By Nathaniel Counts
High school health classes that are effective in preventing high-risk behaviors employ two educational models: the social influences model and the life skills model. The social influences model teaches children about social norms and techniques for resisting social influences. The life skills focuses on developing child autonomy, self-esteem, and self-confidence to help children resist social influences and gain a sense of self. There are two explanations for why health classes premised on these models would be effective: either they replace the preferences the children were likely to develop with different preferences or they help children develop their own preferences which, for some reason, consistently disfavor high-risk behaviors.
If the first explanation is correct, that health classes simply replace the child’s preferences, this is not especially interesting. Health class then is an exercise in paternalism designed to either align the child’s preferences with those that promote health or to make the child’s preferences more similar to those of the previous generation under the guise of health promotion.
The second explanation, that health class promotes autonomy which often leads to the formation of health promoting preferences, is more interesting. The notion that one can ignore social pressure to form preferences consistent with some sense of self assumes that we as individuals have intrinsic preferences that we can be true to. If all we are is nature and nurture, without any third thing that is our essence, these intrinsic preferences would be the accidents and requirements of biology, along with, depending on the leanings of those defining intrinsic, early stages of nurture before an individual can be expected to exercise autonomy, i.e. “the way they were raised.” This also runs up against the issue that perhaps a child’s intrinsic preference is to give into social influences.
Why are these intrinsic preferences more often health promoting than the socially influenced preferences? If this were always true, no one should form preferences for high risk behaviors. The answer could lie in the fact that many children overestimate the extent to which their peers are engaging in high risk behaviors. Very few children actually need to engage in high risk behaviors before there becomes pressure to engage and preferences begin to change in response. It could also be that individuals always prioritize health in a vacuum and it is only when they can collude with others that they will prioritize more immediate benefits in exchange for health. If this is true, children need to decide together to engage in high risk behaviors – they do not form the preference and then look for activity partners – and if they are resisting social pressure they will rarely prefer high risk behaviors.
If one of these theories about why health classes change children’s behavior is true, public health experts and lawyers could use this in designing informational interventions and sculpting choice architecture to inculcate health promoting values, explain the actual prevalence of behaviors, or ask individual to harken to intrinsic preferences in decision-making, in dealing with the adult population, which will likely share characteristics with the adolescent population.