Preparation Manual: Section 4: Sample Selected-Response Questions

Section 4: Sample Selected-Response Questions
Health EC–12 (257)

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This section presents some sample exam questions for you to review as part of your preparation for the exam. To demonstrate how each competency may be assessed, sample questions are accompanied by the competency that they measure. While studying, you may wish to read the competency before and after you consider each sample question. Please note that the competency statements do not appear on the actual exam.

The sample questions are included to illustrate the formats and types of questions you will see on the exam; however, your performance on the sample questions should not be viewed as a predictor of your performance on the actual exam.

Selected-Response Questions with Rationales

Each sample exam question here includes the correct answer and a rationale for each answer option.

Domain I—Health and Wellness

Competency 001—(Body Systems and Health-Related Factors): Demonstrate understanding of health promotion and disease prevention practices; structures and functions of human body systems; and factors that influence health, growth, and development.

1. To effectively prevent the spread of germs and contagious diseases in an early childhood or prekindergarten setting, it would be most appropriate for teachers and caregivers to encourage children to wash their hands according to which of the following schedules?

when they touch other children, after sitting on the floor, and after they eat
following play in partner activities or small groups, and before they go outside
when they arrive; after playing at sand, water, and craft tables; and before eating
throughout the school or childcare day, at least every 45 minutes to an hour

Enter to expand or collapse answer.Answer expanded: Option C is correct because the schedule described maximizes opportunities for students to clean germs off their hands by washing before and after interactions with other students in the classroom (e.g., arriving and connecting with classmates, after playing at activity centers), as well as before eating, when students are likely to repeatedly touch their mouths and faces. Option A is incorrect because it would be impractical to follow every physical contact between students with handwashing. Washing hands after sitting on the floor, as in circle time, or after eating, is less effective than following play or before eating. Option B is incorrect because it is impractical to follow all partner and small-group activities with handwashing. Also, it would be more effective to have students wash hands after they go outside, where they interact with others, rather than before they go outside. Option D is incorrect primarily because of the impracticality of having students take turns washing hands every 45 minutes and the negative impact that this schedule would have on instructional time and student attention.

2. In an elementary school health education class, the teacher and students regularly discuss how "healthy lifetime habits" developed during childhood help decrease students' susceptibility to illness and disease throughout life. Which of the following habits would be most appropriate to discuss and highlight as a strategy for preventing type 2 diabetes and other metabolic diseases?

striving to consistently get eight hours of sleep each night
drinking at least eight glasses of water each day
consuming a daily diet low in fats and high in carbohydrates
engaging in physical activity for a total of at least 30 minutes each day

Enter to expand or collapse answer.Answer expanded: Option D is correct because sustained physical activity increases the body's sensitivity to insulin, allowing it to use glucose more efficiently. When insulin sensitivity is increased, muscle cells are better able to take up glucose during and after physical activity, thereby reducing the risk of developing type 2 diabetes (an impairment in regulating and using glucose as fuel). Engaging in 30 minutes of daily physical activity is essential for avoiding metabolic syndrome and metabolic diseases, including cardiovascular diseases linked to inactivity. Option A is incorrect because while sufficient nightly sleep is an important factor in maintaining overall health, it is not commonly thought of as a specific strategy for preventing metabolic disease. Option B is incorrect because although drinking eight glasses of water daily may be an appropriate recommendation for adults, it is not appropriate for all elementary school-age students and is not a specific strategy for avoiding metabolic disease. Option C is incorrect because an elementary student's diet should include a balance of major nutrients, including healthy fats for brain development and delivery of fatty acids, and enough simple and complex carbohydrates for producing and maintaining energy. Additionally, a high-carbohydrate diet leads to unhealthy weight gain at any age.

Competency 002—(Mental, Emotional, and Social Health and Well-Being): Demonstrate understanding of mental, emotional, and social health and strategies and skills for building, maintaining, and improving mental, emotional, and social health and well-being.

3. A middle school health education teacher is concerned about the mental health of a student. The teacher has noticed that the student no longer participates in discussions, remains isolated during class activities, and is exhibiting signs of depression. The student has difficulty concentrating, cries occasionally, and is not performing well academically. The student met with a school counselor but did not reveal a source of or reason for the apparent distress. However, the student agrees to meet again with the counselor in the health education teacher's presence. Which of the following actions would be most appropriate for the teacher and counselor to take during the meeting with the student?

suggesting that the student may want to talk to their parent/guardian about outpatient mental health services
talking to the student about recent positive experiences and their future aspirations
informing the student that they consider the student at risk and in need of an evaluation by the school crisis team
asking the student directly if they are having thoughts about self-harm or suicide

Enter to expand or collapse answer.Answer expanded: Option D is correct because students who contemplate self-harm and suicide often exhibit depression and other warning signs such as isolation, withdrawal from usual activities, and sadness, and experts recommend always taking such signs seriously, especially in light of increasing evidence that indicates increasing rates of suicide ideation among students. Therefore, given the situation described, asking the student directly about thoughts of suicide is the most appropriate action to take. Option A is incorrect because while a conversation with the student's parents/guardians around the topic of additional mental health services could be appropriate at a later date, the most appropriate and timely action for the teacher and counselor to take would be to ensure the student's safety in the moment. Option B is incorrect because while this strategy may be beneficial in future meetings with the student, it fails to address the immediate issue and intervene if the student is in danger. Option C is incorrect because the action described may be a premature one in this situation.

Competency 003—(Reproductive and Sexual Health): Demonstrate understanding of reproductive development, sexual health concepts, and approaches and skills for protecting overall health and well-being.

4. In a Health I class that addresses the reproductive and sexual health strand, one of the health education teacher's objectives is to promote students' ability to identify the characteristics of healthy and unhealthy dating relationships. The teacher plans to impart to students research on the topic to support skill-based instruction. One important concept to address is that according to anecdotal evidence and interviews with U.S. teenagers, the risk of abuse and violence is likely to increase in an adolescent dating relationship when:

one partner is possessive and monitors the other partner's whereabouts, text messages, and social media activity.
both partners talk about a shared future, but one partner believes that they work harder than the other to sustain the relationship.
one partner is shy and reserved and prefers to socialize with only a few close friends rather than in group settings.
both partners have difficulty communicating their feelings to each other and one partner feels like this is a detriment to a successful relationship.

Enter to expand or collapse answer.Answer expanded: Option A is correct because warning signs of an unhealthy dating relationship include controlling and isolating behaviors on the part of one of the partners. According to research on adolescent health, traits such as jealousy and possessiveness and behaviors such as monitoring a partner's whereabouts, texts, and social media activity lead to emotional problems in dating relationships and can be precursors to physical and psychological abuse. Option B is incorrect because discussing a shared future in a relationship with an imbalance of commitment is not associated with research on risk factors for teen relationship abuse. Option C is incorrect because the situation described is more reflective of difference in personalities or personal preferences rather than risk factors for relationship abuse. Option D is incorrect because while difficulties in communicating feelings may have a negative impact on a dating relationship in which one partner believes that communication is key to success in a relationship, such communication difficulties are not indicative of potential violence or abuse.

5. In a high school health education class in which students have parental/guardian permission to opt in, the teacher plans to address the following TEKS.

(21) Reproductive and sexual health—sexual risk. The student understands that there are risks associated with sexual activity and that abstinence from sexual activity is the only 100% effective method to avoid risks.

During instruction, the teacher should keep in mind that the Texas Education Code stipulates that when contraception methods are included in a health education curriculum, they must be taught in accordance with which of the following concepts?

instruction that addresses barrier methods of contraception in addition to abstinence, but not hormonal methods of contraception
the representation of various methods of contraception without any references to trademarked, copyrighted, or brand names
use of "human use" or "typical use" reality rates rather than theoretical laboratory rates to quantify the effectiveness of contraceptive methods
implementation of instruction that assigns equal time and devotes equal attention to each major type of contraceptive method or behavior

Enter to expand or collapse answer.Answer expanded: Option C is correct because according to Chapter 115.38 of the Texas Education Code, when schools include high school health education on methods of contraception, classes are required to address "human use reality rates"—also known as "typical use" rates in medical literature—that describe the effectiveness of those methods outside laboratory settings. The Health I substandard linked to the Texas Essential Knowledge and Skills (TEKS) for Health Education, High School, presented in the item, asks students to "analyze the effectiveness and the risks and failure rates (human-use reality rates) of barrier protection and other contraceptive methods, including how they work to reduce the risk of STDs/STIs and pregnancy." Options A, B, and D are incorrect because none of the concepts presented in those responses are stipulated in the TEKS for Health Education in the Texas Education Code.

Domain II—Health Skills for Reducing Risks

Competency 004—(Prevention of Alcohol, Tobacco, and Other Drug Use): Demonstrate understanding of concepts related to alcohol, tobacco, and other drug use (e.g., any type of substance abuse) and skills and strategies for preventing and reducing health risks related to alcohol, tobacco, and other drug use.

6. A health education teacher is reviewing research-based strategies for reducing underage alcohol use. The teacher notes that the U.S. Department of Health and Human Services has identified the need for multicomponent comprehensive interventions, including social-behavioral curricula and community task forces, to address availability of alcohol and community norms around alcohol use. Which of the following outcomes best describes the primary objective of these interventions?

integrating community norms about alcohol into health education programs
influencing both the supply and demand of alcohol
fostering dialogue between the school and community about alcohol use
providing additional support for students to say no to alcohol use

Enter to expand or collapse answer.Answer expanded: Option B is correct because prevention programs that have been successful in helping students avoid alcohol and other drugs are evidence-based programs involving targeted skills instruction; social emotional learning principles; community task forces to address availability of alcohol and community norms around alcohol use; and a high level of collaboration between and among teachers and other school staff, students, families, and community professionals. Option A is incorrect because while addressing community norms about alcohol use may indeed be covered in health education, integrating such norms is not the primary objective of the multiple coordinated interventions described. Option C is incorrect because although facilitating a dialogue between the school and community about alcohol use is likely to be part of a school-community awareness and prevention effort, the broader objective is decreasing the availability of alcohol to students and students' perceptions that alcohol use is acceptable. Option D is incorrect because while providing support for students to say no to alcohol use is an appropriate objective, the primary objective of the multiple coordinated interventions described is influencing the supply and demand of alcohol.

Competency 005—(Interpersonal, Social, and Family Relationships and Communication): Demonstrate understanding of skills and strategies for promoting healthy communication and for maintaining healthy interpersonal, social, and family relationships.

7. A health education teacher uses the following steps and examples to introduce a skill to second-grade students.

Tell how you feel. Follow I feel with an emotion word, such as angry, upset, hurt, or insulted.

State the problem behavior: I feel hurt when you tease me.

Tell why it's a problem: I feel hurt when you tease me because it's embarrassing.

Say what you want to happen: I want you to stop teasing me.

This activity is likely to be particularly effective in promoting students' ability to:

apply consensus-building strategies in emotional situations to clarify and work toward shared goals.
acknowledge a conversation partner's emotions so that the partner feels listened to and respected.
monitor understanding of a speaker's feelings by restating the speaker's message in their own words.
express feelings appropriately in interpersonal situations so that tensions do not escalate into conflict.

Enter to expand or collapse answer.Answer expanded: Option D is correct because in the activity described, the teacher is introducing students to the use of I-messages or I-statements to identify strong feelings and unwanted behaviors, which could otherwise escalate into an interpersonal conflict, in a calm and systematic way. I-messages or I-statements focus on the feelings or beliefs of the speaker rather than the characteristics or personality of the listener and allow the speaker to be assertive without making accusations. In this way, participants can resolve disputes and de-escalate conflicts. Option A is incorrect because while building consensus is an important communication skill, it is more relevant to group communication rather than interpersonal communication, and the skill does not involve the technique presented. Option B is incorrect because acknowledging a conversation partner's emotions so that the partner feels listened to and respected is a key feature of empathetic listening, which is not the student skill being promoted in this example. Option C is incorrect because the strategy described is active listening, in which a listener paraphrases the speaker's words to check understanding and seek further clarification if needed.

8. A health education teacher presents the following scenario to a middle school class.

Student X is a sixth-grader who has been friends with a group of peers since the beginning of elementary school. But a few weeks after the start of the school year, friends in the group begin ignoring Student X and blocking X from joining the group for lunch at its usual cafeteria table. Then Student X learns that the leader of the group is spreading false rumors about X. The gossip hurts Student X's feelings and leaves X confused about why the group is behaving the way they are.

When discussing this scenario with the class, it is essential for the teacher to first ensure students understand that:

peer groups of this age are typically fluid and volatile and can be replaced.
while Student X cannot control the group's behavior, the student can control their reactions to it.
the behaviors demonstrated by the group toward Student X are forms of bullying.
individuals need to be held accountable for their actions, even when acting as member of a group.

Enter to expand or collapse answer.Answer expanded: Option C is correct because in the situation described, Student X is experiencing social bullying, also called relational bullying. The peer leader and the other group members are excluding the student, spreading rumors, and embarrassing the student in front of peers—all forms of social bullying. The behaviors described also meet two key criteria for bullying: there is an imbalance of power being used to harm someone, and the behaviors are repetitious. Option A is incorrect because a discussion of peer groups or power dynamics in peer groups would take place after identifying the behaviors in the scenario as bullying. Option B is incorrect because the primary focus should be on the bullying behavior exhibited by the group and how to stop it, not how a student targeted by bullying should attempt to control their reactions. Option D is incorrect because while understanding that individuals should be accountable for their actions even when in groups, this knowledge is less essential than establishing for students that bullying can take multiple forms and must be directly addressed.

Competency 006—(Injury Prevention and Safety): Demonstrate understanding of skills and strategies for promoting safety, preventing accidents and injuries, addressing bullying, and responding to emergencies.

9. During a lesson on bullying prevention, a middle school health education teacher and students discuss cyberbullying, its anonymous nature, its potential to reach a huge audience, and the inability of those targeted to escape harmful lies and rumors. Which of the following additional strategies would best promote responsible digital citizenship skills among students in the context of this lesson?

emphasizing the importance of maintaining self-efficacy and resilience when challenged by negative events beyond one's control
familiarizing students with examples of cyberbullying techniques and suggesting resources for addressing online bullying incidents
modeling how to enable maximum privacy settings and block individual users and others on digital devices and social media servers
describing steps in reporting cyberbullying and the importance of not sharing, tolerating, or providing feedback to bullying posts

Enter to expand or collapse answer.Answer expanded: Option D is correct because in the context of this digital citizenship lesson, it would be essential to discuss with students appropriate and ethical ways to respond, report, and avoid cyberbullying. The teacher should encourage students to report cyberbullying they encounter online to their parents/guardians or to school officials. By familiarizing students with the harmful effects of cyberbullying, the teacher can help students develop empathy and compassion for targets of cyberbullying; students are more likely to think twice before forwarding a hurtful image, post, or text or visiting a cyberbullying site. Option A is incorrect because while self-efficacy and resilience are key aspects of emotional wellness and would be addressed within the context of the lesson, the objective of the additional strategy would be to support students in digital citizenship skill instruction involving resisting and avoiding cyberbullying through highlighting the steps of reporting. Option B is incorrect because students are likely to already be familiar with examples of cyberbullying, and the teacher should be directly teaching skills for addressing cyberbullying rather than suggesting resources for students to consult. Option C is incorrect because modeling how to enable privacy settings and block users on digital devices and social media servers would be unrealistic for a teacher to accomplish, given the ever-changing nature of communication technology.

10. A middle school's safety team is updating a crisis response plan to align with the district's current safety plan. The health education teacher recommends that the team consult with community resources such as local police and fire departments, mental health service providers, representatives from the Federal Emergency Management Agency (FEMA), and other emergency response personnel in the district. The most significant benefit of consulting with these agencies, providers, and officials is that the collaboration:

ensures that crisis situations will be addressed in the most efficient and timely way possible.
provides a unique opportunity to educate local experts about the needs of school-age children in crisis situations.
enhances the overall effectiveness of the crisis response plan by coordinating the provision of services.
enables the team to easily prioritize potential crises that the team must address when developing the crisis response plan.

Enter to expand or collapse answer.Answer expanded: Option C is correct because when developing a plan to respond to various types of school crisis situations, it is vital to consult with local and federal agencies who can provide expert knowledge to the school district on potential risks to the school and community, any particular vulnerabilities associated with the school or its buildings and grounds, and response methods that are most likely to be effective. Coordinating regularly with local police, firefighters, mental health providers, and FEMA and other emergency responders extends the safety team's understanding of how to provide emergency protocols and organize staff and available resources in a crisis. Option A is incorrect because while it is hoped that crisis situations can be addressed efficiently and quickly, that is not always possible. The ultimate goal of a school-community crisis response team collaboration is to protect the physical and mental health and well-being of students. Option B is incorrect because educating local experts about the needs of school-age children in crisis situations should be secondary to planning the coordination of services during a crisis. Option D is incorrect because consulting with local and federal agencies would probably not allow the team to easily prioritize potential crises.

Competency 007—(Personal Health Efficacy Skills): Apply knowledge of strategies and activities for promoting students' use of self-assessment, goal-setting, decision-making, conflict-resolution, and self-advocacy skills to enhance health.

11. Two high school friends plan to support each other in implementing health and wellness programs designed to improve their physical activity and nutritional habits. The students begin by selecting a few different individual and group physical activities that they believe will sustain their interest and commitment in engaging in health-related fitness activity on at least four days per week. Which of the following additional strategies is likely to be most important for the students to use in striving to achieve this health and wellness goal?

making sure that the physical activities chosen can be ordered in a sequence that addresses a different component of health-related fitness each time
narrowing physical activity choices to those in which the students are experienced or can do expertly to prevent frustration and loss of interest
ensuring that the physical activity choices are aligned with personal and family resources and, taken together, provide sustainable fitness opportunities
determining whether each chosen physical activity can be accomplished in about the same amount of time and at a similar level of intensity

Enter to expand or collapse answer.Answer expanded: Option C is correct because ensuring that physical activity choices are aligned with personal and family resources helps eliminate potential barriers to participation and creates a conducive environment for sustaining a program of fitness activity. This positive environment, combined with seeking year-round opportunities to engage in physical activity, will help motivate the students to participate more fully in fitness activities they enjoy, which in turn will help establish lifetime fitness habits. Option A is incorrect because while some students may use a sequence of activities to address each component of health-related fitness, this strategy could easily become boring or limited by factors related to accessibility or equipment. Option B is incorrect because at this age, activities in which the students have little or no experience are likely to interest them as much as or more than activities in which they are experienced. Option D is incorrect because considering whether each physical activity is about the same in terms of duration and intensity should not be a priority over factors such as interest, availability, and enjoyment. In addition, intensity is not always comparable among different types of exercise, and both duration and intensity would vary significantly in individual versus group activities.

12. In elementary health education classes, the teacher periodically leads students in "brain booster breaks." During these breaks, students engage in brief physical activities in the classroom, such as jumping jacks, hopping or high-knee walking, or freestyle dancing to music in personal space. Brain research supports this practice through findings that indicate a strong correlation between regular participation in physical activity and enhancements in which of the following areas?

hypothetical thinking and deductive reasoning used for considering "what-if" questions and multiple solutions or possible outcomes
creative and innovative thinking abilities used for brainstorming, visualizing or mental imaging, and communicating through drawing or storytelling
musical intelligence used for reading and composing music and discerning pitch, tone, and rhythm in music
self-management and executive functioning abilities used for regulating emotions and behavior, planning and organizing, and recalling information

Enter to expand or collapse answer.Answer expanded: Option D is correct because recent research into the relationship between brain development and physical activity supports the consensus that regular physical activity and physical fitness positively influence children's ability to carry out the executive functioning and management processes that help individuals plan, organize, retain working memory, and regulate and adapt behavior. One hypothesis is the same areas of the brain are engaged during executive function tasks and physical exercise, and that physical activity stimulates the development of new neural networks that allow more complex tasks to be carried out. Option A is incorrect because the cognitive abilities involved in hypothetical thinking and deductive reasoning usually begin to emerge around age 12, when students enter adolescence. Option B is incorrect because although creative and innovative thinking used for brainstorming, visualizing, and communicating is desirable, specific connections between the development of these abilities and childhood physical activity is not supported by brain research. Option C is incorrect because current brain research also does not support a correlation between regular physical activity and the development of musical intelligence and related abilities.

Domain III—Health Literacy and Health Education

Competency 008—(Health Literacy): Understand health literacy; influences on health behaviors; and strategies and skills for accessing, evaluating, and using health-related information, products, and services.

13. During a health literacy activity, the teacher leads students in reviewing Web sites for several health-related products. The teacher asks students to use the following criteria:

PIES—Is the purpose to Persuade, Inform, Entertain, or Sell?

The purpose influences the way information is presented!

Does the Web site present fact or opinion?

Is there exaggerated language and/or one point of view?

If there are photos and videos, do they look or sound authentic?

This type of activity is likely to be particularly effective for promoting students' ability to:

cross-check health-related media content with primary or original sources.
detect manipulation and bias in health-related media content.
research the origin of visual content used in health-related media.
analyze common strategies used in marketing health-related products.

Enter to expand or collapse answer.Answer expanded: Option B is correct because the health literacy activity described is designed to promote students' ability to evaluate the credibility and reliability of online content, specifically their ability to recognize the underlying purposes of media content and detect bias, stereotyping language and images, emotion-laden language, and manipulated photos and video clips. Option A is incorrect because while verifying health-related media content with additional sources, such as primary or original sources, is valuable when conducting research, the criteria presented do not directly address this strategy. Option C is incorrect because the ability described is a fairly narrow one and related only to the last criterion presented in the activity. Option D is incorrect because although students are likely to recognize common marketing strategies as they review a variety of health-related Web sites, the criteria are designed to prompt students to do a critical examination of the Web site, such as determining if the site promotes a particular agenda or extreme viewpoint.

14. Which of the following health education approaches would most likely help students resist media images and messages that present underage alcohol use as daring, free of consequences, or a normal "rite of passage"?

asking students to research the influence of marketing trends on the depiction of underage alcohol use in popular and social media
teaching students how to use an individual decision-making process to avoid and resist alcohol, rather than a process involving support from friends and family
presenting to students lessons developed by educational media companies that promote alcohol-free lifestyles among youth
guiding students in analyzing the intentions underlying media depictions of underage alcohol use and the ways in which media use cultural norms to target youth

Enter to expand or collapse answer.Answer expanded: Option D is correct because students benefit from direct health literacy instruction in relation to media portrayals of unhealthy and risky behaviors and attitudes. Guiding students in analyzing the intentions and messages underlying depictions of alcohol use as daring, free of consequences, and a normal "rite of passage" helps students resist being manipulated by misleading media, such as advertisements designed to introduce students to brands of alcohol and prompt development of brand loyalty and interest in branded merchandise long before students are legally able to consume alcohol. Option A is incorrect because individual, student-led research into ways in which marketing influences media depictions of underage alcohol use is likely to be less effective than a teacher-led activity on analyzing and evaluating influences in media involving underage alcohol use. Option B is incorrect because teaching students decision-making skills for health-related situations should address both individual and collaborative decision-making techniques, but such skills are more relevant to choosing healthy behaviors in relation to alcohol rather than resisting unhealthy messages about alcohol. Option C is incorrect because it would be inappropriate to present commercially prepared lessons that promote alcohol-free lifestyles when state and local substance use curricula exists, and supplementary lesson material from educational vendors would have to be thoroughly vetted.

Competency 009—(Health Education Program): Understand the organization, goals, and purposes of the school health education program and principles and practices for effective, data-driven, culturally responsive, and developmentally appropriate instruction and assessment.

15. The Whole School, Whole Community, Whole Child (WSCC) model and philosophy of health education is based in large part on the ecological model of human development. The ecological model, in turn, is based on the concept that healthy human development primarily occurs:

in physically safe communities and environments.
when both innate and environmental factors prompt adaptation.
within multiple contexts of family, community, and culture.
through observation and imitation of others in social contexts.

Enter to expand or collapse answer.Answer expanded: Option C is correct because the Whole School, Whole Community, Whole Child (WSCC) model is characterized by an approach in which the child is the focal point and health and educational goals are linked within multiple contexts. WSCC builds upon the coordinated school health model but calls for even greater integration of health and educational outcomes through family and community involvement and coordinated educational policies and practices to ensure that students are ready to learn, emotionally and physically healthy, engaged, and prepared for adulthood. Option A is incorrect because while physically safe communities and environments are important goals of the WSCC approach, the WSCC framework encompasses much more and extends beyond physical health. Option B is incorrect because although both innate and environmental factors my indeed prompt adaptation, this is not a central concept of the WSCC approach. Option D is incorrect because while children do learn through observation and imitation of others in social contexts, this is only one facet of development of the whole child. In the WSCC model, the whole child is addressed by a range of learning and health supports, which in turn are encircled by community resources.

16. A health education teacher plans to teach a unit on the risks of underage alcohol use and skills for avoiding alcohol use. At the beginning of the unit, the teacher administers a short-answer survey to students about common causes and consequences of underage alcohol use and techniques for avoiding alcohol use. At the end of the unit, the teacher re-administers the survey. The assessment results show an increase in the number of students who demonstrate knowledge of skills for avoiding alcohol and the risks involved in underage alcohol use. The most appropriate interpretation of these results is that the instructional unit succeeds in:

modifying students' health-related attitudes and personal values related to alcohol use.
improving students' ability to identify and evaluate different sources and types of influences to engage in alcohol use.
motivating students to use self-monitoring strategies in learning new content related to minimizing involvement in underage alcohol use.
enhancing students' cognitive understanding of alcohol-use prevention concepts and potential risks and consequences of alcohol use.

Enter to expand or collapse answer.Answer expanded: Option D is correct because given the assessment protocol and the assessment results, it is reasonable to conclude that the instructional unit succeeded in enhancing students' cognitive understanding of the unit objectives. In the scenario, the teacher uses short-answer pre- and post-surveys to gauge student mastery of lesson content. The increase in the number of students who demonstrate knowledge following the unit indicates that lesson material has been cognitively processed and retained by students. Option A is incorrect because the stated intent of the instructional unit does not include addressing students' attitudes and values related to alcohol use, and a pre- and post-survey is unlikely to be effective in measuring changes in the affective domain. Option B is incorrect because the assessments are aligned to learning outcomes related to knowledge of causes and consequences of underage alcohol use and skills for avoiding alcohol use, rather than to student skills in identifying and evaluating sources and types of influences to engage in alcohol use. Option C is incorrect because while the instructional unit may motivate students to use self-monitoring strategies to support learning in relation to prevention of alcohol use, the assessment results described would not be interpreted in this way.

Domain IV—Educating All Learners and Professional Practice

Competency 010—(Differentiation Strategies in Planning and Practice): Understand how to identify and implement developmentally and culturally appropriate strategies and data-driven practices to effectively teach and engage all learners.

17. In an elementary school health education class, students demonstrate a range of learning preferences, strengths, and ability levels. The health education teacher is aware that the upcoming unit on injury and violence prevention and safety might be challenging for some students. The teacher could best help differentiate instruction for the students in this class by implementing which of the following strategies?

placing students into general ability groups to enable the teacher to provide appropriately paced instruction in functional health knowledge
providing regular opportunities for students to provide feedback to the teacher through various modes in relation the instructional activities they prefer
creating various lesson formats for whole-class and cooperative-group instruction and implementing the differently formatted lessons on a rotating basis
analyzing ongoing informal assessment of students' progress and performance to guide the teacher's choice of instructional approaches and materials

Enter to expand or collapse answer.Answer expanded: Option D is correct because given the characteristics of the health education class, the teacher could best differentiate and scaffold instruction by conducting ongoing informal assessment of students' progress and performance and using the resulting formative assessment data to guide instructional planning, including strategies and activities for individualized instruction for students who may be experiencing difficulty with unit content. Option A is incorrect because although small-group instruction is appropriate for teaching functional health knowledge, grouping strategies should be flexible and responsive to many factors, such as student learning preferences, instructional goals related to collaboration and cooperation, and the need for differentiated instruction or targeted interventions. Option B is incorrect because while providing regular opportunities for students to provide feedback to the teacher is likely to help the teacher improve instructional effectiveness, the strategy is not as precise or purposeful as analyzing ongoing informal assessment information to guide the teacher's choice of approaches and materials for implementing differentiated instruction. Option C is incorrect because creating various lesson formats for whole-class and cooperative-group instruction and rotating the formats will not necessarily be effective in differentiating instruction, which involves more than varying the format of materials presented in structured activities.

18. Which of the following activities is a primary responsibility of the health education teacher as a member of an Admission, Review, and Dismissal (ARD) committee?

initiating the purchase of any specialized education materials required to meet the specific health education needs of students
collaborating with special education staff to identify appropriate accommodations and modifications to meet students' specific needs
designing lesson objectives that consider each student's present level of functioning and prescribing disability-specific activities
defining the least restrictive environment (LRE) that provides students with the greatest health education learning opportunities

Enter to expand or collapse answer.Answer expanded: Option B is correct because a primary responsibility of general education teachers who serve on Admission, Review, and Dismissal (ARD) committees in Texas is to work collaboratively with special education teachers and other ARD members to identify appropriate accommodations and modifications that will address students' specific needs and allow students to achieve Individualized Education Program (IEP) goals. A health education teacher's role on an ARD committee would include providing insights on whether the health education curriculum would need to be adapted in order to support a student's progress and recommending classroom and testing accommodations. Option A is incorrect because although the health education teacher might recommend specialized educational materials for addressing the health education needs of students, initiating the purchase of such materials is not within the teacher's realm. Rather, it is a decision in the ARD committee's domain. Option C is incorrect because the responsibilities described are shared responsibilities of the ARD committee and not applicable to every student with an IEP. Option D is incorrect because defining the least restrictive environment (LRE) or educational setting for students is also a shared responsibility of the ARD committee, rather than a specific responsibility of content-area teachers.

Competency 011—(Culturally Responsive Practices): Understand how to identify and implement culturally responsive, developmentally appropriate practices to effectively teach and engage all learners.

19. In an elementary school health education class that includes emergent bilingual students, the teacher uses brief audio recordings of dialogue from U.S. television programs that takes place in common health-related settings (e.g., pharmacy, medical office, dentist office). The teacher uses the audio clips as starting points for small-group role-playing activities. This strategy is most likely to benefit students' English language development in which of the following ways?

illustrating for students ways in which idiomatic expressions in English can be misinterpreted in health-related situations
familiarizing students with authentic language used by English speakers in a variety of common health-related situations
providing students with experience in interpreting a variety of nonverbal cues typically used in health-related contexts
illustrating for students how spoken language can vary depending on factors such as setting, dialect, and the relationship between speakers

Enter to expand or collapse answer.Answer expanded: Option B is correct because the teacher's strategy and the student benefit derived reflects an application of research-based best practices for promoting English language development. The television clips and small-group role-playing activities serve as authentic English language models for the emergent bilingual students, illustrating the teacher's knowledge that these settings and formats produce the natural language that proficient speakers of English use. By exposing students to multiple settings and examples of health-related interactions, the teacher familiarizes students with authentic communication situations in which speakers use sentence fragments and a range of vocabulary. Exposure to new vocabulary in meaningful contexts results in greater depth of understanding and improved retention. Option A is incorrect because the strategy described is unlikely to be beneficial for illustrating ways in which English idiomatic expressions can be misinterpreted in health-related situations. Interpreting the unpredictable meanings of idioms is at a level of complexity that is inappropriate for emerging and intermediate English language learners. Option C is incorrect because while providing students with experience in interpreting nonverbal cues in health-related contexts is beneficial to students' overall communication skills, the greater benefit of the strategy is promoting students' verbal language development. Option D is incorrect because although the activities may illustrate for students how spoken language varies depending on setting, dialect, and the relationship between speakers, this is an incidental rather than a key benefit and likely too advanced to be a learning outcome for the emerging level of English language development.

20. In a sixth-grade health education class, the teacher is about to begin a new unit of instruction on body systems and their role in personal health. The teacher considers how best to begin the unit to maximize learning for all students. Based upon educational research on best teaching practices, the teacher should start the unit in which of the following ways?

presenting a lecture and slide presentation on body systems as a foundation for personal health and encouraging students to listen, take notes, and ask follow-up questions
having students read a few basic illustrated informational articles on body systems and then answer related questions on a worksheet, working at their own pace
asking compelling, open-ended questions about body systems and recording answers from students on a whiteboard to identify and evaluate students' prior knowledge and possible misconceptions
beginning with the questions at the end of a health education textbook chapter on body systems, allowing students to look up the answers in the text, and discussing the questions and answers during the next class

Enter to expand or collapse answer.Answer expanded: Option C is correct because the teacher strategy described is intended to activate students' prior knowledge related to body systems and their role in personal health, as well as build upon this knowledge to design introductory unit lessons. By recording answers from students in order to evaluate students' conceptual knowledge and possible misconceptions, the teacher would be able to gauge student comprehension of the topic and correct misconceptions. Options A and B are incorrect because the practices described involve passive viewing and reading activities that are unlikely to engage students sufficiently in the unit topic. Option D is incorrect because although the practice described might be used at a future point during the instructional unit described, it would be inappropriate to use at the beginning of the unit, and the activity would be ineffective in promoting students' retention of new information in the textbook.

Competency 012—(Data-Driven Practice and Formal/Informal Assessment): Understand the types, selection, and uses of data-driven, developmentally appropriate assessments and assessment practices to effectively support program improvement and all students' learning.

21. Several weeks after the school year begins, an elementary health education teacher remains concerned about a fourth-grade student who worked below grade level in both the physical health and hygiene unit and the physical activity and healthy eating learning units. The teacher wonders if the student is experiencing information processing difficulties. The health education teacher meets with the student's homeroom teacher to discuss the concerns, to understand whether the student experiences these difficulties in multiple settings, and to determine whether the student might benefit from a Multi-Tiered Systems of Support (MTSS) process. Which of the following steps should the health education teacher take in preparation for this meeting?

determining whether the student's academic difficulties would be likely to persist despite direct health education instruction
considering what types of health education assessments should be administered to evaluate the scope of the student's academic challenges
clarifying the health education learning outcomes that are likely to be most affected by a developmental delay or information processing problem
consulting with the student's previous teachers to determine whether a pattern of academic difficulty or decline was apparent during the last school year

Enter to expand or collapse answer.Answer expanded: Option A is correct because in this situation, the most appropriate step for the teacher to take prior to the meeting is to attempt to determine if the student's difficulties would likely persist if they had direct, purposeful, and supportive health education instruction. The initial step in intervention, according to a Multi-Tiered Systems of Support (MTSS) process, is to provide additional support to ensure that a student's difficulties are not due to inadequate instruction. Option B is incorrect because considering assessments for evaluating the student's academic challenges would be a premature step to take in the MTSS process. Option C is incorrect because clarifying health education learning outcomes affected by a developmental delay or information processing problem presupposes that the student is indeed experiencing information processing difficulties, which should be addressed by further assessment and possible referral to an Admission, Review, and Dismissal (ARD) committee. Option D is incorrect because although consulting with the student's previous teachers to determine whether a pattern of academic difficulty exists would be helpful and encompasses a team approach, the MTTS process would likely place greater focus on current data-based decision making to inform instruction and potential interventions for this student.

22. At the beginning of the school year, a fifth-grade health education teacher welcomes students to class, including new students who are emergent bilingual students. The teacher wants to use fair and unbiased assessments that will allow the emergent bilingual students to provide evidence of what they learn. Which of the following assessment approaches is likely to be most effective for accomplishing this goal?

conducting informal interviews with the students to gauge their levels of knowledge and skill related to lessons
creating regular opportunities for the students to choose how to demonstrate their knowledge and skills
arranging for the students a separate, quiet area in which to complete worksheets, quizzes, and other assessments
providing the students' parents/guardians with opportunities to preview lesson plans and materials for language difficulty issues

Enter to expand or collapse answer.Answer expanded: Option B is correct because creating regular opportunities for the students to choose how to demonstrate their knowledge and skills illustrates the teacher's use of universal design for learning (UDL) principles. Incorporating UDL principles in assessment promotes greater accessibility for emergent bilingual students and helps accommodate individual differences. UDL practices emphasize flexibility and differentiation in ways in which students can demonstrate learning and express what they know. Option A is incorrect because conducting informal interviews with the students to gauge their levels of knowledge and skills represents only one method of assessment. Option C is incorrect because while the approach described is an appropriate accommodation for emergent bilingual students, it does not encompass providing the students choice in how to demonstrate knowledge. Option D is incorrect because although providing students' parents/guardians with previews of lesson plans and materials is a supportive strategy, it does not directly facilitate students' ability to demonstrate what they have learned.

Clustered Questions

Use the information below, excerpted from a middle school health education lesson plan outline, to answer the three questions that follow.

Strand: Risk and Protective Factors

Lesson Objective: Students will recognize risk and protective factors that influence resistance and susceptibility to substance use.

Lesson Materials

Slide presentation: definitions and examples of risk and protective factors

Graphic organizer: types of personal, family, and community/society risk and protective factors; fixed versus variable

Opioids

Infographic: "Opioids: Get the Facts"

Recent statistics on opioid overdoses

Critical-thinking questions

Vaping

Newspaper articles and other student readings (grades 6–8) on adolescents and vaping

Class discussion

Competency 002—(Mental, Emotional, and Social Health and Well-Being): Demonstrate understanding of mental, emotional, and social health and strategies and skills for building, maintaining, and improving mental, emotional, and social health and well-being.

23. In the graphic organizer activity, which of the following factors would be categorized as a community or societal protective factor that helps decrease the likelihood of negative outcomes related to substance use during childhood and adolescence?

development of social and cultural competence
adequate supervision during after-school and weekend hours
availability of faith-based resources and after-school activities
genetic dispositions and biological characteristics

Enter to expand or collapse answer.Answer expanded: Option C is correct because in health education and the context of this lesson, protective factors refer to factors related to security and stability that maintain and enhance students' mental and emotional health. The community/societal category of external protective factors includes the availability of faith-based resources and after-school activities. The Centers for Disease Control and Prevention (CDC) and other public health agencies confirm the importance of school, community, and positive social connections in promoting students' sense of belonging and security and in decreasing negative outcomes related to substance use. Resources such as faith-based programs, recreation programs, and after-school clubs help create support networks and safe environments for students, fostering their ability to forge healthy relationships. Options A and D are incorrect because although risk and protective factors may exist in multiple contexts, the factors presented are characterized as individual-level, or internal, protective factors in the field of health education. Option B is incorrect because while adequate supervision of students during after-school and weekend hours is associated with a lower likelihood of negative outcomes related to substance use, this factor is categorized as a relationship or family-related protective factor rather than a community or societal protective factor.

Competency 004—(Prevention of Alcohol, Tobacco, and Other Drug Use): Demonstrate understanding of concepts related to alcohol, tobacco, and other drug use (e.g., any type of substance abuse) and skills and strategies for preventing and reducing health risks related to alcohol, tobacco, and other drug use.

24. During the lesson on opioids, which of the following teacher questions is likely to be most effective in eliciting critical thinking and a meaningful class discussion?

How do prescribed opioid medications and illegal opioids differ?
What types of factors or situations might put adolescents at an increased risk for opioid use?
Why should adolescents take precautions if they are prescribed an opioid medication?
What are some actions that adolescents could take to help control the opioid overdose crisis?

Enter to expand or collapse answer.Answer expanded: Option B is correct because the question is an open-ended one that prompts students to reflect on and analyze general factors and circumstances that increase risks related to adolescent opioid use, rather than reflect on questions that are more likely to elicit personal opinion. In addition, the question connects back to lesson content presented in the slide deck and graphic organizer, making it an appropriate basis for a meaningful discussion. Option A is incorrect because the question is a recall-type question that calls for students to remember facts rather than engage in critical thinking. Options C and D are incorrect because the questions require students to think in terms of addressing the issue of opioids in their personal lives, through individual precautions or advocacy actions, which could cause discomfort in some students. In addition, the connection between the questions and lesson material is less evident than a question on risk factors and situations.

25. The health education teacher has heard students say that they have started vaping because it is a less harmful alternative to cigarettes. The teacher would like to address this belief in the lesson on vaping. Which of the following statements accurately describes an essential point to include in the planned class discussion?

Vaping is an effective way to quit smoking cigarettes but causes the same long-term health effects as cigarette smoking.
Both the liquids used in vaping and the tobacco in cigarettes contain nicotine, which is highly addictive and harmful to the developing brain.
Vaping, unlike smoking cigarettes, is not physically addictive but it is highly psychologically addictive.
The addictive potential of vaping is greater than smoking cigarettes because the vapor is drawn deeper into the lungs.

Enter to expand or collapse answer.Answer expanded: Option B is correct because in order to correct students' misconception about vaping being less harmful than cigarettes, the teacher should point out that vape products often contain a lot of nicotine, a highly addictive substance that can harm the brain. In fact, many e-cigarette and vape products deliver even more nicotine than combustible tobacco products such as cigarettes. Option A is incorrect because although e-cigarettes and other vaping products continue to be advertised as aids to quitting smoking, some manufacturers have tried to entice youth into trying their products by marketing flavored varieties. And although vape products may expose a user to fewer toxic chemicals than smoking cigarettes, the aerosol produced contains ultrafine particles that can damage the lungs and cause lung disease. Option C is incorrect because nicotine use can quickly develop into both a physical and psychological addiction. Option D is incorrect because addiction to both vaping and cigarette smoking is directly related to nicotine's role in causing the release of dopamine in the brain and the recurring need to experience the resulting feelings of well-being, rather than to the depth of inhalation into the lungs.

Additional Selected-Response Questions

This section includes additional sample selected-response questions for you to review in preparation for the exam. The correct answer is provided for each question below.

Domain I—Health and Wellness

Competency 001—(Body Systems and Health-Related Factors): Demonstrate understanding of health promotion and disease prevention practices; structures and functions of human body systems; and factors that influence health, growth, and development.

26. In which of the following stages of growth do children require more kilocalories for their size than at any other stage because of the rate of physical development that occurs?

infancy
early childhood
middle childhood
adolescence

Enter to expand or collapse answer.Answer expanded: Option A is correct.

27. Which of the following environmental exposures is especially harmful to young children due to its strong association with impaired neurobehavioral development, decreased stature, and impaired speech?

chlorofluorocarbons (CFCs) in aerosol cans
bisphenol A (BPA) in polycarbonate plastics
lead in water supply lines and soil
carbon monoxide in automobile exhaust

Enter to expand or collapse answer.Answer expanded: Option C is correct.

Competency 002—(Mental, Emotional, and Social Health and Well-Being): Demonstrate understanding of mental, emotional, and social health and strategies and skills for building, maintaining, and improving mental, emotional, and social health and well-being.

28. A secure attachment style is likely to contribute most directly to which of the following aspects of an adolescent's social development?

formation of coping strategies
rejection of pressure to adopt peer values
presence of identity or role confusion
rapid acquisition of conflict-management skills

Enter to expand or collapse answer.Answer expanded: Option A is correct.

29. Several high school students have individually approached a health education teacher to discuss their difficulty dealing with various pressures that they are experiencing. Among their issues are feeling overwhelmed by the demands of keeping up good grades and working part-time, apprehensive about meeting social expectations, and anxious about tensions within the family. With the students' permission, the teacher connects them to the school counselor to determine the best way forward for them to obtain help. Which of the following strategies should the teacher use next to help the students and their classmates address the types of issues raised by the students?

providing students with a comprehensive list of local therapists that treat adolescents, including information about their specialties and methods used
reviewing and analyzing with the class an adolescent case study that addresses the concerns of the students who sought the teacher's advice
meeting with each member of the class individually to assess the amount of stress they are experiencing and their overall mental and emotional health
planning and delivering a unit focusing on emotional issues faced by adolescents and introducing and modeling coping and stress-management skills

Enter to expand or collapse answer.Answer expanded: Option D is correct.

Competency 003—(Reproductive and Sexual Health): Demonstrate understanding of reproductive development, sexual health concepts, and approaches and skills for protecting overall health and well-being.

30. During an eighth-grade class, a health education teacher leads a discussion on the topic of protecting personal sexual and reproductive health. When presenting strategies for avoiding risks such as resisting sexual contact, the teacher should primarily focus on promoting students' ability to:

manage and resolve interpersonal conflicts calmly.
counter or negate pressure by presenting well-reasoned arguments.
use self-regulatory strategies to prevent and avoid stress.
communicate personal boundaries clearly and assertively.

Enter to expand or collapse answer.Answer expanded: Option D is correct.

31. While chlamydia testing is important for all sexually active individuals, it is critical for females due to the likelihood of asymptomatic infection. Which of the following outcomes is a major risk of untreated infections for females?

infertility
ovarian cancer
toxic shock syndrome
oral cancer

Enter to expand or collapse answer.Answer expanded: Option A is correct.

Domain II—Health Skills for Reducing Risks

Competency 004—(Prevention of Alcohol, Tobacco, and Other Drug Use): Demonstrate understanding of concepts related to alcohol, tobacco, and other drug use (e.g., any type of substance abuse) and skills and strategies for preventing and reducing health risks related to alcohol, tobacco, and other drug use.

32. Stimulants used to treat attention deficit hyperactivity disorder (ADHD) should not be shared, or taken without a prescription, because they tend to cause which of the following effects in individuals without a diagnosis of ADHD?

a dangerous drop in blood sugar and decreased blood pressure
mental confusion and an inability to engage in a coherent conversation
a dangerous rise in body temperature and an irregular heartbeat
depressed respiration, wheezing, and bronchial spasms

Enter to expand or collapse answer.Answer expanded: Option C is correct.

33. According to evidence-based research on adolescent health, which of the following factors has been found to be most highly correlated with a teenager's ability to avoid a pattern of underage alcohol, tobacco, or other drug use?

secure attachments to family and involvement in school and community institutions
a strong emphasis on academic excellence in the teenager's family
access to a wide variety of communication and technological resources at school and at home
the absence of illness, disease, and medication use in the teenager's family

Enter to expand or collapse answer.Answer expanded: Option A is correct.

Competency 005—(Interpersonal, Social, and Family Relationships and Communication): Demonstrate understanding of skills and strategies for promoting healthy communication and for maintaining healthy interpersonal, social, and family relationships.

34. During a health education lesson, the teacher presents students with the following scenarios.

One cloudy night, friends invite you to join them at a fast-food restaurant, but you must walk across a busy highway to get there.

On a hot summer day, friends dare you to jump from a ledge into a shaded area of a lake, but you do not know the depth of the water.

The teacher and students discuss ways to respond to these situations, such as suggesting a different, safe group activity; making an excuse; blaming one's parents/guardians for being unable to participate; and seeking support from someone else who does not want to participate. This activity is likely to help students minimize physical risks by promoting students' use of:

refusal, delaying, and negotiation strategies.
conflict-management and resolution skills.
goal-setting and decision-making strategies.
executive functioning and management skills.

Enter to expand or collapse answer.Answer expanded: Option A is correct.

35. A health education teacher discusses with students ways in which the use of passive, aggressive, or assertive types of communication can influence the outcome of a peer pressure situation. Which of the following behaviors are most characteristic of an assertive communication approach?

prioritizing the needs of others, speaking softly with a calm tone, and avoiding direct eye contact
listening without interrupting, displaying confidence, and using I statements to state needs
maintaining a neutral expression, speaking loudly and quickly to communicate urgency, and asking questions
using humor to establish dominance, maintaining constant eye contact, and using you statements

Enter to expand or collapse answer.Answer expanded: Option B is correct.

Competency 006—(Injury Prevention and Safety): Demonstrate understanding of skills and strategies for promoting safety, preventing accidents and injuries, addressing bullying, and responding to emergencies.

36. During an open house at an elementary school, the health education teacher briefly describes to families a project on safety that students have just completed. The teacher points out a display of student artwork showing outdoor safety behaviors, such as waiting for a turn on the slide, wearing a helmet while riding a scooter, swimming with an adult, and looking both ways before crossing a street. Which of the following subjects would be most appropriate to communicate to families in the context of the project and display?

influences on children's safety, such as living conditions and whether parents/guardians discuss safety risks
societal expectations related to the protection of children's health and safety
simple physical activity workouts to incorporate into children's daily lives as stress-management strategies
the importance of continuing to model safe behaviors and praising children when they demonstrate the behaviors

Enter to expand or collapse answer.Answer expanded: Option D is correct.

37. During a fire safety lesson in an early elementary classroom, a health education teacher reviews the following instructions with students for what individuals should do if their clothing catches fire.

Stop where you are.

Drop to the ground with legs straight and cover your face with your hands.

Roll over back and forth until the flames are out.

Which of the following activities is likely to be most effective for the teacher to use next?

asking students to draw pictures of the steps discussed in class that they can take home
leading the class in brainstorming precautions to prevent clothing fires in the first place
setting up floor mats and having students practice all three steps of the process
showing students video clips of actions to take if they see someone else's clothing catch fire

Enter to expand or collapse answer.Answer expanded: Option C is correct.

Competency 007—(Personal Health Efficacy Skills): Apply knowledge of strategies and activities for promoting students' use of self-assessment, goal-setting, decision-making, conflict-resolution, and self-advocacy skills to enhance health.

38. In a health education class, middle school students use the problem-solving steps below to examine health-related issues.

Specify the problem.

Analyze the problem.

Suggest possible solutions.

Evaluate alternative solutions.

Choose a solution.

After reviewing the five steps with students, the teacher wants students to apply the process. Students identify time management as a common problem affecting their daily routines. Which of the following activities could assess students' understanding of step 1 of the process?

gathering information about various time management strategies and weighing the pros and cons of each strategy
identifying the resources needed to resolve time management concerns and thinking of strategies for obtaining the resources
summarizing the difficulties associated with managing time and identifying the condition or conditions most in need of change
brainstorming potential actions to manage time more effectively and considering barriers to implementing each action

Enter to expand or collapse answer.Answer expanded: Option C is correct.

39. Educational research into adolescent health and development has shown that adolescent students tend to perform better academically, have higher aspirations for their futures, and engage more frequently in college preparation activities when they:

have established and maintained multiple positive developmental relationships with caring adults and peers.
derive satisfaction from their appearance, body image, and perceived status among peers.
enjoy membership in a competitive peer group whose members challenge themselves physically and academically.
have demonstrated the ability to overcome a significant crisis or grievous event in their personal lives.

Enter to expand or collapse answer.Answer expanded: Option A is correct.

Domain III—Health Literacy and Health Education

Competency 008—(Health Literacy): Understand health literacy; influences on health behaviors; and strategies and skills for accessing, evaluating, and using health-related information, products, and services.

40. During a ninth-grade health education lesson on drug use prevention, the class discusses effects and consequences of using illicit drugs. Some students believe that many teenagers try street drugs like heroin and methamphetamine. The teacher shares data from a recent statewide survey, which indicate that only 1.3 percent of nearly 2,000 Texas high school students reported ever trying heroin, and only 2.2 percent reported ever trying methamphetamine. The teacher's approach for addressing students' misperceptions reflects use of the:

health belief model.
social norms approach.
theory of planned behavior.
transactional model of health care.

Enter to expand or collapse answer.Answer expanded: Option B is correct.

41. Which of the following resources/Web sites would be an appropriate first choice for students seeking free or low-cost testing for HIV or other sexually transmitted infections (STIs) in or near their school districts?

American Sexual Health Association (ASHA)
Texas Department of Health and Human Services/Texas Healthy Communities (TXHC)
Society for Adolescent Health and Medicine (SAHM)
Texas Department of Health and Human Services/Texas Department of State Health Services (DSHS)

Enter to expand or collapse answer.Answer expanded: Option D is correct.

Competency 009—(Health Education Program): Understand the organization, goals, and purposes of the school health education program and principles and practices for effective, data-driven, culturally responsive, and developmentally appropriate instruction and assessment.

42. A team of health education teachers is planning a new health literacy curriculum for the school district. The teachers begin by examining national health education standards and the Texas Essential Knowledge and Skills (TEKS) for Health Education. Which of the following strategies for planning the curriculum is likely to be most effective to use next?

reviewing peer-reviewed professional journal articles and other resources that address health literacy
analyzing current and significant health needs and issues in the school district in light of the standards
collaborating with community health organizations to establish health literacy outcomes linked to public health efforts
consulting health education teachers in surrounding school districts about their ideas for a health literacy curriculum

Enter to expand or collapse answer.Answer expanded: Option B is correct.

43. According to Texas school law, which of the following statements accurately describes a general requirement of School Health Advisory Councils (SHACs)?

The majority of SHAC members must be parents/guardians who are not employed by the school district.
Each SHAC must develop and distribute to school district staff and community members information on its specific role in creating healthy school environments for students.
A health education teacher or other school health professional must serve as the chair of the SHAC and be appointed by the school board.
SHAC members must, as a group, represent all key sectors of the community (e.g., members from education, business, media, health, and government organizations).

Enter to expand or collapse answer.Answer expanded: Option A is correct.

Domain IV—Educating All Learners and Professional Practice

Competency 010—(Differentiation Strategies in Planning and Practice): Understand how to identify and implement developmentally and culturally appropriate strategies and data-driven practices to effectively teach and engage all learners.

44. Students in a health education class watch a video showing several role-playing skits. In one skit, two students are working out in a gym and one says to the other, "I can hook you up with some pills that will build muscle really fast." The second student replies, "Thanks, but I'd rather do this on my own." A second skit takes place at a restaurant. One student suggests leaving without paying, but the other student says, "I wouldn't like getting cheated, so I'm not going to cheat someone else." Which of the following teaching strategies is likely to be most effective for facilitating students' health-related skill and knowledge development in the context of this activity?

initiating a class discussion on the influences of negative peer pressure on interpersonal and social relationships and techniques for improving peer relationships
viewing with the class video clips from movies and TV shows involving interpersonal and social conflicts and asking students to evaluate the conflict-management skills depicted
identifying with students other types of risk-related interpersonal or social situations and guiding students in practicing refusal and negotiation skills for responding to those situations
brainstorming with students social determinants associated with adolescents who may be at increased risk for unhealthful peer relationships and skills needed to overcome such challenges

Answer: Option C is correct.

45. During a unit on social, environmental, and hereditary influences on health, a student with a reading disability is having difficulty retaining information from the health education text. The student explains to the teacher that even though they understand the content when reading, they often struggle to recall specific information or explain the content afterward. The health education teacher could best support this student's learning by:

encouraging the student to use study periods or school library time to reread health education text assignments and take notes.
photocopying the text and highlighting text features, such as headings and summaries, and important excerpts that the student should focus on.
suggesting that the student try reading the health education text aloud in a quiet voice while trying to visualize the content.
showing the student how to use comprehension strategies with the text, such as outlining, summarizing, self-questioning, and concept mapping.

Answer: Option D is correct.

Competency 011—(Culturally Responsive Practices): Understand how to identify and implement culturally responsive, developmentally appropriate practices to effectively teach and engage all learners.

46. During the school year, the health education teacher collaborates with other teachers to host periodic after-school presentations in which parents/guardians can listen to a professional from a local organization speak and then participate in a question-and-answer session. Speakers have included a pediatrician, social worker, school counselor, and child development specialist. These presentations are likely to benefit parents/guardians primarily by:

encouraging them to form personal relationships with their children's teachers and caregivers.
prompting them to recognize their responsibilities in relation to children's health needs.
helping them access community services and resources that address family-oriented needs.
providing them with an in-depth introduction to content that is essential to their children's education.

Answer: Option C is correct.

Competency 012—(Data-Driven Practice and Formal/Informal Assessment): Understand the types, selection, and uses of data-driven, developmentally appropriate assessments and assessment practices to effectively support program improvement and all students' learning.

47. After engaging sixth-grade students in introductory and skill-based lessons on mental health and wellness promotion, a health education teacher distributes a graphic organizer to students. The graphic organizer includes the following categories.

Changes during puberty that can affect self-concept
Strategies for managing everyday stress and anxiety
Sources of help for ongoing negative thoughts or actions
The benefits of setting and working toward long-term health goals

The teacher asks students to write down three concepts under each category. The teacher would most appropriately use this assignment to:

evaluate students' mastery of lesson objectives.
design a skills-based rubric for the mental health and wellness unit.
help students start individualized academic work portfolios.
informally assess students' understanding of lesson objectives.

Answer: Option D is correct.

48. A health education teacher of students in kindergarten through second grade has established a portfolio system in which some of the students' classwork is maintained in individual files. Student portfolios include drawings of physical activities and healthy foods, completed graphic organizers on healthy hygiene habits, worksheets on friendship skills, and photos of students participating in puppet shows about healthy communication. For which of the following purposes should this type of portfolio primarily be used in a K–2 health education program?

evaluating the materials in students' portfolios according to a checklist of grade-appropriate learning outcomes
utilizing the portfolios to demonstrate alignment with the CDC's "Characteristics of an Effective Health Education Curriculum"
monitoring students' progress with examples of student efforts that can be shared with parents/guardians
obtaining a comprehensive overview of students' relative content-area strengths and areas for improvement

Answer: Option C is correct.

Clustered Questions

Use the information below to answer the two questions that follow.

During a lesson on nutrition, a middle school health education teacher provides students with a chart that lists nutrients, their major dietary sources, and their major functions in the body. The following excerpt from the chart includes information for four common nutrients; one cell is missing information.

Important Nutrients, Their Major Sources, and Their Roles in the Body
Nutrient Major Sources Role of the Nutrient in the Body

iron meat, eggs, dark-green leafy vegetables blank

calcium dairy products helps build bones and teeth; also important in muscle contraction and transmission of neural impulses

vitamin C citrus fruits necessary for the manufacture of collagen, which is critical for wound healing; also important in immune response to infection

vitamin K green leafy vegetables required for the production of prothrombin, which is necessary for blood clotting

Important Nutrients, Their Major Sources, and Their Roles in the Body
Nutrient	Major Sources	Role of the Nutrient in the Body
iron	meat, eggs, dark-green leafy vegetables	blank
calcium	dairy products	helps build bones and teeth; also important in muscle contraction and transmission of neural impulses
vitamin C	citrus fruits	necessary for the manufacture of collagen, which is critical for wound healing; also important in immune response to infection
vitamin K	green leafy vegetables	required for the production of prothrombin, which is necessary for blood clotting

Competency 001—(Body Systems and Health-Related Factors): Demonstrate understanding of health promotion and disease prevention practices; structures and functions of human body systems; and factors that influence health, growth, and development.

49. Which of the following phrases would accurately complete the cell in the chart describing a significant role of iron in the body?

required for the formation of hormones and DNA, as well as the healthy functioning of nerve cells
helps the body convert food into energy and create new blood cells; also important in maintaining skin elasticity
necessary for the formation of hemoglobin, which enables red blood cells to carry oxygen to tissues
prevents the oxidation of fat molecules in the intestines, which allows fat to be absorbed and stored in fat cells

Answer: Option C is correct.

Competency 009—(Health Education Program): Understand the organization, goals, and purposes of the school health education program and principles and practices for effective, data-driven, culturally responsive, and developmentally appropriate instruction and assessment.

50. Which of the following activities would best extend this lesson and help students more deeply understand the links between diet and nutrition?

providing students with major nutrient recommendations for their ages and asking them to design a balanced daily meal plan
assigning different nutrients to students and asking them to provide a summary of each nutrient's importance in maintaining wellness
bringing prepared food packages to class and asking students to use their nutrition facts labels to compare nutrient contents
asking students to pick a nutrient from the chart for further research and expand the list of dietary sources of the nutrient selected

Answer: Option A is correct.

Section 4: Sample Selected-Response Questions Health EC–12 (257)

Selected-Response Questions with Rationales

Domain I—Health and Wellness

Competency 001—(Body Systems and Health-Related Factors): Demonstrate understanding of health promotion and disease prevention practices; structures and functions of human body systems; and factors that influence health, growth, and development.

Competency 002—(Mental, Emotional, and Social Health and Well-Being): Demonstrate understanding of mental, emotional, and social health and strategies and skills for building, maintaining, and improving mental, emotional, and social health and well-being.

Competency 003—(Reproductive and Sexual Health): Demonstrate understanding of reproductive development, sexual health concepts, and approaches and skills for protecting overall health and well-being.

Domain II—Health Skills for Reducing Risks

Competency 005—(Interpersonal, Social, and Family Relationships and Communication): Demonstrate understanding of skills and strategies for promoting healthy communication and for maintaining healthy interpersonal, social, and family relationships.

Competency 006—(Injury Prevention and Safety): Demonstrate understanding of skills and strategies for promoting safety, preventing accidents and injuries, addressing bullying, and responding to emergencies.

Competency 007—(Personal Health Efficacy Skills): Apply knowledge of strategies and activities for promoting students' use of self-assessment, goal-setting, decision-making, conflict-resolution, and self-advocacy skills to enhance health.

Domain III—Health Literacy and Health Education

Competency 008—(Health Literacy): Understand health literacy; influences on health behaviors; and strategies and skills for accessing, evaluating, and using health-related information, products, and services.

Competency 009—(Health Education Program): Understand the organization, goals, and purposes of the school health education program and principles and practices for effective, data-driven, culturally responsive, and developmentally appropriate instruction and assessment.

Domain IV—Educating All Learners and Professional Practice

Competency 010—(Differentiation Strategies in Planning and Practice): Understand how to identify and implement developmentally and culturally appropriate strategies and data-driven practices to effectively teach and engage all learners.

Competency 011—(Culturally Responsive Practices): Understand how to identify and implement culturally responsive, developmentally appropriate practices to effectively teach and engage all learners.

Competency 012—(Data-Driven Practice and Formal/Informal Assessment): Understand the types, selection, and uses of data-driven, developmentally appropriate assessments and assessment practices to effectively support program improvement and all students' learning.

Clustered Questions

Competency 002—(Mental, Emotional, and Social Health and Well-Being): Demonstrate understanding of mental, emotional, and social health and strategies and skills for building, maintaining, and improving mental, emotional, and social health and well-being.

Additional Selected-Response Questions

Domain I—Health and Wellness

Competency 001—(Body Systems and Health-Related Factors): Demonstrate understanding of health promotion and disease prevention practices; structures and functions of human body systems; and factors that influence health, growth, and development.

Competency 002—(Mental, Emotional, and Social Health and Well-Being): Demonstrate understanding of mental, emotional, and social health and strategies and skills for building, maintaining, and improving mental, emotional, and social health and well-being.

Competency 003—(Reproductive and Sexual Health): Demonstrate understanding of reproductive development, sexual health concepts, and approaches and skills for protecting overall health and well-being.

Domain II—Health Skills for Reducing Risks

Competency 005—(Interpersonal, Social, and Family Relationships and Communication): Demonstrate understanding of skills and strategies for promoting healthy communication and for maintaining healthy interpersonal, social, and family relationships.

Competency 006—(Injury Prevention and Safety): Demonstrate understanding of skills and strategies for promoting safety, preventing accidents and injuries, addressing bullying, and responding to emergencies.

Competency 007—(Personal Health Efficacy Skills): Apply knowledge of strategies and activities for promoting students' use of self-assessment, goal-setting, decision-making, conflict-resolution, and self-advocacy skills to enhance health.

Domain III—Health Literacy and Health Education

Competency 008—(Health Literacy): Understand health literacy; influences on health behaviors; and strategies and skills for accessing, evaluating, and using health-related information, products, and services.

Competency 009—(Health Education Program): Understand the organization, goals, and purposes of the school health education program and principles and practices for effective, data-driven, culturally responsive, and developmentally appropriate instruction and assessment.

Domain IV—Educating All Learners and Professional Practice

Competency 010—(Differentiation Strategies in Planning and Practice): Understand how to identify and implement developmentally and culturally appropriate strategies and data-driven practices to effectively teach and engage all learners.

Competency 011—(Culturally Responsive Practices): Understand how to identify and implement culturally responsive, developmentally appropriate practices to effectively teach and engage all learners.

Competency 012—(Data-Driven Practice and Formal/Informal Assessment): Understand the types, selection, and uses of data-driven, developmentally appropriate assessments and assessment practices to effectively support program improvement and all students' learning.

Clustered Questions

Competency 001—(Body Systems and Health-Related Factors): Demonstrate understanding of health promotion and disease prevention practices; structures and functions of human body systems; and factors that influence health, growth, and development.

Competency 009—(Health Education Program): Understand the organization, goals, and purposes of the school health education program and principles and practices for effective, data-driven, culturally responsive, and developmentally appropriate instruction and assessment.

Section 4: Sample Selected-Response Questions
Health EC–12 (257)