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Teenage Health Teaching Modules (THTM)

Teenage Health Teaching Modules (THTM), a school-based health curriculum for students in grades 6-12, attempts to improve students' immediate and long-term health by impacting their knowledge, attitudes, and behaviors regarding critical adolescent health content areas, including alcohol, tobacco, and other drug use; injury and violence prevention; and mental and emotional health. THTM is made up of 14 modules designed for use with students in middle/junior high or senior high school:

  • Aggressors, Victims, and Bystanders: Thinking and Acting to Prevent Violence (which was reviewed by NREPP as a separate curriculum)
  • Building Foundations: Developing Skills for Life
  • Choosing Not To Use: Alcohol, Tobacco and Other Drugs
  • Communicating With Caring: A Program for Early Adolescents and Caregivers of Adolescents
  • Growing Into Healthy Sexuality
  • Living With Feelings and Handling Stress
  • MetLife Foundation Read for Health Program: Getting Active and Eating Well
  • MetLife Foundation Read for Health Program: Taking Action To Stop Bullying
  • Preventing Injuries
  • Protecting Oneself and Others: Tobacco, Alcohol, and Other Drugs
  • Respecting Healthy Sexuality
  • Strengthening Relationships With Family and Friends
  • Teacher's Guide for Grades 9 & 10
  • Voices Against Violence: Helping Students, Parents, and School Staff Speak Up

Each module addresses five areas of development: self-assessment, communication, decisionmaking, health advocacy, and healthy self-management. The modules are designed to complement and reinforce each other, and they can be used in any sequence. Modules range from 10 to 15 sessions, and each session can be delivered in a 45-minute class period. The developers recommend delivering at least 76 sessions. The modules are in teacher's guide format, providing a detailed framework for conducting classroom sessions and reproducible handouts for students. THTM can be taught by health education teachers or others designated to teach health in school at the middle and high school levels. Training for teachers is strongly encouraged although not required.

The study reviewed for this summary evaluated nine modules, which differ slightly from those currently available. Four of these modules were used with middle/junior high school students (Being Fit, Having Friends, Living With Feelings, and Preventing Injuries), and five modules were used with senior high school students (Eating Well, Handling Stress, Protecting Oneself and Others, Promoting Health in Families, and Planning a Healthy Future).

The study also evaluated two conditions for using THTM: one in which all identified modules were implemented by teachers who had never taught the course (experimental) and another in which teachers experienced in the use of THTM selected modules to implement from those identified (naturalistic). No restrictions were placed on the sequence of modules for either condition.

Descriptive Information

Areas of Interest Mental health promotion
Substance abuse prevention
Outcomes Review Date: May 2010
1: Tobacco use
2: Illegal drug use
Outcome Categories Drugs
Tobacco
Ages 6-12 (Childhood)
13-17 (Adolescent)
Genders Male
Female
Races/Ethnicities American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
White
Race/ethnicity unspecified
Settings School
Geographic Locations Urban
Suburban
Rural and/or frontier
Implementation History THTM was first developed by Education Development Center in the early 1980s, and public dissemination of the program began in 1982. Since then, THTM has been used in over 10,000 school districts, representing urban, suburban, and rural communities in 50 States, reaching an estimated 1,250,000 students.
NIH Funding/CER Studies Partially/fully funded by National Institutes of Health: No
Evaluated in comparative effectiveness research studies: Yes
Adaptations THTM was adapted for use with Native American students at a Navajo school in New Mexico and for adjudicated youth in Colorado.
Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories Universal

Quality of Research
Review Date: May 2010

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

Errecart, M. T., Walberg, H. J., Ross, J. G., Gold, R. S., Fiedler, J. L., & Kolbe, L. J. (1991). Effectiveness of Teenage Health Teaching Modules. Journal of School Health, 61(1), 26-30.

Parcel, G. S., Ross, J. G., Lavin, A. T., Portnoy, B., Nelson, G. D., & Winters, F. (1991). Enhancing implementation of the Teenage Health Teaching Modules. Journal of School Health, 61(1), 35-38.

Ross, J. G., Errecart, M. T., Lavin, A. T., Saavedra, P., & Gold, R. S. (1989, December). Final report: Teenage Health Teaching Modules evaluation (Contract No. 200-86-0932). Silver Spring, MD: Macro Systems.

Ross, J. G., Gold, R. S., Lavin, A. T., Errecart, M. T., & Nelson, G. D. (1991). Design of the Teenage Health Teaching Modules evaluation. Journal of School Health, 61(1), 21-25.

Ross, J. G., Luepker, R. V., Nelson, G. D., Saavedra, P., & Hubbard, B. M. (1991). Teenage Health Teaching Modules: Impact of teacher training on implementation and student outcomes. Journal of School Health, 61(1), 31-34.

Supplementary Materials

American School Health Association, Association for the Advancement of Health Education, & Society for Public Health Education. (1989). The National Adolescent Student Health Survey: A report on the health of America's youth. Oakland, CA: Third Party Publishing.

O'Malley, P. M., Bachman, J. G., & Johnston, L. D. (1983). Reliability and consistency in self-reports of drug use. International Journal of the Addictions, 18(6), 805-824.  Pub Med icon

Outcomes

Outcome 1: Tobacco use
Description of Measures Use of tobacco (cigarettes and smokeless tobacco) was measured with the THTM Survey, which used items from the National Adolescent Student Health Survey to examine two measures: the mean number of cigarettes smoked in the past 30 days and the percentage of students not using tobacco in the past 30 days. The survey was administered to students immediately before the start of the program (pretest) and immediately after the program (posttest).
Key Findings Middle/junior high and senior high school students were assigned to one of three groups: the experimental group or the naturalistic group, both of which received THTM, or the control group, which received a different academic subject. Experimental group teachers had never implemented THTM and were required to use all identified modules. Naturalistic group teachers were experienced in implementing THTM and were encouraged to select modules to implement from those identified. No restrictions were placed on the sequence of modules for either THTM group.

For senior high school students, pre- to posttest findings from the study included the following:

  • The mean number of cigarettes smoked in the past 30 days decreased for the experimental group and increased for the control group (p < .046). The effect size was small (Cohen's d = 0.47).
  • Compared with the control group, the naturalistic group had a significant increase in the percentages of students who reported not smoking cigarettes in the past 30 days (p < .03) and not using smokeless tobacco in the past 30 days (p < .006). The effect sizes were medium (Cohen's d = 0.50 and 0.65, respectively).
  • The mean number of cigarettes smoked in the past 30 days decreased for the experimental and naturalistic groups combined and increased for the control group (p < .038). The effect size was small (Cohen's d = 0.26).
  • Compared with the control group, the experimental and naturalistic groups combined had a significant increase in the percentages of students who reported not smoking cigarettes in the past 30 days (p < .018) and not using smokeless tobacco in the past 30 days (p < .032). The effect sizes were small (Cohen's d = 0.38 and 0.35, respectively).
For middle/junior high school students, no significant differences were found from pre- to posttest among the three groups in regard to the mean number of cigarettes smoked or the percentage of students not using tobacco.
Studies Measuring Outcome Study 1
Study Designs Quasi-experimental
Quality of Research Rating 2.9 (0.0-4.0 scale)
Outcome 2: Illegal drug use
Description of Measures Illegal drug use was measured with the THTM Survey, which used items from the National Adolescent Student Health Survey to examine two measures: the mean incidents of illegal drug use in the past 30 days and the percentage of students not using illegal drugs in the past 30 days. The survey was administered to students immediately before the start of the program (pretest) and immediately after the program (posttest).
Key Findings Middle/junior high and senior high school students were assigned to one of three groups: the experimental group or the naturalistic group, both of which received THTM, or the control group, which received a different academic subject. Experimental group teachers had never implemented THTM and were required to use all identified modules. Naturalistic group teachers were experienced in implementing THTM and were encouraged to select modules to implement from those identified. No restrictions were placed on the sequence of modules for either THTM group.

For senior high school students, pre- to posttest findings from the study included the following:

  • The mean incidents of illegal drug use decreased for the experimental group and increased for the control group (p < .012). The effect size was medium (Cohen's d = 0.58).
  • The percentage of students who reported not using illegal drugs in the past 30 days increased for the naturalistic group and decreased for the control group (p < .034). The effect size was small (Cohen's d = 0.49).
  • The mean incidents of illegal drug use in the past 30 days decreased for the experimental and naturalistic groups combined and increased for the control group (p < .004). The effect size was small (Cohen's d = 0.48).
For middle/junior high school students, no significant differences were found from pre- to posttest among the three groups in regard to the mean incidents of illegal drug use or the percentage of students not using illegal drugs.
Studies Measuring Outcome Study 1
Study Designs Quasi-experimental
Quality of Research Rating 2.9 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study Age Gender Race/Ethnicity
Study 1 6-12 (Childhood)
13-17 (Adolescent) 		54.3% Male
45.7% Female 		74.4% White
11.5% Hispanic or Latino
9.8% Black or African American
2.7% Asian
1.2% American Indian or Alaska Native
0.4% Race/ethnicity unspecified

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome Reliability
of Measures 		Validity
of Measures 		Fidelity Missing
Data/Attrition 		Confounding
Variables 		Data
Analysis 		Overall
Rating
1: Tobacco use 4.0 4.0 1.5 2.3 1.5 4.0 2.9
2: Illegal drug use 4.0 4.0 1.5 2.3 1.5 4.0 2.9

Study Strengths

The items used in the instrument have established and well-known psychometric properties and are considered a gold standard in the field. Reliability estimates of the items ranged from good to excellent. The study used appropriate analyses, including gain score analysis and linear models.

Study Weaknesses

Implementation logs were used, but no fidelity data were presented. Although the school attrition rate was relatively low, differential attrition among students appeared to generate groups that may not have been equivalent across important and relevant domains (e.g., health behaviors); on 22 of the 48 comparisons regarding behavioral items, the students who were dropped from the study appeared to be at higher risk for less desirable health behaviors. Potential confounds are a concern because of different implementation and intervention options in the experimental and naturalistic groups (i.e., use of all required modules or selected modules). No data were presented on the patterns of modules used in the naturalistic schools. Teachers had different characteristics across the two THTM conditions. Additionally, in both the experimental and naturalistic schools, teachers could use other curriculum materials in addition to THTM.
Readiness for Dissemination
Review Date: May 2010

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

Education Development Center. (1991). Protecting oneself and others: Tobacco, alcohol, and other drugs. Newton, MA: Author.

Education Development Center. (1991). Strengthening relationships with family and friends. Newton, MA: Author.

Education Development Center. (1991). Teacher's guide for grades 9 and 10. Newton, MA: Author.

Education Development Center. (2008). Getting active and eating well. Newton, MA: Author.

Education Development Center. (2008). Sample training binder. Newton, MA: Author.

Education Development Center. (2009). Living with feelings and handling stress. Newton, MA: Author.

Education Development Center. (2009). THTM fidelity guidelines & checklist. Newton, MA: Author.

Education Development Center. (n.d.). Living with feelings and handling stress: Student handouts and transparencies. Newton, MA: Author.

Other quality assurance materials:

  • Implementation Log for Teachers Using Grades 6-8 THTM Modules
  • Implementation Log for Teachers Using Grades 9-12 THTM Modules
  • THTM High School Student Survey
  • THTM High School Student Survey Answer Key
  • Using THTM Outcome Data To Improve Program Delivery

Other training materials:

  • Description of THTM training
  • Module description
  • Overview of Teenage Health Teaching Modules
  • Sample handouts from THTM teacher trainings
  • Sample high school teacher training agenda
  • Sample pretraining memo
  • Sample 3-day THTM training event training design
  • Teenage Health Teaching Modules: A Comprehensive Health Curriculum for Grades 6-12 [PowerPoint slides]
  • THTM coaching, technical assistance, and consultation
  • THTM implementation overview

Program Web site, http://www.thtm.org

THTM Order Form

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

  1. Availability of implementation materials
  2. Availability of training and support resources
  3. Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation
Materials 		Training and Support
Resources 		Quality Assurance
Procedures 		Overall
Rating
3.9 3.5 3.7 3.7

Dissemination Strengths

The program modules are comprehensive and clearly organized, and they are accompanied by learning objectives, procedures for activities, and handouts. The modules also include adjustments for age differences among participants. Ample guidance is provided to schools on preparing for and implementing THTM, including information on the program's requirements, determining the fit of the program with school needs and adapting it to varying circumstances, and qualifications of teachers who are appropriate for implementing the program. The developer offers on-site teacher training and training of trainers, supplemented with consultation by phone or email. Quality assurance tools clearly connect the curriculum content to outcome measure questions and are accompanied by guidance on administering the tools and using evaluation data to improve program delivery.

Dissemination Weaknesses

Some program language (e.g., references to the amount of the program implemented as "dosage") is not commonly used by the intended school-based audience. A fully developed, written training curriculum is not available to support a standardized training. The simple fidelity tool assesses whether module components were delivered and reason for omitting a component, but it does not collect important information on the quality of delivery.
Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description Cost Required by Developer
Teacher's guide (includes one copy of handouts and transparencies) for each module $69.95-$99.95 each Yes
On-site teacher training or training of trainers Varies depending on site, trainer, and modules selected for implementation No
Phone or email consultation Free No
Quality assurance tools (includes fidelity guidelines and checklist, teacher implementation logs, and student pre- and posttests) Free No

Additional Information

Discounts are available for program materials purchased as a set or in bulk.
Replications

No replications were identified by the developer.
Contact Information

To learn more about implementation, contact:
Erica Macheca
(617) 618-2737
emacheca@edc.org

To learn more about research, contact:
Christine Blaber, Ed.M.
(617) 618-2364
cblaber@edc.org

Consider these Questions to Ask (PDF, 54KB) as you explore the possible use of this intervention.

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