health education is a crucial subject in high school. Notably, it presents lasting effects on young learners, specifically by equipping them with skills and knowledge to develop positive attitudes and healthy behavior into adulthood.

Moreover, the World Health Organization (WHO) regards health education as one of the most effective tools for improving wellness in the population. Therefore, delivering effective health education in high school is important in minimizing illnesses since individuals adopt and maintain healthy practices and lifestyles at a young age (DevWaikhom, Singh & Singh, 2020). Based on research, well-designed and implemented school-based health education programs equip learners with functional practice skills and knowledge and strengthen their beliefs and attitudes toward adopting and maintaining lifelong healthy behaviors (DevWaikhom, Singh & Singh, 2020). In this context, nutrition education is one of the most critical aspects of health education since it provides learners with comprehensive knowledge that supports a healthy lifestyle. It mainly covers dietary choices, nutrients, and meal planning and teaches learners to interpret complex food labels. Exposing learners to nutrition concepts at an early age largely shapes a person’s food behaviors and choices into adulthood, including mindful eating practices. Therefore, through nutrition education, learners obtain crucial information to make better dietary decisions throughout their lifetime.

Nutrition education is essential for teenagers since they are at a higher risk of developing chronic illnesses in future. Childhood obesity is one of the leading causes of chronic illnesses such as diabetes in adulthood. Therefore, reversing childhood obesity is a crucial goal for health education in high school. HE focuses on equipping learners with knowledge about the role of nutrition in their overall health and guides them to acquire skills to make healthier food and lifestyle choices. A study by Nga et al. (2019) indicates that nutrition education helps reduce obesity and overweight and ultimately guides learners in reversing childhood obesity through lifestyle changes. These include consuming healthy, balanced meals and remaining actively involved in physical exercises to lose weight. Adapting these changes helps learners to become healthy and more vibrant in the classroom and other school activities. Additionally, the dietary preference for most teenagers typically includes a high consumption of low-nutritional beverages and foods. They also demonstrate low consumption of their recommended daily nutrient-dense foods, including dairy products and vegetables. Instead, their dietary patterns include a higher intake of refined carbohydrates, cholesterol and saturated fats than recommended. These factors increase their consumption of sugar, which is a significant risk factor for obesity and overweight, and other related chronic illnesses. According to Park et al. (2023), the calorie intake from added sugars should be at most 10% of the total daily intake for Americans above the age of two years. However, although there is a significant decline in the added sugar intake among adolescents and children in the U.S., the rate is still significantly high.

Further, Park et al.’s (2023) research study also indicates that about 14% of daily calorie intake for children and adolescents aged between two and nineteen comprised added sugars, with only 35% meeting the set DGA recommendation for added sugar limitation from 2015 to 2016. The group mainly consumed the added sugars from candy, bakery products, and sweetened beverages. Additionally, a survey by the National Health and Nutrition conducted between 2017 and 2018 established that children between the ages of 6 and 11 years consume an average of 17 tablespoons of added sugars daily, while adolescents between 12 and 19 years take about 18 tablespoons every day (Park et al., 2023). The high sugar intake among children and adolescents significantly increases their risk of chronic illnesses, which cause the highest number of deaths in the United States. Reports from the Centers for Disease Control and Prevention indicate that for every ten deaths, chronic diseases such as heart disease, stroke, cancer, hypertension, and diabetes account for one death.

Additionally, managing chronic diseases accounts for 86% of the total healthcare costs in the U.S., with over 140 million Americans living with one or more of these chronic illnesses (Bardhan, Chen & Karahanna, 2020). These statistics demonstrate one of the most significant benefits of nutrition education in high schools. Based on the statistics, health education greatly helps young people achieve healthy outcomes in adulthood by consuming healthy foods and ensuring that they meet the recommended nutrient intake in their daily meals. Further, providing learners with health education at an early age presents other benefits, including helping them to achieve academic success. Moreover, based on their study findings, Pulimeno et al. (2020) have illustrated a positive relationship between nutrition and academic outcomes. Their study observes that consuming foods with the required nutritional value and meeting the recommended daily nutrient intake enhances attention, cognitive function, and boosts learners’ interest in learning. As a result, the high attention spans and attentiveness in the classroom leads to improved grades. In this context, the authors’ attention portrays nutrition education as a valuable tool in enhancing learning and promoting higher academic excellence.

On the other hand, a 2021study by Conner et al. indicates that health education shapes responsible behavior in adolescents by exposing them to the consequences of practices such as drug abuse and underage sex. These irresponsible behaviors often increase the risk of contracting sexually transmitted illness and lifelong conditions such as HIV/AIDS and drug addictions. Additionally, Conner et al. (2021) also describe the habits as key predictors of mental illnesses, including psychosis. Therefore, equipping learners with practical knowledge on how to avoid substance abuse and irresponsible sex plays a critical role in preparing them for healthy adulthood. The knowledge also deters learners indulging in the habits, and provides them with crucial resources to support them in the change process. In most cases, available resources to resolve such issues include counseling psychologists for teenagers and children, pharmacological interventions, and lifestyle changes that often include physical exercises. Therefore, Conner et al.’s (2021) study emphasizes a positive relationship between healthy learners and higher school attainment, noting that abstaining from underage sex and drug use allows higher concentration in the classroom. It also minimizes absenteeism due to associated medical conditions, leading to improved grades and higher graduation rates.

A study by Hines et al. (2020) also illustrates the significant role of health education among young learners, particularly due to its effectiveness in enhancing their mental health. Through health education, teenagers understand the positive cause-effect relationship between drug and substance abuse and mental illnesses. Notably, Hines et al. (2020 conclude that individuals with a history of using drugs in their early years face a high risk of addiction and severe cases of psychosis. Often, these conditions impair a person’s ability to think and make rational decisions, further exposing them to sexually transmitted diseases. In other instances, addicts may indulge in criminal behaviors such as robbery, leading to incarcerations and death. On the other hand, personality traits and mental health problems such as low emotionality and borderline personality disorder often increase a person’s risk of indulging in drug or alcohol use for self-medication. Therefore, educating learners about the relationship between mental health and drug and substance use plays a vital role in enhancing their wellness since it equips them with the knowledge they require to seek professional help. Moreover, based on the findings of Hines et al., health education is an essential tool in deterring criminal activities in adulthood, demonstrating that it can be used to resolve the mass incarceration problem in America today.

3.2 Benefits of Physical Education for High School Students

Physical education forms the foundation of a high school's comprehensive physical activity program. According to Aditya, Pradeep, and Varun (2023), PE presents numerous cognitive development and social, emotional, and mental benefits that prepare learners to practice and lead a healthy lifestyle in adulthood. It is regarded as an academic subject since it follows a clearly defined curriculum on instruction and cognitive content that aims at developing learners' motor skills and the requisite behavior and knowledge for physical fitness and activity. Broadly, physical education focuses on building the confidence and competence of learners to participate in a wide range of activities that enhance their mental health and help them adopt an active lifestyle beyond high school (Opstoel et al., 2020). In the physical context, PE plays a central role in developing learners' motor skills through regular physical activity. These skills are critical in enhancing reflexes and promoting better control of bodily movements. Additionally, it lays a foundation for individuals to live an active lifestyle by pursuing the activities learned and practised in PE for leisure or professional sports in adulthood.

In most cases, individuals pursuing physical education successfully maintain fitness through sports, running, cycling, or gym. One strategy schools can use to encourage learners to become more physically active throughout their lives is highlighting the benefits of exercising (Opstoel et al., 2020). First, physical activity enhances learners' overall health, improving their school attendance. As a result, most learners participating in physical activity record lower drop-out rates since they rarely miss school due to lifestyle illnesses and achieve a complete education. Moreover, studies have established that physically active learners have higher concentration and memory than sedentary children due to enhanced hippocampus and ganglia capacities (van Sluijs et al., 2021). These brain parts are associated with controlling cognition and memory; therefore, learners retain most of the content taught and focus better in classrooms when their capacities are enhanced. Notably, retaining knowledge is crucial as learners can apply most of their learning to solve real-life problems in their careers and adult lives. On the other hand, better cognitive abilities help learners to attain better grades. Therefore, academic achievement, physical activity, and fitness are directly connected, indicating that learners can improve their grades through regular exercise.

Moreover, schools can influence learners to become more active by incorporating physical activity into the curriculum. School leaders can achieve this by ensuring that PE is well-distributed in lesson plans, including fitness challenges, active lessons and breaks, and activities such as running (van Sluijs et al., 2021). Incorporating physical activity into the learners' daily school routine helps them to have a holistic educational experience with benefits such as improved cognitive function and enhanced energy levels and mood. Further, Opstoel et al. (2020) demonstrate the effectiveness of creating programs such as after-school sports in eliciting learners’ interest to engage in physical activities. Often, these programs are led by competent coaches, a factor that encourages more learners to participate since they would be trained and bullying is minimal in the presence of adult trainers. In this context, Opstoel et al. (2020) have established the need for trainers to provide a supportive environment for all learners to join sports despite having minimal to no skills.

In relation to offering an environment that supports physical activities for all, having a reward system in place also contributes significantly in promoting an active culture among learners. Faulkner et al. (2021) identifies mechanisms such as offering learners special privileges or monetary incentives as key sources of motivation to engage in sports and physical activities beyond the classroom. Additionally, technologies such as fitness trackers also encourage learners to continuously engage in and monitor their physical performance since they are dynamic and fun tools to use for teenagers. Encouraging parents to engage in sporting activities with their children through initiatives such as parent-child competitions has also demonstrated effectiveness in creating interest in learners to participate in exercises outside school.

Based on the above discussion, higher participation in physical activity is vital to promoting mental and emotional wellness in children, hence the need to encourage a lifestyle that embraces exercises in all children. In this context, Faulkner et al. (2021) notes that PE plays a critical role in teaching teenagers and children critical skills that last a lifetime, including anger management and self-control. PE also equips learners with important social skills including teamwork and healthy competition, which are vital to excelling in the workplace and in other aspects of adulthood. From this perspective, PE is an essential tool in preparing learners for adulthood by enhancing their personal growth in the context of developing the skills needed to interact with others, solve complex problems, and resolve challenging situations efficiently.

Moreover, physical education equips individuals with critical tools for stress reduction and enhanced emotional and mental wellbeing. Particularly, physical activity is a leading factor in promoting the release of endorphins in the brains. According to Faulkner et al. (2021),the chemical compounds are responsible for boosting mood and happiness, therefore leading to emotional wellbeing. As a result, exercise promote quality sleeping patterns by enhancing a person’s sense of wellbeing. Further, a study by Schuch and Stubbs (2019) portrays exercise as one of the most effective non-pharmacologic interventions for mild and moderate depression. Notably, it presents similar outcomes as the commonly used antidepressants, and adds an extra benefit of having zero side effects. Gerber et al. (2019) have also highlighted that in addition to managing depression symptoms, physical activity minimizes the risk of the condition by approximately 26% and prevents relapse. Factors that make physical activities a potent deterrent to depression include their ability to minimize inflammation, boost mood, promote neural growth, and serve as a distraction from stressful situations.

Further, physical activity helps in relieving stress and tension and enhances mental energy and mood by releasing endorphins; therefore, it works as a natural treatment for anxiety. Additionally, by helping muscles to relax, exercise helps individuals overcome health issues that emanate from stress, including chest tightness, insomnia, and stomach aches. Moreover, Altman (2022) has also established regular exercises as one of the most effective measures for improving motivation concentration, and reducing ADHD symptoms. Notably, exercises improve the brain's serotonin, norepinephrine, and dopamine levels, influencing attention and focus. In this context, physical activity produces similar results as drugs such as Adderall and Ritalin. On the other hand, Schuch and Stubbs (2019) argue that regular exercise helps the nervous system to recover from the immobilization stress responses that characterize trauma or PTSD. Examples of exercises that have demonstrated success in addressing trauma include dancing, swimming, and running.

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