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Health Education
This page intentionally left blank
Health Education
Elementary and Middle School EIGHTH
EDITION
Applications

Susan K. Telljohann
University of Toledo

Cynthia W. Symons
Kent State University

Beth Pateman
University of Hawaii

Denise M. Seabert
Ball State University
HEALTH EDUCATION: ELEMENTARY AND MIDDLE SCHOOL APPLICATIONS, EIGHTH EDITION

Published by McGraw-Hill Education, 2 Penn Plaza, New York, NY 10121. Copyright 2016 by McGraw-
Hill Education. All rights reserved. Printed in the United States of America. Previous editions © 2012, 2009,
and 2007. No part of this publication may be reproduced or distributed in any form or by any means, or
stored in a database or retrieval system, without the prior written consent of McGraw-Hill Education,
including, but not limited to, in any network or other electronic storage or transmission, or broadcast for
distance learning.

Some ancillaries, including electronic and print components, may not be available to customers outside the
United States.

This book is printed on acid-free paper.

1 2 3 4 5 6 7 8 9 0 DOC/DOC 1 0 9 8 7 6 5

ISBN 978-0-07-802856-4
MHID 0-07-802856-6

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Library of Congress Cataloging-in-Publication Data

Telljohann, Susan Kay
Health education : elementary and middle school applications / Susan K. Telljohann, University of Toledo,
Cynthia W. Symons, Kent State University, Beth Pateman, University of Hawaii, Denise M. Seabert, Ball State
University.—Eighth edition.
pages cm
Includes bibliographical references and index.
ISBN 978-0-07-802856-4 (alk. paper)—ISBN 0-07-802856-6 1. Health education (Elementary)—United
States. 2. Health education (Middle school)—United States. I. Title.
LB1588.U6T45 2014
372.37—dc23
2014035735

The Internet addresses listed in the text were accurate at the time of publication. The inclusion of a website
does not indicate an endorsement by the authors or McGraw-Hill Education, and McGraw-Hill Education
does not guarantee the accuracy of the information presented at these sites.

www.mhhe.com
 BRIEF CONTENTS

Preface xi

SECTION I
Foundations of Health Education 1
1 Coordinated School Health
A Foundation for Health Promotion in the Academic Environment 2
2 Comprehensive School Health Education
Applying the Science of Education to Improving Health Instruction 31
3 Standards-Based Planning, Teaching, and Assessment in Health
Education 56
4 Building and Managing the Safe and Positive Learning Environment 89

SECTION II
Helping Students Develop Skills for Positive Health Habits 117
5 Promoting Mental and Emotional Health 118
6 Promoting Healthy Eating 155
7 Promoting Physical Activity 188
8 Promoting Safety and Preventing Unintentional Injury 220
9 Promoting Personal Health and Wellness 246

SECTION III
Helping Students Translate Their Skills to Manage Health Risks 273
10 Preventing Intentional Injuries and Violence 274
11 Tobacco Use Prevention 315
12 Alcohol and Other Drug Use Prevention 340
13 Promoting Sexual Health 379
14 Managing Loss, Death, and Grief 411

APPENDICES
A 2007 National Health Education Standards for Grades Pre-K–8 430
B Rocky Mountain Center for Health Promotion and Education Rubrics for
the National Health Education Standards 433
C Development Characteristics and Needs of Students in Elementary and
Middle Grades: A Foundation for Age-Appropriate Practice 438

Credits 442
Index 443

v
 CONTENTS

Preface xi Influential Policymakers in the Education Community 32

Influence at the National Level 33
Influence at the State Level 36
SECTION I
Influence at the Local Level 37
Foundations of Health Education 1
Lessons from the Education Literature 37
Chapter 1 Connecting Brain Research with Learning 38
Coordinated School Health Authentic Instruction and Achievement 39
A Foundation for Health Promotion in the Academic Environment 2
Developmentally Appropriate Practice 43
Health: Definitions 3 Research-Based Strategies for Improving Achievement 45
Physical Health (Physical/Body) 3 The State of the Art in Health Education 47
Mental/Intellectual Health (Thinking/Mind) 3 Supporting Sound Health Education Teaching Practice 47
Emotional Health (Feelings/Emotions) 3 Translating Health Education Theory into Practice 48
Social Health (Friends/Family) 4 Characteristics of Effective Health Education Curricula: Foundations
for Decision Making and Best Practice 50
Spiritual Health (Spiritual/Soul) 4
Involving Children in Curriculum Planning 53
Vocational Health (Work/School) 4
- Internet and Other Resources 54
Lokahi: A Model of “Balance, Unity, and Harmony” 4
Endnotes 54
Determinants of Health 5
Healthy Youth, Healthy Americans 8
Chapter 3
Health in the Academic Environment 8
Standards-Based Planning, Teaching, and Assessment in
Coordinated School Health 12 Health Education 56
A Foundation for Understanding 12
Introduction 57
A Program Model for Best Practice 13
Meeting the National Health Education Standards 57
Health Education: The Keys to Quality Health Instruction 14
Standard 1: Core Concepts 58
Health Services 17
Standard 2: Analyze Influences 59
Healthy School Environment 19
Standard 3: Access Information, Products, and Services 61
Nutrition Services 20
Standard 4: Interpersonal Communication 62
Counseling, Psychological, and Social Services 22
Standard 5: Decision Making 64
Physical Education 23
Standard 6: Goal Setting 66
Health Promotion for Faculty and Staff 25
Standard 7: Self-Management 68
Family and Community Involvement 26
Standard 8: Advocacy 69
Pulling It All Together 26
Planning Effective School Health Education 70
Internet and Other Resources 28
Building on Evaluation Research 70
Endnotes 29
Working with the Big Picture in Mind 70
Chapter 2 Teaching to Standards 71
Comprehensive School Health Education Yearly Planning 71
Applying the Science of Education to Improving Health Instruction 31
Unit Planning 71
Introduction 32 Lesson Planning 73

vi
 Including Learners with Diverse Backgrounds, Interests, Guidelines for Classroom Applications 125
and Abilities 78
Important Background for K–8 Teachers 125
Linking Health Education with Other Curriculum Areas 79
Recommendations for Concepts and Practice 129
Assessing Student Work 79
Strategies for Learning and Assessment 135
Engaging Students in Assessment 79
Evaluated Curricula and Instructional Materials 150
Developing and Using Rubrics 81
Internet and Other Resources 150
Designing Performance Tasks 82
Children’s Literature 151
Providing Feedback to Promote Learning and Skill Development 84
Endnotes 154
Strategies for Learning and Assessment 84
Internet and Other Resources 87 Chapter 6
Endnotes 87 Promoting Healthy Eating 155

Chapter 4 Introduction 156

Building and Managing the Safe and Positive Learning Prevalence and Cost of Unhealthy Eating 156
Environment 89 Healthy Eating and Academic Performance 156

Introduction 90 Factors That Influence Healthy Eating 159

Fostering Connectedness: Strategies to Improve Academic Guidelines for Schools 161

Achievement and Student Health 90 State of the Practice 161
Cultivating School Connectedness 90 State of the Art 161
Cultivating Connectedness Through Parent Engagement 91 Guidelines for Classroom Applications 162
Cultivating Classroom Connectedness 94 Important Background for K–8 Teachers 162
Instruction Organized with a Specific Focus on Health Issues 101 Recommendations for Concepts and Practice 168
Instructional Activities with Many Uses 101 Strategies for Learning and Assessment 172
Cooperative Learning: An Instructional Alternative 103 Evaluated Curricula and Instructional Materials 184
Individualized Instruction: An Important Alternative 105 Internet and Other Resources 184
Limitations of Direct Instructional Approaches 108 Children’s Literature 185
Interdisciplinary Instructional Approaches 108 Endnotes 186
Correlated Health Instruction 108
Integrated Health Instruction: Thematic Units 109 Chapter 7
Using Electronic Resources in Health Education 110 Promoting Physical Activity 188
Controversy Management in Health Education 111 Introduction 189
Anticipation: Strategies for School Leaders 112 Prevalence and Cost 189
Recommendations for Teachers 113 Physical Activity and Academic Performance 192
Conclusion 114 Factors That Influence Physical Activity 193
Internet and Other Resources 114 Guidelines for Schools 193
Endnotes 115 State of the Practice 193
State of the Art 194

S E C T I O N II Guidelines for Classroom Applications 195

Important Background for K–8 Teachers 196
Helping Students Develop Skills for Positive Health
Habits 117 Recommendations for Concepts and Practice 200
Strategies for Learning and Assessment 204
Chapter 5 Evaluated Curricula and Instructional Materials 215
Promoting Mental and Emotional Health 118 Internet and Other Resources 217
Introduction 119 Children’s Literature 217
Prevalence and Cost of Mental Health Problems 119 Endnotes 218
Mental and Emotional Health and Academic Performance 122
Factors That Influence Mental and Emotional Health 123 Chapter 8
Guidelines for Schools 124 Promoting Safety and Preventing Unintentional Injury 220
State of the Practice 124 Introduction 221
State of the Art 124 Prevalence and Cost 221

www.mhhe.com/telljohann8e CONTENTS vii

 Safety and Unintentional Injury and Academic Evaluated Violence Prevention Curricula 309
Performance 221
Internet and Other Resources 310
Factors That Influence Safety and Unintentional Injury 222
Children’s Literature 311
Guidelines for Schools 223
Endnotes 312
State of the Practice 223
State of the Art 223 C h a p t e r 11
Guidelines for Classroom Applications 225 Tobacco Use Prevention 315
Important Background for K–8 Teachers 225 Introduction 316
Recommendations for Concepts and Practice 229 Prevalence and Cost 316
Strategies for Learning and Assessment 229 Tobacco Use and Academic Performance 316
Internet and Other Resources 243 Factors That Influence Tobacco Use 317
Children’s Literature 244 Guidelines for Schools 318
Endnotes 245 State of the Practice 318
State of the Art 319
Chapter 9
Guidelines for Classroom Applications 320
Promoting Personal Health and Wellness 246
Important Background for K–8 Teachers 320
Introduction 247
Recommendations for Concepts and Practice 323
Prevalence and Cost 247
Strategies for Learning and Assessment 327
Personal Health and Wellness and Academic Performance 248
Evaluated Curricula and Instructional Materials 337
Factors That Influence Personal Health and Wellness 249
Internet and Other Resources 337
Guidelines for Schools 250
Children’s Literature 338
State of the Practice 250
Endnotes 338
State of the Art 250
Guidelines for Classroom Applications 251 C h a p t e r 12
Important Background for K–8 Teachers 251 Alcohol and Other Drug Use Prevention 340
Recommendations for Concepts and Practice 258 Introduction 341
Strategies for Learning and Assessment 258 Nature, Prevalence, and Cost 341
Evaluated Curricula and Instructional Materials 270 Alcohol and Other Drug Use and Academic Performance 342
Internet and Other Resources 270 Factors That Influence Alcohol and Other Drug Use 343
Children’s Literature 270 Guidelines for Schools 345
Endnotes 272 State of the Practice 345
State of the Art 345
S E C T I O N III Guidelines for Classroom Applications 347
Helping Students Translate Their Skills to Manage Important Background for K–8 Teachers 347
Health Risks 273 Recommendations for Concepts and Practice 358
Strategies for Learning and Assessment 363
C h a p t e r 10
Evaluated Curricula and Instructional Materials 374
Preventing Intentional Injuries and Violence 274
Internet and Other Resources 376
Introduction 275 Children’s Literature 377
Prevalence and Cost 275 Endnotes 377
Intentional Injury Risks as a Threat to Academic
Performance 277 C h a p t e r 13
Factors That Influence Violence 278 Promoting Sexual Health 379
Guidelines for Schools Concerning Preventing Violence 278
Introduction 380
State of the Practice 278
Prevalence and Cost 380
State of the Art 280
Sexual Health and Academic Performance 380
Guidelines for Classroom Applications 281
Factors That Influence Sexual Health 381
Important Background for K–8 Teachers 281
Opposition to Sexuality Education 381
Recommendations for Concepts and Practice 294
Reasons to Include Sexuality Education in Elementary and Middle
Strategies for Learning and Assessment 294 Schools 382

viii CONTENTS
Guidelines for Schools 383 The Teacher’s Role When a Student or a Student’s Relative
Is Dying or Dies 417
State of the Practice 383
The School’s and Teacher’s Roles When Dealing with Disasters or
State of the Art 383 Traumatic Events 418
Guidelines for Classroom Applications 384 The School’s Role When Handling a Suicide 419
Important Background for K–8 Teachers 384 Evaluated Curricula and Instructional Material 420
Recommendations for Concepts and Practice 393 Recommendations for Concepts and Practice 420
Strategies for Learning and Assessment 398 Strategies for Learning and Assessment 421
Evaluated Curricula and Instructional Materials 408 Internet and Other Resources 427
Internet and Other Resources 408 Children’s Literature 428
Children’s Literature 408 Endnotes 428
Endnotes 409

APPENDICES
C h a p t e r 14
A 2007 National Health Education Standards for Grades
Managing Loss, Death, and Grief 411 Pre-K–8 430
Introduction 412 B Rocky Mountain Center for Health Promotion and
Reasons to Include Loss, Death, and Grief Education in Elementary Education Rubrics for the National Health Education
and Middle Schools 412 Standards 433
Important Background for K–8 Teachers 413 C Development Characteristics and Needs of Students
Developmental Stages of Understanding Death 413 in Elementary and Middle Grades: A Foundation for
Age-Appropriate Practice 438
Stages of Grief 414
Stages of Dying 415
Guidelines for Teachers 416 Credits 442
Teaching About Loss, Death, and Grief 416 Index 443

www.mhhe.com/telljohann8e CONTENTS ix
This page intentionally left blank
 PREFACE

VISION AND GOALS curriculum, the concept of developmentally appropriate

practice, lesson and unit planning, and assessment. The
The ideas, concepts, and challenges presented in this text
basics of effective health education and effective instruc-
have developed out of many different experiences: teach-
tion approaches are provided, including a critical analysis
ing elementary and middle-level children; teaching a basic
of standards-based approaches to health education and
elementary/middle school health course to hundreds of
strategies for creating a positive learning environment,
pre-service elementary, early childhood, and special educa-
managing time constraints, and handling controversial
tion majors; working with numerous student teachers; and
topics and issues.
serving on a variety of local, state, and national curriculum
Sections II and III reflect the Centers for Disease Control
and standards committees. Two of the authors of this book
and Prevention’s Health Education Curriculum Analysis
have taken sabbatical leaves from their university teaching
Tool. Section II, “Helping Students Develop Skills for Posi-
positions and taught for a term in a local elementary and
tive Health Habits,” includes Chapters 5 through 9 and fo-
middle school. The third author receives ongoing feedback
cuses on the positive health habits students can adopt and
on health education strategies from preservice elementary
maintain to help them live a healthy life. The chapters in
education majors who teach health education lessons as
Section II cover mental and emotional health, healthy eat-
part of their field experience in elementary K–6 classrooms.
ing, physical activity, safety and unintentional injury pre-
The fourth author has engaged with school-age children
vention, and personal health and wellness. Section III,
through volunteer teaching, school-based health fairs, and
“Helping Students Translate Their Skills to Manage Health
student-facilitated curriculum development projects. This
Risks,” focuses on the health risks students need to avoid or
has provided opportunities to use the strategies included in
reduce to promote health. These chapters (10 through 14)
this eighth edition.
cover intentional injury prevention and violence; tobacco
We have written this textbook with several groups in
use; the use of alcohol and other drugs; sexual health; and
mind: (1) the elementary and middle-level education major
managing loss, death, and grief.
who has little background or experience in health education
Sections II and III present the content and the personal
but will be required to teach health education to her or his
and social skills that comprise the National Health Educa-
students in the future, (2) the health education major who
tion Standards. Each chapter in these sections begins by
will be the health specialist or coordinator in an elementary
discussing the prevalence and cost of not practicing the pos-
or middle school, (3) the school nurse who works in the
itive health behavior, the relationship between healthy be-
elementary/middle school setting, and (4) those community
haviors and academic performance, and relevant risk and
health educators and nurses who increasingly must interact
protective factors. Readers then are provided with informa-
with elementary and/or middle school personnel. Our goal
tion about what schools are currently doing and what they
is to help ensure that elementary and middle school teachers
should be doing in relation to the health behavior. Chapters
and health specialists obtain the information, skills, and
in these sections also provide background information for
support they need to provide quality health instruction to
the teacher, developmentally appropriate strategies for
students.
learning and assessment, sample student questions with sug-
gested answers (Chapters 11–14), and additional recom-
CONTENT AND ORGANIZATION mended resources, including evaluated commercial
curricula, children’s literature, and websites.
The eighth edition is divided into three sections. Section
Three Appendices provide students with resources they
I, “Foundations of Health Education,” includes Chapters
can keep and use in the future:
1 through 4. This section introduces the coordinated
school health program, the relationship between health • Appendix A, “2007 National Health Education Stan-
and learning, the national health initiatives, the develop- dards for Grades Pre-K–8,” includes the latest version of
ment of the elementary/middle school health education the NHES standards and performance indicators.

xi
• Appendix B, “RMC Rubrics for the National Health Ed- • Updated section on childhood obesity includes a list of
ucation Standards,” provides a standards-based frame- the negative influences that can impact children’s
work teachers can use to evaluate student work. The healthy food choices and physical activity.
rubrics were developed by the Rocky Mountain Center for • New Teacher’s Toolbox 6.1, “School Health
Health Promotion and Education of Lakewood, Colorado. Guidelines to Promote Healthy Eating and Physical
• Appendix C, “Development Characteristics and Needs Activity.”
of Students in Elementary and Middle Grades,” summa-
rizes common growth and development characteristics Chapter 7: Promoting Physical Activity
and the corresponding needs of students in kindergarten • New section on the goals of Comprehensive School
through grade 9 that can serve as a foundation for age Physical Activity Programs.
appropriate practice.
Chapter 8: Promoting Safety and Preventing
Unintentional Injury
CHAPTER-BY-CHAPTER CHANGES
OF THE EIGHTH EDITION • New Teacher’s Toolbox 8.2, “Steps in the Safe Kids
Helmet Fit Test.”
The new edition includes updated statistics throughout and
more than twenty-five new “Strategies for Learning and Chapter 9: Promoting Personal Health
Assessment.” and Wellness
Chapter 1: Coordinated School Health • New information on the current state of HIV/AIDS in
the United States and the kinds of interventions that
• The section “Mental or Intellectual Health” has been
should be used for those at the highest risk.
updated to include a discussion of the specific impact of
• New information about children with epilepsy and the
positive mental health in individuals and suggestions for
Epilepsy Foundation’s current Seizure Response Plan for
achieving these results.
the classroom.
• Tables 1–5 through 1–12 have been updated based on
the School Health Index (CDC).
• A new section highlights the 2014 collaborative “Whole
Chapter 10: Preventing Intentional Injuries
School, Whole Community, Whole Child” model devel-
and Violence
oped by the Centers for Disease Control and Prevention • Completely updated section on bullying explores the
and ASCD. spectrum of aggression, distinguishes cyberbullying, and
gives suggestions for creating school climates that deter
Chapter 4: Building and Managing the Safe all forms of student bullying.
and Positive Learning Environment • New table, “Percentage of Districts Adopting Policy
• An updated section, “Cultivating Connectedness Requiring Schools to Teach Specific Health Topics.”
Through Parent Engagement,” emphasizes the impor- • New table, “Percentage of State and Districts Who
tance of parents and school staff working together to Provided Funding for or Offered Professional Develop-
improve the health of children and adolescents. ment on How to Implement Policies and Programs
• New discussion about building positive relationships Related to Violence Prevention.”
with parents includes a list of suggestions for promoting
these connections.
• New Teacher’s Toolbox, “Solutions for Six Common
INSTRUCTOR AND STUDENT
Challenges to Sustaining Parent Engagement.” ONLINE RESOURCES
The 8th edition of Health Education:
Chapter 5: Promoting Mental and Elementary and Middle School Applications
Emotional Health is now available as a SmartBook™—the
• New discussion about a 2009 report from the Institute first and only adaptive reading experience
of Medicine about risk and protective factors in the de- designed to change the way students read
velopment of emotional and behavioral problems in and learn.
children over time. SmartBook creates a personalized reading experience by
• New table, “School Health Policies and Practices Study highlighting the most impactful concepts a student needs to
(SHPPS) 2012 Data Related to Mental Health and learn at that moment in time. As a student engages with
Social Services.” SmartBook, the reading experience continuously adapts by
highlighting content based on what the student knows and
Chapter 6: Promoting Healthy Eating doesn’t know. This ensures that the focus is on the content
New discussion of the 2013 USDA report on food insecurity he or she needs to learn, while simultaneously promoting
and the reach of federal nutrition programs. long-term retention of material. Use SmartBook’s real-time

xii PREFACE
reports to quickly identify the concepts that require more students are performing, identify class trends, and
attention from individual students—or the entire class. The ­provide personalized feedback to students.
end result? Students are more engaged with course content,
can better prioritize their time, and come to class ready to How Does SmartBook Work?
participate. • Preview: Students start off by Previewing the content,
where they are asked to browse the chapter content to
Key Student Benefits get an idea of what concepts are covered.
• SmartBook engages the student in the reading process • Read: Once they have Previewed the content, the student
with a ­personalized reading experience that helps them is prompted to Read. As he or she reads, SmartBook will
study efficiently. introduce LearnSmart questions in order to identify
• SmartBook includes powerful reports that identify what content the student knows and doesn’t know.
­specific topics and learning objectives the student needs • Practice: As the student answers the questions, Smart-
to study. Book tracks their progress in order to determine when
• Students can access SmartBook anytime via a computer they are ready to Practice. As the students Practice in
and mobile devices. SmartBook, the program identifies what content they
are most likely to forget and when.
Key Instructor Benefits • Recharge: That content is brought back for review
• Students will come to class better prepared because ­during the Recharge process to ensure retention of the
SmartBook personalizes the reading experience, allow- material.
ing instructors to focus their valuable class time on Speak to your McGraw-Hill Learning Technology Consultants
higher level topics. today to find out more about adopting SmartBook for Health
• SmartBook provides instructors with a comprehensive Education: Elementary and Middle School Applications,
set of reports to help them quickly see how individual 8th edition!

Online Learning Center

The Online Learning Center for the eighth edition of Health
Education provides key teaching and learning resources in
an easy-to-use format. It includes the following teaching
tools, which have been updated for this edition by Christine
Fisher of Rhode Island College:
• Instructor’s Manual to Accompany Health Education:
Elementary and Middle School Applications.
• PowerPoint slides. A complete set of PowerPoint slides
is available for download from the book’s Online
Learning Center. Keyed to the major points in each
chapter, these slide sets can be modified or expanded to
better fit classroom lecture formats. Also included in the
PowerPoint slides are many of the illustrations from the
text, including the children’s art.

www.mhhe.com/telljohann8e PREFACE   xiii
• Test bank. The test bank includes true-false, multiple cutting edge work in assessment of the N ­ ational Health
choice, short-answer, and essay questions. The test Education Standards.
bank is also available with EZ Test computerized We would also like to thank our chapter contributors:
testing software. EZ Test provides a powerful,
Dr. Michele Wallen, Associate Professor of Health Edu-
easy-to-use test maker to create printed quizzes
cation at East Carolina University, updated Chapter 8,
and exams.
Promoting Safety and Preventing Unintentional Injury.
Dr. Adrian Lyde, Assistant Professor of Health Educa-
tion at Illinois State University, updated Chapter 10,
Preventing Intentional Injuries and Violence.
ACKNOWLEDGMENTS
Dr. JoEllen Tarallo-Falk, Executive Director of the
The authors would like to thank Dr. I. Renee Axiotis for
Center for Health and Learning, updated Chapter 12,
her contributions to this text. Her work in compiling lists
Alcohol and Other Drug Use Prevention.
of the most current, developmentally appropriate, and
relevant children’s literature for this edition is greatly We hope that you enjoy the changes and additions made
­appreciated. in this eighth edition. We welcome any comments or sugges-
We express deep appreciation to Donna Rodenhurst and tions for future editions. We wish all the best and success in
Jimmy Edwards, health education teachers at King Interme- teaching health education to children and preadolescents.
diate School in Kaneohe, Hawaii, and to their s­ eventh-grade
students who provided the artwork on health education Susan K. Telljohann
standards and risk areas. And we thank Mary Doyen and Cynthia W. Symons
Debra Sandau Christopher of the Rocky ­Mountain Center Beth Pateman
for Health Promotion and Education for the use of their Denise M. Seabert

xiv   PREFACE
 SECTION I

Foundations of Health Education

Section I begins with a review of important definitions and concepts that frame current
understandings about health and health promotion. Next, a rationale for the importance
of school health programming as a mechanism to reduce health risks and promote school
success is discussed. With the foundation of the Healthy People agenda and findings from
the most recent School Health Policies and Practices Study, this section contains a review
of the eight critical components of Coordinated School Health. Teachers in elementary and
middle schools will be enriched by examining the ways in which the broad science about
brain function and learning have been translated into strategies for improving health in-
struction. Information about the value of using health education theory to inform practice
is introduced, and a critical analysis of standards-based approaches to health education is
provided. Finally, this section highlights strategies for creating a positive learning environ-
ment, promoting connectedness, managing time constraints, and dealing with controver-
sial content and associated instructional issues in health education and promotion.
 1

(Morgan Hi’ilei Serna, age 11)

OUTLINE
Health: Definitions
Physical Health (Physical/Body)
Mental/Intellectual Health
(Thinking/Mind)
Emotional Health (Feelings/
Emotions)
Social Health (Friends/Family)
Spiritual Health (Spiritual/Soul)
Vocational Health (Work/School)
Lo-kahi: A Model of “Balance,
Unity, and Harmony”
Determinants of Health
Healthy Americans, Healthy Youth
Health in the Academic Environment
Coordinated School Health
A Foundation for Understanding
A Program Model for Best
Practice
Health Education: The Keys to
Quality Health Instruction Coordinated School Health
Health Services
Healthy School Environment
A Foundation for Health Promotion
Nutrition Services in the Academic Environment
Counseling, Psychological, and
Social Services
Physical Education
Health Promotion for Faculty DESIRED LEARNER OUTCOMES
and Staff
After reading this chapter, you will be able to . . .
Family and Community
Involvement Define each of the domains of personal health.
Pulling It All Together Identify behavioral risk factors that influence illness and death.
Internet and Other Resources
Describe the link between student health and academic achievement.
Endnotes
Discuss the influence of school health programs on improving school success.

Summarize the role of each element of Coordinated School Health in improving the health of all
stakeholders in the school community.

Discuss the combined impact of the elements of Coordinated School Health on improving the
health of all stakeholders in the school community.
HEALTH: DEFINITIONS Mental/Intellectual Health (Thinking/Mind)
A review of common understandings about health reveals The capacity to interpret, analyze, and act on information
that most people think in terms of physical well-being. establishes the foundation of the mental or intellectual do-
As such, most people focus their thoughts and efforts on main of health. Additional indicators of mental or intellec-
preventing or managing illnesses, participating in fitness tual health include the ability to recognize the sources of
activities, or modifying dietary behaviors. It is important, influence over personal beliefs and to evaluate their impact
however, for teachers in elementary and middle schools to on decision making and behaviors. Observing the processes
understand that health is a very broad concept that extends of reasoning, the capacity for short- and long-term memory,
far beyond the limitations of the physical domain. and expressions of curiosity, humor, logic, and creativity can
In 1947, the World Health Organization developed an provide clues about mental or intellectual health.4
informative definition of health defining it as “a state of Like the other domains, mental or intellectual health is
complete physical, mental, and social well-being and not important at every stage of life. In addition to exerting influ-
merely the absence of disease or infirmity.”1 This definition ence over all elements of well-being, positive mental health
made a critical contribution by clarifying that health is in- can contribute to the ability of people to:
fluenced by a number of interrelated and influential factors. • Realize their full potential.
Today, health is best understood as the capacity to func- • Manage stresses of daily living.
tion in effective and productive ways, influenced by com- • Work productively.
plex personal, behavioral, and environmental variables that • Make meaningful contributions.
can change quickly. Bedworth and Bedworth have defined
health as “the quality of people’s physical, psychological, Many factors, including those that are biological (e.g.,
and sociological functioning that enables them to deal ade- genetics and brain chemistry) and life circumstances or ex-
quately with the self and others in a variety of personal and periences (e.g., trauma or abuse) can influence mental
social situations.”2 Further, Carter and Wilson have clarified health. Importantly, positive mental health can be enriched
that “health is a dynamic status that results from an interac- by participating in enriching activities in the other domains
tion between hereditary potential, environmental circum- of health including regular and vigorous physical activity,
stance, and lifestyle selection.”3 These definitions confirm getting enough sleep, and maintaining positive relationships
that, although a great deal of personal control can be ex- with others.
erted over some sources of influence over health, the capac- Mental health challenges are common, and help is
ity for a person to be in complete control all such factors is available. However, even though most people are willing to
limited. In summary, current definitions emphasize both the seek professional help when they are physically ill, many
independent strength and the interactive effect of six influ- unfortunately are hesitant or even refuse to pursue thera-
ential domains of health: the physical, mental/intellectual, peutic interventions when confronted with mental health
emotional, social, spiritual, and vocational. challenges. Importantly, when care is provided by a trained
professional, many people feel improvement in their mental
Physical Health (Physical/Body) health status, and others can recover completely.5
The most easily observed domain of health is the physical.
In addition to being influenced by infectious agents, physical Emotional Health (Feelings/Emotions)
well-being is influenced by the combined effects of hereditary The emotional domain of health is represented by the ways
potential, exposure to environmental toxins and pollutants, in which feelings are expressed. Emotionally healthy people
access to quality medical care, and the short- and long-term communicate self-management and acceptance and express
consequences of personal behaviors. As such, physical health a full range of feelings in socially acceptable ways. Expe-
results from a complex and changing set of personal, family, riencing positive emotions and managing negative ones in
social, financial, and environmental variables. productive ways contribute balance to emotional health.
Initial and often lasting impressions of the health of a Importantly, emotionally robust individuals practice a range
friend or classmate is based on observed physical character- of coping skills that enable them to express negative feel-
istics, including height, weight, energy level, and the extent ings (sadness, anger, disappointment, etc.) in ways that are
to which the person appears to be rested. In addition, it is not self-destructive or threatening to others. In this way,
common to make judgments about health status based on emotional health contributes to and is reflected in perceived
observed behaviors. In this context, if friends participate in quality of life.
regular exercise or always wear a seatbelt, others are likely Many people who feel isolated, inadequate, or over-
to conclude that they are healthy. Conversely, very different whelmed express feelings in excessive or abusive ways. Oth-
judgments often are made about the health of friends who ers suppress or bottle up strong emotions. Routinely
are overweight or use tobacco products. Although a per- attempting to cope with negative feelings by burying them
son’s health outcomes might improve if they participated in has been demonstrated to contribute to stress-related ill-
fewer risky behaviors, such individuals might be very nesses, including susceptibility to infections and heart dis-
healthy in other influential domains. ease. Fortunately, counseling, support groups, and medical

www.mhhe.com/telljohann8e CHAPTER 1 COORDINATED SCHOOL HEALTH 3

therapies can help people manage emotional problems of Vocational Health (Work/School)
many types. An important starting resource for those at- The vocational domain of health relates to the ability to col-
tempting to manage such problems is their family doctor. laborate with others on family, community, or professional
This professional, with whom people are familiar and com- projects. Vocationally healthy people are committed to con-
fortable, can diagnose, treat, or make referrals for effective tributing their fair share of effort to projects and activities.
therapies to support and enrich emotional health.6 This commitment is demonstrated by the high degree of in-
tegrity with which individuals approach tasks. In addition
Social Health (Friends/Family) to personal enrichment, the vocational domain of health is
Humans live and interact in a variety of social environ- manifested in the degree to which a person’s work makes a
ments, including homes, schools, neighborhoods, and positive impact on others or in the community. The behav-
workplaces. Social health is characterized by practicing the iors of people with compromised vocational health threaten
requisite skills to navigate these diverse environments effec- personal work-related goals and have a negative impact on
tively. People with strength in the social domain of health the productivity of professional associates and the collabo-
maintain comfortable relationships characterized by strong rative community of the school or workplace.
connections, mutuality, and intimacy. In addition, socially
healthy people communicate respect and acceptance of oth-
- kahi: A Model of “Balance, Unity, and
Lo
ers and recognize that they can enrich and be enriched by
their relationships.7 Harmony”
Unfortunately, many people are unable to function in When evaluating the quality of a person’s health, it is im-
comfortable and effective ways in the company of others. portant to remember that balance across the domains is as
Such individuals can’t integrate a range of important social important as maintaining an optimal level of functioning
skills into daily living. Often, this is a consequence of being within each. In this context, a middle school student who uses
self-absorbed. Such limited focus can compromise one’s a wheelchair because of a disabling condition might produce
ability to recognize needs and issues of importance to oth- very high-quality academic work and have confident and ef-
ers. As a consequence, poorly executed social skills and the fective relationships with classmates. Conversely, a person
associated behavioral consequences can place significant who is very healthy in the physical domain might be limited
limitations on the ability to initiate and maintain healthy in the ability to express emotions productively or to behave in
relationships. Such limitations compromise personal health ways that confirm a poorly developed moral or ethical code.
and the quality of life of others. All cultures have developed ways to communicate about
shared beliefs, values, and norms that influence behaviors
Spiritual Health (Spiritual/Soul) within the group. In Hawaiian culture the term lo-kahi,
The spiritual domain of health is best understood in the meaning “balance, unity, and harmony,” is used to express
context of a combination of three important elements: this ideal. Depicted in Figure 1–1, the Lo-kahi Wheel is a
culturally specific depiction of the domains of health.9
• Comfort with self and the quality of interpersonal rela-
Readers will note that names for each part of the Lo-kahi
tionships with others.
Wheel have been linked to the corresponding name of each
• The strength of one’s personal value system.
domain of health discussed. In addition, this illustration re-
• The pursuit of meaning and purpose in life.8
inforces the importance of maintaining a solid balance
Spiritually healthy people integrate positive moral and across the domains as a foundation for maintaining per-
ethical standards such as integrity, honesty, and trust into sonal, family, and community health.
their relationships. These individuals demonstrate strong With a focus on the health of students in elementary and
concern for others regardless of gender, race, nationality, middle schools, examination of the Lo-kahi Wheel reinforces
age, sexual orientation, or economic status. Although some the negative impact that an imbalance in the health of one
people believe that spiritual well-being is enriched by their person can exert on the “balance, unity, and harmony” of
participation in formal religious activities, the definition of their family, school, and community. In this way, a student
spiritual health is not confined to sacred terms or practices. who uses tobacco, alcohol, or other drugs is likely to face
People with compromised spiritual health might not be negative health, academic, family, and/or legal consequences.
guided by moral or ethical principles that are broadly ac- Simultaneously, such behaviors can threaten the health of
cepted or believe that a higher being or something beyond family and friends. Also, the behavioral risks of one student
themselves contributes meaning to their lives. Among such will disrupt the functional “balance” at school, in the work-
individuals, short-term economic objectives, self-interest, or place, and in the community. As such, it is clear that un-
personal gain at the expense of others could be of primary healthy risk behaviors can have significant personal and
importance. People with compromised spiritual health are far-reaching negative consequences.
likely to feel isolated and have difficulty finding meaning in Lo-kahi serves as a foundation for the Hawaiian term
activities, making decisions about significant issues, or e ola pono. Though this term has a number of related inter-
maintaining productive relationships with others. pretations, generally it is translated as “living in the proper

4 SECTION I FOUNDATIONS OF HEALTH EDUCATION

 Thinking About Health in Hawai’i
The Lo–kahi Wheel
Consider This 1.1
Health: A Personal Evaluation

At the beginning of each chapter in this text, readers will find

artwork done by students in middle school health education
classes. An example of correlated instruction (see Chapter 4),
the drawings reveal student understandings about critical is-
sues discussed in that chapter. Additional drawings reinforce
Coordinated School Health, a concept discussed later in this
chapter, and the National Health Education Standards dis-
cussed in Chapter 3.
Importantly, the artistic depiction at the beginning of Chap-
ter 1 was done by a sixth grader. This Lo -kahi Wheel provides a
very personal view through the eyes of this middle school
student of each domain of health and the balance of their com-
bined effects. To enrich understanding and personalize the
concept of health, teachers are encouraged to have students
draw their own Lo -kahi Wheels. The inclusion of color, person-
ally meaningful depictions, and family characteristics should
be encouraged. As a way to extend the learning activity, stu-
dents could be asked to write a journal entry or share their
“health story” with family members. In addition, the class could
Lo–kahi -kahi Wheel representing events, condi-
(Harmony, Balance, Unity)
create a composite Lo
tions, and circumstances that influence the health of the group
Physical/Body Spiritual/Soul as a whole. Finally, this learning activity could be correlated
Friends/Family Work/School
with social studies instruction as a way to explore ways in
Thinking/Mind Feelings/Emotions
which people depict and communicate about issues of cultural
❘
FIGURE 1–1 The Lo-kahi Wheel
SOURCE: Native Hawaiian Safe and Drug-Free Schools Program, E Ola Pono (Live the
and historical significance.
Proper Way): A Curriculum Developed in Support of Self-Identity and Cultural Pride as
Positive Influences in the Prevention of Violence and Substance Abuse (Honolulu, HI:
Kamehameha Schools Extension Education Division, Health, Wellness, and Family
Education Department, 1999).
leading causes of illness and death among Americans had
undergone dramatic change between the beginning and the
end of the twentieth century. In the early 1900s, the greatest
way” or “living in excellence.” When students live their lives number of Americans died as a result of infectious or com-
in a way that is orderly, successful, and true to what is in municable diseases, including influenza and pneumonia, tu-
their best interest, the elements of their health are in balance berculosis, and diarrhea and related disorders. Fortunately,
and simultaneously enrich the well-being of their family, due to measures such as improved sanitation and medical
school, and community.10 discoveries, Americans living just a century later enjoyed
As discussed in Chapter 2 of this text, to be effective, significantly longer, healthier lives.11
developmentally appropriate health education learning ac- During the past century between 1900 and 2000, the
tivities for students in elementary and middle schools must average life span of Americans lengthened by greater than
enable learners to translate general or abstract concepts into thirty years. Many factors contributed to such dramatic im-
understandings or representations that have personal mean- provement in the health and life span of Americans during
ing or relevance. To enrich student understanding of the in- the twentieth century. In 1999, the Centers for Disease Con-
fluence of each domain of health and the combined trol and Prevention (CDC) compiled a list of ten specific
importance of a balance between them, teachers are encour- achievements that made a “great” impact on improving the
aged to explore the learning activity described in Consider nation’s health during that 100-year period. These achieve-
This 1.1. ments are reviewed in Table 1–1.12 It is important to recog-
nize and celebrate the kinds of individual, community, and
governmental activities that made these advancements pos-
DETERMINANTS OF HEALTH sible. Such efforts continue to influence improvements in the
In 1979, the U.S. government embarked on a sweeping initi- health of all Americans today.
ative to improve the health of all Americans. This multidec- Although there were dramatic increases in the length and
ade agenda was launched with the publication of Healthy the quality of life of Americans since 1900, Healthy People
People: The Surgeon General’s Report on Health Promotion reinforced the need to address factors that continue to cause
and Disease Prevention. This document confirmed that the premature death. This report confirmed that approximately

www.mhhe.com/telljohann8e CHAPTER 1 COORDINATED SCHOOL HEALTH 5

 TABLE 1–1
Ten Great Public Health Achievements in the United States, 1900–1999
1. Vaccination: resulted in eradication of smallpox, elimination of polio in the Americas, and control of measles, rubella, tetanus, and other
infections in the United States and around the world
2. Improvements in motor-vehicle safety: include engineering advancements in highways and vehicles, increased use of safety restraints and
motorcycle helmets, and decreased drinking and driving
3. Safer workplaces: better control of environmental hazards and reduced injuries in mining, manufacturing, construction, and transportation
jobs, contributing to a 40 percent decrease in fatal occupational injuries since 1980
4. Control of infectious disease: resulted from clean water, improved sanitation, and antibiotic therapies
5. Decline in deaths due to heart disease and stroke: a 51 percent decline in cardiovascular death since 1972—related to decreased smoking,
management of elevated blood pressure, and increased access to early detection and better treatment
6. Safer and healthier foods: decreased microbe contamination, increased nutritional content, and food-fortification programs that have
nearly eliminated diseases of nutritional deficiency
7. Healthier moms and babies: better hygiene and nutrition, available antibiotics, greater access to early prenatal care, and technological
advances in maternal and neonatal medicine—since 1900, decreases in infant (90 percent) and maternal (99 percent) death rates
8. Family planning: improved and better access to contraception, resulting in changing economics and roles for women, smaller families, and
longer intervals between births; some methods related to reduced transmission of human immunodeficiency virus (HIV) and other sexually
transmitted diseases
9. Fluoridation of drinking water: tooth decay prevented regardless of socioeconomic status; reduced tooth loss in adults
10. Recognition of the health risks of tobacco use: reduced exposure to environmental tobacco smoke; declining smoking prevalence and
associated deaths
While not ranked in order of significance or degree of contribution, the accomplishments on this list continue to help Americans live longer and
healthier lives.

SOURCE: Centers for Disease Control and Prevention, “Ten Great Public Health Achievements—United States, 1900–1999,” MMWR 48, no. 12 (1999): 241–43.

50 percent of premature morbidity (illness) and mortality TABLE 1–2

(death) among Americans was linked to variables largely Leading Causes of Death Among Americans in 1900 and Today
beyond personal control. These variables include heredity (ranked in order of prevalence)
(20 percent); exposure to environmental hazards, toxins, 1900 Today
and pollutants (20 percent); and inadequate access to qual-
Pneumonia Heart disease
ity medical care (10 percent).13 It is significant to note, how-
Tuberculosis Cancer
ever, that Healthy People confirmed that the remainder of Diarrhea/enteritis Chronic respiratory diseases
premature illness and death (approximately 50 percent) Heart disease Stroke
could be traced to participation in risky health behaviors.14 Liver disease Unintentional injuries
Table 1–215, 16 contrasts past and current leading causes of Injuries Alzheimer’s disease
death among Americans. Cancer Diabetes
Examination of Table 1–2 contrasts the devastating impact Senility Nephritis and other kidney
of communicable/infectious diseases on previous generations disorders
with the consequences of chronic diseases (those that last a Diphtheria Influenza and pneumonia
year or longer and require medical attention or limit daily Suicide
activity) on the length and quality of life of Americans today. SOURCES: U.S. Department of Health, Education and Welfare, Public Health Service,
Healthy People: The Surgeon General’s Report on Health Promotion and Disease
Conditions including heart disease, stroke, cancer, diabetes, Prevention (Washington, DC: U.S. Government Printing Office, 1979). Centers for Disease
Control and Prevention, “QuickStats: Number of Deaths from 10 Leading Causes—
and arthritis are among the most common, costly, and pre- National Vital Statistics System, United States, 2010,” Morbidity and Mortality Weekly
Report (MMWR) 62, no. 8 (March 1, 2013).
ventable of all health problems. The combined effects of just
NOTE: In 1900, the leading causes of death for most Americans were communicable or
three conditions—heart disease, cancer, and stoke—account infectious conditions. Today, however, most Americans die as a result of chronic
conditions.
for more than 50 percent of all American deaths each year.
Importantly, the combined effects of chronic diseases account
for seven of every ten American deaths every year.17 Almost An important first step to understand and address the
one of every two American adults has at least one chronic complex burden of chronic diseases, is to recognize that the
disease. In addition to their prevalence, such conditions cause majority of these conditions have been linked to participa-
limitations in the daily activities among nearly one-fourth of tion in relatively few health-risk behaviors. Recent evidence
people who are affected by them.18 As a nation, 75 percent of suggests that four modifiable health-risk behaviors—the
health care spending goes to the treatment of chronic dis- lack of physical activity, poor nutrition, tobacco use, and
eases. These persistent conditions are the causes of deaths excessive alcohol consumption—account for much of the
that could have been prevented, lifelong disability, compro- illness, suffering, cost, and early deaths related to chronic
mised quality of life, and an overwhelming burden of health diseases.20 Data in Table 1–3 identify the risk behaviors that
care costs.19 undergird the actual causes of most American deaths.21, 22

6 SECTION I FOUNDATIONS OF HEALTH EDUCATION

 TABLE 1–3 those actions discussed in Table 1–1, today’s influential
Underlying Risk Behaviors—Actual Causes of Death in the variables include:
United States in 2000 • Biology and genetics: Examples of such determinants of
Approximate Approximate health include age, sex, and inherited conditions. Impor-
Number of Percent of tantly, some biological and genetic factors affect some
Risk Behavior Deaths Annual Deaths people more than others. In specific, older adults are
Tobacco 435,000 18.1 more prone to poorer health outcomes than their ado-
Poor diet and physical 365,000 15.2 lescent counterparts and sickle-cell disease is most com-
inactivity mon among people with ancestors from West African
Alcohol 85,000 3.5 nations.
Infections 75,000 3.1 • Social factors: The social determinants of health include
Toxic agents 55,000 2.3
physical conditions and other factors in the environ-
Motor vehicles 43,000 1.8
ment in which people are born, live, learn, play, and
Firearms 29,000 1.2
Sexual behavior 20,000 0.8
work. Examples of importance include the availability
Drug use 17,000 0.7 of resources to meet daily needs, prevalent and power-
SOURCES: A. H. Mokdad et al., “Actual Causes of Death in the United States, 2000,”
ful social norms and attitudes, transportation options,
Journal of the American Medical Association 291, no. 10 (March 10, 2004): 1238–45; public safety, and quality schools.
Centers for Disease Control and Prevention, Chronic Diseases and Health Promotion
(www.chronicdisease/overview/index.htm, 2013). • Health services: Both access to, and the quality of avail-
NOTE: It is important to exert influence over the common lifestyle risk behaviors linked to able health services influence health outcomes for all
many of the causes of premature death. These health risks represent the actual leading
causes, rather than the clinical diagnoses provided at the time of death for the majority Americans. Examples of barriers to medical care include
of Americans.
limited availability of specialized services in a local area,
high cost, poor insurance coverage, and limited lan-
guage access. In this context, if people don’t have health
Consistent with the information found in this table, although
insurance, research has demonstrated that they are less
a physician might indicate a clinical diagnosis of heart dis-
likely to participate in preventive care and to delay seek-
ease on a death certificate, the root cause of the heart disease
ing medical treatment for illness or injury.
could be traced to the cumulative effects of participation in
• Public policy: Local, state, and federal laws and policy
any number of underlying risk behaviors.
initiatives have been demonstrated to influence the
It is important to remember that the greatest majority of
health of individuals and the population as a whole. For
adults who participate in risk behaviors initiated those
example, when taxes on tobacco sales are increased, the
health habits during their youth. Public health professionals
health of the people living in that region is improved by
at the CDC identified six priority health behaviors to guide
reducing the number of people using tobacco products.
educational programmers and intervention specialists. Ow-
Readers are encouraged to review the influence of the
ing to the demonstrated link between these behaviors and
federal Affordable Care Act in this regard.
the leading causes of illness and death among Americans,
• Individual behavior: As discussed, positive changes in
curriculum developers and teachers should target educa-
individual behaviors including reducing dietary risks, in-
tional strategies at reducing the risks associated with the
creasing physical activity, and reducing or eliminating
following:
the use of tobacco, alcohol, and other drugs, can reduce
• Tobacco use. chronic diseases. In addition, the simple act of hand
• Poor eating habits. washing is one of the most important individual acts
• Alcohol and other drug risks. with the potential to reduce the short-term impact of
• Behaviors that result in intentional or unintentional infections.24
injuries.
Although each of these factors exerts independent influ-
• Physical inactivity.
ence, the interaction among them is significant. In this con-
• Sexual behaviors that result in HIV infection, other sex-
text, it is clear that health is rooted in homes, schools,
ually transmitted diseases, or unintended pregnancy.23
neighborhoods, workplaces, and communities. While indi-
In addition to addressing specific personal health risks, vidual behaviors such as eating well, staying active, not
school-based professionals must remember that human be- smoking, and seeing a doctor for preventive care or when
havior in general, and health behavior specifically, is influ- sick can influence health, well-being also is influenced by
enced by complex sources. While it is important to equip their cumulative effects. Social determinants and environ-
students with the functional knowledge and essential skills mental factors including access to quality schools, availabil-
to manage personal health risks, it is equally important to ity of clean water, air and healthy foods, and enriching
recognize that such behaviors do not happen in a vacuum. social relationships help to clarify why some people are
Public health researchers have identified five major sources healthier than others. Only when people understand and
of influence on American health. Similar to the causes of can address the independent and combined effects of these
premature death identified in the 1979 Healthy People and sources of influence, will it be possible to achieve the highest

www.mhhe.com/telljohann8e CHAPTER 1 COORDINATED SCHOOL HEALTH 7

quality of health for all. Given the complexity of this chal- other substance use and abuse, sexual risks, motor vehicle
lenge, the coordinated efforts of individuals, families, crashes, and suicidal thoughts or acts can determine current
schools, civic groups, faith-based organizations, and gov- health status or influence the development of chronic dis-
ernmental agencies will be necessary to address the complex eases that will be manifested in adulthood. Research has
health challenges confronting youth.25 demonstrated that adolescents particularly are sensitive to
contextual influences in their environment. Factors includ-
ing cues from family members, peers, those in their neigh-
HEALTHY YOUTH, HEALTHY AMERICANS borhoods, and expectations and norms presented in the
media can challenge or support their health. This is particu-
Since the publication of Healthy People in 1979, local, state,
larly true of the school environment in which policies, prac-
and federal agencies have assumed leadership for a long-
tices, and influential others can exert a powerful impact on
term broad and collaborative initiative to promote health
the decision making and behaviors of youth.28
and prevent disease among Americans. Every ten years, the
In addition to the developmental issues that challenge
U.S. Department of Health and Human Services (HHS) has
adolescents, a growing body of research has documented
gathered the latest data, analyzed accumulated information,
the importance of early childhood (birth to age 8) as a pe-
and reviewed the best science about trends and innovations
riod in which the physical, cognitive, and social-emotional
collected across the previous decade. Then, the best of this
foundation for lifelong health and learning are established.
evidence is used to establish and monitor national health
During this developmental stage, the brain grows to 90 per-
objectives targeting a broad range of health issues. These
cent of its adult size and children learn to regulate their
specific and measurable objectives establish a foundation
emotions, cultivate skills to form attachments, and develop
to help individuals and communities make and act on in-
language and critical motor skills. All of these milestones
formed health decisions.26
can be delayed if young children experience significant envi-
In addition to the focus on a range of critical health is-
ronmental stress or other risks that affect the brain or com-
sues, this decades-long agenda has been organized around
promise physical, social-emotional, or cognitive growth.
measurable objectives targeting diverse ages and groups of
More than any other stages of development, early and
Americans. Among these targeted groups are children and
middle childhood (ages 6 to 12 years) set the stage for de-
youth. Since its inception, Healthy People has encouraged
veloping health literacy and practicing self-management,
collaboration among influential stakeholders and institu-
decision making, and the skills to negotiate conflicts with
tions to protect and promote the health of this age group.27
others. Typical and nonfatal conditions including asthma,
Adolescence has been confirmed to be a period charac-
obesity, and developmental and behavioral disorders can
terized by significant developmental transition. Youth be-
affect the health and education outcomes of those at this
tween the ages of 10 and 19 are confronted with complex
developmental stage. Importantly, health risks encoun-
challenges associated with puberty and the task of cultivat-
tered during early and middle childhood can affect the
ing skills to negotiate requisite developmental tasks. Al-
well-being of the adolescents and adults who children will
though generally a healthy time of life, pertinent issues of
become.29
significance can take root during adolescence. Tobacco and
To review important health promotion targets for chil-
dren and youth contained in Healthy People 2020, readers
are encouraged to examine Table 1–4. Listed are the objec-
tives that identify actions for many influential stakeholders
in school communities designed to promote the health of
youth.30

HEALTH IN THE ACADEMIC

ENVIRONMENT
Today, youth are confronted with health, educational, and
social challenges on a scale and at a pace not experienced
by previous generations of young Americans. Violence, al-
cohol and other drug use, obesity, unintended pregnancy,
and disrupted family situations can compromise both their
short- and long-term health prospects.31
Educational institutions are in a unique and powerful
position to improve health outcomes for youth. In the
United States, nearly 60 million students are enrolled in
Quality health education can help empower children in all more than 1,30,000 public and private elementary and sec-
domains of health. ondary schools. In this context, schools have direct contact

8 SECTION I FOUNDATIONS OF HEALTH EDUCATION

 HEALTHY PEOPLE
TABLE 1–4
Healthy People 2020 Objectives That Specify Action for Advocates and Stakeholders in Schools

Adolescent Health (AH)

AH HP2020–5: Increase the percentage of middle and high schools that prohibit harassment based on a student’s sexual
orientation or gender identity.
AH HP2020–6: Decrease the percentage of adolescents who did not go to school at least once in the past month because of
safety concerns.
AH HP2020–7: Decrease the percentage of public middle and high schools with a violent incident.
AH HP2020–8: Increase the percentage of adolescents who are connected to a parent or other positive adult caregiver.
AH HP2020–9: Decrease the percentage of adolescents who have been offered, sold, or given an illegal drug on school
property.
AH HP2020–10: Increase the percentage of vulnerable adolescents who are equipped with the services and skills necessary
to transition into an independent and self-sufficient adulthood.
Disability and Secondary Conditions (DSC)
DSC HP2020–2: Reduce the proportion of children and adolescents with disabilities who are reported to be sad, unhappy, or
depressed.
DSC HP2020–5: Increase the proportion of children and youth with disabilities who spend at least 80% of their time in regular
education programs.
Early and Middle Childhood (EMC)
EMC HP2020–3: Increase the proportion of elementary, middle, and senior high school that require school health education.
Educational and Community-Based Programs (ECBP)
ECBP HP2020–2: Increase the proportion of elementary, middle, and senior high schools that provide comprehensive school
health education to prevent health problems in the following areas: unintentional injury; violence; suicide;
tobacco use and addiction; alcohol or other drug use; unintended pregnancy, HIV/AIDS, and STD infection;
unhealthy dietary patterns; and inadequate physical activity.
ECBP HP2020–4: Increase the proportion of the Nation’s elementary, middle, and senior high schools that have a nurse-to-
student ratio of at least 1:750.
ECBP HP2020–11: Increase the proportion of elementary, middle, and senior high schools that have health education goals or
objectives that address the knowledge and skills articulated in the National Health Education Standards
(high school, middle, elementary).
Environmental Health (EH)
EH HP2020–19: Increase the proportion of the Nation’s elementary, middle, and senior high schools that have official
school nurse policies and engage in practices the promote a healthy and safe physical school
environment.
EH HP2020–25: Decrease the number of new schools sited within 500 feet of a freeway or other busy traffic corridors.
Family Planning (FP)
FP HP2020–12: Increase the proportion of adolescents who received formal instruction on reproductive health topics before
they were 18 years old.
Hearing and Other Sensory or Communication Disorders (Ear, Nose, Throat-Voice, Speech, and Language) (ENT)
ENT HP2020–21: Increase the proportion of young children with phonological disorders, language delay, or other developmen-
tal language problems who have participated in speech-language or other intervention services.
Injury and Violence Prevention (IVP)
IVP HP2020–8: Increase use of safety belts.
IVP HP2020–13: Reduce physical fighting among adolescents.
IVP HP2020–14: Reduce weapon carrying by adolescents on school property.
IVP HP2020–23: Increase the proportion of bicyclists who regularly wear a bicycle helmet.
IVP HP2020–28: Increase the proportion of public and private schools that require students to wear appropriate protective
gear when engaged in school-sponsored physical activities.
IVP HP2020–41: Reduce bullying among adolescents.
Mental Health and Mental Disorders (MHMD)
MHMD HP2020–2: Reduce the rate of suicide attempts by adolescents.
MHMD HP2020–4: Reduce the proportion of adolescents who engage in disordered eating behaviors in an attempt to control
their weight.
(Continued)

www.mhhe.com/telljohann8e CHAPTER 1 COORDINATED SCHOOL HEALTH 9

 TABLE 1–4 (Continued)
Nutrition and Weight Status (NWS)
NWS HP 2020–5: Reduce the proportion of children and adolescents who are overweight or obese.
NWS HP2020–20: Increase the percentage of schools that offer nutritious foods and beverages outside of school meals.
Physical Activity and Fitness (PAF)
PAF HP2020–2: Increase the proportion of the Nation’s public and private schools that require daily physical education for
all students.
PAF HP2020–3: Increase the proportion of adolescents who participate in daily school physical education.
PAF HP2020–4: Increase the proportion of adolescents who spend at least 50% of school physical education class time
being physically active.
PAF HP2020–5: Increase the proportion of the Nation’s public and private schools that provide access to their physical
activity spaces and facilities for all persons outside of normal school hours (that is, before and after the
school day, on weekends, and during summer and other vacations.
PAF HP2020–7: Increase the proportion of adolescents that meet current physical activity guidelines for aerobic physical
activity and for muscle-strengthening activity.
PAF HP2020–8: Increase the proportion of children and adolescents that meet guidelines for television viewing and
computer use.
PAF HP2020–10: Increase the proportion of trips made by walking.
PAF HP2020–11: Increase the proportion of trips made by bicycling.
Substance Abuse (SA)
SA HP2020–4: Reduce the proportion of adolescents who report that they rode, during the previous 30 days with a drive
who had been drinking alcohol.
Tobacco Use (TU)
TU HP2020–6: Reduce tobacco use by adolescents.
TU HP2020–7: Reduce the initiation of tobacco use among children, adolescents, and young adults.
TU HP2020–9: Increase smoking cessation attempts by adolescent smokers.
TU HP2020–12: Increase tobacco-free environments in schools, including all school facilities, property, vehicles, and
school events.
TU HP2020–14: Reduce the proportion of adolescents and young adults who are exposed to tobacco advertising and promotion—
reduction in the proportion of adolescents grades 6 through 12 exposed to tobacco advertising and promotion.

SOURCE: U.S. Department of Health and Human Services, Healthy People 2020 (www.healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicid=; 11; 2013).
NOTE: Education professionals are encouraged to evaluate the extent to which their schools have established policies and practices that bring them into compliance with these national
health objectives.

with more than 95 percent of American youth between the sweeping efforts to reform public education. Since the early
ages of 5 and 17 years. Sustained for over six hours every 1980s, many research reports, position statements, and leg-
school day, this instructional engagement proceeds over a islative initiatives have been directed at improving the qual-
thirteen-year period, a time of significant social, psychologi- ity of education for all students. The passionate commitment
cal, physical, and intellectual development.32, 33, 34, 35 As to reform the nation’s education enterprise has taken many
such, schools represent the only social institution that can forms, including experimentation with strategies to improve
reach nearly all young people. teacher preparation, evaluation of student performance,
Beyond offering efficient access to the critical mass of and the U.S. Supreme Court decision supporting vouchers
youth, schools provide a setting in which friendship net- to promote school choice options for parents. Most school
works develop, socialization occurs, and norms that influ- improvement plans have increased reliance on quantitative
ence behavior are developed and reinforced.36 Importantly, measures of student performance in the basic, or core, aca-
such social norms prevail in the school environment before demic subjects including language arts, mathematics, social
specific health behaviors can become habitual for individual studies, and the physical sciences. In addition, significant
students. As a result, developmentally predictable experi- efforts and financial resources have been mobilized to en-
mentation with a range of health behaviors occurs in con- rich instructional practices targeting the Common Core
text of relationships with professional adult educators who Standards, an agenda explored in Chapter 2.
are academically prepared to organize developmentally ap- Unfortunately, support for academic activities designed to
propriate learning experiences to empower children to lead address the complex health challenges confronting students
safer, healthier lives. are missing in most calls for education reform. A Nation at
Unfortunately, advocates committed to promoting child Risk, a report by the National Commission on Excellence in
and adolescent health in schools have been challenged by Education, included health education on a list of academic

10 SECTION I FOUNDATIONS OF HEALTH EDUCATION

subjects identified as part of the “educational smorgasbord.” In recognition that school-based activities to promote
This prestigious and powerful 1983 report, sponsored by the student health must occur in the context of, rather than in
U.S. Department of Education, asserted that the American competition with, strategies to improve education out-
education curricula had become “diluted . . . and diffused” comes, many professional and policy advocates have re-
and recommended that educational programs in this “smor- sponded. Of note, the Association for Supervision and
gasbord” category be either eliminated or significantly re- Curriculum Development (ASCD) convened a meeting of
duced in emphasis during the school day.37 Echoes of this the Commission on the Whole Child. This group was
perspective remain in the federal No Child Left Behind and charged with the important task of redefining the “success-
Race to the Top agendas discussed in Chapter 2. ful learner.”43 Their specific responsibility was to reframe
Importantly, a growing body of science confirms that stu- the understanding of a “successful learner” from a student
dent health behaviors, academic outcomes, and school poli- whose achievement is measured only by scores on academic
cies and practices designed to address them are “inextricably tests, to one who is knowledgeable, emotionally and physi-
intertwined.”38 The American Cancer Society and represen- cally healthy, engaged in civic activities and events, involved
tatives of more than forty national organizations concluded in the arts, prepared for work and for economic self-
that “healthy children are in a better position to acquire sufficiency, and ready for the world after completing formal
knowledge” and cautioned that no curriculum is “brilliant schooling.44
enough to compensate for a hungry stomach or a distracted The Position Statement on the Whole Child, developed
mind.”39 To reinforce this position, a recent and significant by the Commission of the Whole Child, affirmed that aca-
research agenda concluded that: demics remain essential, but are only one element of stu-
No matter how well teachers are prepared to teach, no matter
dent learning and development. Rigorous testing can be
what accountability measures are put in place, no matter what only one part of a complete system of educational account-
governing structures are established for schools, educational ability. In an expansion of conventional thinking about
progress will be profoundly limited if students are not motivated education reform, the “new compact” established by ASCD
and able to learn. . . . Healthier students are better learners.40 calls on teachers, schools, and communities to collaborate
to ensure that
In this context, the Council of Chief State School Officers
(CCSSO), the professionals responsible for education pro- • “Each student enters school healthy and learns about
gramming and policy in each state, issued Policy Statement and practices a healthy lifestyle,
on School Health. Recognizing that “healthy kids make bet- • Each student learns in an intellectually challenging
ter learners and that better students make healthy commu- environment that is physically and emotionally safe for
nities,” this policy statement urged education leaders “to students and adults,
recognize the enormous impact that health has on the aca- • Each student is actively engaged in learning and is con-
demic achievement of our nation’s youth.” Further, the es- nected to the school and broader community,
teemed CCSSO urged all educators to “look beyond • Each student has access to personalized learning and to
standards setting and systems of accountability and join qualified, caring adults, and
with public and private sector mental health, health, and • Each graduate is prepared for success in college or
social services providers to address the widespread condi- further study and for employment in a global
tions that interfere with student learning and students’ pros- environment.”45
pects for healthy adulthood.”41
Achieving these ambitious outcomes requires the estab-
Beyond making this statement of advocacy, this important
lishment of coalitions of supportive and involved families,
policy statement contained a number of recommendations for
community volunteers, and advocates for health promotion
state and local education leaders. At the state level, education
networks and school health councils. In addition, ASCD
and legislative leaders were encouraged to demonstrate their
has reinforced the importance of support provided by gov-
commitment to acting on the evidence-based links between
ernmental, civic, and business organizations. Schools must
health and academic success by engaging in such activities as:
develop challenging and engaging curricula, provide pro-
• Disseminating data that confirm the impact of health- fessional development and planning time for high-quality
promoting activities on academic achievement. teachers and administrators, cultivate a safe, healthy, or-
• Designating senior-level staff to oversee school health- derly, and trusting learning environment, promote strong
related activities. relationships between adults and students, and support
• Supporting policies that promote student health, in- health promotion networks and school health councils.
cluding restricting vending machine sales, prohibiting Finally, teachers were called on to use evidence-based in-
tobacco use on school property, and ensuring health struction and assessment practices, engage learners in rich
insurance coverage for all students and staff. content, make connections with students and families,
• Ensuring curricular compliance with the National manage their classrooms effectively, and model healthy
Health Education Standards. behaviors.46
• Allocating adequate funding for school health Given the complex health and learning challenges facing
promotion.42 today’s students it is critical for educators, families, and

www.mhhe.com/telljohann8e CHAPTER 1 COORDINATED SCHOOL HEALTH 11

other advocates to remember that children don’t grow and professionals are not equipped to provide such diagnostic
learn in isolation. They grow physically, emotionally, ethi- and therapeutic intervention. Exceptions exist only in cir-
cally, expressively, and intellectually in networks of families, cumstances in which first aid or emergency care must be
schools, neighborhoods, and communities. Educating the provided. Even in such cases, only trained individuals in the
whole child won’t happen with emphasis only on measures education community should render emergency care. The
of academic achievement.47 appropriate role for school-based professionals in managing
As a result of the contributions of such powerful advo- students who need medical care includes referral, support,
cates, health promotion activities are gaining credibility as and compliance with the prescriptions and proscriptions
an effective and efficient way to promote student success as made by attending clinicians. In this context, the appropri-
stakeholders learn that the choice of focusing on education ate role for educators is to support parents and trained oth-
outcomes or academic success is a false one. Mounting evi- ers to carry out such care plans.
dence has confirmed the destructive impact of student health “Disease prevention” “begins with a threat to health—a
risks on attendance, class grades, performance on standard- disease or environmental hazard—and seeks to protect as
ized tests, and graduation rates.48 many people as possible from the harmful consequences of
Due to the complexity of the health and academic prob- that threat.”51 Disease prevention is best understood as the
lems confronting students, it is not reasonable nor realistic process of “reducing risks and alleviating disease to pro-
to expect that schools can address them without support. mote, preserve, and restore health and minimize suffering
Such challenges will require the collaborative efforts of fam- and distress.”52 Often, teachers emphasize hand washing
ilies, communities, health care providers, legislators, the me- and proper disposal of soiled tissues as part of daily class-
dia, and others. While there are no simple solutions, schools room practice. Education professionals collaborate with
can provide a focal point for many such efforts.49 school nurses, administrators, parents, and medical care
providers to manage outbreaks of infections and other con-
ditions including chicken pox, head lice, and the flu. School
COORDINATED SCHOOL HEALTH policymakers work with public health officials in screening
and enforcing compliance with immunization policies.
A Foundation for Understanding
Whether working independently in the classroom or col-
Each day, in schools across the United States, even the most
laborating with others, teachers assume a much more active
talented students are confronted with risks for alcohol or
role in disease prevention than in the implementation of
other drug-related behaviors, pregnancy, or the negative
medical care delivery in the school setting.
outcomes of violence. In response to these and many other
Though there are circumstances in which medical care
threats, it is common for well-intentioned, but often mis-
and disease prevention strategies are warranted, school-
guided stakeholders to respond with crisis intervention ap-
based professionals must be capable and comfortable with
proaches. Rather than developing stable, evidence-based,
activities that focus on student health promotion. Healthy
and sustained policies and practices, educators attend to
People defined all strategies that begin with “people who are
such health issues only when there is a catastrophic, sen-
basically healthy” as the target for health promotion activi-
sational, or newsworthy event. Importantly, such reactive
ties. Health promotion “seeks the development of commu-
approaches have been shown to meet the needs of only lim-
nity and individual measures which can help [people]
ited numbers of students and have been demonstrated to
develop healthy lifestyles that can maintain and enhance the
produce short-lived outcomes.
state of well-being.”53 More currently, health promotion is
As discussed earlier in this chapter, Healthy People pro-
best understood as any “planned combination of educa-
vided a starting point for organizing many kinds of targeted
tional, political, environmental, regulatory, or organiza-
health initiatives, including those based in the nation’s
tional mechanisms that support actions and conditions of
schools. Concerned advocates for children and youth would
living conducive to the health of individuals, groups, and
be wise to review the important definitions of medical care,
communities.”54
disease prevention, and health promotion contained in this
In this context, the primary task for educators working
historic publication. Understanding these concepts can help
with students who are “basically healthy” is to implement
to establish the boundaries of professional practice, identify
health promotion activities at the school site. As concluded
realistic program expectations, and target key stakeholders
in Healthy People,
with shared responsibility for the promoting and protecting
health of students. Beginning in early childhood and throughout life, each of us
In Healthy People, “medical care” is defined with a pri- makes decisions affecting our health. They are made, for the
mary focus on “the sick” and involves activities designed “to most part, without regard to, or contact with, the health care
delivery system. Yet their cumulative impact has a greater
keep these individuals alive, make them well, or minimize
effect on the length and quality of life than all the efforts of
their disability.”50 Each day, many students in America’s
medical care combined.55
schools receive medical care consistent with this definition.
They have conditions that have been diagnosed and are be- A commitment to health promotion at the school site
ing treated by trained clinicians. School-based education provides a foundation for proactive collaboration by many

12 SECTION I FOUNDATIONS OF HEALTH EDUCATION

stakeholders invested in both the health and school success result, their effectiveness and stainability are compromised
of learners. The contrast between common school health severely.
practice and strategies based on sound health promotion By contrast, evidence suggests that it is far better to orga-
research is highlighted in Consider This 1.2, “A Fence or an nize all school health activities around a framework in
Ambulance.” This poem, written in the 1800s, makes the which the talents and efforts of many professionals and re-
value of a commitment to a health promotion philosophy sources in the school and local community can be mobilized
based on prevention very clear. to promote health and school success for all students, not
just those with episodic or demanding health challenges.
A Program Model for Best Practice Such a coordinated approach is a way for many school
While it is true that most schools invest considerable time health promotion activities to be systematic and inten-
and expertise in managing a range of health problems, in tional.56 In addition, health messages can be communicated
most cases, these efforts are implemented as isolated or with consistency and reinforced through multiple channels,
competing entities. In this context, it is common for school the duplication of services can be reduced, resources funded
communities to organize categorical activities such as Red by tax dollars can be maximized, and advocates are better
Ribbon Week campaigns to reduce drug risks, transporta- able to focus their efforts.
tion safety activities at the start of the school year, physi- Formerly called the Coordinated School Health Program
cal education instruction, and free or reduced-cost lunches (CSHP), it is important to note that this is not another new
for children living in poverty, with little thought about their program to add to the already overflowing responsibility of
focus, coordination, or sustainability. It is easy to see that schools.57 Rather, Coordinated School Health (CSH) is de-
such school health activities are operating under a “more of fined as “[a]n organized set of policies, procedures, and ac-
anything” rather than a “better is better” philosophy. As a tivities, designed to protect, promote, and improve the

Consider This 1.2

A Fence or an Ambulance Joseph Malins

‘Twas a dangerous cliff, as they freely confessed, Let us stop at its source all this mischief,” cried he,
Though to walk near its crest was so pleasant; “Come, neighbors and friends, let us rally;
But over its terrible edge there had slipped If the cliff we will fence we might almost dispense
A duke and full many a peasant. With the ambulance down in the valley.”
So the people said something would have to be done, “Oh, he’s a fanatic,” the others rejoined,
But their projects did not at all tally; “Dispense with the ambulance? Never!
Some said, “Put a fence around the edge of the cliff,” He’d dispense with all charities, too, if he could;
Some, “An ambulance down in the valley.” No! No! We’ll support them forever.
Aren’t we picking up folks just as fast as they fall?
But the cry for the ambulance carried the day,
And shall this man dictate to us? Shall he?
For it spread through the neighboring city;
Why should people of sense stop to put up a fence,
A fence may be useful or not, it is true,
While the ambulance works in the valley?”
But each heart became brimful of pity
For those who slipped over that dangerous cliff; But a sensible few, who are practical too,
And the dwellers in highway and alley Will not bear with such nonsense much longer;
Gave pounds or gave pence, not to put up a fence, They believe that prevention is better than cure,
But an ambulance down in the valley. And their party will soon be the stronger.
Encourage them then, with your purse, voice, and pen,
“For the cliff is all right, if you’re careful,” they said,
And while other philanthropists dally,
“And, if folks even slip and are dropping,
They will scorn all pretense and put up a stout fence
It isn’t the slipping that hurts them so much,
On the cliff that hangs over the valley.
As the shock down below when they’re stopping.”
So day after day, as these mishaps occurred, Better guide well the young than reclaim them when old,
Quick forth would these rescuers sally For the voice of true wisdom is calling,
To pick up the victims who fell off the cliff, “To rescue the fallen is good, but ‘tis best
With their ambulance down in the valley. To prevent other people from falling.”
Better close up the source of temptation and crime
Then an old sage remarked: “It’s a marvel to me
Than deliver from dungeon or galley;
That people give far more attention
Better put a strong fence round the top of the cliff
To repairing results than to stopping the cause,
Than an ambulance down in the valley.
When they’d much better aim at prevention.

www.mhhe.com/telljohann8e CHAPTER 1 COORDINATED SCHOOL HEALTH 13

health and well-being of pre-K–12 students and staff, thus protect, and promote school success and the well-being of
improving a student’s ability to learn. It includes but is not students, families, and education professionals. When fully
limited to health education; school health services; a healthy implemented in a school community, CSH has the capacity to:
school environment; school counseling, psychological and
• Maximize the impact of all available expertise and re-
social services; physical education; school nutrition services;
sources directed toward risk reduction and health pro-
family and community involvement in school health; and
motion.
school-site health promotion for staff.”58
• Conserve taxpayer dollars by reducing duplication of
Consistent with the body of literature confirming links
services for health issues.
between student health and a range of measures of school
• Maximize use of public facilities in the school and com-
success, Dr. Lloyd Kolbe, one of the architects of CSH, revis-
munity to promote health.
ited his original work and concluded that the goals of the
• Enhance communication and collaboration across
modern school health program are consistent with the
health promotion professionals in the school and com-
agenda of educational reform. Consistent with the advocacy
munity.
position taken by ASCD for education for the “whole child,”
• Address student health risks in the context of, rather than
Dr. Kolbe asserted that modern school health programs de-
in competition with, the academic mission of the school.
velop when the efforts of education, health, and social ser-
vice professionals are integrated purposefully to tackle four Student health advocates are encouraged to review
overlapping and interdependent types of goals for students: Figure 1–2, a depiction of several of the elements of Coordi-
nated School Health created by middle school students. Al-
• Goals focused on improving health knowledge,
though this drawing does not include all eight components
attitudes, and skills.
described earlier, it reinforces the importance of collabora-
• Goals focused on improving health behaviors and
tion and the connections between professionals in each area
outcomes.
as seen through the eyes of students.
• Goals focused on improving educational outcomes.
• Goals focused on improving social outcomes among Health Education: The Keys to Quality Health
learners.59 Instruction
In this way, Coordinated School Health puts both student The most familiar element of CSH is its educational, or
health and academic achievement at the heart of the matter instructional, foundation: comprehensive school health
and provides an efficient and effective way to improve, education. This element of an effective school-based health

FIGURE 1–2 ❘ Elements of Coordinated School Health: A Student Perspective

14 SECTION I FOUNDATIONS OF HEALTH EDUCATION
Another random document with
no related content on Scribd:
olisi joutunut tämmöisiin käsiin! Herra Babinicz olisi voinut kuljettaa
minua vaikkapa tuomiopäivään asti ympäri Liettuan, sillä hän ei
pelännyt mitään!

— Herran tähden! — huudahti Sakowicz. — Sanokaa minulle

edes, minkä vuoksi ette tahdo lähteä Preussiin!

Mutta Anusia alkoi itkeä ja olla epätoivoisen näköinen.

— Minut otettiin vangiksi kuin mikäkin tataarilaistyttö, vaikka olen

ruhtinatar Gryzeldan kasvatti eikä kenelläkään ole oikeutta minuun.
Otettiin ja kuljetetaan, väkisin viedään meren taakse maanpakoon,
pian aikaan poltetaan tulikuumilla pihdeillä. Oi, Jumalani!

— Pelätkää edes tuota Jumalaa, jota huudatte avuksenne! —

huudahti
Sakowicz. — Kuka teitä aikoo polttaa tulikuumilla pihdeillä?

— Auttakaa minua, kaikki pyhimykset! — toisti Anusia

nyyhkyttäen.

Sakowicz ei tietänyt mitä tekisi. Hän oli tukehtua raivoon ja vihaan.

Joinakin hetkinä hänestä tuntui, että hän menettää järkensä tahi että
Anusia on tullut mielenvikaiseksi. Viimein hän lankesi tytön jalkoihin
ja vakuutti jäävänsä Taurogiin. Silloin tyttö alkoi pyytää häntä
lähtemään, jos pelkää, ja sai hänet lopullisesti aivan toivottomaksi,
niin että hän nousi pystyyn ja sanoi poistuessaan:

— Hyvä! Me jäämme Taurogiin! Kohta nähdään myös, pelkäänkö

minä
Billewiczejä!
 Samana päivänä hän kokosi Butzowin joukon jäännökset ja omat
miehensä ja läksi lähiseuduilla majailevia Billewiczejä vastaan.
Nämä eivät odottaneet mitään hyökkäystä, koska Taurogin
ympäristössä oli jo useita päiviä puhuttu, että sotaväki lähtisi pois
Taurogista. Siksi Sakowicz yllätti ja voitti heidät. Itse miekankantaja,
joka oli joukon johtajana, pääsi hengissä taistelusta, mutta kaksi
Billewicziä suvun toista haaraa kaatui sekä kolmas osa sotilaista.
Muut pakenivat eri tahoille. Muutamia kymmeniä vankeja Sakowicz
toi mukanaan Taurogiin ja surmautti heidät, ennenkuin Anusia
ennätti pyytää heille armoa.

Taurogin jättämisestä ei enää ollut puhetta, eikä se ollut

tarpeellistakaan, sillä tämän uuden voiton jälkeen pysyttelivät
kapinoitsijat taas edempänä.

Sakowicz tuli taas rohkeaksi ja kehui, että jos Lewenhaupt

lähettäisi hänelle tuhat hyvää ratsumiestä, niin hän kukistaisi kapinan
koko Samogitiassa. Mutta Lewenhaupt ei enää ollut niillä mailla.
Anusia taas suhtautui hänen kerskumisiinsa ilkeästi.

— Suoriutuminen herra miekankantajasta, — sanoi hän, — kävi

helposti… Mutta jos siellä olisi ollut se, jota sekä ruhtinas että te
pakenitte, niin luulenpa, että te olisitte hyvin mielellänne mennyt
Preussiin meren taakse ilman minuakin.

Tämä puhe loukkasi pahasti Sakowiczia.

— Ensiksikään, — sanoi hän, — älkää kuvitelko, että Preussi on

meren takana, sillä meren takana on Ruotsi, ja toiseksi: ketä me,
ruhtinas ja minä, sitten pakenimme?

— Herra Babiniczia! — vastasi tyttö niiaten juhlallisesti.

 — Kunhan vain saan hänet joskus sapelin ulottuville!

— Niin sapeli on kahvaa myöten sisällänne! Älkää kutsuko sutta

metsästä!

Sakowiczilla ei todellakaan ollut halua kutsua tuota sutta metsästä,

sillä niin rohkea mies kuin hän olikin, niin hän viimeisen sotaretken
jälkeen tunsi jonkinmoista pelkoa Babiniczia kohtaan. Ei voinut
myöskään tietää, miten pian saisi taas kuulla tuon peloittavan nimen.

Mutta ennenkuin sitä alettiin mainita kaikkialla Samogitiassa, tuli

eräänä päivänä sanoma, joka toisista oli riemullisin, mitä saada voi,
mutta herätti Sakowiczissa pelkoa. Koko valtakunnassa sitä
toisteltiin:

— Varsova on valloitettu!

Maa näytti lipuvan pois petturien jalkain alta ja koko ruotsalaisten

taivas romahtavan alas heidän päälleen kaikkine jumalineen, jotka
siellä tähän saakka olivat loistaneet kirkkaina kuin aurinko. Oli
melkein uskomatonta, että kansleri Oxenstierna oli vankina, Erskine
vankina, Lewenhaupt vankina, samoin Wrangel ja itse suuri
Wittenberg, joka oli valellut verellä koko Puolan ja valloittanut siitä
puolet jo ennen Kaarle Kustaan tuloa. Ja kuningas Jan Kasimir oli
nyt voittaja ja ryhtyi tuomitsemaan syyllisiä!

Tämä uutinen sai kaikki Taurogissa unohtamaan Sakowiczin

äskeisen voiton. Äsken niin peloittava Sakowicz pieneni kaikkien
silmissä, omissaankin. Kapinalliset alkoivat taas käydä ruotsalaisten
joukkojen kimppuun. Billewiczit olivat tointuneet viime tappiostaan ja
lähestyivät taas lisätyin voimin.
 Sakowicz ei tietänyt itsekään, mihin ryhtyisi ja mistä etsisi
pelastusta. Pitkiin aikoihin hän ei ollut saanut mitään tietoja ruhtinas
Boguslawista ja vaivasi turhaan päätään saadakseen selville, missä
tämä oli. Toisinaan valtasi hänet suuri levottomuus, ja hän pelkäsi
ruhtinaankin joutuneen vangiksi.

Tämä otaksuma, jonka monet hyvin varmasti lausuivat julki, sai

Sakowiczin epätoivoon, sillä ensiksikin hän piti ruhtinaasta, ja
toiseksi hän tiesi, että tuon hänen mahtavan suojelijansa kuoltua
pahin villipeto säilyttäisi henkensä Puolassa paremmin kuin hän,
joka oli ollut petturin oikea käsi.

Hänestä tuntui, että ei ollut enää muuta tehtävissä kuin

välittämättä
Anusian vastarinnasta paeta Preussiin etsimään leipää ja työtä.

— Mutta miten käy, — ajatteli hän usein, — jos vaaliruhtinaskin

taipuu
Puolan kuninkaan vihaa peläten ja luovuttaa kaikki pakolaiset?

Ei ollut muuta keinoa pelastua pulasta kuin mahdollisesti pako

meren taakse Ruotsiin.

Kun tätä epävarmuutta ja näitä sieluntuskia oli jatkunut viikon

verran, saapui onneksi Boguslawin lähetti tuoden ruhtinaalta pitkän
omakätisen kirjeen. Ruhtinas kirjoitti:

"Varsova on valloitettu ruotsalaisilta. Kuormastoni ja tavarani olen

menettänyt. Myöhäistä on jo recedere, sillä kiihtymys minua
vastaan on niin suuri, että amnestiaa ei ole ulotettu minuun. Minun
mieheni on Babinicz lyönyt aivan Varsovan portilla. Ketling on
vankina. Ruotsin kuningas, vaaliruhtinas ja minä Stenbockin
kanssa menemme kaikkine joukkoinemme pääkaupunkia vastaan,
missä päätaistelu tapahtuu. Carolus vannoo sen voittavansa,
vaikka Jan Kasimirin taitava sodankäyntitapa tuottaa hänelle suurta
haittaa. Elämme siinä toivossa, että nostoväki, jota Kasimirilla on
muutamia kymmeniä tuhansia, hajaantuu koteihinsa tahi että sen
ensi-innostus laimenee ja taistelukyky huononee. Suokoon Jumala,
että jokin hajaannus tapahtuisi tuossa joukossa, silloin saattaisi
Carolus tuottaa sille suuren tappion, vaikka mahdotonta on tietää,
mitä sitten seuraa. Meidän kenraalimmekin kuiskuttelevat
keskenään, että tuo kapina on kuin hydra, jolle kasvaa yhä uusia
päitä. Heidän voimiensa yhä kasvaessa meidän voimamme vain
vähenevät. Ei ole millä voisi aloittaa uuden sodan. Vaaliruhtinas on
vaiti, kuten aina mutta ymmärrän hyvin, että jos kärsimme tappion
taistelussa, hän ryhtyy seuraavana päivänä taistelemaan
ruotsalaisia vastaan päästäkseen Kasimirin suosioon. Suokoon
vain Jumala minun selviytyä tästä hengissä ja saada edes jonkin
verran omaisuudestani pelastetuksi. On syytä pelätä pahinta.
Senvuoksi myykää omaisuudestani kaikki, mitä voi rahaksi
muuttaa, vaikkapa sitä varten pitäisi salaa ruveta kauppoihin
liittoutuneitten kanssa. Menkää itse kaikkine joukkoinenne Birzeen,
joka on lähempänä Kuurinmaata. Neuvoisin teitä menemään
Preussiin, mutta siellä on piakkoin vaarallista olla, sillä heti
Varsovan valloituksen jälkeen Babinicz sai määräyksen mennä
Preussin kautta Liettuaan järjestämään kapinaa, ja hän polttaa ja
hävittää kaikki matkan varrella. Tiedätte, että hän pystyy sen
tekemään. Tahdoimme Bugin luona ottaa hänet kiinni, ja Stenbock
lähetti häntä vastaan huomattavan joukon, mutta se on kadonnut
jäljettömiin. Älkää antautuko tekemisiin Babiniczin kanssa, vaan
kiiruhtakaa Birzeen. Kuumeestani olen kokonaan päässyt, sillä
täällä on kaikkialla kuivia ylätasankoja eikä sellaisia soita kuin
Samogitiassa. Jätän teidät Jumalan huomaan."

Vaikka Sakowicz ilostuikin kuultuaan ruhtinaan olevan elossa ja

terveenä, niin tuon ilon saivat kuitenkin kirjeen huolestuttavat uutiset
haihtumaan. Jos kerran ruhtinas aavisti, että voitto päätaistelussa ei
kuitenkaan voisi parahtaa ruotsalaisten huonoja asioita, niin mitä
saattoi odottaa tulevaisuudessa? Kenties ruhtinaan jotenkuten
onnistuu pelastua viekkaan vaaliruhtinaan avulla ja hän, Sakowicz,
pääsee ruhtinaan turviin, mutta mitä oli tehtävä nyt? Mentäväkö
Preussiin?

Sakowicz ymmärsi ilman ruhtinaan neuvojakin olla asettumatta

Babiniczin tielle. Siihen puuttui häneltä sekä voimia että halua.
Jäljellä oli meno Birzeen, mutta sekin oli jo myöhäistä. Matkan
varrella oli Billewiczien joukko ja monia muita kapinallisten joukkoja,
jotka olivat valmiit yhtymään toisiinsa ja lyömään hänen joukkonsa
perinpohjin, mutta yhtymättäkin tekisivät koko matkan yhtämittaiseksi
taisteluksi. Oliko siis jäätävä Taurogiin? Sekin oli vaarallista, sillä
tulossa oli Babinicz hirmuisen tataarilaisjoukon kanssa. Kaikki
liittyvät häneen, ryntäävät Taurogiin ja kostavat niin kamalasti, että
sellaista ei ole ennen kuultu.

Ensikerran tuo äsken vielä itseensä luottava staarosta tunsi, että

hän ei keksinyt mitään neuvoa, että hän oli heikko ja avuton.

Seuraavana päivänä hän kutsui neuvotteluun

Bützowin, Braunin ja muutamia muita upseereita.

Päätettiin jäädä Taurogiin ja odottaa uutisia Varsovasta.

 Mutta Braun meni tästä neuvottelukokouksesta heti toiseen,
nimittäin
Anusian luo.

Kauan he neuvottelivat keskenään. Viimein tuli Braun ulos, ja

mielenliikutus kuvastui hänen kasvoillaan. Anusia taas riensi kiireesti
Oleńkan luo.

— Oleńka, hetki on tullut! — huudahti hän jo kynnyksellä. —

Meidän on paettava!

— Milloin? — kysyi toimelias tyttö kalveten hiukan, mutta nousten

samassa seisomaan valmiina lähtemään vaikka heti.

— Huomenna, huomenna! Braun on päällikkönä ja Sakowicz

nukkuu kaupungissa, jonne herra Dzieszuk on kutsunut hänet
pitoihin. Herra Dzieszuk on liitossa kanssamme ja sekoittaa jotakin
hänen viiniinsä. Braun sanoo lähtevänsä itse ja vievänsä mukanaan
viisikymmentä ratsumiestä. Oi, Oleńka, Oleńka, miten onnellinen
olen!

Anusia lensi neiti Billewiczin kaulaan ja alkoi syleillä häntä

semmoisen riemun vallassa, että Oleńka kysyi ihmeissään:

— Mikä sinun on, Anusia? Kuinka sait Braunin taivutetuksi siihen?

— Sain taivutetuksi? Sain kuin sainkin? Enkö ole sinulle vielä

puhunut mitään? Oi, hyvä Jumala! Etkö tiedä mitään? Herra
Babinicz tulee tänne! Polttaa, hävittää! Erään joukon hän on
tuhonnut viimeistä miestä myöten, on voittanut itsensä Stenbockin ja
tulee niin nopeasti kuin kiiruhtaisi! Mutta kenenkähän luo hän
mahtaa kiiruhtaa tänne? Sano, olenko minä mieletön?
 Kyynelet loistivat Anusian silmissä. Oleńka pani kätensä ristiin,
kohotti katseensa ja sanoi:

— Kenen luo hän tulleekin, niin tasoittakoon Jumala hänen tiensä,

siunatkoon ja varjelkoon häntä!
YHDEKSÄS LUKU.

Kmicicillä oli heti alussa vaikea tehtävä suoritettavanaan, kun hän

pyrki Varsovasta Preussiin ja Liettuaan, sillä jo Serockissa oli vahva
ruotsalaisjoukko, Kaarle Kustaa oli asettanut sen vartavasten sinne
häiritsemään Varsovan piiritystä, mutta kun Varsova nyt oli
valloitettu, niin ei tuolla armeijalla ollut muuta tehtävää kuin estää
niiden joukkojen eteneminen, jotka Jan Kasimir ehkä lähettäisi
Preussiin ja Liettuaan. Sen johtajana oli taitava ja kokenut kenraali
Douglas ja kaksi puolalaista petturia, Radziejowski ja Radziwill.
Näillä oli kaksituhatta miestä parhainta jalkaväkeä ja yhtä paljon
ratsuväkeä sekä tykistöä. Heti kun nämä päälliköt saivat tiedon
Kmicicin retkestä, niin he asettivat hänen tielleen verkon kolmion
muotoon Bugin luona siten, että sen yhdellä sivulla oli Serock,
toisella Zlotorya ja kärkenä Ostroleka.

Kmicicin oli kuljettava tuon kolmion läpi, sillä hänellä oli kiire, ja
siitä oli tie lyhin. Hän huomasi kohta joutuneensa verkkoon, mutta ei
pelästynyt, koska oli tottunut tämmöiseen sodankäyntiin. Hän arveli,
että verkko oli pingoitettu liian laajalle alalle ja että tarpeen tullen voi
pujahtaa sen silmukoista läpi. Ja mikä oli vielä ihmeellisempää:
vaikka häntä yhtä mittaa koetettiin pyydystää, niin hän ei vain
livahtanut pyydystäjien käsistä, vaan itsekin ahdisteli heitä. Ensin
hän meni Bugin yli Serockin luona, kulki joen rantaa Wyszkowiin ja
tuhosi Brariszczykin luona häntä kiinni ottamaan lähetetyn
kolmensadan miehen vahvuisen ratsujoukon, josta ruhtinas
Boguslaw kirjeessään mainitsi, niin perinpohjin, että siitä ei jäänyt
jäljelle ketään, joka olisi vienyt tiedon tappiosta päälliköille. Itse
Douglas kävi hänen kimppuunsa Dlugosiodlen luona, mutta hän löi
ruotsalaisen ratsujoukon pakoon ja pysytteli sen läheisyydessä ja
meni lopulta ruotsalaisten nähden uiden Narvan yli. Douglas jäi joen
rannalle odottamaan proomuja, mutta ennenkuin ne saapuivat, tuli
Kmicic yön pimeydessä taas joen yli takaisin ja sai hyökkäämällä
ruotsalaisten etuvartioita vastaan aikaan pelästystä ja sekamelskaa
koko Douglasin divisioonassa.

Vanha kenraali hämmästyi tätä tekoa, mutta seuraavana aamuna

kasvoi hänen hämmästyksensä vielä suuremmaksi, kun hän sai
tietää, että Kmicic oli kiertänyt armeijan, palannut takaisin siihen
paikkaan, josta hänet oli ajettu pois kuin villipeto, saartanut
Branszczykissa ruotsalaisten kuormaston, ottanut saalista ja kassan
ja surmannut viisikymmenmiehisen saattajiston.

Toisinaan meni useita päiviä niin, että ruotsalaiset näkivät paljain

silmin hänen tataarilaisensa näköpiirin reunassa, mutta eivät voineet
niitä saavuttaa. Sen sijaan teki herra Andrzej yhtä mittaa
hyökkäyksiään. Ruotsalaiset sotilaat uupuivat, ja puolalaiset joukot,
jotka vielä palvelivat Radziejowskia, eivät olleet luotettavia. Väestö
taas oli kokonaan kuuluisan partioretkeilijän puolella. Hänellä oli tieto
jokaisesta liikkeestä, pienimmänkin joukon toimista, jokaisesta
kuormasta, joka sattui olemaan muista hiukan erillään. Usein näytti
siltä, kuin hän leikkisi ruotsalaisten kanssa, mutta se oli tiikerin
leikkiä. Hän antoi tataarilaisten hirttää kaikki ottamansa vangit,
niinkuin muuten ruotsalaiset itsekin menettelivät kaikkialla Puolassa.
Toisinaan näytti hillitön raivo valtaavan hänet, sillä hän hyökkäsi kuin
uhkarohkeuden sokaisemana ylivoimaisia joukkoja vastaan.

— Mielenvikainen johtaa tuota joukkoa! — sanoi hänestä Douglas.

— Tahi hullu koira! — vastasi Radziejowski.

Boguslaw oli sitä mieltä, että kumpikin nimitys oli paikallaan, mutta
hänen täytyi myöntää, että tuo johtaja myös oli kuuluisa soturi.
Ylpeänä hän kertoi kaataneensa kahdesti omin käsin maahan tuon
ritarin.

Häntä vastaan Babinicz rajuimmin hyökkäilikin. Hän aivan

silminnähtävästi etsi ruhtinasta ja vainottunakin vainosi.

Douglas arvasi, että tässä täytyi olla takana yksityistä vihaa.

Ruhtinas ei kieltänyt sitä, mutta ei myöskään antanut mitään

selityksiä. Hän maksoi Babiniczille samalla mitalla ja määräsi
Chowariskin esimerkkiä seuraten palkinnon hänen päästään. Kun
tästä ei ollut apua, päätti hän käyttää hyväkseen Kmicicin vihaa ja
sen avulla houkutella hänet ansaan.

— On häpeä, että puuhaamme näin kauan tuon rosvon kanssa! —

sanoi hän Douglasille ja Radziejowskille. — Hän kiertelee
ympärillämme niinkuin susi lammastarhan läheisyydessä ja livahtaa
aina käsistämme. Minä menen häntä vastaan pienen joukon kanssa,
ja kun hän hyökkää kimppuuni, pidän puoliani, kunnes te tulette
avuksi. Sitten emme enää päästä häntä livistämään.

Douglas, joka jo kauan sitten oli kyllästynyt tähän takaa-ajoon, ei

pannut sanottavasti vastaan, mutta sanoi kuitenkin, että hänellä ei
ole oikeutta eikä velvollisuutta panna yhden rosvon kiinni ottamiseksi
vaaraan niin korkea-arvoisen henkilön ja kuningasten sukulaisen
henkeä. Kun ruhtinas kuitenkin pysyi ehdotuksessaan, niin Douglas
suostui. Päätettiin, että ruhtinas lähtee liikkeelle viidensadan
ratsumiehen kanssa, joiden jokaisen selän taakse sijoitetaan
musketilla varustettu jalkamies. Tällä viekkaudella aiottiin johtaa
Babinicz harhaan.

— Hän ei voi pidättää itseään, kun kuulee, että vain viisisataa

ratsumiestä on liikkeessä, vaan hyökkää ehdottomasti kimppuun, —
sanoi ruhtinas. — Mutta kun jalkaväki ampuu heitä vasten silmiä, niin
tataarilaiset hajaantuvat kuin tuhka tuuleen. Hän itse joko kaatuu tahi
joutuu elävänä käsiimme.

Tämä suunnitelma pantiin nopeasti ja huolellisesti täytäntöön.

Kahta päivää aikaisemmin laskettiin liikkeelle tieto, että viisisataa
ratsumiestä ruhtinas Boguslawin johdolla lähtee retkelle. Kenraalit
olivat varmat siitä, että paikallinen väestö veisi tämän tiedon
Babiniczille. Niin kävikin.

Ruhtinas lähti keskellä pimeätä yötä Wasowiin ja Jelonkaan, meni

Czerewinassa joen yli, pysähdytti ratsuväen avoimelle kedolle ja
sijoitti jalkaväen sen vieressä olevaan viidakkoon, josta se voi
nopeasti hyökätä esille. Sillä välin oli Douglasin kuljettava Narvan
rantaa pitkin ollen menevinään Ostrolekaan. Radziejowskin taas oli
kevyen ratsuväen kanssa lähdettävä liikkeelle Ksiezopolesta.

Ei kukaan näistä kolmesta päälliköstä tietänyt tarkoin, missä

Babinicz tällä hetkellä oli, sillä talonpojilta ei saanut mitään tietoja
eivätkä ratsumiehet kyenneet ottamaan kiinni tataarilaisia. Douglas
otaksui Babiniczin pääjoukon olevan Sniadowin luona, ja hän aikoi
saartaa sen, jotta voisi katkaista Babiniczin paluutien, jos tämä käy
ruhtinas Boguslawin kimppuun.
 Kaikki näytti olevan suotuisaa ruotsalaisten alkeille. Kmicic oli
todellakin Sniadowissa, ja heti kun hän sai tiedon Boguslawin
retkestä, hän painautui metsään hyökätäkseen siitä ulos Czerewinan
luona.

Kääntyessään poispäin Narvasta Douglas muutamia päiviä

myöhemmin näki tataarilaisten jälkiä ja seurasi niitä kulkien siis
Babiniczin jäljessä. Helle rasitti kauheasti hevosia ja rautapukuisia
ratsumiehiä, mutta kenraali kulki eteenpäin siitä välittämättä, sillä
hän oli nyt aivan varma siitä, että hän yllättää Babiniczin joukon juuri
silloin, kun se on taistelussa.

Kaksi päivää kestäneen etenemisen jälkeen tultiin niin lähelle

Czerewinaa, että talojen savut jo näkyivät. Silloin Douglas pysähtyi,
asetti vartijat kaikille teille ja pienimmillekin poluille ja alkoi odottaa.

Muutamat upseerit tahtoivat vapaaehtoisesti lähteä heti

hyökkäämään, mutta hän pidätti heitä sanoen:

— Kun Babinicz käytyään ruhtinaan kimppuun huomaa, että hän

ei ole tekemisissä ainoastaan ratsuväen, vaan myös jalkaväen
kanssa, on hänen pakko peräytyä, eikä hän voi tulla takaisin muuten
kuin entisiä jälkiään, ja silloin hän tulee suoraan meidän syliimme.

Ei ollut siis muuta tehtävää kuin höristää korviaan ja kuunnella,

joko kohta alkaa kuulua tataarilaisten ulvontaa ja ensimmäisiä
musketin laukauksia.

Kului kuitenkin koko päivä täyden hiljaisuuden vallitessa

metsässä, aivan kuin ei yksikään sotamies koskaan olisi siihen
jalallaan astunut.
 Douglas alkoi menettää kärsivällisyyttään ja lähetti yötä vastaan
pienen tiedustelujoukon kedolle päin käskettyään sen noudattaa mitä
suurinta varovaisuutta.

Tiedustelujoukko palasi yösydännä näkemättä mitään ja saamatta

mitään toimeen. Aamun sarastaessa lähti Douglas itse koko
sotavoimansa kanssa liikkeelle.

Muutamia tunteja kuljettuaan hän tuli paikalle, joka oli täynnä

merkkejä siitä, että siinä oli ollut sotilasleiri. Löydettiin korpunpalasia,
särkynyt lasi, vaateriekaleita ja patruunavyö sitä mallia, jota
ruotsalaiset sotamiehet käyttivät. Selvää oli, että siinä paikassa oli
ollut Boguslawin jalkaväki, mutta nyt sitä ei näkynyt missään.
Edempänä suoperäisellä niityllä huomasivat Douglasin etujoukot
joukon ratsuväen hevosten jälkiä ja niityn reunalla pienempien
tataarilaisten hevosten jälkiä. Vielä edempänä oli hevosen raato,
josta sudet jo olivat vetäneet sisälmykset esille. Nähtävästi Boguslaw
oli vetäytynyt takaisinpäin ja Babinicz seurannut jäljessä. Douglas
ymmärsi, että jotakin erikoista oli sattunut.

Mutta mitä? Siihen hän ei saanut vastausta. Douglas rupesi

miettimään.
Äkkiä hänen mietiskelynsä keskeytti eräs etujoukkoihin kuuluva
upseeri.

— Teidän ylhäisyytenne! — sanoi hän. — Viidakossa näkyy pieni

ryhmä miehiä. He seisovat liikkumattomina ikäänkuin vahdissa.
Pysähdytin etujoukot ja tulin ilmoittamaan tästä teidän
ylhäisyydellenne.

— Ovatko ne ratsu- vaiko jalkamiehiä?

 — Jalkaväkeä, niitä on neljä tahi viisi yhdessä, ei voi aivan
tarkkaan nähdä, kun oksia on edessä.

Mutta niiden puvuissa näytti olevan keltaista niinkuin meidän

muskettisotureillamme.

Douglas kannusti hevostaan, ratsasti kiireesti etujoukkoon ja

syöksähti eteenpäin. Harvan metsikön läpi näkyi ryhmä sotamiehiä,
jotka liikkumatta seisoivat puun juurella.

— Ne ovat meikäläisiä! — sanoi Douglas. — Ruhtinaan täytyy olla

lähellä.

— Omituista! — sanoi hetken kuluttua upseeri.

— He seisovat vahdissa, mutta yksikään heistä ei sano mitään,

vaikka heidän täytyy kuulla lähestymisemme.

Tässä loppui viidakko ja alkoi metsän reuna. Siinä näkyi neljä

miestä seisomassa vierekkäin ja katselemassa maahan. Jokaisen
pään kohdalta kohosi kohtisuoraan ylös musta nuora.

— Teidän ylhäisyytenne! — sanoi äkkiä upseeri.

— Nuo miehet on hirtetty!

— Niin on! — vastasi Douglas.

He lähtivät kulkemaan kiireemmin ja olivat pian ruumiitten luona.

Neljä jalkamiestä riippui silmukoissa vieretysten kuin neljä lintua jalat
vain tuuman päässä maasta, sillä oksa oli matalalla.

Douglas silmäsi niihin jokseenkin välinpitämättömästi ja lausui

sitten aivan kuin itsekseen:
 — Nyt tiedämme, että niinhyvin ruhtinas kuin Babiniczkin ovat
tästä kulkeneet.

Ja hän vaipui taas mietteisiin, sillä hän ei tietänyt oikein itsekään,

oliko hänen kuljettava eteenpäin tuota metsäpolkua vai mentävä
Ostrolekaan johtavalle valtatielle.

Puoli tuntia myöhemmin löydettiin vielä kaksi ruumista. Nähtävästi

ne olivat rosvoja tahi sairaita, jotka Babiniczin tataarilaiset olivat
ottaneet kiinni seuratessaan ruhtinasta.

Mutta miksi ruhtinas oli peräytynyt?

Douglas tunsi liian hyvin hänen rohkeutensa ja hänen

päällikkötaitonsa voidakseen hetkeäkään epäillä ruhtinaalta
puuttuneen päteviä syitä peräytymiseen. Jotakin oli täällä varmasti
tapahtunut.

Vasta seuraavana päivänä asia selvisi. Saapui nimittäin

kolmenkymmenen miehen suuruinen ratsumiesjoukko Bies Kornian
johdolla, jonka Boguslaw oli lähettänyt ilmoittamaan, että Jan
Kasimir oli lähettänyt Bugin yli Douglasia vastaan kuusituhatta
liettualaista ja tataarilaista ratsumiestä hetmani Gosiewskin johdolla.

— Saimme sen tietää, - sanoi herra Bies,-ennenkuin Babinicz

meidät saavutti, sillä hän läheni varovasti ja hitaasti. Gosiewski on
neljän tahi viiden penikulman päässä. Saatuaan tämän tiedon oli
ruhtinaan pakko nopeasti peräytyä yhtyäkseen herra Radziejowskiin,
joka helposti olisi voinut kärsiä tappion. Koska kuljimme nopeasti,
onnistui meidän yhtyä. Nyt on ruhtinas lähettänyt pieniä
ratsumiesosastoja — kaikkiin suuntiin ilmoittamaan asiasta teidän
ylhäisyydellenne. Paljon heitä joutuu tataarilaisten tahi talonpoikien
käsiin, mutta tämmöisessä sodassa sitä ei voi välttää.

— Missä ruhtinas ja herra Radziejowski ovat?

— Kahden penikulman päässä täältä, rannalla.

— Onko ruhtinaalla koko sotavoima mukanaan?

— Hänen täytyi erota jalkaväestä, joka on palaamassa tiheimpien

metsien läpi välttääkseen tataarilaisia.

— Sellainen ratsuväki kuin tataarilaisten kulkee kaikkein

pahimpienkin tiheikköjen läpi. Ei ole toiveita saada enää nähdä tuota
jalkaväkeä. Mutta siihen ei ole kukaan syypää, ja ruhtinas on
menetellyt niinkuin kokenut sotapäällikkö.

— Ruhtinas on lähettänyt melkoisen suuren partiojoukon

Ostrolekaan johtaakseen hetmanin harhaan. Vihollinen ryntää
viipymättä sinne luullen koko armeijamme olevan Ostrolekassa.

— Se on hyvä! — sanoi Douglas ilostuen. — Laitamme herra

hetmanille kuumat paikat!

Hetkeäkään viivyttelemättä lähdettiin liikkeelle, jotta tavattaisiin

ruhtinas Boguslaw ja Radziejowski. Nämä tavattiinkin vielä samana
päivänä herra Radziejowskin suureksi iloksi, sillä hän pelkäsi
vangiksi joutumista pahemmin kuin kuolemaa hyvin tietäen, että saisi
kalliisti sovittaa petoksensa ja kaikki valtakunnalle tuottamansa
onnettomuudet.

Nyt yhtyneessä ruotsalaisessa armeijassa oli yli neljätuhatta

miestä, joten se saattoi toivoa hyvin selviytyvänsä hetmanista. Tällä
oli tosin kuusituhatta ratsumiestä, mutta tataarilaisia — Babiniczin
miehiä lukuunottamatta — ei voitu käyttää avoimessa
hyökkäyksessä, ja itse Gosiewski, vaikka olikin taitava soturi, ei
osannut Czarnieckin tavoin innostaa joukkoaan.

Douglasille antoi kuitenkin paljon päänvaivaa kysymys, missä

tarkoituksessa oikeastaan Jan Kasimir oli lähettänyt hetmanin Bugin
yli. Ruotsin kuningas ja vaaliruhtinas olivat menossa Varsovaa
vastaan, ja siellä oli päätaistelu ennemmin tahi myöhemmin
tapahtuva. Vaikka Jan Kasimirilla olikin sotajoukko, joka oli
miesluvultaan suurempi ruotsalaisten ja brandenburgilaisten
armeijaa, niin kuusituhatta taistelukuntoista miestä oli sentään liian
huomattava joukko, jotta Puolan kuningas olisi ilman pakottavaa
syytä siitä luopunut.

Totta oli, että Gosiewski pelasti Babiniczin tuhosta, mutta

Babiniczin pelastamiseksi ei kuninkaan olisi tarvinnut lähettää koko
divisioonaa. Tällä retkellä oli siis jokin salainen tarkoitus, josta
ruotsalainen kenraali ei tarkkanäköisyydestään huolimatta päässyt
selville.

Ruotsin kuninkaan kirje, joka tuli viikkoa myöhemmin, ilmaisi

suurta levottomuutta, melkeinpä pelkoa tämän retken johdosta, jonka
tarkoitus siinä lyhyesti selitettiin. Kaarle Kustaan käsityksen mukaan
ei hetmania oltu lähetetty hyökkäämään Douglasin armeijan
kimppuun ja Liettuaa auttamaan, sillä siellä oli ruotsalaisten
muutenkin jo mahdoton viipyä, vaan tarkoituksena oli uhata Preussia
ja nimenomaan sen itäistä osaa, jossa ei ollut sotaväkeä.

"Heidän pyrintönään on", — kirjoitti kuningas, — "järkyttää

vaaliruhtinaan uskollisuus Marienburgin sopimusta ja Meitä
kohtaan, mikä helposti voi onnistua, koska vaaliruhtinas on valmis
samalla kertaa tekemään liiton Kristuksen kanssa perkelettä
vastaan ja perkeleen kanssa Kristusta vastaan saadakseen etuja
kummaltakin."

Kirje loppui kehoituksella Douglasille ponnistamaan kaikki

voimansa estääkseen hetmania pääsemästä Preussiin, sillä jos tämä
ei muutamaan viikkoon kykene sinne pääsemään, niin hänen on
palattava Varsovaan.

Douglas oli sitä mieltä, että hänelle annettu tehtävä ei ollenkaan

mennyt yli hänen voimiensa. Vähän aikaa sitten hän oli melkoisen
hyvällä menestyksellä vastustanut itse Czarnieckia eikä senvuoksi
pelännyt Gosiewskia. Hän ei tosin toivonut voivansa tuhota hänen
divisioonaansa, mutta oli varma siitä, että voisi estää sen
etenemisen.

Tästä lähtien alkoivat molemmat armeijat taitavasti liikehtiä

koettaen kiertää toisensa ja samalla välttää ryhtymistä lopulliseen
taisteluun. Molemmat kenraalit kilpailivat keskenään valppaudessa,
mutta Douglasilla oli sikäli yliote., että hän sai estetyksi hetmanin
pääsemästä ylemmäksi kuin Ostrolekaan. Babinicz ei ollenkaan
kiiruhtanut yhtymään liettualaiseen divisioonaan, vaan kiinnitti
huomionsa siihen jalkaväkeen, joka Boguslawin oli täytynyt jättää
jälkeensä, kun hän lähti kiireesti tavoittamaan Radziejowskia.
Paikallisten asukkaitten opastamina tataarilaiset seurasivat noita
sotamiehiä yöt päivät ja surmasivat jokaisen, joka oli varomaton tahi
jäi jälkeen. Elintarpeitten puute pakotti viimein ruotsalaiset
jakautumaan pieniin osastoihin, joiden oli helpompi hankkia
ravintonsa, mutta juuri tätä Babinicz oli odottanutkin.

Hän jakoi joukkonsa kolmeen osastoon, joista yhtä johti hän itse,
toista Akbah-Ulan ja kolmatta Soroka, ja muutamassa päivässä hän
teki lopun melkein koko ruotsalaisjoukosta. Se oli yhtämittaista
ihmismetsästystä metsissä ja viidakoissa, jotka kaikuivat huudoista,
rytinästä, laukauksista ja vaikertelusta.

Tämä teki Babiniczin nimen laajalti tunnetuksi masurilaisten

keskuudessa. Hänen joukkonsa kokoontuivat ja yhtyivät Gosiewskin
armeijaan, mutta silloin oli hetmani, jonka retki pääasiassa oli ollut
vain mielenosoitus, jo saanut kuninkaalta käskyn palata Varsovaan.
Babinicz sai vain vähän aikaa nauttia tuttujensa seurasta,
nimenomaan Zagloban ja Wolodyjowskin, jotka laudalaisten johtajina
olivat hetmanin mukana. Molemmat nuoret everstit olivat hyvin
harmissaan siitä, että eivät sillä kertaa voineet saada mitään toimeen
Boguslawia vastaan, mutta Zagloba lohdutti heitä täyttämällä
ahkeraan heidän pikarinsa ja puhuen tähän tapaan:

— Ei se mitään haittaa! Jo toukokuusta asti olen hautonut

päässäni sotajuonia, enkä minä koskaan vielä ole suotta
ponnistellut. Minulla on jo valmiina muutamia aivan erinomaisia
tuumia, mutta ei ole nyt aikaa panna niitä täytäntöön, vaan se
tapahtuu vasta Varsovan luona, jonne kaikki kiiruhdamme.

— Minun on mentävä Preussiin! — vastasi Babinicz. — En ole siis

Varsovan luona mukana.

— Luuletteko todellakin pääsevänne Preussiin asti? — kysyi

Wolodyjowski.

— Niin totta kuin Jumala on taivaassa, menen Preussiin, ja sen

lupaan teille pyhästi, että teen siellä puhdasta jälkeä. Minun
tataarilaisteni sormet syyhyvät jo täällä kovin, mutta olen uhannut
hirsipuulla jokaisesta väkivaltaisesta teosta. Preussissa sen sijaan
saa minut oma halunikin hieman riehumaan. Minäkö en pääsisi