HEALTH AND FAMILY LIFE EDUCATION RESOURCE HANDBOOK THEMES: Self and Interpersonal Relationships Sexuality and Sexual Health Appropriate Eating and Fitness Managing the Environment Second (2nd) Edition July 2009 Ministry of Education, Jamaica with support from the United Nations Children’s Fund, UNICEF - 1 - Acknowledgements The Ministry of Education extends sincere thanks to the United Nations Children’s Fund (UNICEF) for their tremendous support towards the development and implementation of the National Health and Family Life Education (HFLE) Programme. Recognizing the role that HFLE has played and will continue to play in the development of Jamaica’s adolescent and youth; UNICEF must also be lauded for investing in the development of this Resource Handbook which will enable our teachers to be better prepared to deliver the programme at local levels. Heartfelt gratitude is also extended to the many government and non-government entities who contributed to the development of this document. These include the Ministry of Health (MOH), National HIV/STI Programme (NHP), National Environment and Planning Agency (NEPA), the Office of Disaster Preparedness and Emergency Management (ODPEM), Jamaica Information Service (JIS), Peace and Love in Society (PALS), Jamaica Aids Support for Life (JASL), National Family Planning Board (NFPB), the Community Relations Office of the Jamaica Constabulary Force (JCF), and the Joint Board of Teacher Education (JBTE). Members of staff at the Ministry of Education’s Guidance and Counselling Unit must also be lauded for their contribution, and of course a special thanks to Ms. Althea Bailey who assisted the Ministry in the development of this Resource Handbook. Thank you for your hard work and dedication to development of the people of Jamaica. Salomie Evering (Mrs.) Deputy Chief Education Officer (DCEO) Curriculum and Support Services Ministry of Education - 2 - HFLE RESOURCE HANDBOOK ~ TABLE OF CONTENTS ~ 1.0 CHAPTER ONE: PURPOSE AND OVERVIEW OF TRAINING MANUAL & RESOURCE HANDBOOK ……………………………………………….…6 2.0 CHAPTER TWO: OVERVIEW OF HEALTH AND FAMILY LIFE EDUCATION………..9 3.0 CHAPTER THREE: REGIONAL STANDARDS AND CORE OUTCOMES ..................... 14 Vision of the Caribbean in the future and the ideal Caribbean person…/15 Regional standards, descriptors, key skills and core outcomes.../16 Self and Interpersonal Relationships theme.../16 Appropriate Eating and Fitness Theme…/20 Sexuality and Sexual Health Theme…/25 Managing the Environment Theme…/31 4.0 CHAPTER FOUR: LIFE SKILLS EDUCATION .................................................................. 37 Overview of Life Skills Education & Interactive Teaching Methods…/38 Theories Supporting Life Skills Education…../ 42 Using the Health & Family Life Education Curriculum…/49 Using the Resource Materials…. / 50 Types of Life Skills… / 53 Translating Life Skills Instruction into Steps…. / 56 Using Life Skills to Promote Positive Health Behaviours…. / 59 5.0 CHAPTER FIVE: INTERACTIVE TEACHING METHODS……………………………....79 Interactive Teaching Methods for Life Skills Education…/ 80 Reasons for Using Different Interactive Teaching Methods…/ 84 Lesson planning…/ 85 Questioning techniques…/ 89 Creating a Respectful and Conducive Environment for Learning…/ 91 Tips for Using Interactive Teaching …/ 98 Classroom Organization…/ 97 HFLE Classroom Environment …/ 98 Setting up the Classroom Atmosphere…/ 99 Ice Breakers.../105 Sample Lesson Plan…/ 106 Some Sample Instructional Materials…/ 108 6.0 CHAPTER SIX: ALTERNATIVE ASSESSMENT METHODS…………………………113 What are Performance Tasks?.../ 114 Creating and Using Performance Tasks & Rubrics for Assessment…/ 116 Creating and Using an HFLE Student Portfolio…/ 119 7.0 CHAPTER SEVEN:EXPLORING THE SELF……………………………………………..........123 Circles of Sexuality…/ 124 The Emotional and Spiritual Self…/ 126 Self Esteem & Self Acceptance/129 Values Clarification Activity Sheet #1…/ 131 - 3 - Values Clarification Activity Sheet #2.../132 Values and Jamaican Culture… / 133 Sexual Development through the Life Cycle…/ 135 Facts and Fiction about Sexuality and Sexual Health…../ 137 Health and Hygiene Matching Game …/144 Sexuality Quiz ………………………./145 Health and Hygiene Matching Game answers …/146 Sexuality Quiz Answers…/ 147 Gender & Sexuality…/148 Impact and Influence of the Media on Children and Adolescents…/ 149 8.0 CHAPTER EIGHT: HIV AND AIDS EDUCATION………………………………………....152 HIV/AIDS Quiz…../ 153 Global, Regional & National HIV/ AIDS Stats…/ 155 HIV/AIDS Fact or Fiction…. / 163 Frequently Asked Questions and Answers about HIV/AIDS… / 164 Definitions and descriptions of HIV & AIDS…/168 Tips for teaching about HIV& AIDS... /171 Stigma and Discrimination against PLWA… / 174 HIV in Schools …/ 177 Social Factors Driving the HIV epidemic …/ 180 Negotiating Sex.../ 180 Answers to HIV/AIDS Fact or Fiction.../ 181 Answers to HIV/AIDS Quiz …/ 181 Male & Female condoms …/184 HIV & AIDS Glossary.../186 Sexually Transmitted Infections (STIs).../ 187 HIV/AIDS/STI Information sources…/194 9.0 CHAPTER NINE: SELF AND INTERPERSONAL RELATIONSHIPS UNIT ............... 195 Interpersonal Relationships & Communication…/ 196 Diversity, Discrimination & Inclusion…/198 Self Esteem…/ 201 Refusal skills …/ 204 Assertiveness Practice .../ 205 The Johari Window …/ 206 Conflict Resolution …/ 209 10.0 CHAPTER TEN: SEXUALITY AND SEXUAL HEALTH UNIT ................................... 212 Sexuality, Gender and Sexual Preference.../ 213 Views of Homosexuality…/ 215 Scenarios for Discussing Sexuality…/217 Pressured (Unwanted) Sexual Activity.../ 219 Abstinence.../ 222 Contraceptives.../ 224 Parenting Readiness Exercise…/ 231 Rights of the Child…/ 232 The Child Care and Protection Act…/ 232 Agencies Providing Child Protection …/ 234 11.0 CHAPTER ELEVEN: APPROPRIATE EATING AND FITNESS UNIT…………………235 Sample Eating and Fitness Lesson Plans…/ 236 Energy Balance… / 239 Nutrition through the Life Cycle.../ 240 Obesity.../ 245 Healthy Food Choices and Eating Behaviours... / 246 Alcohol and Substance Abuse .../ 247 Physical Activity…/248 Physical activity Guide…/250 - 4 - 12.0 CHAPTER TWELVE: MANAGING THE ENVIRONMENT UNIT.............................. 251 Sample Managing the Environment Lesson plans…/ 252 Health & the Environment .../ 260 Conservation…/ 260 Pollution... / 261 Recycling …/ 265 Soil Erosion.../ 267 Cyclones.../ 268 Storm Surges…/269 Fire Safety…/270 Environmental Laws…/ 272 Website Sources of Regulations Relating to Managing the Environment…/273 References……………………………………………………………………………………...…………274 List of Acronyms and Abbreviations……………………………………………………………….......275 - 5 - CHAPTER TWO PURPOSE AND OVERVIEW OF THE TRAINING MANUAL AND RESOURCE HANDBOOK This HFLE manual which this Resource Handbook accompanies has been developed in order to support the implementation of the revised Health and Family Life Education (HFLE) curriculum to be implemented in schools across the island. In order to be able to teach a new curriculum using the non- traditional teaching methodologies and strategies of the Life Skills approach, those involved in delivering this new curriculum need to participate in effective training and development activities that result in building their sensitivities, knowledge, skills and capabilities to create a learning environment that facilitates students’ learning in an enjoyable manner. The social dynamics within which our children and teachers operate are changing in a manner that places new demands on their psyche and the resultant relationships within and outside of the classroom. These changes require a new way of thinking on the part of teachers and school administrators in order to create a learning environment that motivates students to seek after knowledge and become agents in their own learning process. The principles embodied in the Life Skills Approach to learning form the basis of the training practices adopted in the HFLE training manual. Silberman (1999) explains that learning that is embedded in a Life Skills approach influences the mind of both teachers and students in a positive manner. Students are inspired to engage in the processing of information rather than just regurgitating information from a book, or the chalkboard, or from the teacher. The Life Skills approach to teaching and learning develops “lifelong habits of thinking on the part of students.” Students will think about “how and what” they are learning, thus taking responsibility for their own education. 1.1 Training Objective The Health and Family Life Education (HFLE) staff training aims to provide opportunities for training participants; to explore the nature and benefits of incorporating the HFLE curriculum in schools, participate in planning, implementing and assessing HFLE lessons using Life Skills participatory methodologies, thus building their knowledge, skills, abilities and attitudes so that they can become effective HFLE teachers in Jamaican schools. 1.2 Learning Objectives The HFLE Staff Training Programme was designed in order to adequately prepare teachers to deliver the HFLE curriculum to grades 1 to 9 in Jamaican schools. In order for teachers to be able to do this they will be taken through a process of instruction that seeks to develop their abilities to deliver instruction in the HFLE curriculum using the Life Skills approach. As such, by the end of the HFLE staff training programme, teachers should be able to: - 6 - 1.2.1 Interpret the four HFLE themes against the background of the CARICOM Regional Framework. The HFLE themes are: • Self and Interpersonal Relationships • Sexuality and Sexual Health • Appropriate Eating and Fitness, and, • Managing the Environment 1.2.2 Experience greater psychological comfort with their own: • Emotions • Values • Sexuality • Social and interpersonal relations • Coping mechanisms 1.2.3 Engage in individual and group processing and evaluation. 1.2.4. Participate in HFLE lesson planning processes utilizing the Life Skills-based interactive teaching methodologies. 1.2.5 Deliver selected components of the HFLE curriculum using the Life Skills-based approaches. 1.2.6 Design alternative assessment procedures to be applied to teaching the HFLE curriculum. 1.3 Training Evaluation In order to ascertain the effectiveness of the training, the trainer should conduct training evaluation at the start of training, along the way and at the end. At the beginning of the training during registration, a pre test questionnaire should be administered. This questionnaire should be short and should seek to determine the knowledge, skills and attitude levels of the participants with respect to the themes of the Health and Family Life Education curriculum. During the training sessions, the trainer should use a Rubric (see sample in Session Five, Alternative Assessment of this manual) to record participant’s level of involvement and participation in the various training activities. Levels of mastery should also be recorded. Journaling should be used as another training evaluation strategy. At the end of the first day of training, participants should be given a notebook, called a journal, which they will label with their name and school. The trainer will place three questions on the wall that participants will record at the front of their journal. The questions are: • What went well? • What could have been improved? • What are your questions/comments? The trainer will budget for fifteen minutes at the end of each training day for participants to answer these questions in their journals. The journal entries are a vital source of data to be used in the training evaluation. The trainer should read through the entries of each day and provide written feedback consistent with each journal entry - 7 - for that day. The first session of the next training day should be spent addressing some of the salient issues recorded in the journals the day before, in an open discussion forum. At the end of the training session, just prior to doing the reflections the pre-test instrument should be re-administered. This is important for the trainer as the responses would be a vital source of measurement of the changes in knowledge, skills and attitudes with respect to the HFLE curriculum planning and delivery that are attributable to the training experience. A copy of the pre-test/post test accompanies this manual. Facilitators may request permission to view the training evaluation report based on the first round of training. This will provide some guidance on how to analyze, interpret and report on their training sessions. These evaluation methods are critical to the future planning and delivery of the teacher training programme as well as the delivery of the HFLE curriculum in schools. 1.4 Using the Support Material for the Manual to Implement the Training The manual was written to support teacher training that lasts for four days. It is acknowledged however that in many situations training to teach HFLE cannot be accommodated in four days because of resource constraints. Often only a few hours in a day can be devoted to the training. The manual does lend itself to this kind of stand-alone treatment of the relevant issues. Trainers would need to determine through a mini needs analysis procedure which skills are most lacking among the proposed trainees, then apply the instructional sections relevant to meeting those needs. Trainers should adopt strict time management strategies to ensure that the training follows the schedule exactly. Begin on time even if all are not present and end on time according to the schedule. Encourage trainees to adopt the same principle in their various trainee tasks. Ideally there should be a timer that is set for each activity that alarms when the time has expired for that activity. It is typical for trainees to want to discuss a lot of items at different points during the training. The trainer should not allow issues irrelevant to the issue at hand to consume the training time. Promise to address those issues outside of the training time either at the end of the training day or early in the morning prior to the start of training. Using the Resource Handbook This resource handbook has been created to support this manual. It contains resource information in the manual as well as supplementary information on all the topics contained in the thirteen sessions. This is intended to be resource information for the Master trainers, trainers and those implementing the HFLE programme. The resource material is organized in the same order as in the manual. - 8 - CHAPTER TWO OVERVIEW OF HEALTH AND FAMILY EDUCATION The Ministry of Education has projected in the Final Report of the Task Force on Educational Reform a profile of the educated Jamaican to be one who loves to learn and will therefore be a lifelong learner, continuously developing wisdom and knowledge. He /she will also be well-rounded, agile of mind, able to adjust to different situations, responsible and able to make decisions. This Jamaican would also contribute to national development by being socially-aware and responsible, conscious of what is good for society, committed to a sustainable lifestyle, spiritually-conscious and mature, tolerant of diversity and rooted in his/her Jamaican “Smaddiness”. (Task Force on Educational Reform Final Report, 2004) The Health and Family Life Education curriculum using the life skills-based approach has the potential to facilitate the acquisition and development of the requisite attitudes, knowledge and skills in our students enabling them to become productive citizens in charge of their personal advancement and contributing to national, socioeconomic and political development. 2.1 The Need for Life Skills Education among Children and Youth Programme evaluation studies in other countries reveal that competence in the use of life skills can:  Eliminate the onset of drug abuse  Prevent high-risk sexual behaviours  Facilitate anger management and conflict resolution  Improve academic performance and  Promote positive social adjustment. Children and adolescents who fail to acquire the skills for interacting with others in a socially acceptable manner early in life often engage in unhealthy behaviours and are at a higher risk of poor academic performance (Parker and Ashe, 1987) Concerns for the status of family life and adolescent sexuality and sexual health in Jamaica were expressed as early as 1958. By 1962, a joint health and education committee had been established by the Ministry of Education to formulate a response and develop basic material. A personal development curriculum, developed in the late 1970s, served as the basis for the curriculum developed between 1983 and 1985 for the primary and secondary levels of the education system. As the problems relating to family life seemed to escalate and more agencies began to offer school- based interventions, a policy for Family Life Education was formulated in 1993 with the strong support of the Planning Institute of Jamaica. In 1997, the Ministry of Education, formally recognized the terminology “Health and Family Life Education”, acknowledging the direct link between health and education in promoting student and community wellness. The National Health and Family Life Education (HFLE) Policy seeks to guide policy-makers and programme implementers into effective programme development with specific guidelines for conceptualizing HFLE, standardizing the delivery of HFLE and the development of HFLE materials. The Health and Family Life Education policy formulated in 1994 was revised in 1999. - 9 - The Ministry of Education, in an effort to confront the reality of the HIV & AIDS epidemic, considered that the Health and Family Life programme was the logical vehicle through which this issue could be addressed in the Jamaican education system. HFLE has been a taught subject since the 1960s; however, the programme tended to be knowledge based and the didactic approach in delivery did not facilitate the effective transfer of life skills. 2.1.1 Why Health and Family Life Education? There is the perception that traditional curricula do not ensure that children and youth achieve their full potential as citizens. In addition, increasing social pressures are impacting on young persons in ways that make teaching a challenge. Teachers are finding that young people are more disruptive, are more likely to question authority, and see little relevance in schooling that fails to adequately prepare them for their various life roles. The paradox is that schools are now seen as key agencies to address some of these very issues. HFLE, then, is a curriculum initiative that not only reinforces the connection between health and education, but also uses a holistic approach within a planned and coordinated framework. It “is perceived as the viable way to bridge existing gaps to enable young persons to attain the high levels of educational achievement and productivity required for the 21st century.” (UNICEF/CARICOM, 1999 p 15.) 2.1.2 The Health and Social Profile of Caribbean Children and Youth A World Bank Country Study revealed that young persons 10-24 years make up about 30% of the population in the Caribbean (World Bank, 2003). The data for available countries indicate that the proportion of youth 10 to 24 years varies from as high as 34% in St. Lucia to 24% in St. Kitts and Nevis. This group has also historically been “at risk”. In the past, it was infectious diseases that ravaged this age cohort. Today, however, emotional and behavioural disabilities rank high among the health conditions that affect young persons in the region. Increasingly, Caribbean youth are being adversely affected by a number of social, psychological and physical problems. Evidence of this is sustained by the findings of Dicks, (2001); Halcon, Beuhring & Blum, (2000); Heath, (1997); PAHO (1998); UWI-Cave Hill (1998); and the World Bank (2003). The findings identified certain key social and environmental concerns: poverty, unemployment, high academic failure rates, family instability, fragmented communities, child abuse and neglect, violence, stress and alienation, the negative influence of the media, questionable sub cultures, and unavailability, of physical education and recreational facilities. Health threats include such lifestyle-related conditions as diabetes, hypertension, obesity, HIV/AIDS/STDs, substance abuse, depression and teenage pregnancy. 2.2 CARICOM Multi-Agency HFLE Project In 1994, the Caribbean Community Standing Committee of Ministers of Education passed a resolution supporting the development of a comprehensive approach to HFLE by the Caribbean Community (CARICOM) and the University of the West Indies (UWI). This commitment gave rise to the CARICOM Multi-Agency HFLE Project. - 10 - The objectives of the Project were:  To develop policy, introducing advocacy and funding, for the overall strengthening of HFLE in and out of schools.  To strengthen the capacity of teachers to deliver HFLE programmes.  To develop comprehensive life skills-based teaching materials.  To improve co-ordination among all the agencies at the regional and national levels in the area of HFLE.  The Ministry of Education and Youth revised the HFLE curricula for rollout in 2007. 2.3 Defining Health and Family Life Education Health and Family Life Education is a comprehensive, life skills-based programme, which focuses on the development of the whole person, in that, it:  Enhances the potential of young persons to become productive and contributing adult persons.  Promotes an understanding of the principles that underlie personal and social well- being.  Fosters the development of knowledge, skills and attitudes that make for healthy family life.  Provides opportunities to demonstrate sound, health-related knowledge, attitudes and practices.  Increases the ability to practice responsible decision-making about social and sexual behaviour.  Aims to increase the awareness of children and youth that the choices they make in everyday life profoundly influence their health and personal development well into adulthood. 2.4 Ethical Guidelines for the Delivery of the Health and Family Life Education 2.4.1 Responsibility to students Teachers and other resource persons involved in the delivery of HFLE should:  Have primary responsibility to the student, who is to be treated with respect, dignity, and with concern for confidentiality.  Make appropriate referrals to service providers based on the needs of the student, and monitor progress.  Maintain the confidentiality of student records and exchange personal information only according to prescribed responsibility.  Provide only accurate, objective, and observable information regarding student behaviours.  Familiarise themselves with policies relevant to issues and concerns related to disclosure. Responses to such issues should be guided by national and school policies, codes of professional organizations/unions, and the existing laws. 2.4.2 Responsibility to families  Respect the inherent rights of parents/guardians for their children and endeavour to establish co-operative relationships. - 11 -  Treat information received from families in a confidential and ethical manner.  Share information about a student only with persons authorized to receive such information.  Other ongoing support and collaboration with families for support of the child. 2.4.3 Responsibility to colleagues  Establish and maintain a cooperative relationship with other members of staff and the administration.  Promote awareness and adherence to appropriate guidelines regarding confidentiality and the distinction between private and public information.  Encourage awareness of and appropriate use of related professions and organizations to which the student may be referred. 2.4.4 Responsibilities to self  Monitor one’s own physical, mental and emotional health, as well as professional effectiveness.  Refrain from any destructive activity leading to harm to self or to the student.  Take personal initiative to maintain professional competence.  Understand and act upon a commitment to HFLE. 2.5 Overview of the Health and Family Life Curriculum The HFLE curricula are organized around four themes. These themes have been adopted from the core curriculum guide developed for teachers’ colleges as part of a PAHO initiative (see PAHO/Carnegie, 1994). Standards and core outcomes have been developed for each of these themes. This thematic approach marks a departure from the traditional topic-centered organization of curricula. For example, the use of alcohol and drugs, as well as premature sexual activity, represent maladaptive responses to coping with poor self worth, boredom, failure, isolation, hopelessness and fragmented relationships. The thematic approach, therefore, addresses the complexity and connectedness between the various concepts and ideas, goals, components and standards, which are associated with attitude and behaviour change. The four thematic areas are as follows:  Self and Interpersonal Relationships  Managing the Environment  Sexuality and Sexual Health  Eating and Fitness 2.5.1 Self and Interpersonal Relationships Key Ideas:  Human beings are essentially social, and human nature finds its fullest expression in the quality of relationships established with others.  Self-concept is learned, and is a critical factor in relationship building. - 12 -  Effective or healthy relationships are dependent on the acquisition and practice of identifiable social skills.  Supportive social environments are critical to the development of social skills in order to reduce feelings of alienation, and many of the self-destructive and risk-taking tendencies, such as violence and drug-use among children and youth in the region.  Teachers have a critical role to play in creating supportive school and classroom environments that preserve and enhance self-esteem, a critical factor in the teaching/learning process. 2.5.2 Sexuality and Sexual Health Key Ideas:  Sexuality is an integral part of personality, and cannot be separated from other aspects of self.  The expression of sexuality encompasses physical, emotional, and psychological components, including issues related to gender.  Sexual role behaviours and values of teachers and children are conditioned by family values and practices, religious beliefs, and social and cultural norms, as well as personal experiences.  Educational interventions must augment the socialization role of the family and other social and religious institutions in order to assist in preventing/minimizing those expressions of sexuality that are detrimental to emotional and physical health and well-being. 2.5.3 Appropriate Eating and Fitness Key Ideas:  Dietary and fitness practices are influenced by familial, socio-cultural and economic factors, as well as personal preferences.  Sound dietary practices and adequate levels of physical activity are important for physical survival.  The quality of nutritional intake and level of physical activity are directly related to the ability to learn, and has implications for social and emotional development.  The eating and fitness habits established in childhood are persistent, conditioning those preferences and practices, which will influence quality of health in later life.  Teachers are well poised to assist students in critically assessing the dietary choices over which they have control, using the leverage provided by classroom instruction and the provision of nutritionally-sound meals in the school environment. 2.5.4 Managing the Environment Key Ideas:  All human activity has environmental consequences.  Access to, and current use of technologies have had an unprecedented negative impact on the environment.  Human beings are capable of making the greatest range of responses to the environment, in terms of changing, adapting, preserving, enhancing, or destroying it.  There is a dynamic balance between health, the quality of life, and the quality of environment. - 13 - CHAPTER THREE Regional Standards and Outcomes The Caribbean Atlantic Ocean - 14 - 3.1 Vision of the Caribbean in the Future and the Ideal Caribbean Person Source: CARICOM Informed by: The Regional Cultural Policy The West Indian Commission Report The Caribbean Charter for Health Promotion The Special Meeting of SCME, May 1997 3.1.1 Caribbean future The Caribbean should be seen as that part of the world where the population enjoys a good quality of life with the basic needs of food, clothing, shelter, health care and employment being all virtually satisfied. The environment should be one which provides clean air and water, unpolluted seas and healthy communities - an environment that has not been destroyed by the development process. 3.1.2 The ideal Caribbean person The Ideal Caribbean Person should be someone who, among other things: 3.1.2.1 Is imbued with a respect for human life since it is the foundation on which all the other desired values must rest. 3.1.2.2 Is emotionally secure with a high level of self confidence and self esteem; sees ethnic, religious and other diversity as a source of potential strength and richness. 3.1.2.3 Is aware of the importance of living in harmony with the environment. 3.1.2.4 Has a strong appreciation of family and kinship values, community cohesion, and moral issues including responsibility for and accountability to self and community. 3.1.2.5 Has an informed respect for the cultural heritage. 3.1.2.6 Demonstrates multiple intelligences, independent and critical thinking, questioning of the beliefs and practices of past and present and brings this to bear on the innovative application of science and technology to problems solving. 3.1.2.7 Demonstrates a positive work ethic. 3.1.2.8 Values and displays the creative imagination in its various manifestations and nurtures its development in the economic and entrepreneurial spheres in all other areas of life. 3.1.2.9 Has developed the capacity to create and take advantage of opportunities to control, improve, maintain and promote physical, mental, social and spiritual well being and to contribute to the health and welfare of the community and country. 3.1.2.10 Nourishes in him/herself and in others the fullest development of each person's potential without gender stereotyping and embraces differences and similarities between females and males as a source of mutual strength. - 15 - 3.2 Regional Standards, Descriptors, Key Skills and Core Outcomes The four themes of the Health and Family Life Education have a set of regional standards along with the relevant descriptors, key skills to be developed and the core outcomes of the instructional process for that particular theme. Below are the themes with the associated regional standards, descriptors, key skills and core outcomes. Theme: Self and Interpersonal Relationships Regional Standards The Self and Interpersonal Relationships theme 1. Examine the nature of self, family, school, and community in order to build strong healthy relationships. 2. Acquire coping skills to deter behaviours and lifestyles associated with crime, drugs, violence, motor vehicle accidents, and other injuries. 3. Respect the rich differences that exist among Caribbean peoples as a valuable resource for sustainable development of the region within the framework of democratic and ethical values. - 16 - Regional Standard 1 Examine the nature of self, family, school, and community in order to build strong, healthy relationships. Descriptor: Acceptance of self, the need to belong, and the need to be loved are some of the universal needs and rights that contribute to the shaping of our individual selves. Students need to develop a healthy self- concept in order to foster healthy relationships within the family, school, and community. They also need to be assisted in developing resiliency—the capacity to assess, cope, manage, and benefit from the various influences that impact on relationships. Key Skills: Coping Skills (healthy self-management, self-awareness) Social Skills (communication, interpersonal relations) Cognitive Skills (critical thinking, creative thinking, problem-solving, decision-making) Core Outcomes Core Outcomes Core Outcomes Age Level 9–10 Age Level 11–12 Age Level 13–14 1. Demonstrate an 1. Analyse the influences that 1. Demonstrate ways understanding of self. impact on personal development to use adverse 2. Identify ways to (media, peers, family, significant experiences for promote healthy others, community, etc.). personal growth and relationships with family 2. Demonstrate an understanding development. and friends. of issues that impact on 2. Recognise risks to relationships within the family, mental and school, and community. emotional well- being. - 17 - Regional Standard 2 Acquisition of coping skills to deter behaviours and lifestyles associated with crime, drugs, violence, motor vehicle accidents, and other injuries. Descriptor: Students need to practise skills that reduce their involvement in risky behaviours. Crime, violence, bullying, alcohol and other drugs, and motor vehicle accidents and other injuries threaten the very fabric of Caribbean society and the lives of Caribbean youth. The acquisition of these skills will increase students’ ability to assume a responsible role in all aspects of personal, family, and community living. Key Skills: Coping Skills (healthy self-management, self-awareness) Social Skills (communication, interpersonal relations, assertiveness, conflict resolution, mediation, anger management) Cognitive Skills (critical thinking, creative thinking, problem-solving, decision-making) Core Outcomes Core Outcomes Core Outcomes Age Level 9–10 Age Level 11–12 Age Level 13–14 1. Identify ways of coping 1. Develop resilience for 1. Demonstrate skills to with feelings and coping with adverse avoid high-risk emotions in adverse situations (death, grief, situations and pressure situations. rejection, and separation). to use alcohol and other 2. Demonstrate skills to 2. Analyse the impact of illicit substances. cope with violence at alcohol, and other illicit 2. Demonstrate skills to home, school, and in drugs on behaviour and cope with violence at the community. lifestyle. home, school, and in 3. Demonstrate skills to cope the community. with violence at home, school, and in the community. - 18 - Regional Standard 3 Respect the rich diversity that exists among Caribbean peoples as a valuable resource for sustainable development of the region within the framework of democratic and ethical values. Descriptor: Survival in a global economy demands that we pool our individual and collective resources in order to be productive as a people. Students must be committed to valuing and respecting the rich diversity (cultural, ethnic, and religious) of the people of the Caribbean. Additionally, they must be encouraged to realise their fullest potential as contributors to sustainable development while embracing core values and democratic ideals. Key Skills: Coping Skills (healthy self-management) Social Skills (communication, interpersonal relations, assertiveness, refusal, negotiation) Cognitive Skills (critical thinking, creative thinking, problem-solving, decision-making) Core Outcomes Core Outcomes Core Outcomes Age Level: 9–10 Age Level 11–12 Age Level 13–14 1. Affirmation of persons 1. Assess ways in which 1. Critically examine how who are different from personal and group efforts relationships can be oneself (ethnic and can be enhanced by the affected by personal cultural). interactions and prejudices and biases. 2. Appreciate that contributions of persons 2. Advocate for acceptance resources among of diverse cultural and and inclusion of persons diverse people are ethnic groupings. from diverse groupings at essential to developing 2. Recognise the value of all levels of society. positive relationships. personal commitment and 3. Recognise that the hard work to the development of the region improvement of self, depends on individual and others, and the wider collective efforts at all community. levels of society. - 19 - Theme: Appropriate Eating and Fitness Regional Standards The Appropriate Eating and Fitness Theme 1. Build individual capacity to make healthy eating choices throughout the life-cycle and reduce the risk factors associated with the development of lifestyle diseases. 2. Demonstrate an understanding of fitness and its relationship to good health and quality of living. 3. Analyze the influence of socio-cultural and economic factors as well as personal beliefs and choices related to appropriate eating and fitness. 4. Develop knowledge and skills to access age-appropriate sources of information, products, and services related to eating and fitness. - 20 - Regional Standard 1 Build individual capacity to make healthy eating choices throughout the life-cycle, and reduce the risk factors associated with the development of lifestyle diseases, all of which impede productivity. Descriptor: Children are now at greater risk of obesity and other lifestyle diseases that were typically associated with adults. Students therefore need to understand that healthy eating and the right balance of safe, nutritious and wholesome foods (especially locally grown foods) are critical to optimum health throughout the life-cycle, and they should acquire skills to make healthy food choices and reduce the incidents of diet-related/lifestyle diseases (diabetes, heart diseases, hypertension, stroke, and some forms for cancer) that affect personal productivity and national development. Key Skills: Coping Skills (healthy self-management, self-awareness) Social Skills (communication) Cognitive Skills (critical thinking, creative thinking, problem-solving, decision-making) Core Outcomes Core Outcomes Core Outcomes Age Level 9 – 10 Age Level 11 – 12 Age Level 13 – 14 1. Recognize healthy 1. Assess personal eating 1. Demonstrate eating as a critical habits. knowledge of the component of healthy 2. Relate food relationship between living. imbalances to specific types and uses of 2. Demonstrate ways to lifestyle diseases nutrients in food and select a balanced meal (diabetes, heart overall health. using a variety of disease, and 2. Critically analyze food foods. hypertension). choices throughout the 3. Apply safe food- 3. Make appropriate life-cycle (including handling principles. food choices to avoid snacks) to avoid risk 4. Appreciate the need risk factors associated factors associated with for healthy eating with lifestyle diseases. lifestyle diseases. throughout the life- (e.g. excess salts, 3. Develop diets applying cycle. sugars, and fats). multi-mix principle and 4. Apply safe food- using food-based handling principles. dietary guidelines. 5. Appreciate the 4. Apply safe food- importance of handling principles. selecting nutritious foods to a healthy lifestyle. - 21 - Regional Standard 2 Demonstrate an understanding of fitness and its relationship to good health and quality of living. Descriptor: Changes in communication and transportation have discouraged the inclination and opportunity for physical activity as part of growing up. The majority of our children do not participate in sports; as a result, it is important for all students to develop skills that will help them make choices in favour of sound fitness habits to achieve optimum levels of age-appropriate physical activity and reduce the heavy dependence on sedentary activities, which could lead to obesity and related lifestyle diseases such as diabetes, hypertension, and heart disease. Students need to assess barriers relating to fitness, develop the skills to conduct physical fitness self- assessments, and select appropriate physical activity, spot fitness, and exercise to develop fitness for health across the life-cycle. Key Skills: Coping Skills (healthy self-management, self-awareness, self-monitoring) Social Skills (communication, interpersonal relations, assertiveness) Cognitive Skills (critical thinking, creative thinking, decision-making) Core Outcomes Core Outcomes Core Outcomes Age Level 9 – 10 Age Level 11 – 12 Age Level 13 – 14 1. Recognize and value 1. Differentiate between 1. Critically analyze the fitness as another exercise (aerobic capacity, complementary critical component of flexibility, muscular nature of a healthy healthy lifestyle. strength, and endurance), lifestyle (i.e. eating 2. Incorporate safety sport fitness, and physical right, daily physical principles when activity. exercise/fitness, engaged in fitness 2. Make appropriate choices sleep, school/work, activities. with respect to physical and leisure activities). 3. Design and activity and exercise to 2. Incorporate safety implement an age- attain and maintain a principles when appropriate physical healthy lifestyle. engaged in physical fitness plan. 3. Incorporate safety fitness. 4. Appreciate the role of principles when engaged 3. Design and fitness in achieving in physical fitness. implement an age- good health. 4. Design and implement an appropriate physical age-appropriate physical fitness plan. fitness plan. - 22 - Regional Standard 3 Analyze the influence of socio-cultural and economic factors, as well as personal beliefs and choices related to appropriate eating and fitness. Descriptor: Eating and exercise behaviours are formed early in life and are influenced by the media as well as social, emotional, cultural, economic and religious factors. Students need to critically examine what motivates them to adopt particular eating and fitness habits. In addition, they need to be encouraged to demonstrate positive attitudes and behaviours related to eating and fitness (e.g. experience culturally diverse foods, alternative methods of food preparation, forms of adaptation, physical activity, and sport). Key Skills: Coping Skills (healthy self-management, self-awareness) Social Skills (communication, interpersonal relations, assertiveness, negotiation) Cognitive Skills (critical thinking, creative thinking, problem-solving, decision-making) Core Outcomes Core Outcomes Core Outcomes Age Level 9 – 10 Age Level 11 – 12 Age Level 13 – 14 1. Demonstrate an 1. Recognize the impact of 1. Analyze social, understanding of factors socio-cultural and emotional, and that influence eating and economic factors as economic influences on fitness behaviours. well as personal beliefs personal choices of 2. Make varied choices to and choices related to food and fitness. broaden experiences eating and fitness 2. Make varied choices to related to eating and behaviours. broaden experiences fitness. 2. Assess the nutritional related to eating and value of culturally fitness. diverse foods. 3. Set personal eating and 3. Make varied choices to fitness goals for broaden experiences optimum health. related to eating and fitness. - 23 - Regional Standard 4 Develop knowledge and skills to access age-appropriate sources of information, products, and services related to eating and fitness. Descriptor: Students should be capable of identifying and accessing age-appropriate information, products, and services relating to eating and fitness within their community, Students should be encouraged to critically assess information, products, and services relating to eating and fitness for the attainment and maintenance of good health throughout the life-cycle. Key Skills: Coping Skills (healthy self-management) Social Skills (communication, interpersonal relations) Cognitive Skills (critical thinking, creative thinking, problem-solving, decision-making) Core Outcomes Core Outcomes Core Outcomes Age Level 9 – 10 Age Level 11 – 12 Age Level 13 – 14 1. Identify sources of 1. Demonstrate the ability 1. Evaluate the validity accurate, age- to locate and utilize and appropriateness of appropriate information accurate, age- the eating and fitness relating to eating and appropriate resources resources. fitness. within the community, 2. Make informed in regard to eating and decisions regarding fitness. eating and fitness information, products, and services. - 24 - Theme: Sexuality and Sexual Health Regional Standards The Sexuality and Sexual Health Theme 1. Demonstrate an understanding of the concept of human sexuality as an integral part of the total person that finds expression throughout the life- cycle. 2. Analyze the influence of socio-cultural and economic factors, as well as personal beliefs on the expression of sexuality and sexual choices. 3. Build capacity to recognize the basic criteria and conditions for optimal reproductive health. 4. Develop action competence to reduce vulnerability to priority problems, including HIV&AIDS, cervical cancer, and STIs. 5. Develop knowledge and skills to access age-appropriate sources of health information, products, and services related to sexuality and sexual health. CIRCLES OF SEXUALITY SENSUALITY SEXUALIZATION INTIMACY Body Image Human Sexual Rape Response Cycle Caring Incest Skin Hunger Sharing Sexual Harassment Fantasy Loving/Liking Withholding Sex Risk Taking Seduction- Flirting Vulnerability Factual Information Feelings & Attitudes Bias Intercourse Gender Identity Physiology & Anatomy of Gender Role the Reproductive Organs Sexual Orientation Sexual Reproduction SEXUAL HEALTH & REPRODUCTION SEXUAL IDENTITY - 25 - Regional Standard 1 Demonstrate an understanding of the concept of human sexuality as an integral part of the total person that finds expression throughout the life-cycle. Descriptor: A differentiation needs to be made between the terms sex and sexuality. Sexuality is presented as including biological sex, gender, and gender identity. One’s sexuality also encompasses the many social, emotional, and psychological factors that shape the expression of values, attitudes, social roles, and beliefs about self and others as being male or female. It is important to have students develop positive attitudes about self and their evolving sexuality. Key Skills: Coping Skills (healthy self-management, self-awareness) Social Skills (communication, interpersonal relations, assertiveness, refusal) Cognitive Skills (critical and creative thinking, decision-making) Core Outcomes Core Outcomes Core Outcomes Age Level 9–10 Age Level 11–12 Age Level 13–14 1. Explore personal 1. Develop strategies for 1. Assess experiences, attitudes, and coping with the various the capacity to enter into feelings about the roles that changes associated with intimate sexual boys and girls are expected puberty. relationships. to play. 2. Assess traditional role 2. Demo 2. Demonstrate awareness of expectations of boys and nstrate use of strategies for the physical, emotional, and girls in our changing recognizing and managing cognitive changes that society. sexual feelings and occur during puberty. 3. Assess ways in which behaviours. behaviour can be interpreted as being “sexual.” - 26 - Regional Standard 2 Analyze the influence of socio-cultural and economic factors, as well as personal beliefs on the expression of sexuality and sexual choices. Descriptor: Young people make daily decisions about their sexual behaviour, values, and attitudes. Family, religion, culture, technology—including media, and peers, influence these decisions. It is critical to provide students with knowledge and skills that will assist them in understanding their own sexuality and realizing their potential as effective and caring human beings. Key Skills: Coping Skills (healthy self-management, self-awareness) Social Skills (communication, interpersonal relations, assertiveness, refusal, negotiation) Cognitive Skills (critical thinking, creative thinking, problem-solving, decision-making, critical viewing) Core Outcomes Core Outcomes Core Outcomes Age Level 9–10 Age Level 11–12 Age Level 13–14 1. Demonstrate an 1. Critical 1. Critically analyze the understanding of the ways ly analyze the key factors impact of personal in which sexuality is learned. influencing sexual choices beliefs, media, money, 2. Demonstrate ways to and experiences. technology, and respond appropriately to the 2. Demo entertainment on early key factors influencing nstrate skills in sexual involvement. sexual choices and communicating about 2. Demonstrate skills to experiences. sexual issues with parents, counter the negative 3. Demonstrate knowledge of peers, and/or significant influences reaching the various types of sexual others. youth through personal abuse and exploitation. beliefs, media, money, marketing, and technology. - 27 - Regional Standard 3 Build capacity to recognize the basic criteria and conditions for optimal reproductive health. Descriptor: Young people are facing a variety of risks that compromise their sexual and reproductive health. Acquisition of requisite skills to counteract these risks will increase the opportunity to maximize learning and provide a foundation for a healthy population. Key Skills: Coping Skills (healthy self-management) Social Skills (communication, interpersonal relations, assertiveness, refusal, negotiation) Cognitive Skills (critical thinking, creative thinking, problem-solving, decision-making) Core Outcomes Core Outcomes Core Outcomes Age Level 9–10 Age Level 11–12 Age Level 13–14 1. Demonstrate 1. Demonstrate knowledge 1. Make appropriate knowledge of factors of the impact of raising choices to avoid risks that influence a child. to reproductive health. reproductive health. 2. Critically analyze the 2. Evaluate the social and 2. Demonstrate risks that impact on biological factors that knowledge of the basic reproductive health. support healthy health and social pregnancy and child requirements of raising rearing. a child. - 28 - Regional Standard 4 Develop action competence to reduce vulnerability to priority problems, including HIV&AIDS, cervical cancer, and STIs. Descriptor: Beyond knowledge of HIV&AIDS, cervical cancer, and STIs as a disease, efforts have to be intensified to render students less vulnerable to contracting and spreading HIV, cervical cancer, and STIs. Addressing issues related to the physical and emotional aspects of HIV&AIDS, stigma of living with HIV&AIDS, and discrimination against people living with HIV&AIDS is critical. Importantly, students are encouraged to examine a range of options for reducing vulnerability to these problems such as abstinence, a drug-free lifestyle and so on. Key Skills: Coping Skills (healthy self-management, self-monitoring) Social Skills (communication, assertiveness, refusal, negotiation, empathy) Cognitive Skills (critical thinking, creative thinking, problem-solving, decision-making) Core Outcomes Core Outcomes Core Outcomes Age Level 9–10 Age Level 11–12 Age Level 13–14 1. Identify the risk 1. Make appropriate choices 1. Critically examine behaviours/agents that are to reduce risk associated abstinence, fidelity, and associated with contracting with contracting HIV, condom use (if permitted) HIV, cervical cancer, and cervical cancer, and STIs. as preventive methods in STIs. 2. Set personal goals to transmission of HIV and 2. Demonstrate skills to assist minimize the risk of STIs. and respond contracting HIV, cervical 2. Make appropriate choices compassionately to persons cancer, and STIs. to reduce risk associated affected by HIV. 3. Demonstrate ways of with contracting HIV, empathizing and supporting cervical cancer, and STIs. persons and families 3. Critically examine social affected by HIV/AIDS. norms and personal beliefs in light of current knowledge of the transmission and spread of HIV. 4. Advocate for reducing the stigma and discrimination associated with HIV, cervical cancer, and STIs. - 29 - Regional Standard 5 Develop knowledge and skills to access age-appropriate sources of health information, products, and services related to sexuality and sexual health. Descriptor: Students should be capable of identifying a range of age-appropriate health services in their communities. Through an informed use of these services, they should acquire the necessary knowledge, skills, and attitudes needed for a lifelong commitment to the promotion of personal, family, and community health, including advocacy. Age-appropriate health services in the community may address the following: sexuality, child abuse, sexual assault/harassment, and domestic violence. Key Skills: Coping Skills (healthy self-management) Social Skills (communication) Cognitive Skills (critical thinking, creative thinking, problem-solving, decision-making) Core Outcomes Core Outcomes Core Outcomes Age Level 9–10 Age Level 11–12 Age Level 13–14 1. Identify sources of 1. Demonstrate the 1. Evaluate the availability and accurate information. ability to locate and appropriateness of the resources to 2. Identify family, school, utilize community address reproductive health and and community resources that parenting issues. resources that deal with support the health, 2. Demonstrate an understanding of health, social, and social, and the basic tenets that address the emotional issues. emotional needs of sexual health of children and families. youth. - 30 - Theme: Managing the Environment Regional Standards The Managing the Environment Theme 1. Demonstrate an understanding of the inter-relationships of a sustainable natural environment. 2. Demonstrate an understanding of the environmental threats to the health and well-being of students, families, schools, and communities. 3. Analyze the relationship between a sustainable and healthy environment and the social and economic well-being of students, schools, and communities. 4. Demonstrate scientifically sound and affordable responses to the creation of healthy and sustainable environments and the reduction of environmental health threats in the home, school, community, and region. 5. Develop knowledge and skills to access age-appropriate sources of information, products, and services related to managing the environment. - 31 - Regional Standard 1 Demonstrate an understanding of the inter-relationships of a sustainable natural environment. Descriptor: Caribbean countries and the peoples are particularly vulnerable to environmental degradation and threats by virtue of their size, geography and topography. It is important for students to develop a basic understanding of the features and operations of natural environmental systems (ecosystem, habitats, water resources, air quality, energy resources, and food) and the threats to their sustainability. Key Skills: Coping Skills Social Skills (communication, collective action) Cognitive Skills (critical thinking, creative thinking, problem-solving, decision-making) Core Outcomes Core Outcomes Core Outcomes Age Level 9 – 10 Age Level 11 – 12 Age Level 13 – 14 1. Identify elements of a 1. Describe basic functions 1. Analyze the interaction of sustainable environment and characteristics of a basic environmental systems (air, sunlight, water, land, sustainable environment and implications for plants, and germs). (e.g., water cycle, food environmental risks. 2. Identify threats to a chain, and carbon cycle). 2. Critically analyze sustainable environment. 2. Recognize ways human community policies and 3. Appreciate the need for a behaviour affects a actions as these relate to a sustainable environment. sustainable environment. sustainable environment. 3. Appreciate the value of a 3. Value the importance of a sustainable environment. sustainable environment. - 32 - Regional standard 2 Demonstrate an understanding of the environmental threats to the health and well-being of students, families, schools, and communities. Descriptor: Caribbean people are vulnerable to a variety of environmental treats. These include quality of water and sanitation, solid waste management, exposure to pesticides and toxic substances, food safety, dengue fever, leptospirosis, malaria etc. Students need to understand the environmental health threats and the main factors in their causation. Key Skills: Coping /skills Social Skills (communication, assertiveness) Cognitive Skills (critical thinking, problem-solving, advocacy, decision-making) Core Outcomes Core Outcomes Core Outcomes Age Level 9 – 10 Age Level 11 – 12 Age Level 13 – 14 1. Identify environmental 1. Explore how the main 1. Critically analyze the key health threats with factors contribute to the factors in priority emphasis on priorities in priority environmental environmental health issues their country. health threats (e.g., agents, in the school and 2. Identify the main factors vectors, and host). community setting (e.g., and sources that contribute 2. Appreciate the personal and malaria risk increased in the to these environmental collective role of students, school/community by an health threats. their families, and infestation of the carrying communities in either mosquito in a mangrove increasing or reducing swamp). exposure to environmental 2. Appreciate the importance health risks. of individuals, school, community, and nation to advocate for a healthy environment. - 33 - Regional Standard 3 Analyze the relationship between a sustainable and healthy environment, and the social and economic well-being of students, schools, and communities. Descriptor: Caribbean countries are heavily dependent on their environmental resources for economic development, particularly in countries where there is no mineral wealth (e.g., beach pollution or dengue can affect tourism). Likewise, environmental health threats can affect the personal, social, and economic well-being of children, families, and communities (e.g., poor air quality or excessive mosquitoes can affect motivation, attention, and learning in schools). Students need to understand and appreciate the impact and benefits of a healthy, sustainable environment on their health and well-being. Key skills: Coping Skills (self-monitoring) Social Skills (communication) Cognitive Skills (critical thinking, creative thinking, decision-making, problem-solving) Core Outcomes Core Outcomes Core Outcomes Age Level 9 – 10 Age Level 11 – 12 Age Level 13 – 14 1. Identify ways in which the 1. Demonstrate an 1. Critically analyze how the quality of the natural understanding of the quality of the environment environment can affect relationship between a can impact on personal, personal health and the healthy, sustainable social, and economic well- well-being of the school environment and the being in schools, and community. quality of life in the school communities and the 2. Appreciate how a healthy, and community. nation. sustainable environment 2. Describe the benefits of a 2. Appreciate the relationship contributes to their well- healthy, sustainable between a healthy, being and that of their environment as it relates to sustainable environment peers. the socio-economic well- and well-being. being of students, family, school, and community. - 34 - Regional Standard 4 Demonstrate scientifically sound and affordable responses to the creation of healthy and sustainable environments and the reduction of environmental health treats in the home, school, community, and region. Descriptor: Caribbean countries are experiencing significant environmental health threats as well as threats to the sustainability of their environment. Environmental threats to health include water quality and sanitation, solid waste management, vector control, exposure to pesticides, and food safety. Threats to environmental sustainability vary between island and mainland countries. These threats can range from deforestation to reef damage and pollution of beaches and other water sources and air. Students need to develop the knowledge and skills to effectively utilize scientifically sound and affordable responses to address both the issues of protecting the environment and protection from the environment. Key Skills: Coping Skills (healthy self-management, self-monitoring) Social Skills (communication, interpersonal relations, assertiveness, negotiation, advocacy) Cognitive skills (critical thinking, creative thinking, problem-solving, decision-making) Core Outcomes Core Outcomes Core Outcomes Age Level 9 – 10 Age Level 11 – 12 Age Level 13 – 14 1. Identify practical 1. Demonstrate skills to select 1. Critically assess options for opportunities for maintaining appropriate responses for maintaining a healthy and a sustainable environment reducing threats to the sustainable environment and reducing health threats. environment and priority and reducing environmental 2. Make appropriate choices to environmental threats. health risk. reduce exposure to 2. Describe benefits of 2. Implement an age- environmental health risk for adopting sound practices for appropriate plan to reduce self and family. reducing environmental environmental health 3. Appreciate that each health threats in the home, threats in the school or individual has a responsibility school, and community. community. to contribute to a healthy, 3. Develop an age-appropriate 3. Appreciate efforts made by sustainable environment. plan to reduce public sector agencies in environmental threats in the reducing environmental home and school. health threats. 4. Appreciate the need for 4. Advocate for individuals, students, families, and schools, community, and schools to work together to the nation to address contribute to a healthy environmental health risks. environment. - 35 - Regional Standard 5 Develop knowledge and skills to access age-appropriate sources of information, products, and services as it relates to managing the environment. Descriptor: Students should be capable of identifying, accessing, and critically assessing age-appropriate information, products, and services relating to managing the environment. Key Skills: Coping Skills (healthy self-management) Social Skills (communication, interpersonal relations) Cognitive Skills (critical thinking, creative thinking, problem-solving, decision-making) Core Outcomes Core Outcomes Core Outcomes Age Level 9 – 10 Age Level 11 – 12 Age Level 13 – 14 1. Identify sources of accurate, 1. Demonstrate the ability to 1. Evaluate and validate the age-appropriate information locate and utilize accurate, appropriateness of resources relating to managing the age-appropriate resources for managing the environment. within the community in environment. regard to managing the 2. Make informed decisions environment. regarding environmental information, products, and services. - 36 - CHAPTER FOUR Life Skills Education - 37 - 4.1 Overview of Life Skills Education and Interactive Teaching Methods Sources: Life Skills Manual, Caribbean Community (CARICOM) Project, 2006 Skills for Health: Skills-based health education including life skills: An important component of a Child- Friendly/Health-Promoting Schools, WHO Information Series on School Health Life Skills, Doc. 9, 2003. 1. What is Life Skills Education? Skills-based or Life Skills education focuses on the development of “abilities for adaptive and positive behavior that enables individuals to deal effectively with the demands and challenges of everyday life” (WHO 1993). The acquisition of life skills can greatly affect a person’s overall physical, emotional, social, and spiritual health which, in turn, is linked to his or her ability to maximize upon life opportunities. The success of skills-based health education is tied to three factors: 1) the recognition of the developmental stages that youth pass through and the skills they need as they progress to adulthood, 2) a participatory and interactive method of pedagogy, and 3) the use of culturally relevant and gender-sensitive learning activities. Various health, education and youth organizations and researchers have defined and categorized key skills in different ways. Despite these differences, experts and practitioners agree that the term “life skills” typically includes the life skills listed in the table on page 43. The process of categorizing various life skills may inadvertently suggest distinctions among them. However, many life skills are interrelated and several of them can be taught together in a learning activity. The Life Skills programme is a comprehensive behaviour change approach that concentrates on the development of the skills needed for life such as communication, decision-making, managing emotions, assertiveness, self- esteem building, resisting peer pressure, and relationship skills. Additionally, it addresses the important related issues of empowering girls and guiding boys towards values. The programme moves beyond providing information. It addresses the development of the whole individual, so that a person will have the skills to make use of all types of information, whether it be related to HIVIAIDS, STDs, reproductive health, safe motherhood, other health issues, and other communication and decision-making situations. The Life Skills approach is completely interactive, using role- plays, games, puzzles, group discussions, and a variety of other innovative teaching techniques to keep the participant wholly involved in the sessions. In practice the skills are not separate or discrete, and more than one skill may be used simultaneously. 2. The Life Skills Approach The Life Skills approach is built on the assumption that opportunities can be created for youth to acquire skills that will boost their protective factors and enable them to avoid being manipulated by outside influences. The use of life skills is to enable youth people to be able to recognise the coercive forces of social pressures in their immediate environment that promote behaviours that can jeopardize their health, emotional and psychological well-being. The Life Skills approach aims to assist young people develop healthy lifestyles and to regain control of their behaviours, while at the same time take informed decisions that will positively influence their values, attitudes and behaviours. This approach should serve as a means to develop in young people skills that will lead to optimum health, social and physical well- being. - 38 - Life Skills education is designed to facilitate the practice and reinforcement of psychosocial skills in a culturally and developmentally appropriate way. It contributes to the promotion of personal and social development, the projection of human rights, and the prevention of health and social problems. Another justification for the life skills approach is that it is a natural vehicle for the acquisition of the educational, democratic and ethical values. In the delivery of Life Skills, the fostering of laudable attitudes and values is set alongside the knowledge and skill components. Some of the commonly held values are respect for self and others; empathy and tolerance; honesty; kindness; responsibility; integrity; and social justice. The teaching of values is to encourage young people to strive towards accepted ideals of a democratic, pluralistic society such as self-reliance, capacity for hard work, cooperation, respect for legitimately constituted authority, and ecologically sustainable development. This is done in the context of existing family, spiritual, cultural and societal values, and through critical analysis and values clarification, in order to foster the intrinsic development of values and attitudes (Regional Curriculum Framework, 2005). To be effective in supporting quality learning outcomes, skills-based health education must be used in conjunction with a specific subject or content area. Learning about decision-making, for example, is more meaningful if it is addressed in the context of a particular issue (e.g., the decisions we make about tobacco use). In addition, while skills-based education focuses somewhat on behavior change, it is unlikely that a learning activity will affect behavior change if knowledge and attitudinal aspects are not addressed (e.g., a student will not try to negotiate for effective condom use if he/she doesn’t know that they can prevent disease transmission or doesn’t believe that condoms are necessary). Therefore, it is important for skills-based approaches to be accompanied by activities which focus on students’ knowledge and attitude. The following figure gives examples of ways in which skills-based health education can be applied to specific informational content. These illustrate only a few possible examples; there are numerous other ways that life skills can be incorporated into these content areas. - 39 - Topics Examples of ways that life skills may be used Sexual and Communication Skills: Students can observe and practice ways to Reproductive Health effectively express a desire to not have sex and HIV&AIDS Critical Thinking Skills: Students can observe and practice ways to analyse Prevention myths and misconceptions about HIV&AIDS, gender roles and body image that are perpetuated by the media Skills for Managing Stress: Students can observe and practice ways to seek services for help with reproductive and sexual health issues Alcohol, Tobacco and Advocacy Skills: Students can observe and practice ways to generate local Other Drugs support for tobacco-free schools and public buildings Negotiation/refusal Skills: Students can observe and practice ways to resist a friend’s request to chew or smoke tobacco without losing face or friends Violence Prevention or Skills for Managing Stress: Students can observe and practice ways to Peace Education identify and implement peaceful ways to resolve conflict Decision-Making Skills: Students can observe and practice ways to understand the roles of aggressor, victim and bystander. Managing our Feelings Communication skills: Students can observe and practice non defensive and Emotions or non destructive ways to honestly express feelings and emotions such as distress and anger to others Problem –solving skills: Students can observe and practice ways to avoid quarrels and fights in situations where they are offended, treated unfairly or victimized Diversity Creative Thinking: Students can observe and practice ways to appreciate the value differences between people Skills for being Non Discriminatory: Students can observe and practice ways of accepting persons who are different in their abilities, religion, status etc. In addition, skills-based education emphasizes the use of learning activities which are culturally relevant and gender-sensitive. To achieve this, the learning activities offer numerous opportunities for participants to provide their own input into the nature and content of the situations addressed during the learning activities (e.g., creating their own case studies, brainstorming possible scenarios, etc.). This approach ensures that the situations are realistic and relevant to the everyday lives of participants. It is critical that the skills youth build and practice in the classroom are easily transferable to their lives outside the classroom. 3. How Do You Teach Life Skills? The primary goal of skills-based education is to change not only a student’s level of knowledge, but to enhance his or her ability to translate that knowledge into specific, positive behaviors. Participatory, interactive teaching and learning methods are critical components of this type of education. These methods include role plays, debates, situation analysis, and small group work. It is through their participation in learning activities that use these methods that young people learn how to better manage themselves, their relationships, and their health decisions. A chart outlining some participatory teaching methods is found in Section 5, Session Two. The foundation of life skills education is based on a wide body of theory-based research which has found that people learn what to do and how to act by observing others and that their behaviors are reinforced by the positive or negative consequences which result during these observations. In - 40 - addition, many examples from educational and behavioral research show that retention of behaviors can be enhanced by rehearsal. As Albert Bandura, one of the leading social psychologists in the area has explained; “When people mentally rehearse or actually perform modeled response patterns, they are less likely to forget them than if they neither think about them nor practice what they have seen” (Bandura, 1977). A summary of behavioral theories that support life skills education is found in this resource handbook in Section 4.2. Cooperative learning or group learning is another important aspect of skills-based programs. Many skills- based programs capitalize on the power of peers to influence the acquisition and subsequent maintenance of positive behavior. By working cooperatively with peers to develop pro-social behaviors, students change the normative peer environment to support positive health behaviors (Wodarski and Feit). “As an educational strategy, therefore, skills-based health education relies on the presence of a group of people to be effective. The interactions that take place between students and among students and teachers are essential to the learning process.”∗ In addition to the use of participatory, interactive teaching methods, skills-based health education also considers the developmental stages (physical, emotional, and cognitive) of a person at the time of learning. There are three distinct stages in the adolescence period-early adolescence (12-14 years), middle adolescence (14-17) and late adolescence (17-19), this explains the major difference between a thirteen year old and an eighteen year old. Each learning activity is designed to be appropriate to the students' age group, level of maturity, life experiences, and ways of thinking. A guideline to the developmental learning tasks of children and adolescents are found in this training manual on page 59. At the same time, participatory activities provide the opportunity for students to learn from one another and appreciate the differences, as well as similarities, among individuals in the classroom setting. 4. Why Is Life Skills Education Important? Over the last decade, a growing body of research has documented that skills-based interventions can promote numerous positive attitudes and behaviors, including greater sociability, improved communication, healthy decision-making and effective conflict resolution. Studies demonstrate that these interventions are also effective in preventing negative or high-risk behaviors, such as use of tobacco, alcohol and other drugs, unsafe sex, and violence. The table below summarizes some of the results from research studies conducted on skills-based education programs. It is important to note that research has also found that programs which incorporate skills development into their curricula are more effective than programs which focus only on the transfer of information (e.g. through lecture format). 5. Research shows that skills-based health education programs can:  Delay the onset age of the abuse of tobacco, alcohol, and marijuana (Botvin et al, 1995. Hansen, Johnson, Flay, Graham, and Sobel, 1988) * “Handouts 1-5 on Life Skills Education,” Gillespie, A. UNICEF (unpublished document) - 41 -  Prevent high-risk sexual behavior (O’Donnell et al., 1999; Kirby, 1994; Schinke, Blythe, and Gilchrest, 1981)  Teach anger control (Deffenbacher, Oetting, Huff, and Thwaites, 1995; Deffenbacher, Lynch, Oetting, and Kemper, 1996; Feindler, et al 1986)  Prevent delinquency (Young, Kelley, and Denny, 1997)  Promote positive social adjustment criminal behavior (Englander-Golden et al. 1989)  Improve health-related behaviors and self-esteem (Elias, Gara, Schulyer, Branden-Muller, and Sayette, 1991)  Improve academic performance (Elias, Gara, Schulyer, Branden-Muller, and Sayette, 1991)  Prevent peer rejection (Mize and Ladd, 1990) 4.2 Theories Supporting Life Skills Each of the theories summarized in the table overleaf forms part of the foundation for the life skills approach. Some of the theories focus on behavioral outcomes, using skill development as a way to encourage pro-social behaviors in young people. According to other theories, the acquisition of skills is the goal, since competency in problem solving, communication, and conflict resolution are crucial to healthy human development. Still other theoretical perspectives view life skills as a way for young people to participate actively in their own development and the construction of social norms. Implications of Theories of Life Skills Theory Implications Child & • Early adolescence presents a critical opportunity for building skills and Adolescent positive habits since at that age there is a developing self-image and Development ability to think abstractly and solve problems. Theory • Early and middle adolescence provide varied situations in which young people can practice new skills with peers and others outside the family. • Acquiring skills and competencies is seen as critical to a child’s development. Constructivist • The learning process is facilitated by social interactions in peer Psychology learning, cooperative groups, and open discussions. • Developing life skills in adolescents is infused with cultural beliefs and values. Theory Implications Social Learning • Teaching life skills needs to replicate the natural processes by which Theory children learn behaviors (e.g., modeling, observation, social interaction). • Children need to develop internal skills (e.g., self-control, stress reduction, decision-making) that support positive behaviors - 42 - Problem- • Behaviors are influenced by one’s values, beliefs and attitudes, as well Behavior as the perception of friends and family about the behaviors. Theory • Young people need values clarification and critical thinking skills to evaluate themselves and the values of their social environment. Social • Addressing social pressures to engage in unhealthy behaviors before Influence the young person is exposed to the pressures can diminish the impact Theory of peer and social pressure. • Teaching children resistance skills is more effective in reducing problem behaviors than simply providing information or provoking fear of the results of the behavior. Cognitive • Poor problem-solving skills often lead to poor social behaviors. Problem • Teaching interpersonal problem-solving skills at earlier stages in the Solving developmental process (e.g. childhood, early adolescence) is more effective. Multiple • Using a variety of instructional methods is critical for engaging Intelligences different learning styles (including • Managing emotions and understanding one’s feelings and the feelings Emotional of others are critical skills that children can learn. Intelligence) Resiliency • Social cognitive skills, social competence, and problem-solving skills Theory can lead to pro-social behavior • Life skills programs can teach skills to help young people respond to adversity and become resilient Source: Mangrulkar, L., Vince Whitman, C., and Poster, M. (in press) Life Skills Approach to Child and Adolescent Healthy Human Development. Washington, DC: Pan American Health Organization, World Health Organization. 5.2.1 Theories and Principles Supporting Skills-Based Health Education1 (From the WHO’s Information Series on School Health Document 9, Skills for Health) Purpose: to summarize the theories and principles that serve as a foundation for skills-based health education, and to highlight how they are applied. A significant body of theory and research provides a rationale for the benefits and uses of skills-based health education. This section outlines a selection of these theories, with brief annotations highlighting their implications for skills-based health education planning. The theories share many common themes and have all contributed to the development of skills-based health education and life skills. Behavioral science, and the disciplines of education and child development, placed in the context of 1 Most of this chapter represents a summary of “Chapter 11: The Theoretical Foundations of the Life Skills Approach,” from Mangrulkar, L., Vince Whitman, C., & Posner, M. (2001), Life Skills Approach to Child and Adolescent Healthy Human Development, Washington, DC: Pan American Health Organization. - 43 - human rights principles, constitute a primary source of these foundation theories and principles. Those who work in these disciplines have provided insights acquired through decades of research and experience - into the way human beings, specifically children and adolescents, grow and learn; acquire knowledge, attitudes, and skills; and behave. Research and experience have also revealed the many spheres of influence that affect the way children and adolescents grow in diverse settings, from family and peer groups to school and community. Most of the theories outlined below are drawn from Western or North American social scientists and may or may not be equally relevant to other cultures and practices. Therefore, programme designers, together with local social and behavioral scientists, pediatricians, anthropologists, educators, and others who study child and adolescent development, may want to consider the relevance of these ideas and their own cultural basis for programme design. 1. Child and adolescent development theories An understanding of the complex biological, social, and cognitive changes, gender awareness, and moral development that occurs from childhood through adolescence lies at the core of most theories of human development. The onset of puberty constitutes a fundamental biological change from childhood to early adolescence. An important component of social cognition in the transition from adolescence to adulthood is the process of understanding oneself, others, and relationships. The ability to understand causal relationships develops in early adolescence, and problem-solving becomes more sophisticated. The adolescent is able to conceptualize simultaneously about many variables, think abstractly, and create rules for problem-solving (Piaget, 1972). Social interactions become increasingly complex at this time. Adolescents spend more time with peers; increase their interactions with opposite-sex peers; and spend less time at home and with family members. Moral development occurs during this period as well; adolescents begin to rationalize the different opinions and messages they receive from various sources, and begin to develop values and rules for balancing the conflicting interests of self and others. • Implications for skills-based health education planning: a. In the school setting, late childhood and early adolescence (ages 6-15) are critical moments of opportunity for building skills and positive habits. During this time, children are developing the ability to think abstractly, to understand consequences, to relate to their peers in new ways, and to solve problems as they experience more independence from parents and develop greater control over their own lives. b. The wider social context of early and middle adolescence provides varied situations in which to practice new skills and develop positive habits with peers and other individuals outside the family. c. Developing attitudes, values, skills, and competencies is recognized as critical to the development of a child's sense of self as an autonomous individual and to the overall learning process in school. d. Within this age span, the skills of young people of the same age and different ages can vary dramatically. Activities need to be developmentally appropriate. - 44 - 2. Multiple intelligences This theory, developed by Howard Gardner (1993), proposes the existence of eight human intelligences that take into account the wide variety of human capacities. They include linguistic, logical/mathematical, musical, spatial, bodily/kinesthetic, naturalist, interpersonal, and intrapersonal intelligences. The theory argues that all human beings are born with the eight intelligences, but they are developed to a different degree in each person and that in developing skills or solving problems, individuals use their intelligences in different ways. • Implications for skills-based health education planning: a. A broader vision of human intelligence points toward using a variety of instructional methods to engage different learning styles and strengths. b. The capacity of managing emotions and the ability to understand one’s feelings and the feelings of others are critical to human development, and adolescents can learn these capacities just as well as they learn reading and mathematics. c. Students have few opportunities outside of school to participate in instruction and learning for these other capacities, such as social skills. Therefore, it is important to use the school setting to teach more than traditional subject matter. 3. Social learning theory or social cognitive theory This theory is based largely upon the work of Albert Bandura (1977), whose research led him to conclude that children learn to behave both through formal instruction and through observation. Formal instruction includes how parents, teachers, and other authorities and role models tell children to behave; observation includes how young people see adults and peers behaving. Children’s behavior is reinforced or modified by the consequences of their actions and the responses of others to their behaviors. • Implications for skills-based health education planning: a. Skills teaching needs to replicate the natural processes by which children learn behavior: modeling, observation, and social interaction. b. Reinforcement is important in learning and shaping behavior. Positive reinforcement is applied for the correct demonstration of behaviors and skills; negative or corrective reinforcement is applied for behavior skills that need to be adjusted to build more positive actions. c. Teachers and other adults are important role models, standard setters, and sources of influence. 4. Problem-behavior theory Jessor & Jessor (1977) recognize that adolescent behavior (including risk behavior) is the product of complex interactions between people and their environment. Problem behavior theory is concerned with the relationships among three categories of psychosocial variables. The first category, the personality system, involves values, expectations, beliefs, and attitudes toward self and society. - 45 - The second category, the perceived environmental system, comprises perceptions of friends’ and parents’ attitudes toward behaviors and physical agents in the environment, such as substances and weapons. The third category, the behavioral system, comprises socially acceptable and unacceptable behaviors. More than one problem behavior may converge in the same individuals, such as a combination of alcohol and tobacco or other drug use and sexually transmitted disease. • Implications for skills-based health education planning: a. Behaviors are influenced by an individual’s values, beliefs, and attitudes and by the perceptions of friends and family about these behaviors. Therefore, skills in critical thinking (including the ability to evaluate oneself and the values of the social environment), effective communication, and negotiation are important aspects of skills-based health education and life skills. Building these types of interactions into activities, with opportunities to practice the skills, is an important part of the learning process. b. Many health and social issues, and their underlying factors, are linked. Interventions on one issue can be linked to and benefit another. c. Interventions need to address personal, environmental, and behavioral systems together. 5. Social influence theory and social inoculation theory These two theories are closely related. Social influence theory is based on the work of Bandura (see above) and on social inoculation theory by researchers such as McGuire (1964, 1968), and was first used in smoking prevention programmes by Evans (1976; et al., 1978). Social influence theory recognizes that children and adolescents will come under pressure to engage in risky behaviors, such as tobacco or premature or unprotected sex. Social influence and inoculation programmes anticipates these pressures and teach young people both about the pressures and about ways to resist them before youth are exposed. Usually these programmes are targeted at very specific risks, tying peer resistance skills to particular risk behaviors and knowledge. Social resistance training is usually a central component of social skills and life skills programmes. • Implications for skills-based health education planning: a. Peer and social pressures to engage in unhealthy behaviors can be dissipated by addressing them before the child or adolescent is exposed to the pressures, thus pointing towards early prevention rather than later intervention. b. Making young people aware of these pressures ahead of time gives them a chance to recognize in advance the kinds of situations in which they may find themselves. c. Teaching children resistance skills is more effective for reducing problem behaviors than just providing information or provoking fear of the results of the behavior. 6. Cognitive problem solving This competence-building model of primary prevention theorizes that teaching social-cognitive problem-solving skills to children at an early age can improve interpersonal relationships and impulse control, promote self-protecting and mutually beneficial solutions among peers, and reduce or prevent negative “health-compromising” behaviors. Poor problem-solving skills are related to poor social behaviors, indicating the need to include problem-solving and other skills in skills-based health education. - 46 - • Implications for skills-based health education planning: a. Teaching interpersonal problem-solving skills at early stages in the developmental process (childhood, early adolescence) develops a strong foundation for later learning. b. Focusing on skills for self-awareness and self-management, as in anger management or impulse control, as well as generating alternative solutions to interpersonal problems, can reduce or prevent problem behaviors. Focusing on the ability to conceptualize or think ahead to the consequences of different behaviors or solutions can help children make positive choices. 7. Resilience theory This theory explains the process by which some people are more likely to engage in health-promoting rather than health-compromising behaviors. It examines the interaction among factors in a young person’s life that protect and nurture, including conditions in the family, school, and community, allowing a positive adaptation in young people who are at risk. The importance of this theory is its emphasis on the need to modify and promote mechanisms to protect children’s healthy development. Resilience theory argues that there are internal and external factors that interact among themselves and allow people to overcome adversity. Internal protective factors include self-esteem and self-confidence, internal locus of control, and a sense of life purpose. External factors are primarily social supports from family and community. These include a caring family that sets clear, nonpunitive limits and standards; the absence of alcohol abuse and violence in the home; strong bonds with and attachment to the school community; academic success; and relationships with peers who practice positive behaviours (Kirby 2001; Infante, 2001; Luthar, 2000; Kirby 1999; Kass, 1998; Blum & Reinhard, 1997; Luthar & Ziegler, 1991; Rutter, 1987). According to Bernard (1991), the characteristics that set resilient young people apart are social competence, problem-solving skills, autonomy, and a sense of purpose. Today, there seems to be agreement on the sets of factors that are present in resilient behaviors. Research is focusing on identifying the types of interactions among these factors that allow resilient adaptation to take place despite adverse conditions. • Implications for skills-based health education planning: a. Social-cognitive skills, social competence, and problem-solving skills can serve as mediators for behavior. b. The specific skills addressed by skills-based health education, and life skills-based education for other learning areas, are part of the internal factors that help young people respond to adversity and are the traits that characterize resilient young people. c. It is important that both teachers and parents learn these same skills and provide nurturing family and school environments, modeling what they hope young people will be able to do. d. Resilience focuses on the child, the family, and the community, allowing the teacher or caregiver to be the facilitator of the resilient process. While skills may protect young people, many larger factors in the environment play a role and may also have to be addressed if healthy behavior is to be achieved. - 47 - 8. Theory of reasoned action and the health belief model The Theory of Reasoned Action and the Health Belief Model contain similar concepts. Based on the research of Fishbein and Ajzen (1975), the Theory of Reasoned Action views an individual’s intention to perform a behaviour as a combination of his attitude toward performing the behaviour and subjective normative beliefs about what others think he should do. The Health Belief Model, first developed by Rosenstock (1966; Rosenstock et al., 1988; Sheehan & Abraham, 1996) recognises that perceptions - rather than actual facts - are important to weighing up benefits and barriers affecting health behaviour, along with the perceived susceptibility and perceived severity of the health threat or consequences. Modifying factors include demographic variables and cues to action which can come from people, policies or conducive environments. • Implications for skills-based health education planning: a. If a person perceives that the outcome from performing a behavior is positive, she will have a positive attitude toward performing that behavior. The opposite can be said if the behavior is thought to be negative. b. If relevant others (such as parents, teachers, peers) see performing a behavior as positive and the individual is motivated to meet the expectations of relevant others, then a positive individual behavior is expected. The same is true for negative behavior norms. 9. Stages of change theory or transtheoretical model This theory, based on a model developed by Prochaska (1979; & DiClemente, 1982), describes stages that identify where a person is regarding her change of behavior. The six main stages are precontemplation (no desire to change behavior), contemplation (intent to change behavior), preparation (intent to make a behavior change within the next month), action (between 0 and 6 months of making a behavior change), maintenance (maintaining behavior change after 6 months for up to several years), and termination (permanently adopted a desirable behavior). • Implications for skills-based health education planning: a. It is important to identify and understand the stages where students are in terms of their knowledge, attitudes, motivation, and experiences in the real world, and to match activities and expectation to these. b. Interventions that address a stage not relevant to students are unlikely to succeed. For instance, a tobacco-cessation programme for people who mostly do not smoke or who smoke but have no desire to change is not likely to lead to quitting smoking. For more information, see Chapter II in Life Skills Approach to Child and Adolescent Healthy Development, by Mangrulkar, L., Vince Whitman, C., and Posner, M., published by the Pan American Health Organisation in 2001. Available at http://www.paho.org/English/HPP/HPF/ADOL/Lifeskills.pdf - 48 - 4.3 Using the Health and Family Life Education Curricula The Health and Family Life Education Curriculum is very ACTIVITY focused. The activities are used to make learning fun, but are also intended to help children learn the skill, attitude and information in ways that enhance learning. The curriculum is organized into Units and Lessons (see below). Please note that often you will need more than one class session to complete a lesson. You may not be able to cover all the lessons for the respective grade in the school year. Select those that will be more beneficial to the group. Bear in mind the HFLE programme Vision and Mission as you make the selection of lessons. The suggested content and activities for the Sexuality and Sexual Health theme are designed to help students acquire knowledge about sexuality but more so to develop positive attitudes and helpful skills that enable healthy sexual growth and development. The focus will be to develop coping skills – especially self awareness and self management, social skills (communication, interpersonal, assertiveness and refusal) and to a lesser extent cognitive skills. As you prepare to teach the units under that theme, remember, students are coming from different backgrounds with different value systems relating to sexuality and sexual behaviour. These value systems may be different from your own. Special sensitivity is required especially in your choice of resource materials and persons. Resource materials should be age-appropriate and relevant. Resource persons should be competent and comfortable with their own sexuality. It is essential that teachers are aware of their sexuality and be willing to discuss sexual issues honestly with grade-appropriate openness. Disclosures which are made in the class room should be treated with respect and confidentially. Each class should be adequately prepared to deal with such confidentiality. The section of the curricula on Managing the Environment lends itself to highlighting contextual (community/ parish) factors and issues that are related to managing the environment. Highlight issues that are of importance to the community. If there is a rodent problem – focus the lesson on rats and rodent management. You can include, for example, protecting food in situations where rodent infestation is a problem. Similarly, if dumping of household garbage/refuse in gullies and rivers is the problem highlight that. Open burning of garbage is a problem for air pollution and affects the health of individuals with breathing/ respiratory problems so spend time on that issue. If the community/parish is an agricultural community/parish, be sure to include discussion of the safe use of pesticides and fertilizers. We have included issues associated with wetlands. Objectives Content Strategies Activities Assessment This is where Content is the A method of This refers to A task which is you’ll need to subject matter instruction which what students will used to present detail what which students are the teacher will do. The process evidence of students will expected to learn use to deliver the that students will learning. accomplish by the during the course content of the undergo in order This could be a end of the lesson of the lesson. lesson. to learn the tangible product in measurable content. or an observed terms and should Example: performance or a be specific. Example: Example: combination of HIV and AIDS: both. - 49 - Example: Human Questioning Children role play Immunodeficiency Role Play what to do if there Example: By the end of the Virus (HIV). Song is an accident in lesson, students Acquired Video school and there is Students should be able to: Immunodeficiency Presentation blood. demonstrate grasp Syndrome (AIDS). Resource Persons of Demonstrate Games the correct The virus lives in (i) HIV behaviours in blood and some (ii) AIDS cases of other body fluids. (iii) Transmiss accidents with It depresses the ion blood. body’s immune system, making it difficult for the body to resist bacteria that might cause disease. 4.4 Using the Resource Materials A primary objective of the HFLE initiative is the development and distribution of comprehensive life- skills based teaching materials in all primary and secondary schools. It was agreed that materials should be attractive in design, innovative in the presentation of ideas to young people (using illustrations, games and experimental learning techniques) build and/or supplement existing resources, and incorporate a gender perspective. Material development continues in the effort to meet the changing needs of Caribbean societies. (UNICEF, 2006) A teaching aid is a tool used by teachers, instructors, lecturers, facilitators and trainers to reinforce a skill, fact, idea or concept. Teaching aids may also be used to display instructions and or information. These aids may be in the form of charts, games and flash cards which are known as visual aids and television, tape recorders, DVD players, overhead projectors and computers known as electronic instructional aides. Within the context of the Health and Family Life Education programme, teachers should be encouraged to make their own instructional aids. Some ready-made instructional material or equipment may not effectively enhance an idea or concept, thus making the teaching experience confusing for learners. As such, teachers should develop their own instructional materials which should be written into their lesson plans. Here are some tips for using instructional aides.  Orientate learners to the instructional aides being used. For participatory learning, it might be a good idea to ask students to give their interpretation of the graphic or information on the teaching aid. For example, Teacher may ask: What are we looking at? This is an excellent opportunity to provide clarification as some students may misinterpret the intention of the instructional aide.  Be familiar with the teaching aid yourself. It is quite embarrassing to be using a teaching aid you are not familiar with. Learn the content (if applicable) and be prepared to answer any questions that may surface due to interactions with the material. - 50 -  Some instructional aides may have text that may not be visible to all students, hence, while orientating students to the aid, you may need to read or explain unfamiliar graphics words and phrases.  While teaching, reference must be made to the instructional aide/s to reinforce concepts and or ideas.  Teaching aids should be used to prompt and generate discussion among students.  Use students to assist in making instructional aides when possible. Some students are quite creative and talented at graphic art. When students are involved, there is greater appreciation and care of the material.  Remember, an instructional aid is not a poster. It is intended to enhance and or supplement other teaching materials and may not be clear to some students at first glance.  Know when during the lesson to use the instructional aide. A properly planned lesson ensures ease of use. - 51 - Sample poster and its use The teacher may need to clarify illustrations which may be misinterpreted by students, such as this one. It is also wise to decide for yourself what the illustration represents. For example, the illustration the arrow is pointing to may be representing Geography or it may represent traveling. One must be consistent when highlighting what the graphic represents. Activity: This poster may be used to initiate discussion among students. 1. How would you introduce this chart to your students? 2. How would you use this chart to prompt discussion and interaction among your students? 3. What graphics and or texts would you need to clarify? Why? 4. What other types of instructional aides could you use to illustrate the concept of safety? - 52 - 4.5 Types and Categories of Life Skills The core of life skills that facilitate the practice of healthy behaviours is divided into the following groups: Social Skills Cognitive Skills Emotional/Coping Skills • Interpersonal Skills • Decision-making skills • Healthy self- • Communication Skills • Problem-solving skills management skills • Refusal Skills • Critical-thinking skills • Self-monitoring skills • Negotiation Skills • Creative-thinking skills • Self-awareness skills • Empathy Skills • Coping with emotions • Cooperation Skills (anger, self-esteem, grief, loss) • Advocacy Skills • Cooperative learning skills Life Skills Definitions Significance Cooperative The ability to work together for Allows us to gain from each other’s Learning skills mutual learning and achievement efforts knowing that all group members using a variety of learning activities share a common fate and that performance is the result of both self and team members contribution Interpersonal The ability to relate positively with Allows us to keep friendly relationships, relationship people, creating an environment in which can be of great importance to our skills which people feel secure and free to mental and social well-being, and interact and express their opinions. impacts the way we communicate with, motivate and influence each other. Self-awareness Having a sense of identity and an Helps us to recognize our feelings and understanding of our own feelings, values and is a prerequisite for effective beliefs, attitudes, values, goals, communication, interpersonal motivations, and behaviors. relationships, and developing empathy for others. - 53 - Life Skills Definitions Significance Empathy The ability to imagine what life is Can help us to accept others who may like for another person, even in a be very different from ourselves, situation that we are unfamiliar with. respond to people in need, and promote other positive social interactions. Coping with The ability to recognize a range of Enables us to respond appropriately to emotions feelings in ourselves and others, the our emotions and avoid the negative awareness of how emotions effects that prolonged, pent up emotions influence behavior, and the ability to may have on our physical and mental respond to emotions appropriately. health. Coping with The ability to recognize the sources Enables us to adjust our levels of stress stress of stress in our lives and the effects and avoid the negative consequences of that stress produces, and the ability stress, including boredom, burnout, to act in ways that help us cope or susceptibility to diseases, and behavioral reduce our levels of stress. changes. Negotiation The ability to communicate with Helps us to meet and address individual Skills other people for the purpose of needs and concerns in ways that are settling a matter, coming to terms, mutually beneficial. This is a key factor or reaching an agreement. This may in working and playing cooperatively involve the ability to compromise or with others. to give and take. Refusal Skills The ability to communicate the Enables us to carry out health-enhancing decision to say “no” effectively (so behaviors that are consistent with our that it is understood). values and decisions. Decision The ability to choose a course of Helps us deal constructively with health making action from a number of options and other decisions about our lives by which may result in a specific enabling us to assess the different outcome or involve only the resolve options and what effects different to behave in a certain way in the decisions may have. future. Problem The process thought through which Allows us to deal constructively with solving a situation/problem is resolved (i.e., problems in our lives, which if left diagnosing the problem, taking unattended, could cause new problems, action to close the gap between including mental and physical stress. present situation and desired outcome, and generalizing the principles to other situations) Creative The ability to depart from Contributes to both decision making - 54 - thinking traditional ways of thinking, and problem solving by enabling us to resulting in the generation of explore the available alternatives and original and innovative ideas that various consequences of our actions or enable us to respond adaptively to non-actions. life situations. Effective The ability to express ourselves, Allows the transfer of information, communication both verbally and non-verbally, in understanding, and emotion from one ways that are appropriate to our person to another to make one’s intent cultures and situations. clear. Assertiveness The ability to state one’s point of Assertiveness skills enable people to Skills view or personal rights clearly and take actions that are in their own best confidently, without denying the interests. Such actions include the ability personal rights of others. to stand up for oneself or someone else without feeling intimidated or anxious and to express feelings and points of view honestly and openly. Healthy self- The ability to make situational and Enables us to maintain health-enhancing management/ lifestyle behavior choices that result decisions from day to day as well as to monitoring in attaining and/or maintaining reach longer-term health and wellness skills one’s physical, social, emotional, goals. spiritual, and environmental health. Source: CARICOM Multi-Agency HFLE Programme Manual for Facilitators of Life Skills Based HFLE Programmes in the Formal and non-Formal Sectors and Teenage Health Teaching Sessions - 55 - 4.6 Translating Skills Instruction into Steps – Examples from the HFLE Curriculum 1. Refusal Skills  Use the word "no" in your refusal.  Emphasize your refusal by repeating the refusal assertively (clear, strong voice, eye contact, not smiling)  Use appropriate body language ( serious expression, walking away, gesturing with hands)  Give your reasons for refusing or list possible consequences.  Suggest an alternative that includes your friend.  Change the subject or walk away. 2. Problem solving skills For younger learners:  Stop (check out the scene, and remind yourself to think before acting).  Think (become aware of the choices and consider the sequences).  Act (choose the best alternative and act on it)  Review (decide whether the action has helped or hurt). For older learners:  Define the problem  Identify the desired solution.  Gather necessary information. Identify all possible solutions/choices and how these possible solutions will impact your life, your values, and your beliefs. Look at a wide range of alternatives. Don't limit yourself to a few choices.  List the negative and positive consequences of each solution or choice.  Select one solution or choice. 3. Self-awareness skills  Understand your personality: an understanding of our personalities can help find situations in which we will thrive, and help us avoid situations in which we will experience too much stress  Know and focus on your values: It is important to know and focus on your values. When we focus on our values, we are more likely to accomplish what we consider most important  Identify your habits: Identify all your habits that increase and decrease your effectiveness.  Identify your needs: It is important to identify, prioritize and plan for needs as they drive behaviours. If needs are not satisfied you may become easily frustrated and. frustration often times lead to poor decision making  Understand your emotions: It is important to know your own feelings, what causes them, and how they impact your thoughts and actions. A person with high emotional self-awareness has greater control over his or her behaviour. - 56 - 4. Advocacy skills  Identify target audience  Present information that appeals to audience  Information must be accurate  Information about the issue or program explicitly shows intended effect  Suggest various ways to implement the proposal or resolve the issue  Identify how the program or solution to the issue changes the current behavior. 5. Effective communication skills Being an effective listener  Body language  Face the speaker and make eye contact  Nod your head when you understand what the speaker is saying.  Pay attention to both words and body language. Empathetic listening:  Show the speaker you understand by making comments like "I know what you mean".  Give brief verbal encouragement—for e.g. "I see" or "Oh?"  Do not interrupt with your own stories or information. Don't tell the speaker what he or she should do. Listen for the feelings behind the words and show the speaker you understand by saying, for e.g., "It sounds like you must be feeling ..." or "That must have been fun for you ...".  Make sure you understand by restating what the speaker says in your own words. Use comments like "I heard you say ..." or "Do you mean ....?" Being an effective speaker  Pick a good time to talk - for e.g., not when the other person is busy or tired.  Face the other person and make eye contact.  Do not yell, demand, whine, or ridicule the other person.  Be respectful, even when you think the other person has made a mistake.  Express yourself with confidence, and respect the other person's right to do the same. If you are or the other person is expressing very strong feelings, take a break if need you to. This could help each of you calm down and think more clearly. 6. Critical thinking skills Frame thoughtful probing questions such as: 1. What evidence exists to support your conclusions? 2. Where did you/ where would you search for such evidence? 3. How does this evidence affect the issue? 7. Decision making skills  State the problem  Examine the consequences of the problem  State your desired objective  Examine all alternatives and possible outcomes  Make a decision  Act on your decision 8. Creative thinking skills (group or individual)  Offer innovative solutions  Identify resources to implement solution - 57 -  Identify or agree on one or more likely solutions  Implement solution selected  Evaluate decision or outcome 9. Empathy skills  Ask the person to talk about how they feel  Share your feelings - be honest and open  Give support when as is needed  Offer encouragement  Be available to listen and talk 10. Negotiation skills  Refuse the behaviour in a positive and assertive way. Explain why you are unwilling to engage in that particular behaviour  Suggest alternative actions  Talk about it in a respectful manner seeking to reach the desired outcome 11. Social skills  Generate information necessary to perform the behaviour  Model behaviour  Practice  Reinforce through verbal feedback  Re-teach (not punish) 12. Cooperative Learning Skills  Form small groups with students of different levels of ability  Use a variety of learning activities to improve understanding of a subject  Assign individual and group responsibilities  Randomly examine and record the actual contribution of each member to the group assignment  Have students teach what they learned to someone else  Help students to discuss the group process and identify elements that facilitate mutual benefits and achievement ______________________________________ Contributed by: C. Constantine, EDC, 2005-06-12 & David and Roger Johnson http//www.clcrc.com - 58 - 4.7 Using Life Skills to Promote Positive Health Behaviours Developmental Characteristics of Students Ages Five to Eighteen and Implications for Health and Family Life Education: Growth and Development: Ages 5 to 9 Selected Developmental Characteristics Desired Health Knowledge, Attitudes, or Behaviors • Is curious about the human body, but • Learns correct names and functions of may not know correct names; can parts of body draw human body • Learns ways individuals grow and what • High interest in growth affects growth; accepts that individuals • Eyes and ears not fully mature and grow in different and similar ways may present some problems • Learns importance of ears and eyes; • Is curious about the birth of animals understands the importance of glasses; and humans and the phenomenon of takes care of eyes and ears growth • Understand the concept “like begets like” Growth and Development: Ages 9 to 12 Selected Developmental Characteristics Desired Health Knowledge, Attitudes, or Behaviors • High interest in human body; concern • Learns structure and function of human with body image body; relates health habits to body image • Shows interest in human growth and • Acquires basic and accurate information development on how one grows and develops mentally, • Concerned with differences in growth physically, intellectually, and socially patterns; may be embarrassed about • Understands normalcy of differences in own and others’ physical development growth patterns and cycles • High interest in growth and • Appreciates the process of healthy growth development of embryos and fetuses and development • Tends to fear any differences in sexual • Explores accurate information on orientation differences in sexual preferences - 59 - Growth and Development: Ages 12 to 15 Selected Developmental Characteristics Desired Health Knowledge, Attitudes, or Behaviors • Concerned with body image • Knows relationship of exercise, food • Has interest in structure and function selection, metabolism, physical activity, if related to immediate concerns heredity, environment, attitude, and • High interest in continued changes in grooming on body image body at puberty • Reviews systems of body as they relate to • Ambivalent feelings about dependence use of drugs, appearance, illness, etc. and independence • Understands how heredity and the • High interest in embryonic and fetal endocrine system affect body changes growth • Investigates possible interrelationship of Tends to fear differences in sexual physical, emotional, and social growth • orientation • Understands mother’s ability to affect Menstrual disorders may occur healthy embryonic and fetal development • • Explores accurate information on differences in sexual preferences • Explores relationship of good health to normal menstrual periods; accepts medical assistance if necessary Growth and Development: Ages 14 to 18 Selected Developmental Characteristics Desired Health Knowledge, Attitudes, or Behaviors • Develops fully physically • Understands and appreciates growth and • Shows concern for healthy children development, especially variances • May be impatient with other age • Understands factors involved in healthy groups embryonic and fetal development, especially effects of nutrition; knows that mothers can affect development • Cites major growth and developmental characteristics of people at selected ages - 60 - Developmental Characteristics of Students Ages Five to Eighteen and Health Education Implications: Personal and Family Relationships: Ages 5 to 9 Selected Developmental Characteristics Desired Health Knowledge, Attitudes, or Behaviors • Needs security of family • Knows that families take care of young • Likes to be helpful people and young people need a lot of care • Shows interest in different types of • Demonstrates ways to help at home family configurations • Appreciates families Personal and Family Relationships: Ages 9 to 12 Selected Developmental Characteristics Desired Health Knowledge, Attitudes, or Behaviors • Shares sexuality misinformation • Seeks sources of and acquires reliable • Ambivalent toward need of family information • Has “crushes” • Contributes to family harmony; knows • Girls ahead of boys in wish to date needs of all people; knows importance of family to individual development • Examines factors that help to identify ‘love’; contrasts qualities inherent in successful dating, friendship, and marriage relationships • Analyzes pressures in society that influence dating; develops friendships with both boys and girls; seeks individuals as people first and then as sexual beings - 61 - Personal and Family Relationships: Ages 12 to 15 Selected Developmental Characteristics Desired Health Knowledge, Attitudes, or Behaviors • Influence by parents on young • Continued communication from and person’s behavior diminishing outside involvement with parents important even the home but needs adult affection if there is rejection; understands parents’ even if reaction is rejection or concerns; knows where reliable help is ambivalence available • Physical changes may result in • Understands normalcy of maturation and emotional stress; changes may not be especially differences in rate of change; easily accepted explores changes in roles and • Interested in opposite sex, although responsibilities as age level change girls may be more interested than boys • Explore similar and different factors in • Crushes and hero worship common friendships and dating; seeks a variety of for same and opposite sex friends of both sexes • Unwanted pregnancies may occur • Explores “in love” phenomenon; explores patterns of growth and development • Knows functioning of the reproductive system; knows types and correct use of contraceptives; assesses impact of early unwanted pregnancies on mother, infant, father, family, society; explores ways to enhance relationships other than sexually; analyzes pressures that influence men- women relationships • Develops a code of behavior for self constraint with value system - 62 - Personal and Family Relationships: Ages 14 to 18 Selected Developmental Characteristics Desired Health Knowledge, Attitudes, or Behaviors • Struggles to learn socially approved • Relates goals and values to sexual outlets for sex drive; may experiment behavior, to type of relationships into with intimate and casual sexual activity which one enters, and to responsibilities • Usually has great concern for children towards children; shows respect for • Is aware of risks to child and mother individuals as individuals and not just of early unwanted pregnancy sexual beings Shows high interest in the birth • Understands and appreciates effect of • process family on the development of individuals; Anxious about formation and needs to develop parenting skills for food • continuation of relationships; looks for selection, caring for a sick child, nurturing permanence in relationships a child physically and emotionally, etc. Concerned with alternative forms of • Relates life goals and values to sexual • sexual preference activity; knows ways to prevent conception if involved in sexual activity until one is able to meet a child’s physical, emotional, and social needs • Knows the normal activities of birth; critiques literature on differing viewpoints on birth; knows father’s role • Assesses own values and goals and their relationships to mate selection; explores factors in successful relationships; needs to know self in relationship to capabilities of sustaining relationships • Takes opportunities to understand all forms of sexual preference; establishes own sexual preference - 63 - Developmental Characteristics of Students Ages Five to Eighteen and Health Education Implications: Community Health: Ages 5 to 9 Selected Developmental Characteristics Desired Health Knowledge, Attitudes, or Behaviors • May ingest harmful substances • Recognizes importance of medicine; • May need encouragement to visit knows who should give a person medicine medical advisor, dentist, nurse • Understands what health professionals do; • Is curious about hospitals, fire learns importance of physical and dental departments, etc. examinations; asks questions of health- • May not be aware of where to go for care professionals help • Learns place of community and in caring Associates self with school community for the ill • Needs immunizations • Knows and seeks help from reliable adults • • Learns about a wider community; is aware of how community and self affect each other • Accepts immunizations Community Health: Ages 9 to 12 Selected Developmental Characteristics Desired Health Knowledge, Attitudes, or Behaviors • Does some of own shopping • Evaluates advertising and its effect on • Has feelings of pride in own purchasing food and personal products; town establishes criteria for purchasing • Interested in stories of great • Determines activities to contribute to making people town better; predicts effect of community • May experiment with drugs problems on health of people • Learns how people have contributed to health advances; studies health careers • Identifies drugs and their effect on the body and behavior - 64 - Community Health: Ages 12 to 15 Selected Developmental Characteristics Desired Health Knowledge, Attitudes, or Behaviors • Is faced with decisions regarding • Acquires accurate information on products; use of drugs, including alcohol evaluates information against one’s own and tobacco, foods, and health established criteria; understands motivation products behind abuse and misuse • Sometimes seeks assistance for • Knows community resources; evaluates health problems on one’s own resources against one’s own established • Gets involved in solutions to criteria; asks questions of health-care community problems professionals • Investigates and utilizes good problem- solving techniques for community health problems Community Health: Ages 14 to 18 Selected Developmental Characteristics Desired Health Knowledge, Attitudes, or Behaviors • Begins development of • Assesses individual’s and society’s responsibility socially responsible behavior for certain community health problems; • Utilizes more drugs, contributes to the maintenance and improvement independent of family of health of friends, neighbors, family; recognizes • Formulates and tests the emotional health value of consideration hypotheses to solve problems towards others; asks questions of health-care Is concerned with the professionals • hypothetical and the future • Acquires accurate information about drugs and Worries about career choice regulations concerning their use; purchases, uses, • and stores drugs correctly • Chooses occupations suited to individual’s capacities • Assesses community health problems and possible solutions; evaluates world food shortage • Explores possible health decisions that may arise from research and technology • Assesses self in relation to selected health careers; understands change as an acceptable factor throughout life • Identifies potential and health assets and liabilities in choosing a career - 65 - Developmental Characteristics of Students Ages Five to Eighteen and Health Education Implications Safety: Ages 5 to 9 Selected Developmental Characteristics Desired Health Knowledge, Attitudes, or Behaviors • Likes to play with abandon • Consciously uses rules of safety on • Relates cause to effect playground, in gymnasium, on bicycles, • May not know or practice safety rules when skating, etc. in cars and buses • Assesses situations as safe or hazardous • Is involved in accidents to and from • Learns and practices safe travel rules, school including use of seat belts • May take unfamiliar paths • Takes safest route to school; respects May “show off” safety patrol; does not play in streets • Avoids dangerous situations when • Avoids strangers offering rides or candy; • reminded learns what to do if lost • Assesses relationship of “showing off” to • May be victim of sexual abuse Sometimes samples contents of accidents; knows why people “show off” • bottles • Begins to take responsibility for own May forget rules and safeguards when safety, i.e., uses drinking fountains safely, • on vacation picks up objects from floor, cleans spilled liquids • Is serious about fire and earthquake drills • Learns what is acceptable behavior by others • Is concerned about small cuts and bruises • Avoids ingesting unknown substances; does a home check with parents on storing cleaning supplies and medicines; begins to watch out for younger children ingesting substances • Learns to swim and practices safety in and on the water; learns camping safety; identifies common poisonous plants • Practices fire and earthquake drills • Learns how to care for minor injuries to self - 66 - Safety: Ages 9 to 12 Selected Developmental Characteristics Desired Health Knowledge, Attitudes, or Behaviors • Accidents are leading cause of • Develops behavior patterns that contribute to death and injury personal and group safety; analyzes relationship of • Is interested in fires and fire accidents and behavior hazards • Learns principles of fire control; learns what to do • Uses electricity and stoves at in case of fire home and tools at school • Learns safety in use and care of tools, pans, • Is interested in first aid electrical devices, and stoves • Spends much time bicycling • Demonstrates stoppage of bleeding, mouth-to- and skating mouth resuscitation, care of minor wounds, and Dares and accepts risks reporting injuries; knows when not to move • May spend much time victims; learns about explosives, electrical • swimming, boating, and fishing accidents, and poisonous substances • Understands and obeys traffic signs and regulations relating to cycling and skating • Understands motivation behind daring and risking; predicts consequences of risking • Learns how to swim and what to do and what not to do when others are in trouble in the water; learns boating safety Safety: Ages 12 to 15 Selected Developmental Characteristics Desired Health Knowledge, Attitudes, or Behaviors • Accidents are the leading cause of • Investigates causes and preventions of death in this age group accidents related to this age group; • Is interested in emergency procedures, suggests reasons for high accident rate in but tends to panic in emergencies his age level • Demonstrates basic first aid - 67 - Safety: Ages 14 to 18 Selected Developmental Characteristics Desired Health Knowledge, Attitudes, or Behaviors • Accidents are the leading cause of • Assesses situations as safe or hazardous; death in this age group explores safety problems of young children; • May resent limitations imposed on assesses own attitudes, values, skills, and driving knowledge in preventing accidents • Has opportunities to use first aid • Explores reasons for limitations Developmental Characteristics of Students Ages Five to Eighteen and Health Education Implications Disease Prevention: Ages 5 to 9 Selected Developmental Characteristics Desired Health Knowledge, Attitudes, or Behaviors • Experiences periods of great • Understands how germs travel; covers susceptibility to communicable sneezes and coughs, does not share diseases; comes to school when ill personal objects; learns activities to stay • May fear immunizations well • Exhibits interest in what is eaten or • Learns reasons for and importance of drunk immunizations • Is curious about diseases friends or • Learns where food comes from and how it family have is safeguarded; knows medicine may help individuals get well if taken properly • Knows what causes diseases and health problems; investigates selected diseases and health problems; learns that flies carry germs - 68 - Disease Prevention: Ages 9 to 12 Selected Developmental Characteristics Desired Health Knowledge, Attitudes, or Behaviors • Is interested in disease; may show • Learns about disease prevention and the signs of hypochondria body’s defenses • Is curious about health-related • Understands sanitation, water purification, problems in the world and health laws and regulations • Identifies with “ideal” men and • Studies about people who have women and imitates actions; period of contributed to health and medical hero worship advances • Period of good health generally • Takes responsibility for preventing illness, • Is curious about disabilities especially in avoiding behavior that may be detrimental • Understands physical, social, emotional implications of having a disability Disease Prevention: Ages 12 to 15 Selected Developmental Characteristics Desired Health Knowledge, Attitudes, or Behaviors • Shows interest in sickness and disease • Explores diseases, their causes and • Beginning increase of sexually preventions; assumes personal transmitted diseases responsibility in controlling selected • Has empathy for disabled disease and health problems • May pretend illness • Learns about transmission, dangers, and prevention of STD • Investigates emotional, physical, and social implications of disabilities • Understands relationship of physical and mental health; explores coping mechanisms - 69 - Disease Prevention: Ages 14 to 18 Selected Developmental Characteristics Desired Health Knowledge, Attitudes, or Behaviors • Shows selected interest in disease • Understands relationship of lifestyle and prevention disease; is able to care for minor problems; • Shows much interest in health investigates the epidemiology of selected problems diseases • Explores physical, emotional, and economic costs of handicapping conditions and chronic illness; explores preventative measures; assesses personal and societal responsibility for health problems - 70 - Developmental Characteristics of Students Ages Five to Eighteen and Health Education Implications: Mental Health: Ages 5 to 9 Selected Developmental Characteristics Desired Health Knowledge, Attitudes, or Behaviors • Is aware of attitudes and opinions of • Discusses feelings resulting from helping others; begins to be influenced by others; is pleased with self individual and societal expectations • Describes how it feels to be included and • Feels urge to be friendly but focuses excluded from a group on two or three best friends, which • Learns that feelings are normal and can be change frequently expressed in positive ways; understands • Exhibits openly feelings of anger, fear, that feelings affect behavior joy, hate, jealousy • Realizes that everyone makes mistakes and • May fear making mistakes; needs making a mistake can be a learning opportunities to try independence process; seeks help of others; learns to • May have disturbing dreams, fears, predict consequences anxieties • Understands reason for dreaming and that • Gives up easily when task is difficult dreams are just dreams; talks out fears and anxieties • Accepts ideas of others at times and yet may want own way too often • Recognizes that learning sometimes takes • May have difficulty accepting effort differences in others • Shares and takes turns; realizes how one’s • May tattle, invent stories, say cruel actions affect others things • Knows when to report actions; learns that • Needs frequent assurance of love and thoughtfulness brings happiness to self approval; self-concept not always and others strong • Feels loved and feels secure; identifies Works well in groups; may be actions that make one feel good about self • preoccupied with acceptance by • Shares and cooperates; respects rights of groups others; recognizes power to influence others and be influenced; develops comfort with being alone at times - 71 - Mental Health: Ages 9 to 12 Selected Developmental Characteristics Desired Health Knowledge, Attitudes, or Behaviors • Wants independence but needs to • Values seeking help from reliable adults know that help is nearby when • Identifies ways to feel good; explains reasons wanted behind rules; identifies reasons adults may be • Wants adult approval but not at the concerned expense of own group relationship • Receives parent or guardian involvement; explores • Feels considerable peer-group ways to cope with peer pressure; assesses why influence; becomes overly others can influence; shows increasing concerned with peer-imposed rules independence • Enjoys satisfaction of achievement; • Accepts challenges of new experiences; is likes hard work; desires to be challenged intellectually; needs opportunities to helpful plan, lead, and execute • Forms cliques to the exclusion of • Learns all people need friends; learns to show others; wants to make friends; is concern for others; seeks groups through interests; aware of importance of belonging identifies and practices qualities of good friendship • Occasional emotional outbursts • Learns to release built-up emotion in acceptable • Has tendency to carry stories about ways others; engages in considerable • Appreciates importance of truth; learns how stories competition and boasting hurt self-image of self and others; nee sot know • Wants to impress friends and be failure can be learning situation; learns to attractive to others; worries about appreciate differences in individuals’ abilities lack of popularity or achievement • Strengthens habits of personal cleanliness, good • Feels peer criticism if deviation grooming; develops communication skills; from stereotype of sex roles recognizes positive traits in self; learns empathy • Tends to want things own way; skills develops strong concepts of right • Values individual differences; becomes aware of and wrong changes in role expectations in today’s society • Is capable of planning • Practices reasoning with contingencies; considers Sees cause-effect relationship alternative solutions; assesses effect on total group • • Becomes sensitive to criticism or on individual Worries • Is able to set goals and show movement toward • reaching goals • Understands motivation for using and understands effects of use of caffeine, alcohol, tobacco, and drugs; understands role habit plays • Develops self-confidence; learns how to give and take positive criticism • Gains understanding of such problems as death, disease, divorce, and financial problems of parents; learns skills for dealing with stress - 72 - Mental Health: Ages 12 to 15 Selected Developmental Characteristics Desired Health Knowledge, Attitudes, or Behaviors • Needs to belong to a group or groups • Explores groups related to own interests, • Ambivalent between independence values, hobbies and need for adults; self-identity • Strengthens self-concept and self- strong at times to a point of rebellion understanding; explores effect of selected • Easily upset with self and others situations; assesses own feelings about • Questions values, beliefs, and rules selected risk behavior Concerned with group opinions and • Practices coping skills; knows needs of • yet is beginning to assert and develop people; assesses positive qualities about own value system; sometimes self; infers why each person must set own intolerant of others’ apparent standards; discusses fairness in judging differences because of importance of others conformity • Needs strong parental or other adult role • Needs practice in making decisions; models about acceptable behavior; can apply logic and can consider understands need for rules; understands alternatives relationship of values and behavior • May lack self-confidence and may be • Knows own values, where they come from self-conscious, shy, and worry about and how they influence; parental or other popularity adult influence important; develops • Sometimes moody and unpredictable, appreciation of the value of differences; but emotional outbursts less frequent; understands social, emotional, physical needs to be aware that suicides are a implications of disabilities leading cause of death in this age • Explores decision-making process; applies group process to a variety of health problems; explores consequences of hypothetical decisions • Assesses strengths; develops interests and hobbies; relates good physical and mental health to attractiveness; practices communications skills; learns qualities of good friendship • Understands emotions and positive ways of expressing them; participates in mental health practices - 73 - Mental Health: Ages 14 to 18 Selected Developmental Characteristics Desired Health Knowledge, Attitudes, or Behaviors • May aspire to more than is possible • Assesses own strengths and weaknesses in • Fluctuates between following own determining capabilities beliefs and being influenced by groups • Understands influence; knows own beliefs • Makes independent judgments (values); compares own beliefs to groups regarding drugs, including alcohol and with which one is involved tobacco • Understands decision-making process; • Needs communication skills and group understands factors that influence activities behavior; makes responsible judgments • May leave home for extended periods; • Uses communication skills in work, home, enjoys freedom but may feel uncertain play; explores and participates in group • Experiences stress activities related to interests; develops and Does not always comprehend uses coping skills • ramifications of risk-taking • Understands ambivalent feelings; accepts Needs to integrate values into a parental advice and support during • personal philosophy that includes transition period into adulthood ethical and moral values to be used • Develops a variety of coping skills, such as throughout adult life hobbies and sports, and utilizes them Independently judges matters despite • Theorizes consequences of selected • tendency to conform behavior and utilizes this information May have extreme emotional states when making decisions • Shows concern for interpersonal • Establishes relationship of individual’s • problems values to societal values; knows own values • Explores consequences of decisions based on own values and compares to consequences of other’s values; develops confidence in self as a unique person; increasingly is less influenced by others • Explores mental health practices and utilizes those best suited to self • Understands possible causes and preventions of abusive behavior; formulates plan for maintaining mental health - 74 - Developmental Characteristics of Students Ages Five to Eighteen and Health Education Implications: Physical Well-Being: Ages 5 to 9 Selected Developmental Characteristics Desired Health Knowledge, Attitudes, or Behaviors • Wants to grow/learn • Learns relationship of growth/learning to • Needs adequate amounts of nutrients health habits; identifies activities that deter and minimum amounts of sweets and growth/learning soft drinks • Eats food served; knows value of and eats • May need encouragement to try new breakfast; tries healthful snacks; knows foods effect of sugar on teeth • Participates in scheduled time for • Tries new foods; knows values of and eats eating a variety of foods • May not be aware of effect of • Chews well; eats slowly; makes mealtimes unsanitary practices pleasant • Has a high level of energy; tires easily • Washes hands before eating and after Experiences eruption of all primary using bathroom; correctly uses toilets, • teeth; is forming foundation and toilet paper, drinking fountains calcification of permanent teeth • Understands value of rest, relaxation, and • Poor posture may develop exercise; participates in big muscle activities; takes responsibility for own bedtime • Brushes teeth and visits dentist; understands why first teeth need to be kept in good condition; learns importance of six-year molars • Responds to encouragement for improvement in posture - 75 - Physical Well-Being: Ages 9 to 12 Selected Developmental Characteristics Desired Health Knowledge, Attitudes, or Behaviors • Constantly active or wants to be busy; • Plans for well-balanced days; knows own shows tendency to over-exert and physical limitations; is physically fit become fatigued • Develops healthy hobbies and interests, • Has a great amount of energy that some of which may be quiet activities; needs to be channeled; becomes over- recognizes need for relaxation; learns stimulated easily relaxation techniques • Shows increasingly poor posture • Investigates aesthetic, social and physical • May have ear infections or problems value of good posture; practices good • Eyes are not fully mature; views posture television frequently • Knows relationship of ear infections to Wants to stay up late loss of hearing; selects actions not • Values fitness injurious to ears • May not take time to eat leisurely; may • Responds to need for eye examinations; • begin to miss meals, especially wears glasses, if needed; practices eye care breakfast • Recognises the need for sufficient sleep; May be selective in what is eaten discovers amount of sleep needed • Is interested in what happens to food • Relates health habits to fitness; knows • eaten effect of drugs on fitness • Shows concern about overweight and • Learns to relax at mealtime; has regular underweight; most are unceasingly time for meals; knows value of and eats hungry breakfast Questions need for personal hygiene, • Knows what constitutes a well-balanced • but is interested in appearance diet; tries new foods, knows effect of sugar on teeth and general health • Permanent teeth appearing; may need orthodontic care • Understands that food is needed for energy. Building new tissue, and for maintenance of health • Calculates input and output of energy • Investigates hygiene’s effect on personal relationships and health and energy • Relates structure and health of teeth to dental care; responds to need for dental check-ups and care. - 76 - Physical Well-Being: Ages 12 to 15 Selected Developmental Characteristics Desired Health Knowledge, Attitudes, or Behaviors • May make poor selection of food; • Applies knowledge of nutrition to may avoid breakfast food selection; understands • May have concern with relationship of nutrition to underweight or overweight appearances and health; examines • Postural difficulties increase with research on value of breakfast; body changes understands relationship of food selection to dental health • Spends many hours in recreational activities • Knows principles of weight • May practice extremes in maintenance; stabilizes weight grooming • Brings good-posture feel into May have skin problems consciousness; practices good posture • Tires easily • Participates in a variety of activities • that contribute to fitness, some of • Vision and hearing defects which can be lifetime activities increase • Develops criteria and assesses health • Personal appearance important products related to grooming; • May have dental problems considers effects of grooming on health and interpersonal relationships • Assesses value of and practices good health habits; visits dermatologist if necessary • Determines relationship of nutrition, exercise, balanced day, sleep, and stress to fatigue • Responds to need for ear and eye check-ups; assesses effects of noise pollution, respiratory infections, etc., on ear; wears glasses if necessary, evaluates how eyes are used • Determines what good personal appearance is: selects behavior that contributes to good personal appearance • Understands effect of good dental health practices on health of teeth and mouth - 77 - Physical Well-Being: Ages 14 to 18 Selected Developmental Characteristics Desired Health Knowledge, Attitudes, or Behaviors • May worry about physical • Understands relationship of exercise, appearance, attractiveness, and nutrition, attitude, and grooming to physical development appearance and development and • May have obesity problem utilizes this information. • May indulge in bizarre health • Understands and practices principles behavior; may need more sleep of weight maintenance; determines than one is getting dangers of fad diets and schemes; loses • Has all permanent teeth except weight slowly and with safe methods third molar • Knows when and how to exercise; eats • May not be living at home so no a variety of foods; critiques longer has parental concern for information on food; knows need for health sleep; organizes lifestyle to get more sleep • Uses good dental health practices to preserve teeth and gums • Acquires and uses knowledge about low-cost good nutrition. Physical check-ups, etc.; projects relationship of well-being to achievement of goals - 78 - CHAPTER FIVE Interactive Teaching Methods - 79 - 5.1 Interactive/Participatory Teaching Methods for Life Skills Education Each of the teaching methods in the following chart can be used to teach life skills. Teaching Method Description Benefits Process CLASS The class examines a Provides opportunities • Decide how to DISCUSSION (in problem or topic of for students to learn arrange seating Small or Large interest with the goal of from one another and for discussion Groups) better understanding an practice turning to one • Identify the goal issue or skill, reaching another in solving of the discussion the best solution, or problems. Enables and communicate developing new ideas students to deepen it clearly and directions for the their understanding of • Pose meaningful, group. the topic and open-ended personalize their questions connection to it. Helps • Keep track of develop skill in discussion listening, assertiveness, progress and empathy. BRAINSTORMING Students actively Allows students to • Designate a leader generate a broad variety generate ideas quickly and a recorder of ideas about a and spontaneously. • State the issue or particular topic or Helps students use problem and ask question in a given, often their imagination and for ideas brief period of time. break loose from fixed • Students may Quantity of ideas is the patterns of response. suggest any idea main objective of brain- Good discussion starter that comes to storming. Evaluating or because the class can mind debating the ideas occurs creatively generate • Do not discuss later. ideas. It is essential to the ideas when evaluate the pros and they are first cons of each idea or suggested rank ideas according to certain criteria. • Record ideas in a place where everyone can see them • After brainstorming, review the ideas and add, delete, categorize - 80 - Teaching Description Benefits Process Method ROLE PLAY Role play is an Provides an excellent • Describe the situation to informal strategy for practicing be role played dramatization in skills; experiencing how • Select role players which people act one might handle a • Give instruction to role out a suggested potential situation in players situation. real life; increasing • Start the role play empathy for others and their point of view; and • Discuss what happened increasing insight into one’s own feelings. SMALL For small group Useful when groups are • State the purpose of GROUP/BUZZ work, a large class large and time is limited. discussion and the GROUP is divided into Maximizes student amount of time available smaller groups of input. Lets students get • Form small groups six or less and to know one another • Position seating so that given a short time better and increases the members can hear each to accomplish a likelihood that they will other easily task, carry out an consider how another • Ask group to appoint action, or discuss person thinks. Helps recorder a specific topic, students hear and learn problem, or from their peers. • At the end have question. recorders describe the group’s discussion GAMES AND Students play Games and simulations Games: SIMULATIONS games as activities promote fun, active • Remind students that the that can be used learning, and rich activity is meant to be for teaching discussion in the enjoyable and that it content, critical classroom as does not matter who thinking, participants work hard wins problem, solving, to prove their points or Simulations: and decision- earn points. They • Work best when they are making and for require the combined brief and discussed review and use of knowledge, immediately reinforcement. attitudes, and skills and • Students should be asked Simulations are allow students to test to imagine themselves in activities out assumptions and a situation or should play structured to feel abilities in a relatively a structured game or like the real safe environment. activity to experience a experience. feeling that might occur in another setting - 81 - Teaching Method Description Benefits Process SITUATION Situation analysis Situation analysis • Guiding questions ANALYSIS AND activities allow students allows students to are useful to spur CASE STUDIES to think about, analyze, explore problems and thinking and and discuss situations dilemmas and safely discussion they might encounter. test solutions; it • Facilitator must be Case studies are real- provides opportunities adept at teasing life stories that describe to work together, share out the key points in detail what ideas, and learn that and step back and happened to a people sometimes see pose some ‘bigger’ community, family, things differently. Case overarching school, or individual. studies are powerful questions catalysts for thought • Situation analyses and discussion. and case studies Students consider the need adequate forces that converge to time for make an individual or processing and group act in one way creative thinking or another, and then • Teacher must act evaluate the as the facilitator consequences. By and coach rather engaging in this than the sole thinking process, source of ‘answers’ students can improve and knowledge. their own decision- making skills. Case studies can be tied to specific activities to help students practice healthy responses before they find themselves confronted with a health risk. FIELD The class visits an off- Students get the Make contact with the EXPERIENCE site location where opportunity to view work organization and activities relating to the real life events in real seek permission to lesson are being carried time. They also get to conduct the class visit. out. This organization talk with workers, Ensure that you are may be, for example, managers and fully appraised of the the electric company, sometimes customers requirements for the or water commission or clients about the visit with respect to when lessons on work and service attire, date and time. environmental offered. This allows The lesson must management are being classroom learning to already be taught so done. be concretized and that students are able become more to ask intelligent meaningful. questions related to their learning. - 82 - Teaching Description Benefits Process Method DEBATE In a debate, a particular Provides opportunity • Allows students to take problem or issue is to address a particular positions of their presented to the class, issue in-depth and choosing. If too many and students must take creatively. Health students take the same a position on resolving issues lend themselves position, ask for the problem or issue. well: students can volunteers to take the The class can debate as debate, for instance, opposing point of view. a whole or in small whether smoking • Provide students with groups. should be banned in time to research their public places in a topic. community. Allows • Do not allow students to students to defend a dominate at the expense position that may of other speakers. mean a lot to them. • Make certain that Offers a chance to students show respect for practice higher the opinions and thinking skills. thoughts of other debaters. • Maintain control in the classroom and keep the debate on topic. STORY The instructor or Can help students • Keep the story simple TELLING students tell or read a think about local and clear. Make one or story to a group. problems and develop two main points. Pictures, comics and critical thinking skills. • Be sure the story (and photo-novels, Students can engage pictures, if included) filmstrips, and slides their creative skills in relate to the lives of the can supplement. helping to write students. Students are stories, or a group can • Make the story dramatic encouraged to think work interactively to enough to be interesting. about and discuss tell stories. Story Try to include situations important (health- telling lends itself to of happiness, sadness, related) points or drawing analogies or excitement, courage, methods raised by the making comparisons, serious thought, story after it is told. helping people to decisions, and problem- discover healthy solving behaviors. solutions. - 83 - 5.2 Reasons for Using Varying Interactive/Participatory Teaching Methods Participatory learning is central to life skills teaching; it is also the basis for the training of life skills trainers. Participatory learning relies primarily on learning in groups. During childhood and adolescence, as in adulthood, much social interaction occurs in groups. This can be capitalized upon, and used in a structured way to provide a situation in which members can learn, share experiences and practice skills together. The role of the teacher or teacher trainer is to facilitate this participatory learning of the group members, rather than conduct lectures in a didactic style. Participatory learning: • utilizes the experience, opinions and knowledge of group members • provides a creative context for the exploration and development of possibilities and options • provides a source of mutual comfort and security which is important for the learning and decision making process It is recognized that there are advantages of working in groups, with adults and with young people because group work: • increases participants' perceptions of themselves and others • promotes cooperation rather than competition • provides opportunities for group members and their trainers/teachers or careers to recognize and value individual skills and enhance self-esteem • enables participants to get to know each other better and extend relationships • promotes listening and communication skills • facilitates dealing with sensitive issues • appears to promote tolerance and understanding of individuals and their needs • encourages innovation and creativity. The place and importance of participatory learning draws some of its influence from adult learning theory and from research on in-service training which suggests the following: • The adult learner has accumulated a reservoir of experience that is a substantial resource to be utilized in the learning process. This emphasizes the need for experiential techniques to be used. • The adult learner is often concerned with the immediacy of application of learning. The theoretical must thus always have a practical outlet. • Lecturing, as a method of communicating relevant information to adult professionals has little effect on their actual work practice. • Lecturing, followed by general discussion, does not tend to have much influence on practice; unstructured discussion is seen as creating a circular reaction: people picking up anecdotes and strong opinion leaders perhaps swinging the group towards things that are not wholly relevant. - 84 - • There are indications that if participants are asked to perform practical tasks in the middle of the in-service work, or if they have to go back to try out ideas in their work practice, then this heightens the chance of the in-service experience having some long term effect. • The experience of the participants must be used and built on. Unless this is taken account by in-service providers, it is unlikely that participants will apply what they learn to their work setting. Taken from CARICOM Multi-Agency HFLE Programme Manual for Facilitators of Life Skills Based HFLE Programmes in the Formal and Non-Formal Sectors. 5.3 Lesson Planning The units of the HFLE curriculum are intended to be taught over three to six lessons. Teachers of the curriculum must therefore develop a set of learning activities for each 35- or 40-minute lesson that they intend to teach. In order to do this effectively, teachers must make lesson plans. The popular adage, “he who fails to plan, plans to fail,” applies to the teacher as much as it applies to the business executive or bride and groom to be. A lesson plan is a description of the intended educational outcomes of a teaching and learning process along with the resources needed as well as the methodologies and strategies to be used to achieve the intended outcomes. 1. The Purpose of Lesson Planning The first purpose that a lesson plan serves is to allow teachers to think about and write what students should learn from the lesson. This is setting the goal or learning objective for the lesson. “If you don’t know where you want to go any road will take you there,” is a proverb that describes the individual who starts to execute an activity without having first defined the goal to be achieved by such activity. The second purpose is to identify the resource needs and relevant strategies required to achieve the goals within the allotted time. Planning ahead assists teachers to think about these issues relating to the lesson to be taught ahead of time so that all necessary resources can be acquired and the objectives and strategies tailor-made to fit the learners’ needs given their age, level of cognitive development and emotional maturity. Thirdly, the lesson plan becomes the teachers’ guidebook for executing the lesson. This guide book assures teachers that their efforts during the class time will not be wasted, as all the critical learning points would have already been considered, ascertained and established. The fourth point is that the lesson plan gives teachers confidence as they execute their lessons. They would have already anticipated students’ reactions and devised strategies to address most concerns. Fifthly, lesson planning assists school administrators and Ministry of Education officials to evaluate the education process, student performance and teacher performance. And finally, lesson planning can be used to support effective decision-making; at the class level and at the school level and at the Ministry of Education level. - 85 - 2. Parts of the Lesson Plan Educators vary in their views of the actual nomenclature of a lesson. Even format is in question among some schools of thought. There are some fundamental and critical parts of a plan however which must be present if the plan is to make a meaningful contribution to the successful execution of the lesson. These are: the lesson topic, student academic maturity, duration, learning objectives instructional materials, then the introduction body and conclusion of the lesson. For the purpose of this Training Manual, we have adopted the parts of the lesson plan as given in the HFLE curriculum sample lessons. These basic components are; the lesson topic, grade level, lesson duration, learning objectives, life skills focus, instructional materials, overview of the concept, introduction, steps, and culmination activity. Some lessons may have a preparation section where students may carry out an activity prior to attending the class. There may also be an extension activity where students are given a take-home assignment to be completed within a specified time. 3. The Learning Objectives Objectives are statements about a future state that is to be achieved. Learning objectives describe the behaviours that students should have been able to perform by the end of the lesson in question. The learning objective must be written from the learners’ perspective. It is the learner who should be able to do something by the end of the lesson, not the teacher who should have carried out a set of actions. When writing learning objectives, teachers should ask, “How is this objective going to be measured during the time allotted for the lesson?” The learning objective, therefore, should be related to the assessment the teacher will conduct before the lesson comes to an end. There are six characteristics of a learning objective. The mnemonic SMARTU can be used to designate them. S – Specific Objectives must indicate precisely and clearly what is to be achieved. “Students should improve their grade,” is not specific as one does not know the precise grade that students must achieve in order for it to be said that that objective has been realized. An appropriate learning objective for that situation would be; “Students should improve their grades from a “C” to an “A”. The specificity of this objective makes is easy to be measured. The uses of words such as, appreciate, understand and learn and are too general and vague to be used in the learning objective. The objective may however say that, “students should be able to demonstrate an appreciation of preparing for a hurricane.” M – Measurable Teachers must assess the achievement of the objectives written in the plan. When an objective is measurable, the teacher is able to determine levels of achievement. The second objective statement written above is measurable therefore one can determine whether the grades were moved from a “C” to an “A”. Also how many persons’ grades moved in this direction and how many persons’ grade moved only to a “B”, etc. A – Achievable The resources available, the students’ age and intellectual maturity, the learning environment and the content will determine whether the objective is achievable given the time constraints. - 86 - R – Results-oriented Every learning objective must be related to the lesson topic, to the unit objectives and to the broader educational system’s principles and philosophies. A learning objective, however well written, if it bears no relation to the broader framework of the education programme of the school or country should be eliminated as working to achieve it would represent wasted efforts. T – Time-bound The reader needs to know how long it would take for the objective to be achieved. Usually this is addressed in the stem of the objective: By the end of the lesson on Good Touch, Bad Touch students should be able to…….. The use of the word, “By” suggests that throughout the period of time designated to the lesson the objectives will be met, perhaps in an incremental way, for example. Using “should” instead of will or must in the stem of the objective indicates that there are no guarantees that the objectives will be met. No teacher can guarantee that an objective will be met by the time she or he reaches the end of a lesson. Writing a lesson plan makes it highly likely that they will be met, if not all, then most. U – Unitary Each learning objective must address ONLY ONE issue. Examining the following learning objective, illustrates the point. “… students should be able to list two kinds of solid waste and describe how to manage solid waste.” The teacher may administer an assessment to students and find that they can perform one of the two actions given in the objective. It is easy for such a teacher to believe that the objective has been achieved when there is only partial achievement. To solve this problem, the teacher should make two objectives out of that one objective. “Students should be able to: 1) List two kinds of solid waste. 2) Describe how to manage solid waste. The following is an example of three lesson objectives for the lesson topic, “Coping with Difficult Situations”, (HFLE grade 6 Curriculum, page 211). By the end of the lesson on Coping with Difficult Situations, students should be able to: a. Discuss their fears about moving to a new school. b. Develop a plan to find out ten things about their new school. c. Demonstrate three ways of coping with new situations. 4. Life Skills Focus This training manual is using the 3-point classification of life skills, social, cognitive and coping. As such, the plan should be written so that at least one of the skills under each broad heading must be taught or strengthened during the lesson. Please consult the previous section entitled, “Suggested Approaches for Teaching Life Skills” for a full list of the life skills to be included in the HFLE lessons along with suggestions for building those skills. Instructional Materials Instructional materials are the items that the teacher will use to support the learning during the lesson. Typically the teacher will call attention to the materials and use them to bring home the learning points. Instructional materials may be, charts, videos, pictures, models, and the like. - 87 - 5. Overview of the Concept This section of the lesson plan provides some background information to provide a context within which the concepts forming the lesson topic are used. 6. Preparation & Extension Activity When a lesson has “take-home” assignments to be done by the students, this is placed at the end of the lesson as an extension activity. When the next lesson is being written, the extension activity for the previous lesson becomes the preparation activity for the current lesson. For example, at the end of one lesson students may be asked to interview the school nurse. This is the extension activity for this lesson. For the follow-up lesson, this activity becomes the preparation activity. Hence under the heading preparation for the next lesson in written, “Students interviewed the school nurse and prepared and interview report.” 7. Step by Step Activities These activities are given an introduction, steps 1, 2, 3……. and culmination activity. Each activity must have a time period associated with it. The introduction is usually short, no more than 2 to 5 minutes long. This activity sets the pace for the activities to be carried out during the lesson. It is preferred that the activities be broken into mini steps rather than have one step involve several activities. The culmination activity should be used to guide the teacher as the level of learning attained during the lesson; as such it is viewed as an assessment activity. A song that captures the concepts of the lesson, a poem or a display of information of models, etc. are the kinds of activities that culminate the lesson. 8. Teaching Strategies There are a wide variety of life skills-based teaching strategies from which the teacher can choose. The precious section entitled, Suggested Approaches to Teaching Life Skills provides some ideas. Additionally, the following may be adopted: engaging students in the visual and performing arts, small group discussions, question and answer discussions, story- telling, role play, games, modeling, dialoguing, monologuing, designing all sorts of images and literary pieces, viewing and listening to audio visual clips, interviewing, research, field trips, portfolio preparation, journaling, planning, decision-making, quizzes, case study analyses, case study writing, displays and exhibitions, simulations, experimentation, hiking and other physical fitness activities, introspection, giving and listening to speeches, observation, self expression etc. - 88 - 5.4 Questioning Techniques Asking questions is an art and a science. Questions should be related to the learning objectives given at the start of the lesson plan. The questioner must set a goal to be achieved before beginning the questioning. The questions then will be leading to the achievement of such a goal. Questioning is a powerful teaching strategy yet, it can be equally powerful in blocking student learning. For this reason we discuss approaches to questioning in this training manual. During any one class where questions are being asked, the teacher should draw on several levels of Bloom’s Taxonomy of Educational Objectives. The questions may start at the lower levels (knowledge and understanding) and gradually increase in complexity to encourage students to process information more critically, creatively and with evaluation. Table 2 below delineates Blooms’ Taxonomy of Educational Objectives for the cognitive domain along with sample verbs and questions. Critical to the practice of engaging students in processing their thoughts, feelings and behaviours is the ability to ask appropriately worded questions. There are basically two types of questions that can be used, that are very different in character, usage and outcomes: Closed and open question. 1. Closed Questions There are two definitions that are used to describe closed questions. A common definition is: A closed question can be answered with either a single word or a short phrase. Thus 'How old are you?' and 'Where do you live?' are closed questions. A more limiting definition is: A closed question can be answered with either 'yes' or 'no'. Using closed questions Closed questions have the following characteristics: • They give you facts. • They are easy to answer. • They are quick to answer. • They discourage the object of the question from processing information in order to provide full and complete responses to thought situations • The questioner keeps control of the conversation or discussion Note how you can turn any opinion into a closed question that forces a yes or no by adding tag questions, such as "isn't it?", "don't you?" or "can't they?" to any statement. The first word of a question sets up the dynamic of the closed question, signaling the easy answer ahead. Note how these are words like: do, would, are, will, if. - 89 - Examples and usage of closed ended questions Usage Example As opening questions in a conversation, as It's great weather, isn't it? it makes it easy for the other person to answer, and doesn't force them to reveal Where do you live? too much about themselves. What time is it? For testing their understanding (asking So, you want to move into our apartment, with your yes/no questions). This is also a great way own bedroom and bathroom? to break into a long ramble. For setting up a desired positive or Are you happy at home? negative frame of mind in them (asking successive questions with obvious answers Would you prefer to live with your father? either yes or no ). For achieving closure of a persuasion If I can deliver this tomorrow, will you sign for it (seeking yes to the big question). now? 2. Open-ended Questions An open question can be defined as: A question that is likely to receive a long answer or an explanation. Although any question can receive a long answer, open questions deliberately seek longer answers, and are the opposite of closed questions. Open-ended questions have the following characteristics: • They ask the respondent to think and reflect. • They will give you opinions and feelings. • They hand control of the conversation to the respondent. This makes open questions useful in the following situations: - 90 - Examples and usage of Open-ended Questions Usage Example As a follow-on from closed questions, to What did you do on you holidays? develop a conversation and open up someone who is rather quiet. How do you keep focused on your work? To find out more about a person, their What's keeping you awake these days? wants, needs, problems, and so on. Why is that so important to you? To get people to realize the extent of their I wonder what would happen if your mother action or problem. became aware? To get persons to feel good by asking after How have you been after your operation? their health or otherwise demonstrating human concern about them. You're looking down. What's up? Open questions begin with words such as: what, why, how, describe. When opening conversations, a good balance is two closed questions to one open question. The closed questions start the conversation and summarize progress, whilst the open question gets the other person thinking and continuing to give you useful information. Teachers should avoid, though not eliminate altogether, the closed-ended questions. When closed ended questions are asked, there should be follow-up with probing open-ended questions. For example, “What is the name of the last hurricane that did damage to Jamaica?” The answer would be Hurricane Dean. Dean passed by Jamaica, on August 18, 2007. The teacher may now probe to get more answers from the respondent. “How do you know that Hurricane Dean did damage to Jamaica?” and, “What kind of damage did Dean do?” “Why do you think the damage to the Caribbean Terrace area was so bad?” another example is to use the pair or questions given below. “Which nutrients do fruits contain?” This closed ended question will attract quick and short questions. The follow-up question should be asked, “Why therefore is it important to eat fruits?” - 91 - 5.5 Creating a Respectful & Conducive Environment for Learning 1. Responding to Students’ Answers Awareness that children can become uncomfortable with being asked a question for which they have no answer, can help the teacher use tact to build students’ confidence by encouraging their continued participation and avoiding the negative consequences of what may appear to be an evaluation. The process of questioning should promote continued enthusiastic participation by students. The following six strategies provide suggestions for handling the question and answer class sessions. Taxonomy of Educational Objectives with Sample Verbs and Questions Levels of the Cognitive Meaning Typical Verbs Sample Questions Domain Evaluation Judging the value of Criticize, decide, How does daily material based on personal defend, interpret, exercising benefit you? values/opinions. judge, justify, support, recommend Synthesis Creatively apply prior Compile, compose, What do you call a list knowledge and skills to collaborate, formulate, of dishes to be served produce a new or original generate, rearrange, by a hostess? whole. substitute Ans. Menu Analysis Breaking down the Analyze, categorize, What causes a informational materials illustrate outline hurricane to develop? into their component prioritize, separate parts. subdivide Application Applying previously learnt Compute, solve, Given the definition information to a new demonstrate, apply, for Sexually situation to solve a construct, complete, Transmitted Infections problem or complete a calculate, experiment, (STI), which diseases task. modify, relate fall into this category? Comprehension Demonstrating that one Explain, paraphrase, When we say someone has sufficient compare, contrast, is self confident, what understanding to organize describe, interpret , do we mean? and arrange the material in translate, organize a different way from the way it was learnt. Knowledge Memorizing, Define, state, list, label, What are the physical remembering, recalling, identify, who, what, changes that a girl recognizing information when, where experiences during puberty? 2. Allow Processing Time after a Question has been asked Discourage students from racing to give the answers to questions. Encourage them to think for one minute or so before raising their hands. This will give an opportunity to the slower students to have a chance of getting the answer correct. Some questions should require students to confer with each other before answering. This will seek to reduce the competitiveness within the class room and stimulate cooperation which is an essential life skills based teaching approach. - 92 - 3. Acknowledge without Evaluation When students give an incorrect response, teachers may give a neutral acknowledgement and move on quickly to the next one. Phrases such as, “That’s an idea. Okay. I see. Thank you for that contribution” may be used to remove any negative stigma from the student. Later in the lesson, the teacher can address the correctness of an answer without making reference to the person who said it. 4. Avoid Reinforcing the Correct Response Early in the Process When a child gives the correct response early in the questioning process, the teacher should give a guarded response such as, “Okay, Good,” etc. When the teacher stops the questioning process to reinforce and elaborate on the correct answer that is given it discourages others to process their own responses and provide a response. Questioning should encourage participation from a wide cross section of students in the class. 5. Apply Active Listening Techniques Make eye contact with the student who is answering a question. Nod as he or she struggles to make the point and give assistance where needed. The student may be searching for the right work and after a brief pause, supply the word. Later in the class discussion, make reference to a point made earlier by a student and call the student by name especially if the student does not normally get it right. 6. Deal with the Talkers Some students will always raise their hands to answer. If the teacher always accepts an answer from these students, others will always remain silent and even lose confidence in any response they may give. The teacher may say, “ Let’s give someone else a chance to answer.” The teacher may also indicate that the response must be a group response and if anyone in the group gets the answer incorrect the group will lose points. The teacher calls members from the group randomly. This will encourage the talkers to discuss responses with the group and stimulate the quiet ones to speak up. 7. Vary Questioning Strategy Some questions should be thrown at individual students; others may be thrown out to the class. The teacher should encourage students to develop their own questions in a group about a topic. When each group has written their questions they exchange with another group and the group discusses the answers and answers the questions of their peers. When there is open discussion and students ask questions of the teacher, she may throw the question back at the class or the questioner in order to encourage more discussion. - 93 - 5.6 Tips for Teachers in the Use of Interactive Teaching Methods a. If your class time is 80 minutes, the expectation would be to cover 2 lessons not drag out one lesson to fill up the time. b. Leave time to reinforce conclusions and skills at the end of the lesson. c. Reinforce to teachers to make lessons age/language appropriate. If necessary, the teacher must interpret lessons so students can understand. d. Keep small group work to the limited time frame. Tell students that it’s okay if they didn’t get everything done before time was up. There will be time to discuss further as a class. 1. Tips on how to facilitate group discussion • Give students examples of possible answers if no one is willing to start the discussion. You might say, “What about….” • Keep the discussion to the limited amount of time. • Allow as many students as possible to participate. If one student is dominating the conversation, ask “[Name of student] has provided some great ideas. Does anyone else have an answer?” • If there is not enough time for all students to answer, say “We’ve had a really good discussion. There will be time in a later activity or lesson for others to participate.” 2. Tips on using small group work • Small groups are useful for encouraging student participation. • Divide students into even groups (e.g., five students in each group). • For topics that may be gender-sensitive, separate girls and boys. • Note that one person may need to report back to the larger group, and for students to select one person to be that reporter. • Encourage students to take notes if necessary. • Walk around during the group activity to hear what students are saying. 3. Tips on using role-playing • Role-playing is a useful teaching method for practicing interpersonal skills. • Let students know before the activity if they may be asked to role-play in front of the class afterwards. • Remind students of the importance of body language during role-playing and paying attention to non-verbal cues. • If students start to get rowdy during role-playing activities, remind them to stay on the topic and walk around the class to help them focus. 4. Tips on using brainstorming • Brainstorming is useful for gather many answers in a short amount of time. • Although a number of students may want to provide answers to your question, this exercise should last only 5 minutes. You may not be able to get answers from all the students. - 94 - • Tell students after 5 minutes that they will have many other opportunities to provide answers. Give students positive feedback on their answers. 5. Tips to Encourage Discussion a. Ask open-ended questions which allow for any possible response (How did you feel about...) b. Ask open-ended questions which guide the discussion in a particular direction (What else could the boy have done in the story?) c. Use active or reflective listening. This technique involves paraphrasing a person's comments (without inserting opinions and/or judgments) so that the person knows why they have been heard. For example: 1. Student: "I think my friend acted like a spoiled child." 2. Teacher: "So you feel some of her behavior was immature." d. Paraphrasing allows the teacher to clarify his/her understanding of the speaker's word. If the paraphrasing is incorrect, the student has the opportunity to restate what she/he meant; if the paraphrasing is correct the teacher will feel encouraged to elaborate her/his initial comment. In either case, paraphrasing shows the student that the teacher cares enough to the listen. This type of listening takes time and special effort in attending to the student and the communication process. It is necessary that the teacher put aside preoccupation and concern with what she/he is going to say next. e. Active listening conveys to the student that her/his point of view has been communicated and understood. This requires the teacher to: i. Listen to the total meaning of the message. (i.e. the content of the message and the feeling or attitude underlying this content.) ii. Respond to feelings. In some instances the content is far less important than the feeling which underlies it. You must respond particularly to the feeling component to catch the full meaning of the message. iii. Reflect back in his/her own words what the student seems to mean by his/her words or actions. The teacher's response will demonstrate whether the student feels understood. An example of a reflective question is: "What I heard you say is that you are concerned about the importance of knowing everything. Is that what you said?" iv. Listen to and support every student’s contribution. This does not mean that you agree or disagree with their ideas. It means that you listen carefully and accurately and respect the feelings of others. v. Use body language which engages students. Make direct eye contact; if you are sitting, lean in the direction of the group: if you are standing, circulate so as to increase contact with the students. - 95 - f. The teacher avoids: i. Using closed-ended questions - questions which are answered by yes or no. (Did you like the film?) ii. Making judgments about the rightness or wrongness of students' opinions - (I couldn't disagree with you more) iii. Interpreting students remarks: You must really have a hang-up about your father." Prepared by: Annette Wiltshire 6. Tips on Giving Feedback • Keep in mind that the feedback process should be experienced as a positive, learning experience for everyone. The emphasis should be on strengthening skills, not making judgments. • If possible, allow the person to do a self-assessment before you offer your comments. • Use clear criteria or a checklist for giving feedback. If there are specific expectations for performance, share these with the person in advance and then use the written expectations as the basis for your feedback. • If appropriate, make eye contact with the other person. Eye contact is an example of how body language can reinforce a verbal message. Be aware that in some cultures, eye contact between two people (e.g., a young person and an adult) might be considered disrespectful. • First, share positive comments. This will help the person to feel good about him or herself, and might enable the person to be more open to your suggestions for new strategies to try. • Use constructive, positive language to offer your comments. For example, you can say, "Have you considered... ?" or "It might help to try . . ." • Focus your comments on aspects of the performance or task, not on the person. • Be as specific as possible. The clearer and more specific you are with your feedback-your sense of what worked as well as suggestions for improvement-the more likely the person will be to learn from the feedback and integrate your input. • Make sure that the feedback process is two-way. Allow the person opportunities to ask clarifying questions, offer his or her opinion, etc. • Remember that there are many ways to perform a task effectively. Don't expect the other person to adopt your way of doing things; each person needs to find an approach that works for him or her. • Following the feedback session, give the person opportunities to demonstrate how he or she has improved in the performance of the task. Ideally, feedback should be an ongoing part of the learning process, not an isolated event. Education Development Center, Inc., Newton, MA. 2001. - 96 - 5.7 Classroom Organization The trainer should adopt a classroom layout that facilitates the formation of work groups and group interaction. All trainees should be able to see the front of the room with ease and should be able to see each other with ease. The facilitator’s position in the room should not be stationary. Instead he or she should continuously move about the room observing trainees, asking and answering questions, giving feedback in the form of commendation or taking any corrective action that may be necessary. Some suggested classroom formations are: The U shape where the tables are arranged in a U. The facilitator’s table would be placed at the opening of the U. The T shape where tables are arranged in the formation of a T. In this formation the facilitator’s table would be at the tail of the T. There is also the scattered-table formation. An example of this organization-type is: In this formation the facilitator’s table may be placed at any opening. It is important that wherever the facilitator’s table is placed, trainees should not be seated with their backs turned to the facilitator’s table. This would mean that trainees would sit in a U shape around their work area. At all times trainees should have a clear view of the activities being conducted by the facilitator. - 97 - 5.8 The Health and Family Life Education Classroom Environment Health and Family Life Education aims to enable and empower students to manage the challenges of growing up in the 21st century. Creating a safe environment for the sharing of ideas and the expressing of thoughts and feelings is central to the successful implementation of the life-skills approach. Students may be initially uncomfortable to honestly share information about self, friends or family. Establishing guidelines with the participation of the students in each classroom begins the process of engaging the students and sets the stage for meaningful interaction. Here are some suggested activities: Whole Class Activity: a. Teacher and students should collaborate together to make a set of rules for the class that would provide a climate of openness and respect for each other as sensitive issues are discussed in the class. b. Engage in discussions with different class structures. Some items are discussed in pairs, others are discussed with larger groups, perhaps three to five persons and others are discussed as whole class discussion items. The idea is that all should feel safe and confident when discussing difficult issues in class. c. Make a poster to show the rules and put it up when you are discussing things in HFLE classes. d. The teacher should share his/her ideas about what can be done to help everyone feel safe. Activities in pairs The teacher can group children in pairs and have them engage in an activity that addresses openness and confidentiality. Use questioning to address issues about making the class feel safe. a. How do you feel talking about your family in class? b. How do you feel about talking about your feelings in class? c. How do you feel about talking about HIV and sex in class? d. What can the teacher do to help you feel able to speak freely in class? e. What can your fellow students do to help you feel less shy? Here is a set of suggested class rules. Add to or subtract from the list as is relevant to the particular situation within which the learning situation is taking place. a. Each person has an equal right to speak. All others should listen carefully while the other person speaks. b. If someone wants to speak he or she should raise a hand and wait for the teacher to say when it is OK to speak. c. Students should take turns to speak so that all will have a chance to say something if and when they want to. d. Each person has the right to remain silent about his or her own personal situation, the issues about family or community that they are faced with. e. Students and teachers should speak respectfully to others, about others and about the family and or friends of others so that all may feel comfortable during all class discussions. f. Everyone must keep the information discussed during class times highly confidential. This means that when we are outside of the class, we will not talk about what anyone said during the class. - 98 - It is very important that both the teacher and the students understand and agree to the principle of confidentiality. Discussing the meaning of confidentiality and the value of trust with the class could play a significant role in creating the emotionally safe environment that is desired. The group structure which will facilitate the interaction needs to be carefully handled. When discussing sensitive matters it may be wise, depending on the age or the maturity of the students, to have them in separate groups of boys and girls. Encouraging the honest expression of feelings, including the freedom to say when they are embarrassed or upset by what someone else may have said, is essential to the positive outcome of the experience. Having a question box at a inconspicuous place so students may write down their questions when they don’t want to ask them out aloud allows for the sometimes needed privacy. The teacher will then answer the question not needing to know who asked the question. ('Adapted from Health and Family Life Education course Student's Book 1, to be published by Macmillan Caribbean 2008, with kind permission of the publisher) 5.9 Setting up the Classroom Atmosphere It is very important that both the teacher and the students understand and agree to the principle of confidentiality. Discussing the meaning of confidentiality and the value of trust with the class could play a significant role in creating the emotionally safe environment that is desired. The group structure which will facilitate the interaction needs to be carefully handled. When discussing sensitive matters it may be wise, depending on the age or the maturity of the students, to have them in separate groups of boys and girls. Encouraging the honest expression of feelings, including the freedom to say when they are embarrassed or upset by what someone else may have said, is essential to the positive outcome of the experience. Having a question box at a inconspicuous place so students may write down their questions when they don’t want to ask them out loud allows for the sometimes needed privacy. The teacher will then answer the question not needing to know who asked the question. Students’ initial reaction to the content and methodology of the HFLE curriculum may vary. Some of these may be: • Ask baiting questions (to try to embarrass you). • Remain silent because they are embarrassed. • Shock others or try to amuse the class by describing sexually explicit behaviors. • Ask very personal questions about your private life. • Make comments that open themselves to peer ridicule or criticism. • Giggle about most issues and disrupt the progress of the class activity. - 99 - To deal with these situations it is important to set class rules. These must be very clear to the students before you start. You can have students develop their own rules or you can start with a list and discuss with the students if they are fair and why they are important. A suggested list might be: • Each student should listen carefully to other classmates without interrupting and always with respect for the speaker. • Students are expected to treat each other in a positive way and be considerate of each other’s feelings. • Students are not to discuss personal matters that were raised during the lesson with others outside of the classroom. • Students should avoid interrupting each other. • Students should listen to each other and respect each other’s opinions. • Both students and teachers have a “right-to-pass” if questions are too personal. • No put-downs – no matter how much you disagree with the person you do not laugh, make a joke about them or use language that would make that person feel inferior. • Students may be offered the possibility of putting their questions anonymously to the teacher. • Many times students laugh and giggle about sex. This should only be allowed at the beginning of the class sessions on HFLE. This is important as it lowers the barriers when discussing sexuality. As the lessons continue however this behaviour should be discouraged as students become more mature in discussing these issues in an objective and responsible manner. Strategies to Deal with Special Problems The following strategies might be used to deal with personal questions, explicit language and inappropriate behavior. • Respond to statements that put down or reinforce stereotypes (for example, statements that imply that some groups of people are responsible for the AIDS epidemic) by discussing the implications of such statements. • Be assertive in dealing with difficult situations – for example, “That topic is not appropriate for this class. If you would like to discuss it, I’d be happy to talk to you after class.” • Avoid being overly critical about answers – so that students will be encouraged to express their opinions openly and honestly. • Present both sides of a controversial issue. Avoid making value judgments. • It might be important to separate males and females in group activities that might be embarrassing to the students or where separated groups may function more efficiently. Helping the Anxious Student • It is helpful to think ahead of how you might respond to students in the class who feel particularly sensitive to a topic covered in class as a result of their own personal experiences. It is important that you behave in such a way that students who are worried will feel comfortable seeking your advice. • Your responsibility in teaching a life-skills programme includes learning in advance what help and services are available in your community. - 100 - • Listen to the student who approaches you, without imposing your values, moral judgments, or opinions. Do not ask leaning or suggestive questions about his or her behavior. • Convey your concern for the student’s health or well-being and when appropriate, tell the student that you know of services that can help him/her. Offer to start the process by contacting the one the student chooses. • Continue your support by confidentially asking the student from time to time if he or she needs more information, has taken any action, or is still concerned about anything related to your conversation. Helping the Overzealous Student • It is helpful to think ahead of how you might respond to students in the class who are particularly overzealous in their desire to participate in class activities and, as a result, may not afford other students the chance to participate. • If the student is the only one who is volunteering to answer your questions, you might say to him or her, “You’ve provided some great ideas and answers. Does anyone else have any ideas or answers?” • Don’t ignore the student, as this may make her or him feel disrespected or unappreciated. Acknowledge and commend his or her enthusiasm, but remind the student of the importance of getting everyone’s input and viewpoint. • Consider calling on students, particularly those you think would like to answer, but are feeling reluctant. You might say, “How about you, [name of student]? What do you think?” • As you observe small group work or role-playing activities, encourage other students to participate if it seems that one student is dominating the group work. Facilitator: Critical Role for Teachers When facilitating learning activities, skillful facilitators take on several roles. They: • Develop and maintain a positive atmosphere. • Address all goals and objectives of the training and “cover” essential content. • Balance the content and the process of training. Developing a Positive Atmosphere Teachers need to establish an atmosphere of trust – one that supports and encourages respectful, open, and honest sharing of ideas, opinions, attitudes, and behaviors. Such an atmosphere is characterized as warm, accepting, and non-threatening, and promotes learning. The behavior and attitude of the teacher are critical in establishing warmth, interest, and support, establish an atmosphere that invites active participation. This kind of atmosphere can be established by: • Including opportunities for non-threatening introductory activities – an “ice-breaker’ – to acclimate students to the subjects to be addressed. • Establishing norms – ranging from concerns about confidentiality, the amount of time allotted for lunch, and even the location of the amenities. - 101 - • Discussing expectations – what will and wont’ be addressed, what learners will and won’t do, and what teachers will and won’t do. • Encouraging all learners to join in discussions and keeping overly zealous participants from monopolizing. • Acknowledging sound ideas and interesting points and rephrasing comments so that learners know that they’ve been heard and understood. • Maintaining trust and confidentiality by reminding learners of established ground rules/norms. • Remaining open and responding positively to comments. Reaching Goals and “Covering” Material To address goals and objectives, as well as “cover” appropriate content, a teacher needs to be able to: • Link topics together by introducing new topics and pointing out connections to ones addressed earlier. • Provide needed information clearly, succinctly, and in an interesting way. • Give (and model) clear, step-by-step instructions for each activity. • Promote thoughtful discussion by asking well-planned questions that require more than “yes” or “no” responses. • Know when and how to bring a discussion back to the topic at hand when the discussion strays. • Tie things together by reminding learners of feelings, ideas, opinions, or questions mentioned earlier. • Bring closure to an activity or lesson by seeking final questions and acknowledging when time requires the group to move. Balancing Content and Process During activities, teacher facilitators: • Circulate among learners to develop a clear picture of what’s happening and how it’s happening. • Help learners redirect their focus when they need to. • Accept that outcomes of activities may not be exactly what was planned – and that many different, valuable ways of learning can come out of the same activity. • Help learners identify, analyze and generalize from activities – whether outcomes were planned or not! Developed by the National Training Partnership, EDC. Inc., 1998 - 102 - 5.10 Handling Large Groups When we find ourselves teaching a “mob”, it's easy to throw up our hands, and conclude that there's no chance of getting any responsiveness out of a large unruly disinterested group. Fortunately, there are ways to make large classes almost as effective as their smaller counterparts. Without turning yourself inside out, you can get students actively involved, help them develop a sense of community, and give frequent homework assignments without killing yourself with impossible grading loads. Following are some ideas for doing all that. In-Class Exercises A technique you can count on is the in-class exercise. As you teach a topic or go through a problem solution, instead of just posing questions to the class as a whole and enduring the ensuing time-wasting silences, occasionally assign a task and give the students anywhere from 30 seconds to five minutes to come up with a response. Anything can serve as a basis for these exercises, including the same questions you normally ask in classes and perhaps some others that might not be part of your current repertoire. For example, • Using colloquial or trendy terms. (Always rephrase using standard English at some point in the lesson) • Give both sides of an argument. • Use an inappropriate or incorrect example and ask students to give the correct or appropriate response/action. You might pose a problem or describe a situation and ask the students, individually or in groups, to • Draw and label a flow chart of how to solve or best deal with the problem or situation. • Sketch a plot of how to solve the problem. • Give several possible solutions. • Brainstorm a list of appropriate ways to behave. • List possible outcomes if nothing is done. In these exercises you might sometimes ask the students to write responses individually, sometimes to work in pairs or groups of three, and sometimes to work alone and then to form pairs and combine and improve their individual responses ("think-pair-share"). The more you vary your methods, the more interesting the class tends to be. Whichever approach you use for the exercises (individual, pairs, groups, or think-pair-share), at least some of the time you should call on groups or individuals to present what they came up with, perhaps landing disproportionately on students near the back of the room so they know they can't hide from you there. If you never do this, students will have little incentive to work on the exercises when you assign them and many won't, but if they think they may be called on, they won't want to be embarrassed and so you'll get 90+ percent of them actively involved in what you're teaching. Even if you're an award-winning traditional lecturer, that's probably better than your usual percentage for active student involvement during class. The principal benefit of these exercises is that they get students acting and reflecting, the only two ways by which human beings learn. The students who succeed in a task will own the knowledge in a way they never could if you simply handed it to them, and those who try and fail will be receptive to discovering what they didn't know. Group exercises have the added benefit of giving students an opportunity to meet and work with one another, a good first step toward building a sense of - 103 - community. (You can augment this benefit by periodically asking the students to sit in different locations and work with students they haven't been with before.) Competition is one way of keeping students engaged. Divide the class into manageable groups. Ask each group to write down and hand in a brief statement of the main point of the class, or come up with two good questions related to what you just presented, or tell you how they think you could improve the class. You can scan their responses and quickly see if they got the main idea you were trying to present, identify their main points of confusion, or discover things you could do that would make the class better for them while maintaining their interest to see which group was most successful. Decide on having a tangible reward or not based on affordability but you must create an incentive for winning e.g. most outstanding group for the month etc. You don't have to spend a great deal of time on active learning exercises in class: one or two lasting no more than five minutes in a 50-minute session can provide enough stimulation to keep the class with you for the entire period. The syllabus is safe! Group Assignments When you're teaching a class of 50 students and you give individual work weekly, that's 50 papers to grade every week. If the students complete the assignments in teams of four and only one solution is handed in by each team, that's 12-13 papers to grade every week. Getting students to work on assignments in fixed teams relieves the grading problem but introduces another set of problems, most of which have to do with the fact that the students in a group may have widely varying levels of ability, work ethics, and senses of responsibility. If an instructor simply tells students to get into groups and do the work, more harm than good may result. In some groups, one or two students will actually do the work and the others will simply go along for the ride. In other groups, the students will parcel out the work and staple the individual products together, with each student understanding only one-fourth of the assignment. To minimize the likelihood of these situations occurring, the instructor must structure the assignments to assure that the defining conditions of cooperative learning are met: (1) positive interdependence (if one team member fails to meet his or her responsibilities, everyone loses in some way); (2) individual accountability (each student is held personally accountable for his or her part and for everyone else's part as well); (3) face-to-face interaction, at least part of the time; (4) development and appropriate use of teamwork skills (leadership, time management, effective communication, and conflict resolution, to name a few), and (5) periodic self-assessment of group functioning (What are we doing well as a group? What do we need to do differently?) Miscellaneous Ideas • Learn as many of the students' names as you can. If you have 150 of them to deal with and you're not a mentalist, it may not be worth the effort to try learning them all; however, if the class is small enough to justify the attempt, tell the students to sit anywhere they want to on the first day and remain there in subsequent classes. Then prepare a seating chart and study it during tests and when the students are working on in-class exercises. • Prepare handouts far enough ahead of time to make sure that they will be ready for the class in which they will be used. Telling a secretary at 9:30 a.m. that you need 75 copies of a six-page document printed front-and-back in time for your 10:00 class is not a good way to win friends and influence people Source: Beating the numbers game: Effective teaching in large classes. Richard m. Felder North Carolina state university - 104 - 5.11 Suggested Ice breakers BIP\ BOP\ BOOM There is no leader in this game. Players sit in a circle and count off with the words "Bip, bop, and boom." Each group is numbered 1, 2, or 3. Group # 1 starts off, rapidly saying in unison, "Bip, bop, and boom," followed by their group name (either bip, bop, or boom). Group #2 is next, followed by group #3. The group that makes a mistake is out. BUZZ 7 The leader stands in the center of the circle and points to the person who will start the count. Participants form a circle around the leader and continuously count around. Each participant counts in turn. Here's the catch: all numbers with 7 or divisible by 7 must not be counted off; instead the person must say "Buzz.” Any player who does not do this will be automatically out; any player who says "Buzz” and the number is neither divisible or has 7 is also eliminated. The remaining person is the winner. 2 TRUTHS AND A LIE People write down two truths about themselves and a lie. Then introduce the three "facts" to the rest of the group who tries to guess which one is a lie. SILENCE There is no leader in this game. Without speaking, participants try to line up in the order of their birthdays. To line up in order, participants can mime and do all sorts of actions to indicate their date of birth. (Participants can use just the month and day, or year if desired.) For example, the first person in line would have a birthday on January 20, the next on February 5, the next on February 18, and so on. After everyone is lined up, each person states his/her birthday in order to see how accurate they were. NAME GAME The leader chooses a subject, like animals, or positive adjectives, etc. Everyone sits in a circle. The first person starts with his/her name plus an animal (or whatever subject has been chosen) that begins with the same first letter as the name: "Hi, I'm Adrienne Alligator.” The second person has to then say “Adrienne Alligator” and then his/her own name, ("I'm Bobby Baboon"). It goes all the way around the circle with everyone having to say the names and corresponding animals of all the persons who went before starting with the first person and ending with saying their own name and animal. WHO'S THE LEADER? The leader will make gestures, sing chants, or performs other actions. (It is up to the leader to do any action he/she wants the entire group to do.) Participants copy the actions of the leader. Send one person out of the room. All other participants in the room choose a "leader" who is to dictate the group's actions. When the person returns, the participants stand in a circle, copying the leader's actions. The person has to guess who the leader is. - 105 - 5.12 Sample Lesson Plan REGIONAL Acquisition of coping skills to deter behaviours and lifestyles associated STANDARD 2: with crime, drugs, violence, motor vehicle accidents, and other injuries. CORE OUTCOME 2: Analyse the impact of alcohol, and other illicit drugs on behaviour and lifestyle. Title Could It Happen To Me? Age Level 12 – 13 yrs Time 40 min Students need to reflect on the consequences of drug use on people’s lives. Purpose . Overview Students will reflect on their hopes and dreams for their future lives. They (Include Concepts) will also discuss reasons people use illegal drugs and the devastating effects drugs can have on all aspects of their life. Using a graphic organizer, students will identify behaviours associated with drug abuse and possible consequences. Specific Objectives Students should be able to: 1. Discuss their hopes and dreams for their future lives. 2. Explore the emotional, social, physical and academic effects of drug use. 3. Determine their own reaction to drug use amidst their determination to achieve their bright beautiful drug-free future. 4. Determine the negative consequences of drug abuse on the success of a person’s life. Resources and Scenario, the poster, “Choices” and graphic organizer Materials Methods and Individual and small group work Strategies PROCEDURE Step I Introduction Have students talk about their hopes and dreams of having a bright and (15 min) beautiful future. Let some students share their hopes with the class. Have others engage them in conversations to discuss the way drug use will thwart their prospects for achieving their hopes and dreams. Do several conversations among different groups of students. Teacher writes responses on the board. Step II Skill Hand out a graphic organizer to each student and have them complete it Development and based on the Alicia story. Reinforcement (15 1. What is the problem? min) 2. What drug(s) is being abused? 3. What do you think are the emotional, social, physical and academic impact of drug use on Alicia? 4. How is the drug impacting Alicia’s behaviour? - 106 - 5. What could be the consequences of that behaviour on Alicia’s personal life, home life, performance in school, on friends, family and the community (accidents, crime etc)? CONCLUSION ( 5 Draw on real life examples of drug use causing negative impacts on persons min) in public life and in the school and home community. Explain why alcohol, tobacco and ganja are harmful substances. HOMEWORK: Students will make a list of actions they plan to take to stay drug free in order to achieve their life goals. Beside each action step have them write what help they will need to make their action steps a reality. Notes For Lesson Alicia My name is Alicia and I started using drugs at 13 years old. It first started with drinking beer and smoking cigarettes with my friends, and then I was introduced to ganja. From there, I was up for trying anything. I found that the more drugs I took the more worthless I felt. I didn’t care about how I looked any more. I didn’t bathe or wash my hair as often, I stopped visiting my grandmother who was ill and I fought with my mother all the time. My best friend decided she wanted to be friends with other girls. My parents would try to talk to me, but I knew better. It was MY life! I started hanging around boys that were drinking and doing drugs, and I got pregnant by a boy who didn’t love me at all. At sixteen, I had to drop out of school and my mother had to take care of my baby. I looked in my mother’s eyes and saw her disappointment. I would look in the mirror and ask myself, “what went wrong?” This was not how I dreamed my life would be. I am twenty years old now and trying to get my life back together. My daughter will be going to school soon. I dumped that boyfriend and I am dating a man who respects and values me. My advice to young people is to hold on to your hopes and dreams and avoid drugs at all costs. This story could be about you! - 107 - 5.13 Some Suggested Instructional Materials The following materials are samples of the kind that trainers and teachers may use to facilitate the interactive teaching methods. Decision-making Activity Decision-Making is: Decision-making begins with identifying a problem that needs to be solved. The decision-maker then seeks additional information on the problem and then tries to list some possible ways to solve the problem. After these possible ways have been examined the best of the lot is chosen as the decision to be made. The Steps in Decision-making are: 1. Identify the problem 2. Describe the problem 3. Develop some possible solutions to the problem 4. Look at the pros and cons of each possible solution 5. Check the best solution and implement it. Congratulations! You have now made a decision! Coping with Puberty - 108 - Coping with Puberty Flash Card 1 Question: What is Puberty? Answer: _____________________________________________________ ______________________________________________________________ _______________________________________________________________ Coping with Puberty Flash Card 2 Question: What changes do BOYS experience during puberty? Answer: _____________________________________________________ ______________________________________________________________ _______________________________________________________________ ________________________________________________________________ - 109 - Coping with Puberty Flash Card 3 Question: Why doesn’t everyone’s body change at the same rate during puberty? Answer: _____________________________________________________ ______________________________________________________________ ______________________________________________________________ Coping with Puberty Flash Card 4 Question: What changes do GIRLS experience during puberty? Answer: _____________________________________________________ ______________________________________________________________ _______________________________________________________________ _______________________________________________________________ - 110 - Dealing with Gender Issues Song I am Woman/Man by Helen Reddy I am woman/man, hear me roar In numbers too big to ignore And I know too much to go back and pretend 'cause I've heard it all before And I've been down there on the floor No one's ever gonna keep me down again. Refrain Yes I am wise But it’s wisdom full of pain Yes I’ve paid the price But look how much I’ve gained If I have to I can do anything I am strong I am invincible (invincible) I am woman/man - 111 - Refusal Skills NO. GO. TELL. RAP By Theresa Easy NO! - - - Don’t you dare do that! NO! - - - I say No! I say Stop! Now! GO! - - - I must run as fast as I can. I must run to safety. TELL! - - - I will tell a trusted adult. I must tell a trusted adult He (She) will protect me from harm No, I go tell! No, I go tell! No, I go tell! - 112 - CHAPTER SIX Alternative Assessment Methods - 113 - 6.1 What are Performance Tasks? Performance tasks are assignments that ask students to undertake a task or series of tasks to demonstrate proficiency with health knowledge and skills. They provide a means for students to demonstrate progress in meeting HFLE objectives. A performance task presents a descriptions of the student work and the health education standards and criteria by which the students' work will be evaluated. 1. What kinds of activities could qualify as a performance task? Generally, performance tasks will fall into one of four categories: constructed responses: answers on tests, student-generated diagrams, and/or visuals presentations such as concept maps or graphs. Products: an essay, research paper, or lab report; a journal; a story, play, or poem; a portfolio; an exhibit or model; a video- or audio-tape; a spreadsheet Performances: an oral report; a dance demonstration; a competition; a dramatic presentation; an enactment; a debate; a recital Processes: a session for oral questioning; observation; an interview or conference; an ongoing learning log; a record of thinking processes Although some performance tasks may be simple and involve an open-ended question, others Can be more complex and require several days, weeks, or months to complete. For a more ideas, review the options for performance tasks handout. How do you know when you have an effective performance task? A performance tasks is more than an activity or incidental product. It needs to answer a Central question to qualify as valid: 1. Will this task enable students to demonstrate that they have acquired the skills and knowledge embodied in the standards? If this question cannot be answered affirmatively, the pt must be reconsidered. In addition, a good performance task: a. Clearly indicates what the student is being asked to do b. Addresses specific content standards and performance descriptions c. Is developmentally appropriate and of interest to students d. Provides for student ownership and decision-making e. Requires student to be actively engaged f. Flows from previous activities g. Provides an opportunity for the student to stretch abilities to the next level h. Allows the teacher to gather important evidence about what the student knows and does i. Emphasizes higher order thinking skills j. Requires evaluation and synthesis of skills k. Is linked to ongoing instruction l. Reflects a real world situation m. Clearly indicates how good is good enough n. Has criteria that are clear to students and teacher Finally, for a performance task to be sound, it must be one that is actually Feasible and that doesn't require inordinate time or resources or create undue controversy. - 114 - 2. Examples of Different Performance Tasks Advertisement Crossword Family Tree Animated Movie Comic Strip Community Film Annotated Bibliography Display Fitness Art Gallery Calendar Flip Book Fundraising Block Picture Story Brochure Detailed Illustration Game Bulletin Data Analysis Database Graph Board Debate Demonstration Bumper Sticker Diorama Display Historical Perspective Drama Chart Choral Reading Clay Illustrated Story Sculpture Collage Editorial Essay Infomercial Collection Computer Program Cookbook Fairy Tale Pamphlet Role Play Internet Review Paper Mache Interview Petition Storytelling Scrapbook Photo essay Sculpture Skit Journal Pictures Slide Show Picture Book for Children Slogan Letter-writing Play Social-interaction project Poetry Song Map with Legend Popup Book Survey Mobile Portfolio Model Poster T-Shirt PowerPoint Presentation Tapes: Audio or Video Mural Press Conference Public Teamwork Museum Exhibit Announcement Puppet Show Video Needlework Puzzle Newspaper Story Web Page Radio Program Write A New Law Oral Defense Rap Oral Presentation Research Project Riddle - 115 - 6.2 Creating and Using Performance Tasks and Rubrics for Assessments Sample Rubric for Evaluation of a Life Skills-based Lesson Performance Tasks Criteria Highest score Lowest score 4 3 2 1 Task #1: Task #2: Task #3: Total: _________ 116 Sample Rubric for Evaluation of a Life Skills-based Lesson with Weighted Tasks Performance Criteria Weight Tasks Highest score Lowest score 4 3 2 1 Task #1: X 1 Task #2: X 1 Task #3: X 2 Sample Rubric for student Evaluation of the Life Skills used during a lesson Life Skill Criteria Highest score Lowest score 4 3 2 1 Skill #1: Skill #2: Skill #3: Total: _________ 117 Graphic Organizer Problem Effect on Alicia Physical Emotional Social Academic At Home At School Behaviour Consequence Behaviour Consequence Relationships with Family Relationships with Friends Behaviour Consequence Behaviour Consequence Sports Community Behaviour Consequence Behaviour Consequence 118 6.3 Creating and Using an HFLE Student Portfolio What Is a Portfolio? A portfolio is a collection or showcase of examples of a person's best work in a particular field. For example: Architects create portfolios that contain blueprints they have drawn. Artists' port- folios typically include collections of sketches and drawings they. have made. Musicians may create portfolios using audiotapes or videotapes of songs they have performed or composed. People use portfolios to show others what they can do. Students can use the portfolio to demonstrate to others what they know and what they can do in health education. Rationale for Portfolio Portfolios have the advantage of containing students' work (product) over a period of time and their reflections (process) about doing the work and the learning they believe took place. Portfolios provide evidence of students' growth in health knowledge and skills and document progress as a learner. Portfolios form a solid basis for a student's conferencing with teacher, parent, student or other interested parties. Essential Elements of a Portfolio Portfolios should be designed so those who read them will understand why students chose each piece of work and what each piece of work demonstrates. Students need to spend time organizing and describing the pieces they select and their reasons for selecting them. A portfolio is not a collection of everything students have done. Portfolios use samples of students' best work. Decisions about what work to include and not to include are made by teacher and student together. Only the final version of a student's best work should be included. Expert practitioners in every field realize the strategic importance of improving their work samples. In our quest to produce life- long learners, we must encourage students to develop the habits and skills of professional learners. These skills include revision, reflection and self-assessment using clear standards of achievement. These three practices are essential elements of the portfolio process. Revision Throughout the course of a school year, students learn new information and develop and practice new skills. In the portfolio process, students have the opportunity to revise and restructure their work. Teachers should provide multiple opportunities to utilize the health education standards, so students have a wide selection of work from which to choose their best examples. Students must be taught that revision is more than revising to fix mechanical mistakes and be given multiple opportunities to practice revising their work. Students should be encouraged to keep all scratch notes, rough drawings, doodling and draft copies. An examination of these thinking tools and practice works will allow students to compare and contrast, categorize and relate, infer and apply all essential components of revision. With in- creased practice, students will become more skilled at revision. 119 6.3.1 Engaging Students in Portfolio Development Explain to students that a portfolio will be a collection of their best work. Just as artists, models, architects, writers use their portfolios to show others what they have accomplished in their chosen field, students can use their health portfolios to demonstrate what they know, understand and are able to do in health education -in other words, their level of health literacy. Besides teachers and parents, potential employers would be an interested audience for a health portfolio. Clearly explain the logistics (location, schedule for portfolio work', due dates, conference etc.) Let students know that you would like to photocopy their best work as benchmarks for subsequent years. • Clearly explain how portfolios will be assessed. • Have a set portfolio work time. • Set a timeline with due dates for installments. • Encourage peer evaluation. • Check with other teachers to see if some health portfolio work could receive credit in other classes. • Explain that parents will be encouraged to review students’ portfolios and to offer suggestions. Portfolios could also form the basis for a parent/teacher student conference. 6.3.2 Managing Portfolios Of paramount importance is accessibility of portfolios to-students so one of the first challenges is deciding where in your classroom portfolios will be stored. Some teachers use boxes with hanging files, some milk cartons, others a file drawer or stackable plastic bins like the postal workers use. Because student work may come in all shapes and sizes, student folders need to be legal size or accordion. Teachers may use color-coding to distinguish one class from another. Teachers need to set aside time each week for students to work with their portfolios. Getting and staying organized is also important with portfolios. In addition to designing a management system for the portfolios themselves, a management system for the contents of the portfolio is crucial. In addition to arranging the classroom, scheduling time for students to work with portfolio and preparing student handouts, teachers need to think about how they will conference with students. Conferences could be held during the scheduled portfolio time. The conference is an opportunity for student and teacher (or a few students and a teacher) to talk about the student's portfolio work. The more chances students have to discuss their work, (how they did, what they learned, how they feel, how they might improve the work, what new goals they want to set for their work, what growth they see in themselves) the greater the likelihood that they will become better and lifelong learners. Conferences are collaborative, not teacher led; the teacher listens the students and asks leading questions. It is a true blend of instruction and assessment. A conference is a time for teachers to learn first- hand about the instructional strengths and needs of a students. The teacher could meet with one or more students. Building conferencing skills takes time. 120 6.3.3 Involving Parents in the Health Literacy Portfolio Portfolios are a good way to involve parents in their children's learning. Teachers need to communicate to parents (in writing, at meetings, in newsletters): • what portfolios are, • the purpose of this particular portfolio, • how it will be scored, • what part of the child's grade it will be, • how it is different from traditional paper-pencil tests, and • how they, the parents, can play an active part in their child's learning. Teachers can encourage parents to: • be a receptive audience for their child as he/she develops or decides what work to include in the portfolio, • offer the child constructive feedback (this is helped by the use of rubrics), • ask questions that encourage a child's reflection on his/her learning, • communicate with the teacher about the growth in knowledge and skills they observe in their child, • write reflective comments about the child's learning as demonstrated at home and in the portfolio, and • discuss the portfolio work at parent teacher conferences. The less familiar parents are with portfolios, the more important it is for communication about them to be ongoing with parents. 6.3.4 Evaluating the Portfolio Teachers need to decide in advance how they are going to evaluate and share this information with their students. An assessment portfolio documents what a student has learned over time. It serves as a showcase of their best work. A review of a portfolio should provide the reader with a sense of the student's purpose and a portrait of the student's growth over time. In order for this to happen, the portfolios should: Have some kind of organization; Contain a range of work in context rather than as isolated pieces and skills; Include pieces from throughout the assignment period in order to show growth; Provide clear links between the health education standards and the pieces of work; and Present evidence of self-assessment Teachers may also decide to incorporate portfolios as part of a grading system and may even use them in as a final grade. If used for grades, some questions that educators need to answer in ad- vance are: How much of the student's grade will portfolios be? Will they be used as part of or in place of a final examination? Students need to know from the start the requirements for the portfolio and what they need to produce for a portfolio that achieves the performance standard. 121 It is likely that the teacher will develop a rubric or set of rubrics to guide students in their portfolio development. (See Sample HFLE Portfolio and Rubric DRAFT as created by Arthusa Semei, 2006). These rubrics would apply to the entire portfolio not to individual lessons that have their own rubrics. Adapted from: Rhode Island Department of Education Assessment Portfolio Project and Council of Chief State School Officers SCASS Project 6.3.5 Getting Started with Portfolio Worksheets Tasks to consider: • Define the purpose of the collection. How will it relate to the HFLE objectives? • What will you require students to put in their HFLE portfolio? What kinds of student work will you include? How can this be related to performance tasks? • Decide how the finished HFLE portfolio will be evaluated. Will you develop criteria? What are some of the criteria? • Decide what part of the students' grade the portfolio will be. • How will you guide students through the process of reflecting on their work? Will you also include peer reflection? How will you incorporate student self-reflection with teacher reflection? How will this be used? What forms will you need? What would they look like? • Decide how you will manage portfolios in the classroom. • Review sample portfolio forms. Which ones will you use? Which ones will you revise? How? What other forms do you need to prepare? Be sure to include: an information sheet; a table of contents; a reflective summary; examples of student work entry slips. • Explain how you will engage students in portfolio work. How will you introduce it? How will you get them to actively participate? • Decide how to involve parents in their children's portfolio. • How will you instruct, monitor, guide, and conference with students. • Reflect on the portfolio process and revise any of the above as necessary. 122 CHAPTER SEVEN Exploring the Self 123 7.1 Sexual Beingness – Circles of Sexuality 7.1.1 Sensuality Sensuality is an awareness, acceptance of and comfort with one’s own body; physiological and psychological enjoyment of one’s own body and the body of others. These include body image, human sexual response cycle, skin hunger (the need to be touched), fantasy, attraction/desire and pleasure. 7.1.2 Intimacy Intimacy is the ability and need to experience motional closeness to another human being and have it returned. This takes in caring, sharing, loving/liking, risk-taking (emotional), vulnerability, commitment and reciprocity. 7.1.3 Sexual Identity Sexual Identity is the development of the sense of who one is sexually including a sense of maleness and femaleness. Some examples of this are biological sex, gender identity, gender role and sexual orientation. 7.1.4 Sexual Health and Reproduction Sexual Health and Reproduction is an attitude and behavior related to producing children, care of the sex and reproductive organs and health consequences of the sexual behaviour. These include factual information, feelings and attitudes, intercourse, physiology and anatomy of the reproductive organs, infections/diseases, contraception and risk reduction. 7.1.5 Sexualization Sexualization is the use of sexuality to influence, control or manipulate others. Some examples of these are rape, sexual abuse, incest, sexual harassment, withholding sex and seduction- flirting. 7.1.6 Sex Sex is a vital element in everyone’s sexuality. It refers to the reproductive system and gender behaviour in terms of male and female. It has to do with biology, anatomy and physiology. 7.1.7 Sexuality Sexuality is the total expression of who we are as human beings- values, mental attitudes, physical appearance, beliefs, emotions, likes, dislikes, our spiritual selves and how we are socialized. It involves our sexual identity and our entire self concept. It begins at birth and lasts a lifetime. 7.1.8 Masculinity and Femininity Masculinity and Femininity relate to sexuality as sex relates to being male or female. Sources of sexual learning are factors that contribute to our psychosocial development. These include family values, religious beliefs, parental teachings and societal norms. 7.1.9 Gender roles Gender roles are a set of rules laid down by society that tells us what behaviour is appropriate for our sex. Such rules are established by culture and are designed to us at birth. 7.1.10 Gender identity Gender identity is the private conviction each of us has about being feminine or masculine. 124 7.1.11 Sexual Orientation Sexual Orientation refers to a preference for sharing sexual expression with members of the opposite sex, members of our own sex or members of both sexes. 7.1.12 Sexuality Patterns Heterosexual- preferring emotional/sexual partners of the opposite sex. Homosexual- preferring emotional/sexual partners of the same sex. Bisexual- preferring emotional/sexual partners of both sexes. Asexual- having little or no sex drive. Celibacy- deliberate abstentions from sexual activity- a choice people make for a variety of personal reasons. 7.1.13 Values Values are beliefs, principles and standards to which we assign importance. They are things we prize and regard as significant. 7.1.14 Attitudes Attitudes are mental views, opinions, disposition, postures or behaviour. 7.1.15 Values Clarification Values Clarification means sorting out one’s own real (intrinsic) values from the (extrinsic) values of the outside world- separating one’s personal beliefs from the beliefs of others. Contributed by Ingrid Reid, Sex and Sexual Health Consultant to the Ministry of Education 125 7.2 The Emotional and Spiritual Self Emotional Intelligence Daniel Goleman popularized the phrase “Emotional Intelligence” with the publication of his book by the same title in 1995. In his book, Goleman cites research at Bell Labs that examined star performers, and tried to determine what distinguished them from more average performers. It appeared that star performers had significantly stronger relationship skills and personal networks than average performers. EQ is actually a large collection of skills. Goleman and Richard Boyatzis have recently grouped these skills into 4 quadrants as shown below. The research done by Goleman and Boyatzis shows that Self-Awareness skills must be developed before the others can develop. This makes sense if you consider Emotional Self- Awareness. If I don’t know when I am angry how can I have Emotional Self Control? How can I have Empathy for your anger? How can I handle conflict appropriately? SELF AWARENESS OTHER AWARENESS • Emotional self-awareness • Empathy • Accurate self-assessment • Organizational Awareness • Self-confidence • Service Orientation SELF MANAGEMENT RELATIONSHIP SKILLS • Emotional Self-Control • Developing Others • Transparency • Inspirational Leadership (honest/trustworthy) • Influence • Adaptability • Change Catalyst • Achievement Orientation • Conflict Management • Initiative • Teamwork & • Optimism Collaboration The research on EQ has left no doubt that these skills are vital for personal and business success. Defining Spirituality and Spiritual Intelligence What is Spirituality? “Spirituality is the innate human need to connect with something larger than ourselves.” • But what is this “something larger than ourselves?” It is something beyond our ego-self or constricted sense of self. It may be defined as having two components: the vertical and the horizontal. 126 • Vertical component: something sacred, divine, timeless and placeless…a Higher Power, Source, Ultimate Consciousness – or any other language the person prefers. Desiring to be connected to and guided by this Source. • Horizontal component: being of service to our fellow humans and to the planet at large. How can we be “Spiritually Intelligent?” What would a “spiritually intelligent” person look like? Defining Spiritual Intelligence: I define Spiritual Intelligence as “the ability to behave with compassion and wisdom while maintaining inner and outer peace (equanimity) regardless of the circumstances.” Compassion and wisdom together form the manifestation of love. “Behave” is important because it focuses on how well we maintain our center, stay calm, and actually treat others with compassion and wisdom. The statement of “regardless of the circumstances” shows that we can maintain our peaceful center and loving behaviors even under great stress. This is what we admire in our spiritual leaders. Based on this definition I have created a list of skills which I believe represents the skills of Spiritual Intelligence. They are: 127 SPIRITUAL INTELLIGENCE (SQ) SKILLS Higher Self/Ego self Awareness Universal Awareness 1. Awareness of own worldview 6. Awareness of interconnectedness of all life 2. Awareness of life purpose (mission) 7. Awareness of worldviews of others 3. Awareness of values hierarchy 8. Breadth of time / space perception 4. Complexity of inner thought 9. Awareness of limitations/power of human perception 5. Awareness of Ego self / Higher Self 10. Awareness of Spiritual laws 11. Experience of transcendent oneness Higher Self/Ego self Mastery Social Mastery / Spiritual Presence 12. Commitment to spiritual growth 17. A wise and effective spiritual teacher/mentor 13. Keeping Higher Self in charge 18. A wise and effective change agent 14. Living your purpose and values 19. Makes compassionate and wise decisions 15. Sustaining your faith 20. A calming, healing presence 16. Seeking guidance from Spirit 21. Being aligned with the ebb and flow of life Each of these skills has been described in five levels of skill proficiency. Level 0 is implied, and means that the person has not begun to develop that skill. Level 5 is the highest level we measure with our online self-assessment. No skill or level is considered “required.” And even at Level 5 a person is not considered “finished” as there is always room to grow. Adapted from “Emotional Intelligence” by Daniel Goleman 128 7.3 Self –Esteem The Oxford Dictionary defines self-esteem as “a good opinion of one’s own character.” When you have high self-esteem, it means you know you are a worthwhile person, someone worthy of love. You respect yourself and who you are. Good self-esteem generally as to do with the quality of the relationships we’ve had and we build with people throughout our lives. These people may be our parents, brothers and sisters, teachers, partners, or friends. If the relationships we build, and the messages we exchange with those people close to us are positive, friendly, and respectful, and if they value us for what we are, then we’ve probably developed a strong sense of self-esteem. If, on the contrary, we’ve been rejected and not valued, then it will be more difficult for us to love ourselves. Young people who are or have been exposed to violence, even under the pretense of discipline or care, are likely to have a very low self- esteem, and what’s worse, they often feel guilty and unworthy. Sometimes they may even feel that adults have the right to use violence against them. Having high self-esteem does not mean that we never get upset or angry with ourselves. Everyone gets frustrated with themselves at times. High self-esteem is also different from pride or being too conceited. People with high self-esteem like themselves but they don’t think they are perfect or better than other people. HOW TO IMPROVE YOUR SELF ESTEEM Self-esteem is something deep inside you and you can work on it and nurture it on a daily basis. To do this, you should: • Avoid constantly comparing yourself with others. Set your own goals and don’t judge yourself according to someone else’s achievements. Life is a long race; sometimes you will be ahead, sometimes in the middle, and other times behind. • Recognize your special talents and try to appreciate yourself the way you are. Make a list of the things you do well. Are you an artist, athlete, singer, storyteller, or dancer? In what subjects do you excel in at school? Singing may be your talent and you should practice in front of others in order to improve. Work on some of the bright lights that make you shine, and ask others what they most appreciate about you. • Be aware of things that you have already accomplished in life such as receiving an athletic or music award, your high school diploma, CXC (Caribbean Examination Council) awards certificate, or an Associate Degree. • Think about the person you are and be proud of your best qualities. What do you like about yourself? Your generosity? Your sense of humour? Your creativity? Your ability to be a critical thinker? • Be aware of the things you would like to improve about yourself, but don’t be overly self critical. • Be realistic. Set achievable goals so that you can be satisfied when you accomplish them. • Believe in yourself. Tell yourself, “I can do it!” • Spend time with people who care about you, make you feel good about yourself, and boost your self-esteem. Stay away from people who hurt your self-esteem, particularly if they do it on purpose! 129 SELF ACCEPTANCE Self acceptance is being loving and happy with who you are NOW. Some call it self-esteem, others self-love, but whatever you call it, you'll know when your accepting yourself cause it feels great. It is an agreement with yourself to appreciate, validate, accept and support who you are, even those parts you’d like to eventually change. “Acceptance allows change. “When you begin to accept yourself the way you are right now, you begin a new life with new possibilities that did not exist before because you were so caught up in the struggle against reality that that was all you could do.” The Process of Acceptance Self acceptance exists at the core of your being. In order to reach this base level of acceptance, you need only remove the items laying on top. To do this, you must first identify all the things you do not accept about yourself. Then, one by one, eliminate them by examining and questioning your beliefs around that issue.  Know yourself and your beliefs  Take a good hard look at your honesty level  Know you are doing the best you can  Relax your value judgments  Examine guilt  Understand your motivations  Ask yourself questions about what you don't accept 130 7.4 Values Clarification Activity Sheet No. 1 Rank each value in one of three categories according to whether it is the most important, 1st, second most important, 2nd, or least important, 3rd. Each category must have at least three items. 1. My family life ____________________ 2. My health ____________________ 3. My country’s well-being ____________________ 4. My sex life ____________________ 5. My children’s well-being ____________________ 6. My religion ____________________ 7. My husband/wife/significant other ____________________ 8. My career ____________________ 9. Popularity ____________________ 10. Fun and amusement ____________________ Everyone has different values. When interacting with students it is important to keep these differences in mind so that we can help them make up their own minds based on their own values and situations. 131 7.5 Values Clarification Activity Sheet No. 2 Stimulus/Response Statements About my Feelings Agree Disagree 1. Talking to people who are HIV-positive or who have AIDS is difficult 2. People with AIDS should not have sex 3. Condoms greatly reduce sexual pleasure 4. Oral sex is unnatural 5. Masturbation is not normal 6. Life is hopeless and not worth living if you have AIDS 7. I would feel more comfortable caring for an AIDS patient who got the illness from a transfusion than homosexual AIDS patient 8. It is impossible to be monogamous for your whole life 9. I would not be comfortable having a person with HIV/AIDS hold my baby 10. Parents should teach their teenage children how to use condoms 11. Only promiscuous people have HIV/AIDS 12. It is more difficult for men to control their sexual urges than women 13. Talking to youths about sex and condoms encourages them to be promiscuous 14. It is OK to have sex only for pleasure 15. Spiritual/religious people have little difficulty in controlling sexual urges 132 7.6 Values and Jamaican Culture What are values? Values are the weight or importance that we put on certain things. Values make us who we are. They shape our behaviour and influence the way we think. Values can be moral or sentimental and create notions of what is good or bad, what is desirable and undesirable. Children and adolescents learn their values from the family, school, church, the community, friends and the media. These values are passed on from one generation to another through the socialization process. Often we are unaware of our values until we come across someone with a different value set and behaviours. Most societies and culture share a common set of values that influence the norms and behaviours of the general population. There are however many variations to the values of different persons within any one society or culture. It is important to recognize and respect differences in values without necessarily allowing them to unduly influence personal choices and behaviours. Our values influence the choices that we make. We usually make choices that are in line with our values. However, sometimes in order to fit in or to impress others, we ignore our values. It is important that in making choices we: • know our values (our position on things); • listen for and get the facts to help in deciding on things; • are not influenced by peer pressure or allow others to impose their values on us In Jamaica as in most other countries persons of different geographical, social, economic and religious backgrounds hold varying values. Valuing the Self: Why Skin Bleaching? To start with, variety is the spice of life, such as variety in food, clothes, hairstyles, etc. Variety also abounds in nature. That is why all people on Earth belong to different types of skin colours, from white to yellow and to black. Our living environment accounts for the different skin colours we have. For example, in cold climatic regions such as Europe, inhabitants tend to have a lighter complex due to the cold weather, whereas in Africa, darker skin is better suited in the hot and humid climate. However, many people nowadays are bleaching their skin. Why do they want do that? Is fairer skin really more appealing than darker skin? Actually many beauticians and doctors advise us that by eating healthily, exercising and using body cream rich in Vitamin E, Aloe Vera and Collagen Elastin will produce more fascinating effects than applying mere bleaching creams. All skin bleaching products contain one of the two active ingredients--- hydroquinone and mercury. 1. Hydroquinone lightens the colour of the skin areas to which it is applied by killing off the melanin-making cells—the melanolyte. It is also the active ingredient in ‘fade-off’ creams for freckles, age spots, etc. 133 Historical background: Hydroquinone was first use in the thirties. Some of the African- American employees found that spots of discolouration appeared on their skin. The chemical substance responsible for it is Monobenzyl Ether of Hydroquinone (Monobonzone for short). Monobonzone thus became a newly discovered bleaching agent. However the daughter molecule of Hydroquinone later replaced it as it caused spots of depigmentation all over even in unapplied places. 2. Mercury-based bleaching creams contain ammoniated mercury or mercrous chloride as a bleaching agent. Some of these creams may contain up to more than 2-5% mercury that will be harmful to health. Thus resulting in mercury poisoning, especially chronic mercury poisoning, may result. Insights about other harmful effects of skin bleaching: Skin bleaching destroys the black pigment found in the epidermis (top layer of the skin). Exposure of the dermis layer, underneath the epidermis layer, to the harsh weather will increase the incidence of skin cancer. The dermis cannot compensate for the absence of the epidermis and coupled with the hot sun one will get a higher risk of cancer. • The effects of the use of products containing steroids to bleach the skin include: • Increased risk in skin cancer • Thinning of the skin • Irreversible stretch marks • Easy bruising and tearing of the skin • Susceptibility to infection • Delayed wound healing • Hyper-pigmentation ( This is where the skin does not return to its original colour after prolonged bleaching but actually becomes darker than what it was in the beginning.) Thus we can see that despite having fairer skin as desired, skin bleaching is also damaging to our skin. To bleach or not to bleach? Is it worthwhile to risk the high chances of causing damage to our precious teeth, skin or hair, in exchange for our perceived view of beauty? Some said that ‘Beauty is in the eye of the beholder’ and ‘Being natural is beauty in itself’. What do you think? 134 7.7 Sexual Development through the Life Cycle Many people cannot imagine that,humans including babies, children, teenagers, adults and old people are sexual beings. Some believe that sexual activity is reserved for early and middle adulthood and teenagers often feel that adults are too old for intercourse, or “having sex.” Sexuality, though, is much more than just sexual intercourse and humans are sexual being throughout their lifetime. 7.8.1 Infants and toddlers Children are sexual even before birth. Males can have erections while still in the uterus and some boys are born with an erection. Infants touch and rub their genitals because it provides pleasure. Boys and girls can experience orgasm from masturbation, but boys do not ejaculate until puberty. By about age two, children know their gender. They are aware of differences between genitals and in how boys and girls urinate. 7.8.2 Children ages three to seven Preschoolers are interested in everything about their world, including sexuality. They may practice urinating in different positions. They are very affectionate and enjoy hugging other children and adults. They begin to be more social and may imitate adult social and sexual behaviours, like holding hands or kissing. Many young children “play doctor” during this stage, looking at other children’s genitals, and showing theirs. This is normal curiosity. By age five or six, however, most children become more modest and private about dressing and bathing. Children of this age are aware of marriage or “living together,” based on their family experience. They may role-play being married or having a partner while they “play house.” Most young children talk about marrying or living with a person they love when they get older. School-age children may play sexual games with friends of their same sex, touching each other’s genitals or masturbating together. Much of the sex-play at this age happens because of curiosity. 7.8.3 Preadolescent children (ages eight to 12) Puberty, the time when the body matures, begins between the ages of nine and 12 for most children. Girls begin to grow breast buds and pubic hair as early as nine or 10. Boys’ development of penis and testicles usually begins between 10 and 11. After puberty, pregnancy can occur. Children become more self-conscious about their bodies at this age and often feel uncomfortable undressing in front of others, even a same-sex parent. Masturbation continues and increases during these years. Preadolescent boys and girls do not usually have much sexual experience, but they often have many questions. They have usually heard about intercourse, petting, oral and anal sex, homosexuality, rape and incest, and they want to know more about these things. The idea of actually having intercourse, however, is unpleasant for most preadolescent girls and boys. Same-sex sexual encounters at this age tend to happen. Boys and girls tend to play with friends of the same sex and may explore sexually with them. Masturbating together and looking at or caressing each other’s genitals also occurs among some boys and girls. Such same-sex behaviour is usually unrelated to a child’s sexual orientation. Some group dating occurs. Preadolescents may attend girl/boy parties, dance and play kissing games. By age 12 or 13, some young adolescents will pair off and begin dating or “making out.” In some urban areas, boys often experience vaginal intercourse at this age. Girls are usually older when they 135 begin having vaginal intercourse. However, it is not uncommon for young teens to practice sexual behaviours other than vaginal intercourse, like petting to orgasm and oral intercourse. 7.8.4 Adolescents (ages 13 to 19) Once children reach puberty, their interest in genital sex increases and continues through adolescence. There is no way to predict how a particular teenager will act sexually. As a group, most adolescents explore relationships. 7.8.5 Adults Adult sexual behaviours are extremely varied. In most cases, they remain a part of an adult’s life until death. At around age 50, women experience menopause, which affects their sexuality. Their ovaries no longer release eggs, and their bodies no longer produce estrogen. They may experience several physical changes: vaginal walls become thinner and intercourse may be painful; there is less vaginal lubrication; the entrance to the vagina becomes smaller. A lot of women use estrogen replacement therapy to relieve many of these problems, using vaginal lubricants can also make intercourse easier, once a woman’s vagina produces less lubrication. Most women are able to have pleasurable intercourse and experience orgasm for the rest of their lives. Adult men also experience some changes in their sexuality, but not at such a predictable time as menopause. Men’s testicles slow down their testosterone production after age 20 to 25. Erections occur more slowly. Men also become less able to have another erection after an orgasm. It may take up to 24 hours to sustain another erection. The amount of semen released during ejaculation also decreases, but men are capable of producing a baby even when they are very old; some men have become fathers in their 90’s! Some older men often have an enlarged or cancerous prostate gland in their later years. If it is necessary to remove the prostate, a man’s ability to have an erection or an orgasm is unaffected. Although adult men and women do go through some sexual changes as they age, they do not lose their desire or their ability for sexual expression. Even among the very old (those 80 and older), the need for touch and intimacy remains, although the desire and ability to have sexual intercourse may wane. 136 7.9 Fact or Fiction about Sexuality and Sexual Health – Statements 1. Most teenagers have had sexual intercourse by the time they finish high school. 2. Once a girl has had her first period, she can become pregnant. 3. A girl can become pregnant before she has her first period. 4. It is unhealthy for a girl to bathe or swim during her period. 5. Abstinence is the only method of contraception that is 100 percent effective. 6. A teenager has to be 18 years to get contraception from a clinic, without a parent’s consent. 7. Only females can have sexually transmitted diseases without any symptoms. 8. A woman cannot get pregnant if she has sex in certain positions. 9. A woman cannot get pregnant if she has sexual intercourse during her period. 10. Oral contraceptives (the pill) often cause cancer in women. 11. Douching will prevent pregnancy from occurring. 12. Once a person has had gonorrhea and been cured, she or he cannot get it again. 13. Condoms are not very effective in preventing pregnancy and STI’s. 14. Cancer of the testicles is more common among teenage males than among men over 35 years old. 15. Teenagers can be treated for STIs without their parents’ permission. 16. A woman is temporarily infertile while she is nursing a baby. 17. All boys have wet dreams during puberty. 18. Males need to have sex to keep good health. 19. Alcohol makes it easier for people to get sexually aroused. 20. A woman can always calculate the “safe time during her menstrual cycle when she can have vaginal intercourse and be protected from pregnancy. 21. There is no known cure for herpes. 22. Having a sexual experience with someone of the same sex means you are lesbian or gay. 23. Once a man gets aroused and has an erection, he must ejaculate to avoid harmful effects. 24. A woman can get pregnant even if a man doesn’t ejaculate inside her vagina. 25. If a penis is touched a lot, it will become permanently larger. 26. Normal adolescents do not masturbate once they become sexually active. 27. Women should begin having pelvic exams in their late teen years. 28. Woman with a heavy discharge from her vagina probably has a sexually transmitted disease. 29. In a homosexual relationship, one person usually takes the male role and the other takes the female role. 30. Many women experience severe menstrual cramps. 31. “Crack” cocaine is the only drug that affects an unborn baby’s health after the fires three or four months of pregnancy. 32. In males, one testicle usually hangs slightly lower than the other. 33. A woman will always bleed and feel pain when she has vaginal intercourse for the first time. 34. In some cultures, girls’ genitals are mutilated to keep them from having sex before marriage. 35. And intercourse is a safe way for a woman to avoid pregnancy and STI’s. 36. Men who rape are more likely to rape strangers than persons whom they know. 37. A man who has had a vasectomy no longer ejaculates during intercourse. 137 7.10 Fact or Fiction about Sexual Health – Correct Responses to Statements 1. Most teenagers have had sexual intercourse by the time they finish high school. FICTION – Recent research indicates that only 30% of all girls and 50% of all boys have had sexual intercourse by age 17. The figures are even lower for teens under age 15. It is important to recognize that many older teens and most young teens choose not to have intercourse. 2. Once a girl has had her first period, she can become pregnant. FACT – When a girl starts having menstrual periods it means that her reproductive organs have begun working and that she can become pregnant, if she has vaginal intercourse, it does not mean she is ready to have a baby, only that she is capable of bearing one. 3. A girl can become pregnant before she has her first period. FACT – Before a girl’s first period, her ovaries release the first ovum, or egg, during ovulation. She can become pregnant if she has intercourse around the time of her first ovulation, before she has her first menstrual period. 4. It is unhealthy for a girl to bathe or swim during her period. FICTION – There is no health reason to restrict any activity during a menstrual period. Bathing during menstruation is especially important for good hygiene. Some girls and women will avoid certain activities during menstruation because of religious beliefs or cultural customs. 5. Abstinence is the only method of contraception that is 100 percent effective. FACT – Abstaining from sexual intercourse of any kind is the only way to be absolutely sure of avoiding the risk of pregnancy or sexually transmitted infections. 6. A teenager has to be 18 years to get contraception from a clinic, without a parent’s consent. FACT – Though teenagers are allowed to get contraception, without a parent’s consent, very few clinic staff will give contraception to teenagers. They are able to purchase these at pharmacies however. 7. Only females can have sexually transmitted diseases without any symptoms. FICTION – Some STI’s such as herpes have obvious symptoms in men and women. Others, such as Gonorrhea and Chlamydia, typically show no symptoms in women and often show no symptoms in men, as well. HIV infection may occur in men and in women with no symptoms of the disease for 10 years or more. It is important therefore that everyone, male or female, who is sexually active to be take regular tests to detect the presence of STI’s. 138 8. A woman cannot get pregnant if she has sex in certain positions. FICTION – A woman who has vaginal intercourse in any position – sitting, standing, lying down or in the up-side down position – is at risk for becoming pregnant every time she has sex. Even women who have anal intercourse may become pregnant if semen comes in contact with the vulva. Sperms may make their way into the vagina and fertilize an egg. 9. A woman cannot get pregnant if she has sexual intercourse during her period. FICTION – It seems likely a woman should be safe from pregnancy during her period, since her last ovulation was 14 days before and she shouldn’t ovulate again for 10 – 14 days. Pregnancy is possible however, at any time during the menstrual cycle. Women, and especially teens, sometimes ovulate sooner than expected, and even during their periods. Stress, illness and other factors can bring on ovulation at unanticipated times during the normal menstrual cycle.. 10. Oral contraceptives (the pill) often cause cancer in women. FICTION – There is no evidence that the pill causes cancer and, in fact, it may help prevent some forms of cancer. Minor side effects for users of oral contraceptives include nausea, breast tenderness, headaches, spotting and slight weight gain. Compared to the side effects of earlier oral contraceptives in the 1960’s, 70’s, and 80’s, the side effects currently associated with oral contraceptives are minimal. This is primarily due to the lower dosage of estrogen in the pills being manufactured today. There are significant health risks of oral contraceptive use for women who smoke, are over 35 years, are overweight, or who have high blood pressure and diabetes. 11. Douching will prevent pregnancy from occurring. FICTION – Douching may actually force sperm farther up into the vagina and may cause conception. It does nothing to help prevent pregnancy. Douching is not necessary to keep a healthy vagina clean. In fact, commercial douches may harm the body’s natural cleansing mechanism by destroying bacteria that clean the vagina. 12. Once a person has had gonorrhea and been cured, she or he cannot get it again. FICTION – A person can get Gonorrhea as many times as she or he has oral, and anal or vaginal intercourse with an infected partner. It is very important for anyone who is treated for Gonorrhea (or any other sexually transmitted infection) to ensure that his or her sexual partners are also treated. 13. Condoms are not very effective in preventing pregnancy and STI’s. FICTION – Condoms are not 100% effective, but besides abstinence, they are the most effective way of preventing STI’s including HIV 14. Cancer of the testicles is more common among teenage males than among men over 35 years old. FACT – Cancer of the testicle is rare, but it usually occurs among teens and young adult men. The first sign is a lump on the testicle that can easily be detected through testicular self- 139 examination. All boys should feel their testicles on a regular basis after a bath or shower when the scrotum is relaxed. If they feel any unusual lumps or irregularities, they should consult a health practitioner. If detected early, this is very treatable form of cancer. 15. Teenagers can be treated for STI’s without their parents’ permission. FACT – Teenagers, protected by the law, can be tested or treated for an STI’s without parental permission. 16. A woman is temporarily infertile while she is nursing a baby. FICTION – Some women who breast feed regularly, without supplementing their babies’ feedings with formula, may not ovulate during that time, and therefore will not become pregnant again until after they stop nursing. That is not true, however, for all, or even most, nursing women. Breast feeding cannot be relied on for pregnancy prevention. 17. All boys have wet dreams during puberty. FICTION – Some boys do not have wet dreams at all, and that is normal for them. Wet dreams occur only as necessary to release excess sperm. Many males who have regular ejaculations through masturbation or sexual intercourse will not have wet dreams. 18. Males need to have sex to keep good health. FICTION – It is normal and healthy or both males and females to have sexual feelings and a desire to express them, but neither males nor females need to have sex to be healthy. 19. Alcohol makes it easier for people to get sexually aroused. FICTION – Actually, alcohol has the opposite effect. Alcohol is a depressant: it decreases the flow of blood to the genital area, making it more difficult for males to have an erection and more difficult for males and females to experience orgasm. These drugs may reduce a person’s inhibitions (“hang ups”) and make an individual feel more free to have sex, but they can also reduce sexual performance, More importantly, they can make people feel like it is okay to do things they would not ordinarily do sexually, such as have intercourse or not protect against pregnancy, STI’s and HIV. 20. A woman can always calculate the “safe time during her menstrual cycle when she can have vaginal intercourse and be protected from pregnancy. FICTION – There is no time during a woman’s cycle when she is absolutely safe from pregnancy. Even if she is monitoring her cycle for signs of ovulation, she cannot be certain she will not get pregnant during unprotected intercourse. 21. There is no known cure for herpes. FACT – Herpes is a virus that can cause painful sores on the mouth, genitals or anus and other parts of the body. Once contracted, it cannot be cured. Women with herpes may have a greater risk of developing cancer of the cervix, so they should have an annual Pap smear. Herpes in pregnant women can also cause their infants to become infected with the virus which may result in brain damage or the death of the infant. Women who have herpes must 140 not deliver a child vaginally. If any herpes lesions or sores are on the genitals or in the birth canal at the time of delivery, the baby’s sight might be affected. 22. Having a sexual experience with someone of the same sex means you are lesbian or gay. FICTION – Having a same-sex experience does not mean a person is a homosexual. In the USA, almost half of all men and one fourth of all women report having had same-sex experience at least once in their life time, mainly during childhood or adolescence. Many young people have a sexual experience with a close friend or peer of the same sex, as a way of exploring their sexuality. What determines that someone is gay, lesbian or bisexual is their feelings not a one off sexual encounter. Gay men and lesbians feel primarily attracted to, and become romantically involved with, people of their same sex, bisexuals feel strongly attracted to people of both sexes (although they may prefer one over the other). 23. Once a man gets aroused and has an erection, he must ejaculate to avoid harmful effects. FICTION – There is no harm if a man does not ejaculate after he gets an erection: semen does not get backed up in his testicles and cause infection or disease. A man may feel some discomfort and heaviness in his testicles if he is sexually excited for a long period of time without ejaculating. Some people call this condition “blue balls.” The feelings will disappear once he stops the sexually stimulating activity. 24. A woman can get pregnant even if a man doesn’t ejaculate inside her vagina. FACT – If a man ejaculates near the opening to a woman’s vagina or touches her vulva while he has semen on his fingers, it is possible for sperm to find their way inside and fertilize an ovum. Women have become pregnant without ever actually having vaginal intercourse. 25. If a penis or a woman’s breasts are touched a lot, it will become permanently larger. FICTION – Genes from both parents determine a person’s physical characteristics, including size, eye colour, body type, overall adult height and so on. No amount of touching will affect the size of a man’s penis (or a woman’s breast). 26. Normal adolescents do not masturbate once they become sexually active. FICTION –Masturbation, or touching and stimulating the genitals, is a normal sexual behaviour that occurs in males and females of all ages. Masturbation is a common means of achieving sexual pleasure and release of pent up sexual feelings. Masturbation is not physically harmful and it is a safe way to express sexuality without risking pregnancy or disease. People whose family, religion or culture teaches that masturbation is wrong may feel guilty if they masturbate. 27. Women should begin having pelvic exams in their late teen years. FACT – When a woman reaches her late teen years, she should have a pelvic exam once a year to make sure her genitals and reproductive organs are healthy. She does not need to wait until she begins having intercourse to have an exam, but she should certainly have one once she begins to have sexual intercourse. 141 28. Woman with a heavy discharge from her vagina probably has a sexually transmitted disease. FICTION – All women and girls who have reached puberty have a normal virginal discharge that is part of the vagina’s natural way of cleansing itself. The amount of discharge varies at different times in a woman’s menstrual cycle and from woman to woman. It is usually heaviest around the time of ovulation. If the discharge starts to itch or burn, or has a different colour or odour than usual, that may be a sign of a common vaginal infection or of an STD. In either case, the woman should consult a health practitioner. 29. In a homosexual relationship, one person usually takes the male role and the other takes the female role. FICTION – In a homosexual relationship today, traditional male and female roles are not necessarily played out. 30. Many women experience severe menstrual cramps. FACT – Most doctors believe they are caused by hormones called Prostaglandins, which cause the uterus to contract. When women have very strong contractions during their periods, some experience painful cramps. Other women report no cramping during their periods, or only minor discomfort. 31. “Crack” cocaine is the only drug that affects an unborn baby’s health after the first three or four months of pregnancy. FICTION – While crack cocaine certainly affects the fetus’ health, there are other substances that are also harmful to the unborn baby in the mother’s womb. Many newborns suffer brain damage as a result of Fetal Alcohol Syndrome acquired because their mothers drank alcohol during pregnancy. Women who smoke while they are pregnant directly affect the health of the unborn child. Smoking increases a woman’s risk of miscarriage and stillbirth and a baby’s risk of experiencing abnormally low birth weight. 32. In males, one testicle usually hangs slightly lower than the other. FACT – All bodies are uneven – one hand or foot is usually larger. One of a woman’s breasts is usually slightly larger, as well. One testicle hangs slightly lower than the other. This is completely normal and eliminates the likelihood of chafing which would occur if testicles rubbed together when a man walks. 33. A woman will always bleed and feel pain when she has vaginal intercourse for the first time. FICTION – Most women have a hymen, a thin membrane that partially covers the vaginal entrance just inside the opening. Hymens vary in size and thickness and some women are not born with one at all. Many hymens are torn or stretched during normal physical activity. A small amount of bleeding may occur during first vaginal intercourse if a woman’s hymen has never been stretched or torn. If her partner is gentle and they are both ready for lovemaking, there will usually be little or no pain during first intercourse. 142 34. In some cultures, girls’ genitals are mutilated in order to keep them from having sexual vaginal intercourse before marriage. FACT – In some African and Middle Eastern cultures, girls have their clitoris and or their labia removed at birth, during childhood or at puberty. This procedure is meant to prevent young girls from being sexually stimulated and having intercourse or becoming pregnant outside of marriage. Infection and scarring often result. With the clitoris gone, these women will not experience normal pleasure from sex. Female genital mutilation has been declared illegal in many countries, but the tradition continues. Millions of women in Africa are affected and some immigrants continue to practice it in Europe and the United States. 35. Anal intercourse is a safe way for a woman to avoid pregnancy and STI’s. FICTION – This is a particularly dangerous myth, since engaging in anal intercourse is one of the easiest ways to spread HIV infection and some other STI’s. The anus is not as elastic as the vagina neither is it lubricated, it therefore can tear more easily than the vagina. This means that viruses and bacteria can be transmitted directly into the blood through the anus than through the vagina. In addition, it is possible for a woman to become pregnant from anal sex if semen from ejaculation seeps out onto the vulva and moves into the vagina. 36. Men who rape are more likely to rape strangers than persons whom they know. FICTION – Over half of all reported rape cases in Jamaica and the USA are committed by men known to the women; an acquaintance, a friend, a relative or a date. Many people believe that most rape cases happen in deserted alleys or wooded areas when in fact half of the rape incidences occur in the woman’s home. No matter what a woman says or does to make a person think it is okay to have sex with her, once she says, “stop,” and the person forces her anyway, it is considered a rape event. 37. A man who has had a vasectomy no longer ejaculates during intercourse. FICTION – Semen, the fluid ejaculated out of the penis when a man has an orgasm, consists of sperm cells and fluids from several glands in the male reproductive system. When a man has a vasectomy, his vas deferens is removed so that sperm cells can no longer travel from his testicles out through the penis. All of the glandular fluids, however, continue to be recreated and they make up most of the semen that is ejaculated during orgasm. Neither the man nor his partner will notice a difference in the amount of ejaculate after a vasectomy. Adapted from the Life Planning Education, Advocates for Youth, Washington, DC 143 7.11 Health and Hygiene Matching Game (Answers on page 146) Main Concepts Numbered Match the Linking Statements 1 – 15 linking statement to the concept 1. Masturbation 1. May help to prevent acne by eliminating blackheads 2. Using Tampons 2. Is necessary even with regular bathing 3. Wearing an athletic supporter 3. Can help to eliminate “jock itch” 4. Breast self-examination 4. A normal healthy way to relieve sexual tension 5. Using deodorant 5. Important for sexual and reproductive health 6. Douching 6. Cleans the genitals daily and keeps them odour free 7. Washing the groin with an 7. Masks the normal odour associated with antidandruff shampoo healthy genitals 8. Avoiding vaginal infections 8. Protects and supports the penis and testicles 9. Using feminine hygiene sprays 9. May destroy natural bacteria that keep the vagina clean 10. Frequent bathing 10. Protects you and a partner from further infection 11. Using an appropriate facial 11. Can detect small lumps that could develop cleanser into cancer 12. Circumcision 12. Does not affect sexual or reproductive health 13. Applying a hot water bottle or 13. Can cause toxic shock syndrome (TSS) if heating pad to abdomen left too long 14. Being tested and treated for 14. Depends on diet, clothing, bathing, other STIs health behaviours as well as sexual behaviours 15. Having a regular pelvic 15. May eliminate menstrual cramps examination 144 7.12 Sexuality Quiz (Responses on page 147) This quiz may be used for stimulating discussion about feelings Instructions: Circle the response that best represents your own feelings 1. When I think about how things are between me and my parent or parents, I feel: a. really good – things are just fine b. just okay – things are not great, but not bad either c. pretty bad d. miserable – it couldn’t get much worse. 2. Now that I’m older, I seem to feel a lot more ______________ than I used to: a. confident b. angry c. depressed d. happy 3. When I think about my best friend or friends I feel: a. fearful that our friendship may not last forever b. really good that I have someone with whom I can share pleasant moments c. jealous of other people they hang out with d. angry that I am not also that person’s best friend 4. I get the feeling that my older sibling a. feels he/she is more important than I am b. is jealous of my accomplishments c. would like to have sexual intercourse with me d. sets a good example for me to follow 5. When I think about going out with someone I really like, I feel: a. excited b. nervous c. turned on d. scared 6. One of the most powerful feelings I have ever experienced is: a. fear b. anger c. love d. joy e. excitement 145 7.13 Health and Hygiene Game Answers Main Concepts Numbered Match the Linking Statements 1 - 15 linking statement to the concept 1. Masturbation 4 1. May help to prevent acne by eliminating blackheads 2. Using Tampons 13 2. Is necessary even with regular bathing 3. Wearing an athletic supporter 8 3. Can help to eliminate “jock itch” 4. Breast self-examination 11 4. A normal healthy way to relieve sexual tension 5. Using deodorant 2 5. Important for sexual and reproductive health 6. Douching 9 6. Cleans the genitals daily and keeps them odour free 7. Washing the groin with an 3 7. Masks the normal odour associated with antidandruff shampoo healthy genitals 8. Avoiding vaginal infections 14 8. Protects and supports the penis and testicles 9. Using feminine hygiene sprays 7 9. May destroy natural bacteria that keep the vagina clean 10. Frequent bathing 6 10. Protects you and a partner from further infection 11. Using an appropriate facial 1 11. Can detect small lumps that could develop cleanser into cancer 12. Circumcision 12 12. Does not affect sexual or reproductive health 13. Applying a hot water bottle or 15 13. Can cause toxic shock syndrome (TSS) if heating pad to abdomen left too long 14. Being tested and treated for 10 14. Depends on diet, clothing, bathing, other STIs health behaviours as well as sexual behaviours 15. Having a regular pelvic 5 15. May eliminate menstrual cramps examination 146 7.14 Using the Sexuality Quiz This quiz may be used for stimulating discussion about feelings Persons were asked to circle the response that best represents their own feelings for each question. The most ideal answers are given below. The teacher must recognize however that there are no right and wrong answers. Whichever answer the children give should be used as discussion points to bring about awareness in the children that they have a right to feel in different ways about different situations. Help them to adopt coping skills in dealing with the negative feelings. 1. When I think about how things are between me and my parent or parents, I feel: (a) a. real good – things are just fine b. just okay – things are not great, but not bad either c. pretty bad d. miserable – it couldn’t get much worse 2. Now that I’m older, I seem to feel a lot more ______________ than I used to(a) a. confident b. angry c. depressed d. happy 3. When I think about my best friend or friends I feel: (b) a. fearful that our friendship may not last forever b. really good that I have someone with whom I can share pleasant moments c. jealous of other people they hang out with d. angry that I am not also that person’s best friend 4. I get the feeling that my older sibling (d) a. feels he/she is more important than I am b. is jealous of my accomplishments c. would like to have sexual intercourse with me d. sets a good example for me to follow 5. When I think about going out with someone I really like, I feel: (a) a. excited b. nervous c. turned on d. scared 6. One of the most powerful feelings I have ever experienced is: (anyone is equally acceptable) a. fear b. anger c. love d. joy e. excitement 147 7.15 Gender and Sexuality Gender, is a socially defined construct influenced by myriad forces including history, culture, religion and economics. Male and female identities are partially created in the process of socialization. “Strict gender roles are internalized, and boys learn to divorce themselves from qualities they identify as feminine – passivity, weakness, nurturing, dependence and sensitivity Male-defined traits include assertiveness, aggressiveness, ruggedness, toughness, decisiveness, inventiveness, risk-taking, confrontation, conquest seeking, ruthlessness and having a killer instinct.” (H. Gayle Male Survivability in Jamaica chp 3 pg) Traditional Gender Roles in the Caribbean: 1. Primary role as provider- men are seen as the ones who should be responsible for the economic livelihood of their families. This is regardless of the employment status of the woman, as financial provision is not her designated role. The man is not seen as a man if he cannot provide financially for his children and offer protection from external harmful forces. 2. Scriptural authority for family head – Men view it has God’s will that they should be the heads of their families. This view is also shared by women who feel that when they happen to be head of households, it is not by their choice but because they are forced to do so.” 3. Sexuality/sexual identity – the male exhibits his manhood through sexual exploits and the higher the number of women with whom he is involved sexually, the greater his achievement. He provides evidence of this through the number of offspring he produces. 4. Male/female fidelity – Men and women have different views towards fidelity. Men often see it as a need for them to have multiple partners while women view it as an ‘economic necessity’. Men, however, view female infidelity as ‘unacceptable’ and ‘punishable’. Due to the social realities, social codes have evolved to dictate the protocol for women who share a man, and refer to financial as well as behavioural rules that are intended to protect the primary (especially common- law or married) partner and inside children above other parties and families. Changing Roles of women in society 1. In the Caribbean today there are numerous changes taking place within the family structures. Women have greater choice whether to be a housewife and mother or to have a career, or both because of greater educational and employment opportunities 2. Recent forces such as globalization, cultural differences and women’s liberation movements have challenged the male’s authority within the home and have led to power struggles between men and women. 3. The changing role of women affects the role of men. This has resulted in men feeling alienated or marginalized in the family Leo-Rhynie (1993) highlighted very well one key implication of the power embodied in the definition of manhood, given the major changes within the Caribbean in terms of gender over the past three decades: 148 “The man is, however, the symbolic authority figure in the home, but due to the prevalence of matrifocality, in reality it is the woman who is the head of the household. The woman however, shows deference to the man on the basis of her expectations of economic support, and the deference shown to the man in the home is eventually based on his ability to provide for his family economically.” The issue of reproductive health has become a dominant area of discussion as it relates not only to male influence on female health and childbearing but its impact on male participation in the reproductive process, and how their related involvement impacts on their own definition of sexuality, identity, and gender roles. 7.16 Impact and Influence of the Media on Children and Adolescents According to the American Academy of Pediatrics (AAP), "Children are influenced by media–they learn by observing, imitating, and making behaviors their own" (2001, p.1224). The influence of media on children has been the subject of increased attention among parents, educators, and health care professionals. Media influence on children has steadily increased as new and more sophisticated types of media have been developed and made available. Availability, as well as greater affordability, has provided easier access to media for children. Beneficial effects include: • early readiness for learning • educational enrichment • opportunities to view or participate in discussions of social issues • exposure to the arts through music and performance • entertainment. Harmful effects may result from: • sensationalization of violent behavior • exposure to subtle or explicit sexual content • promotion of unrealistic body images • presentation of poor health habits as desirable practices • exposure to persuasive advertising targeting children. Violence in interactive media forms (Internet, computer and video games) as opposed to passive media forms (television, movies, videos) may have even stronger effects on children and, as a result, has become a focus of new research. According to the Office of the Surgeon General USA, "children are theoretically more susceptible to behavioral influences when they are active participants than when they are observers." However some research has already shown that passive media violence has significant influence on children, the implications of increased effects from interactive media are troublesome. 149 Despite the research reports, there was debate between television broadcasters and scientists regarding the harmful effects of television violence on children. Broadcasters asserted that there was not enough evidence to link viewing television violence to children's aggressive behavior. . Domains of Influence Violence and aggressive behavior. The question of violence in the media and its influence on children is probably the most widely researched domain of media influence. Studies over a span of three decades, beginning in the early 1970s, have shown that significant exposure to media violence increases the risk of aggressive behavior in certain children and adolescents. Other effects on children include desensitization to others' pain and suffering and the tendency to be fearful of the world around them, viewing it as a dangerous place. Research has also shown that news reports of violent crimes can traumatize young children. Sexual content. Increased attention has been given to the second domain, sexual content in the media. The sexualization of the media has become the focus of widespread discussion and criticism by children's advocates. Research in Jamaica by Forbes, De Bruin and the women’s media watch show that adolescents spend a considerable amount of time watching television and especially music videos. It is clear that this exposure influences their concepts of love sex, male female relationships and sexual behaviour. They found that such exposure affected adolescents' moral judgment. They qualified the results, however, by saying that parental discussion and clear of personal values mitigated the effects on adolescents. Body image and self-esteem. The third domain, body image and self-esteem, is widely affected by advertising in the media. Researchers have suggested that media may influence the development of self-esteem in adolescents through messages about body image. Television, movies, magazines, and advertisements present images that promote unrealistic expectations of beauty, body weight, and acceptable physical appearance. Efforts to sell an image that adheres to certain standards of body weight and size may be a catalyst for eating disorders suffered by some adolescents. And, when adolescents fall short of their own expectations based on media images, self-esteem can suffer. Media theorists and researchers have determined that the effects of this trend are being seen in both boys and girls, with negative psychological affects. Advertisement of appealing, but often financially unaffordable, clothing and promotion of negative gender stereotypes are other areas of concern. Further research on the connections among media messages, body image, and self-esteem is warranted. Physical health and school performance. The fourth domain involves the amount of time that children spend engaged with media activities. The Jamaican All- Media survey (2002) done island-wide show that adolescents contributed the largest percentage of the overall television audience comprising 22.5%. In addition 20.5% of radio listeners are adolescents and an estimated 60% of the Jamaican population has access to computers. Additional time is often spent watching movies, listening to music, watching music videos, playing video or computer games, or spending computer time on the Internet. This increase in time spent by children using media for recreation has been shown to be a significant factor in childhood obesity due to associated physical inactivity. School achievement may also be affected as a result of decreased time spent on homework or school 150 assignments. And parents often unintentionally contribute to this negative influence by using the television as a way to occupy their children's attention–as a babysitter of sorts. Educators have expressed concerns that the passive nature of media exposure undermines the ability of students to be active learners. Conversely, there have been concerns that overstimulation due to excessive media use might be related to attention deficit disorder or hyperactivity. There has been no research to date that indicates a clear relationship. Increasingly, tobacco, alcohol, and illicit drugs have been glamorized in the media. Tobacco manufacturers spend $6 billion per year and alcohol manufacturers $2 billion per year in advertising that appeals to children. Movies and television programs often show the lead character or likeable characters using and enjoying tobacco and alcohol products. On the other hand, media also provide factual information and venues for discussion, typically through public service announcements or through public programming, informing children and warning them of the dangers of addictions to these substances. Results in the Jamaica Reproductive Health Survey (2002) show that after school the media rated second in adolescent sources of healthy lifestyle information. These educational messages, however, are on a much smaller scale and are much less appealing in their presentation. 151 CHAPTER EIGHT HIV and AIDS Education Let’s Think about HIV/AIDS Stigma & Discrimination hurts all of us. Help yourself. Fight Discrimination. Fight AIDS. 152 8.1 HIV/AIDS QUIZ (answers on page 181) Instructions: Have participants circle the correct answer to each statement. Give the correct answers at the end of the quiz. Randomly ask some trainees to explain why a particular answer is the correct one and why some of the others could not be accurate. 1. Does HIV only affect homosexuals? a. Yes b. No c. Only gays d. Only lesbians 2. How can you tell if somebody has HIV or AIDS? a. Because of the way they act b. They look tired and ill c. You cannot tell 3. Can you get HIV from sharing the cup of an infected person? a. No b. Yes c. Only if you don’t wash the cup 4. Which protects you most against HIV infection? a. Contraceptive pills b. Condoms c. Spermicidal jelly 5. What are the specific symptoms of AIDS? a. A rash from head to toe b. You start to look very tired c. There are no specific symptoms of AIDS 6. HIV is a… a. Virus b. Bacteria c. Fungus 7. Can insects transmit HIV? a. Yes b. No c. Only mosquitoes 8. When is World AIDS day held? a. 1st January b. 1st June c. 1st December 9. Is there a cure for AIDS? a. Yes b. Drinking hot coffee in a cold bath c. No 153 10. Is there a difference between HIV and AIDS? a. Yes b. No c. Not very much 11. Worldwide, what is the age range most infected with HIV? a. 0 – 14 years b. 15 – 24 years c. 25 – 34 years 12. Is it possible for a woman infected with HIV to prevent herself from having an infected baby? a. Yes b. No c. Only if she takes a special drug 13. How many sizes do condoms come in? a. One b. Regular and large c. Many different sizes 14. How effective are condoms in preventing pregnancy and STI’s? a. Barely effective b. 100% effective c. Mostly effective 15. Teenagers … a. Are protected by law to be tested for STI’s without their parents permission b. Can be treated for STI’s without their parents’ permission c. Are allowed to purchase contraception without their parents’ permission d. All of the above 16. Anal intercourse.. a. Can cause a woman to become pregnant since semen can seep into the vulva and move into the vagina b. Is one of the easiest ways to spread HIV infection and other STI’s c. Allows for viruses and bacteria to be transmitted directly into the blood through the anus d. All of the above 154 9.2 Global, Regional and National HIV/AIDS Statistics Global summary of the AIDS epidemic, December 2007 Number of people living Total 33 million [30 – 36 million] with HIV in 2007 Adults 30.8 million [28.2 – 34.0 million] Women 15.5 million [14.2 – 16.9 million] Children under 15 years 2.0 million [1.9 – 2.3 million] People newly infected Total 2.7 million [2.2 – 3.2 million] with HIV in 2007 Adults 2.3 million [1.9 – 2.8 million] Children under 15 years 370 000 [330 000 – 410 000] AIDS deaths Total 2.0 million [1.8 – 2.3 million] in 2007 Adults 1.8 million [1.6 – 2.1 million] Children under 15 years 270 000 [250 000 – 290 000] July 2008 e 1 Source: www.unaids.org Adults and children estimated to be living with HIV, 2007 Western & Eastern Europe Central Europe & Central Asia North America 730 000 1.5 million 1.2 million [580 000 – 1.0 million] [1.1 – 1.9 million] East Asia [760 000 – 2.0 million] 740 000 Middle East & North Africa [480 000 – 1.1 million] Caribbean 380 000 230 000 [280 000 – 510 000] South & South-East Asia [210 000 – 270 000] 4.2 million Sub-Saharan Africa [3.5 – 5.3 million] Latin America 22.0 million Oceania 1.7 million [20.5 – 23.6 million] 74 000 [1.5 – 2.1 million] [66 000 – 93 000] Total: 33 million (30 – 36 million) July 2008 e 4 Source: www.unaids.org 155 Estimated number of adults and children newly infected with HIV, 2007 Western & Eastern Europe Central Europe & Central Asia North America 27 000 110 000 54 000 [14 000 – 49 000] [67 000 – 180 000] East Asia [9600 – 130 000] 52 000 Middle East & North Africa [29 000 – 84 000] Caribbean 40 000 20 000 [20 000 – 66 000] South & South-East Asia [16 000 – 25 000] 330 000 Sub-Saharan Africa [150 000 – 590 000] Latin America 1.9 million Oceania 140 000 [1.6 – 2.1 million] 13 000 [88 000 – 190 000] [12 000 – 15 000] Total: 2.7 million (2.2 – 3.2 million) July 2008 e 5 Source: www.unaids.org Estimated adult and child deaths from AIDS, 2007 Western & Eastern Europe Central Europe & Central Asia North America 8000 58 000 23 000 [4800 – 17 000] [41 000 – 88 000] East Asia [9100 – 55 000] 40 000 Middle East & North Africa [24 000 – 63 000] Caribbean 27 000 14 000 [20 000 – 35 000] South & South-East Asia [11 000 – 16 000] 340 000 Sub-Saharan Africa [230 000 – 450 000] Latin America 1.5 million Oceania 63 000 [1.3 – 1.7 million] 1000 [49 000 – 98 000] [<1000 – 1400] Total: 2.0 million (1.8 – 2.3 million) July 2008 e 6 Source: www.unaids.org 156 HIV/AIDS in the Caribbean 2007  The second highest HIV prevalence rate in the world after sub-Saharan Africa. The leading cause of death among persons aged 15-44 years. An estimated 330,000 persons living with HIV/AIDS 22,000 are children < 15 years An estimated 27,000 became infected in 2006 For current international and regional statistics on HIV & AIDS go to the UNAIDS website: www.unaids.org NB: Explanation of the term prevalence in the Glossary Page 185 157 9.3 Source: National HIV/STI Programme 158 Figure 1: Number of AIDS cases and deaths in Jamaica 1982-2007 Cases Deaths '82 '83 '84 '85 '86 '87 '88 '89 '90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 Cases 1 1 0 3 7 35 36 65 70 143 135 219 335 511 491 609 643 892 903 939 989 1070 1112 1344 1186 781 Deaths 0 1 1 0 9 18 21 40 37 105 108 146 200 269 243 393 375 549 617 588 692 650 665 514 432 320 Source: National HIV/STI Programme 159 N u m b e r o f C a s e s MINISTRY OF HEALTH NATIONAL HIV&STI PROGRAM JAMAICA HIV/AIDS EPIDEMIC UPDATE JANUARY- DECEMBER 2008 SUMMARY OF AIDS CASES BY 5-YEAR AGE GROUPS 1982 – JUNE 2008, JAMAICA Age Group Male Female Total 00 to 4 321 281 602 05 to 9 145 137 282 10 to 14 17 16 33 15 to 19 31 121 152 20 to 24 287 434 721 25 to 29 761 850 1611 30 to 34 1184 945 2129 35 to 39 1282 837 2119 40 to 44 1073 650 1723 45 to 49 817 439 1256 50 to 54 598 271 869 55 to 59 406 184 590 60 to 64 239 132 371 65 to 69 104 74 178 70 to 74 57 31 88 75 to 79 17 13 30 80 to 84 3 8 11 85 to 89 3 2 5 90 to 94 0 1 1 Unknown 80 42 122 Total 7425 5468 12893 Source: National HIV/STI Programme 160 AIDS Case Rates in Jamaica by Age and Sex (per 100,000 population) 1982 - 2006 1400 Male 1200 Female 1000 800 600 400 200 0 0 - 4 5 - 9 10 - 19 20 - 29 30 - 39 40 - 49 50 - 59 60 + Male 273.8 100.4 16.4 453.7 1192.1 1077 854.6 277.2 Female 248.1 98.6 45.6 517.9 806.9 573.4 403.9 146.3 Age Group AIDS definition includes advanced HIV disease in 2005 and 2006 Source: National HIV/STI Programme SUMMARY OF AIDS CASES BY PARISH 1982- 2006 Summary of AIDS Cases by Parish in Jamaica 1982-2001 (Rate per 100,000 Pop.) N W E S Hanover Trelawny St. Ann St. Mary Westmoreland Portland St. Elizabeth St. Catherine Manchester Clarendon St. Thomas AIDS/100,00 Pop. 85.1 - 95.5 95.5 - 149.7 149.7 - 203.5 203.5 - 217.1 217.1 - 552.6 From presentation by Professor Peter Figueroa Ministry of Health 2008 161 Rate per 100,000 pop. MINISTRY OF HEALTH NATIONAL HIV&STI PROGRAM JAMAICA HIV/AIDS EPIDEMIC UPDATE JANUARY- DECEMBER 2008 SUMMARY OF AIDS CASES BY PARISH IN JAMAICA (BY DATE OF REPORTING) Jan - June Jan - June 1982 – June RATE PER PARISH 2007 2008 2008 100,000 Population Cumulative Total KINGSTON & ST. ANDREW 124 147 5004 754.0 ST. THOMAS 4 2 223 237.5 PORTLAND 5 13 263 321.0 ST. MARY 3 7 366 321.4 ST. ANN 17 18 772 446.9 TRELAWNY 8 15 336 446.0 ST. JAMES 34 49 1968 1071.2 HANOVER 7 7 313 449.3 WESTMORELAND 39 28 696 481.9 ST. ELIZABETH 9 12 297 197.3 MANCHESTER 15 26 357 187.7 CLARENDON 20 12 489 199.1 ST. CATHERINE 38 36 1777 357.9 PARISH NOT KNOWN 1 1 20 n/a OVERSEAS ADDRESS 0 0 12 n/a TOTAL 324 373 12893 480.7 Source: National HIV/STI Programme Transmission of HIV • In Jamaica, HIV is primarily transmitted through sexual intercourse. Among all reported adult AIDS cases on whom data about sexual practices are available (76% of cases), heterosexual practice is reported by more than 90% of persons. • Among reported AIDS cases on whom risk data are available (73% of cases), the main risk factors fuelling the epidemic are multiple sex partners, history of STIs, crack/cocaine use, and sex with sex workers. No high risk behaviour was reported by 21% of reported AIDS cases and this may represent persons who report having one sex partner who was HIV infected by 162 another partner. For current local statistics on HIV & AIDS go the National HIV&AIDS programme website: www.jamaica-nap.org 8.4 HIV and AIDS Fact or Fiction (answers on page 181) Read these statements and have trainees stand under the “strongly agree” sign or strongly disagree” sign. 1. HIV is curable. 2. Having sex with a virgin can cure some STI’s including HIV. 3. You can get HIV from touching someone with the infection. 4. Mosquito bites cannot transmit HIV infection. 5. If someone gets sick a lot and looks weak and “puney, puney” very likely they have HIV infection. 6. No student should be denied access to a school place based on his or her HIV and AIDS status. 7. There should be no routine testing of students or teachers in Jamaican schools 8. Safe sex means using a condom every time you have sex. 9. Oral sex is not safe sex. 10. Only anal sex places the partner at risk of contracting HIV infection. 11. A person who is classified as a virgin cannot have HIV. 163 8.5 Frequently Asked Questions and Answers about HIV and AIDS? 1. What is HIV? HIV is the Human Immunodeficiency Virus that causes AIDS. HIV is found in the body fluids (particularly blood; semen, and vaginal secretions) of infected persons. It is believed that on average, people infected with HIV will develop AIDS between 5 – 10 years after infection. 2. What is AIDS? AIDS is Acquired Immune Deficiency Syndrome, results from HIV infection. HIV attacks the body’s immune system and over time renders it unable to fight other infections. AIDS is manifested by a number of symptoms, of which many, but not all, are visible. Even if the symptoms of AIDS subside for a while, the virus that causes them is still present and the infected person can still transmit the infection. At present there is no cure for AIDS, and until there is a cure, doctors expect that all people with AIDS will die from the infection. AIDS has become a worldwide epidemic. 3. How many types of HIV viruses are there? There are two main strains of HIV virus; the HIV-1 and the HIV-2. The main difference between the viruses is in the time between infection and the onset of AIDS and AIDS-related illnesses. Immunodeficiency (or a weakened immune system) develops more slowly and is milder in person with HIV-2. Persons with the HIV-1 are more infectious in the early stages of the virus than those with HIV-2. 4. How is HIV contracted? a. Through unprotected sexual contact (anal, oral, or vaginal intercourse) with an infected person. b. Through transfusions or treatments using infected blood products. Since 1985, the National Blood Transfusion Service has screened all blood for HIV and supply uncontaminated blood. c. Through use of skin-piercing instruments that have been in contact with infected blood/body fluids and have not been properly sterilized (needles, syringes, razor blades, circumcision instruments, etc.). d. By infants of infected mothers during pregnancy and childbirth, and, more rarely, from breast milk. HIV is NOT contracted through ordinary social contact, for example, shared clothing, dishes, food, kissing and hugging, shaking hands, toilet seats, insect bites, or touching or living with an infected person. 5. Can HIV be transmitted through kissing? There is no risk of HIV transmission if kissing involves lips to cheek, or cheek to cheek, unless there is open wound on the part of both persons. In the case of kissing during which saliva is exchanged from person to person, it is unlikely that HIV will be transmitted. Saliva contains very little of the virus and it is believed that as much as three quarts of saliva would be needed in order for one party to be infected by another. 6. Can HIV be transmitted through oral sex? 164 Yes. Even though oral sex is less risky than anal and vaginal sex, it is advisable to use a condom or dental dam. A dental dam is a rectangular sheet or latex used in dentistry or during sexual activities as a safe sex technique. 7. What are symptoms of HIV and AIDS? Persons infected with HIV are often asymptomatic; it can take an average of 5 – 10 years between infection and the onset of AIDS. Once AIDS begins to develop, however, symptoms may include: a. An unexplained loss of weight lasting at least one month, b. Diarrhea for several weeks. c. A white coating on the tongue. d. Enlarged or sore glands in the neck and/or armpits. e. A cough that persists for more than a month. f. Persistent fever. g. Discoloured areas on the skin. Since these symptoms also characterize other infections (a persistent cough may mean tuberculosis, diarrhea may mean an intestinal illness), tests for the presence of HIV and/or a test for the confirmation of AIDS is the surest way of determining if someone has HIV and AIDS. 8. Who is at risk? Given the modes of transmission of HIV, everyone is at risk. There are however behaviours and practices that increase the risk of HIV transmission and infection. The most common of these are: a. A person with multiple partners b. Sex workers and their partners c. Persons who engage in unsafe sexual intercourse d. Persons who have blood transfusions using infected blood products e. Persons who engage in body piercing using improperly sterilized implements f. Babies with infected mothers g. Married persons with unfaithful partners 9. Does the virus die after leaving the body? The overwhelming majority of viruses present in blood or secretions die within one half of an hour after leaving the body. The amount of time the virus lives outside of the body depends on the environment in which it is found (dry versus humid, warm versus cold, etc.). 10. What are the chances of an HIV antibody-positive mother having an HIV positive baby? Current statistics indicate that there is a 20-30 percent risk of an HIV positive woman having an HIV positive baby. However, this risk is reduced to less than 5% if the mother receives antiretroviral treatment either prior to delivery in the last three months of pregnancy or at the time of delivery. Pregnancy in an HIV woman can hasten the manifestation of AIDS. 165 11. Can an HIV-positive mother pass the virus to her baby through breast feeding? The breast milk of HIV-positive mothers sometimes contains small amounts of HIV. Although there have been some documented cases of HIV transmission through breast milk, the exact risk is still not known. In Jamaica, breast feeding of HIV positive mothers is not promoted. 12. How can you tell if a person is infected with HIV? You cannot tell if someone is infected with HIV by simply looking at them. This is because those infected with HIV may be asymptomatic until they develop AIDS. There are blood tests that can tell if someone has the HIV virus. The tests do not detect the virus itself but detect the antibodies that are produced by the body in response to the virus. The two main tests are: a. The ELISA (Enzyme-Linked Immuno Sorbent Assay) which takes between 4 to 6 hours and costs approximately US$2. b. The Western Blot test which confirms a positive ELISA test. If the tests are done correctly the results will give an accurate indication of the detection HIV antibodies. However, in some instances there can be false-positive readings as well as false-negative readings. The ELISA is not as specific to the HIV-2 virus as it is to the HIV-1 virus. 13. How long does it take for someone who is infected with HIV to develop HIV antibodies? The time period between the initial HIV infection and the development of antibodies can vary from six weeks to six months. On average, 95 percent of those infected with HIV develop the antibodies within three months and 98 percent produce them within six months. 14. Can AIDS be cured? No. there is currently no cure for AIDS. Treatment methods being used today, help to prolong the life of infected persons and or give them a better quality of life. These drugs include Azidothymidine (AZT) and Didanosine (DDI) and are part of antiretroviral therapy. 15. Is there a vaccine against AIDS? There is currently no vaccine available to prevent infection with HIV, although several are being tested. 16. How can AIDS and HIV infection be prevented? The way for adults to prevent HIV infection and AIDS is to avoid high-risk behaviours. a. Abstinence is the only way to be absolutely sure of not being sexually infected with HIV, if you are not already infected. b. Have only one, faithful sexual partner and remain faithful to her or him. If there is a chance that one or both has or have been exposed to the virus already, use a condom during sexual intercourse. c. Use latex condoms because they are the most effective way of preventing transmission during sexual intercourse. Unless one or either of the following applies: 166 i. You have been in a mutually faithful relationship for many years. ii. You or your partner has been tested for HIV at least six months after the last possible exposure. There is no guarantee that he or she doesn’t have HIV. Condoms are a wise choice for avoiding HIV infection, other STI’s and unwanted pregnancy. This will be so as long as they are correctly used. That is; their correct placement prior to sexual intercourse, of latex material, stored properly and have not exceeded their expiry date. d. Avoid sharing needles or using any skin-piercing instruments that have not been sterilized. e. If you need a blood transfusion, certify that the blood you will receive is free of HIV. 17. Is there any way women can protect themselves if a man does not want to use condoms? a. A woman should be as assertive as possible in insisting that her partner wears a condom. b. She should engage in negotiating condom use if he is reluctant. Negotiation means that each partner gets something in exchange for something. c. A female condom is now available, which offers good protection against HIV infection. 18. Is it necessary for a couple to use condoms if they are both infected with HIV? Yes. Partners who are both infected should use condoms every time they have sexual intercourse because: a. They may be infected with different strains of the virus b. More of the virus can be transmitted which may cause an earlier onset of AIDS 19. Does the risk of HIV infection increase if a person already has an STI? Yes. The person who has an ulcerative STI such as herpes, chancroid, and syphilis, is at much greater risk of transmitting or contracting HIV. The open sores provide a “portal” for HIV to enter the body. The same risk factors associated with the transmission of STI’s are present in sexual transmission of HIV. That is, unprotected sexual intercourse. 20. What advice can be given to people living with HIV? People who are infected or are ill with AIDS require special care, information, and counseling. In general they should be advised to: a. Protect themselves against further infection from STIs (including AIDS) and other illnesses and stresses to the immune system. b. Avoid passing the infection to others through unprotected sexual intercourse, or sharing of needles or razors, etc. c. Inform their partner (s) of their condition before initiating intercourse and use latex condoms d. Continue to enjoy loving and affectionate contact with partners, family members, and friends. e. Eat nourishing foods 167 f. Get plenty of rest g. Avoid pregnancy, both for the health of the HIV-infected woman and to avoid infecting a baby. If the person infected is a man, he should avoid passing the virus to a woman and subsequently to the unborn child. h. Seek psychological and/or Spiritual comfort through support groups, churches or additional counseling. Guidance Counselors and HFLE teachers can put persons living with HIV and AIDS in touch with a variety of community support systems and community support resources. Contributed by the National HIV/STD Control Programme, the Ministry of Health, Jamaica. 8.6 Definition and Description of HIV&AIDS HIV/AIDS – What is HIV? HIV/AIDS What is HIV? – a picture of HIV virus Found only in humans Transmitted between humans Preventable by humans Body lacks ability to fight off infections Type of germ Lives and reproduces in body cells HIV/AIDS – What is AIDS? – received, not inherited (does not run in families) – the system that protects the body from disease – a lack of – a group of diseases or infections 168 AIDS - Clinical Signs Clinical Signs of the final stages of the AIDS 1 2 5 Who Can Get HIV? Anybody having sex without a condom. People with more than 1 partner who don’t use a condom during sex People whose sex partner has sex with other partners without using a condom People who share IV drug needles that are not sterilized. People with 1 sex partner can also get HIV HIV progression Speed of progression depends on individuals HIV 3months 6months to infection later 10 years or more Window Antibodies period AIDSare produced =Test shows Illness a false negative like TB, Pneumonia, First sign Asymptomatic period Cancers (2-6weeks) etc. Look and feel healthy so people do not No symptom recognize any signs of HIV. or Flu-like But HIV can be transmitted to symptoms others. 169 How we cannot get HIV HIV cannot be passed on by the daily casual contact! Food Kissing Water fountains Hugging Utensils Talking Telephones Sneezing/coughing Bathrooms Looking Chairs Mosquito bites Beds Shaking hands How to Prevent from infection • A: Abstinence – 100% safe • B: Be faithful to an uninfected faithful partner • C: Condom every time • Do not share needles or razors • Apply “Universal Precautions” -Rubber gloves, goggles, plastic aprons are used to protect those who work in labs from accidents such as needle stick or spillage of blood and other body fluids. -General hygiene – wash hands etc -Proper disposal of contaminated wastes Treatment for HIV/AIDS • Anti-retroviral Drugs • Healthy lifestyle practices • Strong support system • There is No Cure for HIV/AIDS -That is why the prevention is important. 170 What you can do as parents. Do not get infected by HIV. = Please practice Safer Sex Protect your children from HIV infection = Please talk about HIV and AIDS with your children and watch them. Do not discriminate People living with HIV and AIDS. 8.7 Tips for Teaching about HIV and AIDS 1. Teaching young people about HIV infection and AIDS is likely to be professionally and personally challenging. Everyone has feelings and values about the concerns the AIDS epidemic raises. You may not be comfortable with some of the issues that participants raise, examine your discomfort against the importance of helping teens before deciding what material to cover. 2. Acknowledge the wide range of sexual experience in a classroom or group of young people. Some will be dating; others may not yet be interested in romantic relationships, some teenagers will have had vaginal, oral, and anal intercourse; some teens will have had same-sex experiences. Some teens may have good reason to believe that they have been exposed to HIV. Teens may have friends or relatives with AIDS; some will have parents whose behaviours place them at risk. 3. Many young people are afraid of AIDS. Many others have misconceptions about HIV and AIDS. These attitudes may keep them from protecting themselves. Reduce this fear by emphasizing that AIDS can be prevented, that not becoming infected is in their control. Teens can feel empowered by learning that they have the ability to practice behaviours that will prevent them from becoming infected. 4. Be prepared to deal with homophobia (negative and fearful attitudes about homosexuality). The AIDS epidemic has led to a rise in the incidence of violence against gays and lesbians and has the potential of increasing homophobia among teens. This represents an apparent need to want to blame someone for AIDS, but in so doing, it 171 obscures an accurate understanding of the problem. Be aware that some of the group – or their family members – may be gay, lesbian, bisexual or questioning their sexual orientation. The AIDS epidemic may especially affect these youth. Use this opportunity to help them contact local community resources. Additional discussion of these issues will help teens clarify their personal and family values. 5. One subtle, yet powerful, way to help teenagers consider delaying sexual intercourse is to change the language when discussing teenage sexual behaviour. Teens who are having intercourse are usually described as “sexually active.” With this terminology, however, the entire range of sexual behaviour, from fantasy to social interaction, from touch to intercourse, has been narrowed down to only one act. When speaking to teens about sexual behavior, the use of the term sexually active conveys the wrong message. Sexually active means the teen’s passage into adulthood. It is experiencing puberty and adopting the behaviours that are consistent with his or her gender given the cultural environment. Teens must not be made to feel that all such feelings and physical developments are negative. When what we mean to discuss is intercourse, say “vaginal, oral and anal intercourse.” Use “sexual behaviour” is a more general term that includes the range of sexual expression. Teenagers need explicit information about sexual behaviours that put people at risk of HIV infection. Since most teenagers experiment with some types of sexual behaviour, you can help teens understand which ones are safe and which ones place them at risk. 6. Avoid using the term, “intercourse” alone, without modifying it accurately with the terms vaginal, oral and anal. Make it clear that these behaviours by themselves do not create the risk of HIV infection, but engaging in these behaviours with a partner who is infected does. One must remember though that you can’t tell a person’s HIV and AIDS status by the way they look or behave or by what they profess or say and their level of education or success within the society. Many persons who have been infected with HIV or who have AIDS may not even be aware of it. You can help those teenagers to understand their risk of becoming infected and how to practice safer sex. Any type of sex between two uninfected partners is safe. asking your partner about AIDS is an unrealistic way to assess potential risk, especially for teenagers. Teenagers need to understand that it is impossible to tell if someone is infected just by looking at her or him or through intuitive powers. 7. Help teens understand that there are many ways to express sexual feelings – ways that do not risk unplanned pregnancy or sexually transmitted infection. These include touching, fantasizing, caressing, massaging and masturbating. Talking, kissing, whispering, hugging, singing, dancing and holding hands are also ways of showing and receiving affection from a partner. Abstinence from all types of sexual intercourse – vagina, oral, anal – is safe. 8. Strategies for abstinence are an important component of HIV and AIDS education. Teenagers need to know that intercourse is not necessary to give or receive pleasure. Young people need to learn to express affection not only through the involvement of the genitalia but through the wide variety of non-sexual avenues. Some of these may be involvement in sporting activities, attending cultural events such as a play or musical presentations, hiking, participating in activities related to clubs and societies, walking through the park together, reading together, etc. 172 9. Be realistic about the numbers of teens in the programme who are having sexual intercourse, in a group of 16 year olds, half are likely to be virgins and the other half are likely to be engaging in sexual intercourse. Those who engage in sexual behaviours need explicit information about how to protect themselves. 10. Teens need to know that most sexual activities can only be regarded as, “safer sex,”. This is so because even with precautions, only monogamy between two uninfected people or abstinence are 100 percent effective. Intercourse with condoms with an infected partner or a partner whose antibody status is unknown can only be considered “safer,” not fully “safe.” 11. Latex condoms have been proven to be an effective barrier of HIV. They can, however, break or leak, especially when not used correctly, Although condoms are not 100 percent effective against the spread of HIV or for preventing pregnancy, they offer the best protection during intercourse with a partner whose antibody status is unknown. Condoms lubricated with monoxynol-9 may provide additional protection. Many of the problems associated with condoms have to do with incorrect use. 12. When teaching teens about HIV and AIDS, there will be many opportunities for reassessing your personal beliefs and values. Explore your own feelings and seek the support of another youth leader if necessary. 13. If you are not comfortable speaking directly about these matters of sexual activity and HIV and AIDS, seek help from among the resource persons within your school and community. The school’s guidance counselor is the first line support resource to address these issues with the children as well as with other teachers and administrators within the school. Other persons may be the HPEO’s (education officers, health promotion), guidance officers, regional directors, etc. attached to your geographical region or area within the community. This section of the HFLE Training Manual has a variety of resource materials that can be used in parts for different purposes as you prepare yourself and the school community to deal adequately with the issues. 173 8.8 Stigma and Discrimination against Persons Living With HIV and AIDS (PLWA) From the moment scientists identified AIDS, social responses of fear, denial, stigma and discrimination have accompanied the epidemic. Discrimination has spread rapidly, fuelling anxiety and prejudice against particular groups that are affected, as well as those living with HIV or AIDS. Individuals affected (or believed to be affected) by HIV have been rejected by their families, their loved ones and their communities. An HIV advertisement on national television in Jamaica showed the back of a child. Somehow that child’s identity was discovered and the discrimination by students, teachers and other parents became unbearable for the child, he had to be removed from that school by personnel from the Ministry of Education. Ainsley who has been talking about his HIV infection in the public media has related his experience with a cashier at a famous supermarket. The cashier refused to accept the money from him as payment for his groceries. She told him to place the money on the scanner. She then used disinfected chamois to wipe the notes after which she took them up with paper towel. All this was done in plain view of Ainsley and the other shoppers waiting in line. Stigma is a powerful tool of social discrimination. While the societal rejection of certain social groups such as homosexuals, injecting drug users and sex workers may pre-date HIV/AIDS, the disease has, in many cases, reinforced this stigma. By blaming certain individuals or groups, society can excuse itself from the responsibility of caring for and looking after such populations. This is seen not only in the manner in which 'outsider' groups are often blamed for bringing HIV into a country, but also in how such groups are denied access to the services and treatment they need. 1. Why is there stigma related to HIV and AIDS? HIV/AIDS is often seen to bring shame upon the person infected, their family and/or the wider community. It is often associated with the social outcasts of society. Factors which contribute to HIV/AIDS-related stigma: • HIV and AIDS is a life-threatening illness • People are scared of contracting HIV • The disease is associated with socially unacceptable behaviours (homosexuality, drug addiction, promiscuity, and sex work). • People living with HIVandAIDS are often thought of as being responsible for becoming infected • Religious or moral beliefs lead some people to believe that having HIV and AIDS is the result of sin. Persons who have either therefore deserve to be punished. • HIV and AIDS as a crime (e.g. in relation to innocent and guilty victims) • HIVandAIDS as war (e.g. in relation to a virus which must be fought) • HIVandAIDS as horror (e.g. in which infected people are demonized and feared) “My foster son, Michael, aged 8, was born HIV-positive and diagnosed with AIDS at the age of 8 months. I took him into our family home, in a small village in the south-west of England. At first relations with the local school were wonderful and Michael thrived there. Only the head teacher and Michael's class teacher knew of his illness.” 174 “Then someone broke the confidentiality and told a parent that Michael had AIDS. That parent, of course, told all the others. This caused such panic and hostility that we were forced to move out of the area. The risk is to Michael and us, his family. Mob rule is dangerous. Ignorance about HIV means that people are frightened. And frightened people do not behave rationally. We could well be driven out of our home yet again.” - Debbie, speaking on national AIDS day 2. Employment Although there is little evidence of HIV being transmitted in the workplace, the supposed risk of transmission has been used by numerous employers to terminate or refuse employment. There is also evidence that if people living with HIVand AIDS are open about their infection status at work, they may well experience stigmatization and discrimination by their co-workers. “Nobody will come near me, eat with me in the canteen, nobody will want to work with me, I am an outcast here.” - HIV positive man, aged 27, Kingston, Jamaica. Pre-employment screening takes place in many Jamaican organizations, sometimes without the knowledge and consent of the job applicant. 3. Health Care There are various reports revealing the extent to which people are stigmatised and discriminated against by our health care systems. Discrimination may include the withholding of treatment, hospital staff refusing to treat patients, HIV testing without consent, lack of confidentiality, and denial of hospital facilities and medicines. Such responses are often fuelled by ignorance of HIV transmission routes. “There is an almost hysterical kind of fear … at all levels, starting from the humblest, the sweeper or the ward boy, up to the heads of departments, which makes them pathologically scared of having to deal with an HIV-positive patient. Wherever they have an HIV patient, the responses are shameful.” - A retired nurse from a public hospital. One factor fuelling stigma among doctors and nurses is the fear of exposure to HIV as a result of lack of protective equipment. Doctors were also reported to be frustrated with the lack of options for treating people with HIV and AIDS, who were seen as 'doomed' to die. Lack of confidentiality has been repeatedly mentioned as a particular problem in health care settings. Many people living with HIV and AIDS do not get to choose how, when and to whom to disclose their HIV status. 4. The Way Forward HIV-related stigma and discrimination remains an enormous barrier to effectively fighting the HIV and AIDS epidemic. Fear of discrimination often prevents people from seeking treatment for AIDS or from admitting their HIV status publicly. People with (or suspected of having) HIV may be turned away from healthcare services and employment, or refused entry to a foreign country. In some cases, they may be evicted from home by their families and rejected by their friends and 175 colleagues. The stigma attached to HIV and AIDS can extend into the next generation, placing an emotional burden on those left behind. Denial goes hand in hand with discrimination, with many people continuing to deny that HIV exists in their communities. Today, HIV and AIDS threatens the welfare and well being of people throughout the world. At the end of the year 2007, 33.2 million people were living with HIV and during the year 2.1 million died from AIDS-related illness. Combating stigma and discrimination against people who are affected by HIV and AIDS is as important as developing new medicines in the process of preventing and controlling the global epidemic. Many government and private sector entities continue to provide HIV and AIDS education to workers, students and community residents. The annual national HIV and AIDS day provides opportunities for persons to be given accurate and complete information about the disease; both from the perspective of prevention and the compassionate and respectful treatment of persons living with the disease. Stigma & Discrimination Discrimination: The Gleaner Feb 11th, 2005 To treat a person or a group differently in an unfair way Feb 16th, 2005 176 8.9 HIV IN SCHOOLS POLICY FRAMEWORK HIV Education is taught within the context of the National Policy for the Management of HIV and AIDS in schools. Below is a summary of the main tenets of the policy The Ministry of Education, Youth and Culture acknowledges the seriousness of the HIV and AIDS epidemic and, recognizing that international and local evidence suggests that there is a great deal that can be done to influence the course of the epidemic, is committed to minimizing the social, economic and developmental consequences of HIV and AIDS to the education system, and to providing leadership to implement an HIV and AIDS policy. This policy applies to all educational institutions that enroll students in one or more grades and at all levels. It will be reviewed within a five- year period to take into account any new developments in the methods of infection and treatment of persons with HIV and AIDS. In all instances, this policy should be interpreted to ensure respect for the rights and dignity of students and school personnel with HIV and AIDS, as well as all other members of the institution’s community. GOAL The goal of this policy is to promote effective prevention and care within the context of the educational system. STATEMENTS OF INTENT 1. Non- discrimination and Equality 1.1 No student or staff member with HIV and AIDS may be discriminated against directly or indirectly. Speculation or gossip concerning any person suspected of having HIV/AIDS must be discouraged. 1.2 Students and school personnel with HIV and AIDS should be treated in a just, humane and life-affirming way. 1.3 Any special measure in respect of a student or staff member with HIV should be fair and justifiable in light of medical facts; established legal procedures and principles; ethical guidelines; the best interest of persons with HIV and AIDS; institutional conditions; and the best interest of other students and school personnel. 1.4 To prevent discrimination, all students and school personnel should be educated about fundamental human rights as contained in the Constitution of Jamaica and the UN Convention on the Rights of the Child to which Jamaica is a signatory. 177 2. HIV&AIDS Testing, Admission and Appointment 2.1 No student may be denied admission to or continued attendance at an institution on account of his or her HIV and AIDS status or perceived HIV and AIDS status. 2.2 No staff member may be denied the right to be appointed in a post, or to be promoted on account of his or her HIV and AIDS status or perceived HIV and AIDS status. Nor shall HIV and AIDS status be a reason for dismissal, or for refusing to renew any staff member’s employment contract. 2.3 There is no medical justification for routine testing of students or educators for proof of HIV infection. The testing of students for HIV and AIDS as a prerequisite for admission to, or continued attendance at an educational institution, is prohibited. The testing of staff members for HIV and AIDS as a prerequisite for appointment or continued service is also unnecessary and prohibited. 3. Attendance at Institutions by Students with HIV&AIDS 3.1 Students with HIV have the right as any other to attend educational institutions. The needs of students with HIV and AIDS with regard to their right to basic education should as far as is reasonably practicable be accommodated in the school or institution. 3.2 Students with HIV and AIDS are expected to attend classes in accordance with statutory requirements of as long as they are able. 4. Disclosure and Confidentiality 4.1 No student (or parent on behalf of a student), or educator, is compelled to disclose his or her HIV and AIDS status to the institution or employer. 4.2 Voluntary disclosure of a student’s or educator’s HIV and AIDS status to the appropriate authority should be welcomes, and am enabling environment should be cultivated in order to facilitate this disclosure. Confidentiality of such information must be ensured. Confidentiality of such information must be ensured and any form of discrimination is prohibited. UNIVERSAL PRECAUTIONS 1.1 The basis for advocating the consistent application of universal precautions lies the assumption that in situations of potential exposure to blood or body fluids, all persons are potentially HIV-infected and all blood should be treated as such. All blood, open skin lesions, as well as all body fluids and excretions which could be strained or contaminated with blood (for example, tear, saliva, mucus, phlegm, urine, vomit, faeces and pus) should, therefore, be treated as potentially infectious. a. Blood, especially in large spills such as from nosebleeds, and old blood or bloodstains, should be handled with extreme caution. b. Skin exposed accidentally to blood should be washed immediately with soap and running water. 178 c. All bleeding wounds, sores, breaks in the skin, gazes and open skin lesions should ideally be cleaned immediately with running water and /or other antiseptics. d. If there is a biting or scratching incident where the skin is broken, the wound should be washed and cleaned under running water, dried, treated with antiseptic and covered with a waterproof dressing. e. Blood splashes to the face (mucous membranes of eyes, nose or mouth) should be flushed with running water for at least three minutes. Proper facilities should be made available for the disposal of infectious waste. 1.2 All open wounds, sores, breaks in the skin, grazes and open skin lesions should at all times be covered completely and securely with a non-porous or waterproof dressing or plaster so that there is no risk exposure to blood. 1.3 Cleaning and washing should always be done with running water and not in containers of water. Where running tap water is not available, containers should be used to pour water over the area to be cleaned. Schools without running water should keep a supply, e.g. in a 25-litre drum, on hand specifically for use in emergencies. This water can be kept fresh for a long period of time by adding bleach. 1.4 All persons attending to blood spills, open wounds, sores, breaks in the skin, grazes, open skin lesions, body fluids and excretions should wear protective latex gloves or plastic bags over their hands to effectively eliminate the risk of HIV transmission. Bleeding can be managed by compression with material that will absorb the blood, e.g. a towel. 1.5 if a surface has been contaminated with body fluids and excretions which could be strained or contaminated with blood (for instance, tears, saliva, mucus, phlegm, urine,vomit,feaces and pus), that surface should be cleaned with running water and fresh, clean household bleach (1:10 solution), and paper or disposable cloths. The person doing the cleaning must wear protective gloves or plastic bags. 1.6 Blood- contaminated material should be sealed in a plastic bag and incinerated. 1.7 Tissues and toilet paper can readily be flushed down a toilet. 1.8 If instruments (for instance scissors) become contaminated with blood or other body fluids, they should be washed and placed in a strong household bleach solution for at least one hour before drying and re- using. 1.9 Needles and syringes should not be re-used, but should be safely discarded. ------------------------------------------------------------------------------------------------------------ Source: National Policy for HIV/AIDS Management in Schools. Ministry of Education 179 8.10 Social Factors Driving the HIV&AIDS Epidemic Social Factors Driving the HIV/AIDS Epidemic in Jamaica Poverty Sexual practices Ignorance Prostitution/sex Discrimination work Stigmatization Homo/bisexuality Marginalization Substance abuse Migration Sexually Cultural myths & transmitted practices infections Gender imbalance Sex tourism Casual sex 8.11 Worksheet for negotiating sex – Persuading a partner to have sex 1. There is nothing to fear, I’ll be very careful. 2. The fact that I want to do it with you means that you are very special to me. I really care about you. 3. If you really loved me you would. 4. I haven’t got AIDS so you’ve no need to worry. 5. I’ve got some condoms now, so here’s no excuse not to. 6. Everyone else is doing it so what wrong with you? 7. I’ll buy you something nice if you let me do it. 8. I’m really turned on now – if we don’t go the whole way I’ll be in agony. 9. You can’t blame me if I find someone else. A man must have his wood cooled. 10. There are names for people like you who lead others on then leave them high and dry. 180 8.12 Answers to the HIV and AIDS Fact or Fiction Activity 1. HIV is curable. FICTION 2. Having sex with a virgin can cure some STI’s including HIV. FICTION 3. You can get HIV from touching someone with the infection. FICTION 4. Mosquito bites cannot transmit HIV infection. FACT 5. If someone gets sick a lot and looks week and “puney, puney” very likely they have HIV infection. FICTION 6. No student should be denied access to a school place based on his or her HIV/AIDS status. FACT 7. There should be no routine testing of students or teachers in Jamaican schools. FACT 8. Safe sex means using a condom every time you have sex. FACT 9. Oral sex is not safe sex. FACT 10. Only anal sex places the partner at risk of contracting HIV infection. FICTION 11. A person who is classified as a virgin cannot have HIV. FICTION 8.13 Answers to the HIV and AIDS Quiz 1. Does HIV only affect homosexuals? a. Yes b. No CORRECT c. Only gays d. Only lesbians 2. How can you tell if somebody has HIV or AIDS? a. Because of the way they act b. They look tired and ill c. You cannot tell CORRECT 3. Can you get HIV from sharing the cup of an infected person? a. No CORRECT b. Yes c. Only if you don’t wash the cup 4. Which protects you most against HIV infection? a. Contraceptive pills b. Condoms CORRECT c. Spermicidal jelly 5. What are the specific symptoms of AIDS? a. A rash from head to toe b. You start to look very tired c. There are no specific symptoms of AIDS CORRECT 6. HIV is a… a. virus CORRECT b. bacteria c. fungus 181 7. Can insects transmit HIV? a. Yes b. No CORRECT c. Only mosquitoes 8. When is World AIDS day held? a. 1st January b. 1st June c. 1st December CORRECT 9. Is there a cure for AIDS? a. Yes b. Drinking hot coffee in a cold bath c. No CORRECT 10. Is there a difference between HIV and AIDS? a. Yes CORRECT b. No c. Not very much 11. Worldwide, what is the age range most infected with HIV? a. 0 – 14 years b. 15 – 24 years CORRECT c. 25 – 34 years 12. Is it possible for a woman infected with HIV to prevent herself from having an infected baby? a. Yes b. No c. Only if she takes a special drug CORRECT 13. How many sizes do condoms come in? a. One b. Regular and large c. Many different sizes CORRECT 14. How effective are condoms in preventing pregnancy and STI’s? a. Barely effective b. 100% effective c. Mostly effective CORRECT 15. Teenagers … a. are protected by law to be tested for STI’s without their parents’ permission b. can be treated for STI’s without their parents’ permission c. are allowed to purchase contraception without their parents’ permission d. all of the above CORRECT 16. Anal intercourse: a. can cause a woman to become pregnant since semen can seep into the vulva and move into the vagina b. is one of the easiest ways to spread HIV infection and other STI’s 182 c. allows for viruses and bacteria to be transmitted directly into the blood through the anus d. all of the above CORRECT 183 8.14 CONDOMS The male condom A male condom is a soft tube made of latex rubber that is put on a man's erect penis before sexual intercourse. When the man ejaculates, the semen (which contains sperm) is caught in the tip of the condom. Because the sperm is collected in the condom, there is no contact between the man's and the woman's body fluids. This reduces the risk of pregnancy or being infected with an STI including HIV. Most condoms are made from latex. A few condoms are made from animal membrane; these do not protect you from STIs. Be sure that you use latex condoms. There are several brands of latex condoms on the market to choose from. Condoms can sometimes break or slip off, so it is very important to use them correctly, every time you have sexual intercourse. Correct condom use means: Using a new condom every time you have sex. Never use a condom more than once. Condoms are more likely to break if they are old or have not been stored in a cool place, so check the expiration date and do not use discoloured or damaged condoms. Opening the package carefully – teeth and fingernails can tear the condom. Putting on the condom as soon as the man has an erection and before there is any contact between the man’s and woman’s sex organs. Hold the very tip of the condom as you unroll it down the shaft of the penis, leaving space (but no air) at the tip of the condom. Avoiding the use of ‘vaseline’ and oil-based lubricants because they can weaken the condom. Withdrawing the penis (with the condom still on) immediately after ejaculation. Hold on to the condom firmly to keep it from slipping off. PINCH LEAVE AN INCH ROLL Some people think that condoms imply lack of trust, but actually they show trust, respect and caring since either person could have an STI or even be infected with HIV from a previous relationship without noticing any symptoms. It is in everyone's interest to use condoms as they offer protection to both partners. The Female Condom The female condom is a disposable sheath made from polyurethane that is specially designed to protect from pregnancy and STIs by lining the inside of the woman’s vagina. It comes pre- lubricated and is soft and comfortable to use. There is an inner ring inside the sheath which helps you to insert 184 the female condom as quickly and easily as a tampon. When you insert it, the outer ring which is the open end of the sheath will remain outside the body. During sexual intercourse the outer ring should always remain outside the vagina but will be pushed flat against the labia (lip area) so neither you nor your partner should be aware of it. Used according to these instructions, each time you have intercourse, a female condom is extremely effective. Research shows that the female condom is an effective barrier to sperm and sexually transmitted diseases, including HIV. (Adapted from: Sexual and Reproductive Health Teachinf aid for Guidance Counsellors A publication of the Women’s Centre foundation of Jamaica) 185 9.15 HIV/AIDS Glossary of Terms Terms Meanings AIDS Acquired Immune Deficiency Syndrome HIV Human Immunodeficiency Virus HIV Infection Infection with the human immunodeficiency virus, which may or may not cause illness opportunistic infections: infections that can only develop in a weakened AZT Zidovudine (trade name: Retrovir), a medicine that helps the body strengthen the immune system and might improve the life of a person with HIV infection Mutually Describes two people who only have sexual intercourse with each other monogamous Safer sex Describe sexual practices that attempts to prevent the exchange of blood, semen and vaginal fluids IV drug use Taking drugs for non-medical purposes by injecting them into a vein with a needle and syringe Heterosexuality Physical and romantic attraction to people of the other sex Homosexuality Physical and romantic attraction to people of the same sex Latex A kind of rubber used in making condoms Nonoxynol-9 Sometimes abbreviated as N-9. The chemical name for a common sperm-killing ingredient in contraceptive foam or jelly Asymptomatic Showing no outward sign of infection Confidential test When an HIV test taker gives a name, but the information is kept secret from anyone but the test taker Anonymous test When the test taker gives no name and the information is kept secret from anyone but the test taker Immune system The part of the body that kills germs and foreign cells Antibody A specialized cell found in blood that kills a specific germ Sero-positive When a blood test for HIV antibodies shows that there are antibodies in the blood PLWA Abbreviation for a Person Living With AIDS Condom A thin latex rubber covering for a penis used to prevent pregnancy and to protect from STI infections Spermicidal A cream, jelly or foam that works to kill sperms Prevalence Represents the burden of disease at a particular time. It is based on the total number of existing cases among the whole population and represents the probability that any one individual in the population is currently suffering from the disease 186 9.16 SEXUALLY TRANSMITTED INFECTIONS (STIS) • STIs are common and serious especially to women and newborns • STIs often show no signs in women (asymptomatic) • Effective case management is a cornerstone of control • STIs can be prevented by abstinence or safer sex practices What is Vaginal Discharge Syndrome? • Abnormal discharge coming from the womb (uterus), neck of the womb (cervix) or vagina • Abnormal means more than usual amount, or a change in colour (bloody, yellow, greenish) or smell (odour) Two conditions should be considered in women presenting with vaginal discharge are: Vaginitis and Cervicitis • Vaginitis – most common cause of abnormal vaginal discharge. • Cervicitis - more serious, often caused by gonorrhea or chlamydia, both of which may result in inflammation of the tubes or Pelvic Inflammatory Disease(PID), a serious complication. Causes of Abnormal Vaginal Discharge 1. Candidiasis (yeast, thrush) • Common after antibiotic treatment • May be worse or more often if woman has HIV • Common if douching 2. Trichomoniasis (Tric) • Very common • May help to cause PID, early breaking of head water or labour • May help spread HIV • Sex partner treatment needed 3. Bacterial vaginosis • Overgrowth of some normal germs in the vagina often due to “douching” • May help to cause PID, early breaking of head water or labour • May help spread HIV 4. Cervicitis: inflammation of the cervix (neck of the womb): – Gonorrhoea (GC, clap, dose ) – Chlamydia (much more common than GC) Gonorrhoea • Is caused by Neisseria gonorrhoeae, a bacterium that can grow and multiply easily in the warm, moist areas of the reproductive tract, including the cervix (opening to the womb), uterus (womb), and fallopian tubes (egg canals) in women, and in the urethra (urine canal) in women and men. • The bacterium can also grow in the mouth, throat, eyes, and anus. 187 Chlamydia • Is a common sexually transmitted disease (STi) caused by the bacterium, Chlamydia trachomatis, which can damage a woman's reproductive organs. • Even though symptoms of chlamydia are usually mild or absent, serious complications that cause irreversible damage, including infertility, can occur "silently" before a woman ever recognizes a problem. • Chlamydia also can cause discharge from the penis of an infected man. • About three quarters of infected women and about half of infected men have no symptoms. If symptoms do occur, they usually appear within 1 to 3 weeks after exposure. • In women, the bacteria initially infect the cervix and the urethra (urine canal). • Women who have symptoms might have an abnormal vaginal discharge or a burning sensation when urinating. • When the infection spreads from the cervix to the fallopian tubes (tubes that carry fertilized eggs from the ovaries to the uterus), some women still have no signs or symptoms; others have lower abdominal pain, low back pain, nausea, fever, pain during intercourse, or bleeding between menstrual periods. • Chlamydial infection of the cervix can spread to the rectum. • Men with signs or symptoms might have a discharge from their penis or a burning sensation when urinating. Men might also have burning and itching around the opening of the penis. Pain and swelling in the testicles are uncommon. Pelvic Inflammatory Disease (PID): Major Causes: • Gonorrhoea • Chlamydia • Trichomoniasis • Several anaerobic bacterial species found in the vagina For this reason, treatment involves antibiotics that can cover all these germs. Symptoms Suggestive of PID • Belly bottom pain (lower abdominal pain) • Pain on sex • Vaginal discharge • Irregular and/or heavy menstrual periods • Painful period • Burning when passing urine (dysuria) • Fever • Nausea and/or vomiting Complications of PID • About a quarter of women with PID has one or more complications • Infertile – tubes partially or fully blocked or malfunction • Pregnancy outside womb (ectopic pregnancy): 6-10 times more likely 188 • Chronic belly bottom (pelvic) pain (may be confused with acute PID) Many persons may be treated to cover PID because of these situations • Unprotected sex even with regular partner • Certain exposures put more risk • Partner has signs • History of problems with pregnancy • History of past STI Urethral Discharge Syndrome • Discharge coming from the penis opening (urethra) • May be frank pus, or clear • Occasionally discharge will be white in colour Genital Ulcer Diseases include: • Herpes simplex virus type 2 (HSV-2) • Syphilis • Chancroid • Trauma to the genitals e.g. – “hair cut”, zipper injury, other • Chancroid Ulcers Genital Herpes • Is caused by the herpes simplex viruses type 1 (HSV-1) or type 2 (HSV-2). Most genital herpes is caused by HSV-2. • HSV-1 can cause genital herpes, but it more commonly causes infections of the mouth and lips, so-called “fever blisters.” • HSV-1 infection of the genitals can be caused by oral-genital or genital-genital contact with a person who has HSV-1 infection. Genital HSV-1 outbreaks recur less regularly than genital HSV-2 outbreaks. • Most individuals have no or only minimal signs or symptoms from HSV-1 or HSV-2 infection. When signs do occur, they typically appear as one or more blisters on or around the genitals or rectum. • The blisters break, leaving tender ulcers (sores) that may take two to four weeks to heal the first time they occur. • Typically, another outbreak can appear weeks or months after the first, but it almost always is less severe and shorter than the first outbreak. Although the infection can stay in the body indefinitely, the number of outbreaks tends to decrease over a period of years. Syphilis • Is caused by the bacterium Treponema pallidum. It has often been called “the great imitator” because so many of the signs and symptoms are indistinguishable from those of other diseases. 189 • Has distinct early (primary, secondary, and early latent) and late (late latent and tertiary) stages over several years or decades, interspersed with periods of inactive (latent) infection. • Syphilis is passed from person to person through direct contact with a syphilis sore. Sores occur mainly on the external genitals, vagina, anus, or in the rectum. Sores also can occur on the lips and in the mouth. • Transmission of the organism occurs during vaginal, anal, or oral sex. • Pregnant women with the disease can pass it to the babies they are carrying. • Syphilis cannot be spread through contact with toilet seats, doorknobs, swimming pools, hot tubs, bathtubs, shared clothing, or eating utensils. • Incubation period: Usually 2 to 6 weeks Chancroid • Is a bacterial infection caused by the streptobacillus Haemophilus ducreyi. It is a disease found primarily in developing countries, associated with commercial sex workers and their clientele. • After an incubation period of one day to two weeks, chancroid begins with a small bump that becomes an ulcer within a day of its appearance. • The ulcer characteristically: • Ranges in size dramatically from 3 to 50 mm (1/8 inch to two inches) across • Is painful • Has sharply defined, undermined borders • Has irregular or ragged borders • Has a base that is covered with a gray or yellowish-gray material • Has a base that bleeds easily if traumatized or scraped Genital Warts • Also called condylomata acuminata or venereal warts. • Growths in the genital area caused by a sexually transmitted human papilloma virus (HPV) Human papillomavirus is the name of a group of viruses that includes more than 100 different strains or types. More than 30 of these viruses are sexually transmitted, and they can infect the genital area of men and women including the skin of the penis, vulva (area outside the vagina), or anus, and the linings of the vagina, cervix, or rectum. • Low-risk HPV types can cause genital warts and low-grade changes in the cells of the cervix. High-risk HPV types can cause low-grade changes, high-grade changes, pre-cancer, and cancer in the cells of the cervix. • HPV infection is quite common in Jamaica. BELOW IS A STUDENT HANDOUT ON STIs 190 STIs People who have unsafe sexual intercourse may be putting themselves at great danger or risk. These risks include: • Early unplanned pregnancy • HIV and AIDS • Other sexually transmitted infections (STIs) Firstly, what is an STI? STI is a short name for Sexually Transmitted Infection. It is the name we give to all types of illnesses that you get when you have unprotected sex with someone who already has that illness. Sexually Transmitted Infection There are many types of Sexually Transmitted Infections but the most common ones in Jamaica are Gonorrhea, Herpes and Chlamydia. HIV, the virus which causes AIDS, is also a Sexually Transmitted Infection. If you think you have an STI… • Go to a doctor or clinic immediately. Sometimes the sores or other signs of the disease can go away without any medication at all. This does not mean that you are cured. The disease is still living in your body and can make you sicker later on. You can get an STI: • By having oral sex ( where your mouth touches your partner’s penis or vagina); • By anal sex (sex in the bottom); • By vaginal sex (where the penis or sex toys enter the vagina). 191 So how do you know you have an STI? If you see any of these signs, you might have an STI: • Burning when passing urine • Sores or itching around your vagina or penis • Small bumps on your penis or vagina • A swollen and painful lump (wax and kernel) near your penis or vagina • Pain when you pass urine • A discharge from your vagina or penis Anyone can get an STI Some people can have STIs and show no signs of the disease at all. So if you are having sex without a condom, you should ask a doctor to check if you have an STI. STIs that cause a discharge What is a discharge? A discharge is any wetness coming from your vagina or penis that does not look or smell normal. Some sexually transmitted infections can cause a discharge. You could have an STI if you notice any of these signs: • A discharge that is yellow, greenish or grey • A discharge that is frothy or slimy • A discharge with a bad smell STIs that cause sores Syphilis and Herpes are some of the infections that can cause sores on your vagina or penis. Herpes can also cause you to get sores on your mouth. • Sometimes the sores are painful but sometimes they don’t hurt at all. • Sometimes they turn into boils that burst and give off a bad smell. • Syphilis and Herpes can also cause you to get wax and kernel (a painful swelling in your groin area near your vagina or penis). 192 How do you get an STI? You get an STI by having sex without using a condom, with someone who already has an infection. STIs can be spread from: • Woman to man • Man to man • Man to woman • Woman to woman What to do if you get an STI? • Only use the medicine you get from the doctor. Do not take any other medicine that you buy or get without prescription. • Take all the medicine your doctor gives you. Do not give any of your medicine to anyone. • Make sure all the people you have sex with use protection. ALWAYS USE A CONDOM WHEN YOU HAVE SEX. Sexually Transmitted Infections (STIs) People who have been diagnosed with STIs are at risk for HIV.  Persons with STIs are more likely to have sores and small breaks in the skin and lining of their genitals. It is easier for HIV to enter the body through these breaks. (Herpes, Syphilis, Gonorrhoea, Other STIs with sores)  If you have an STI or have had one, you could have contracted HIV because of unprotected sex 193 STIs (Cont’d) HIV/AIDS/ STI INFORMATION SOURCES Information and statistics on HIV& AIDS and STIs is dynamic the sources below consistently provide up to date information on these issues 1. www.unaids.org 2. www.jamaicanap.org 3. www.nacjamaica.com 4. www.moh.gov.jm 5. www.carec.org 194 CHAPTER NINE Self and Interpersonal Relationships 195 9.1 INTERPERSONAL Relationships & INTERPERSONAL COMMUNICATION The term relationship is used to describe how people interact with each other. As shown by the definitions below, a relationship may be based on emotions, association, or blood connection. Relationship is defined as: • a state of connectedness between people (especially an emotional connection). • a state involving mutual dealings between people or parties or countries. • kinship: (anthropology) relatedness or connection by blood or marriage or adoption. Relationships begin in the family setting. The family is the first place where we learn to get along with others and to express our thoughts and feelings about others. In a family there are persons of different ages and genders, with different roles, temperaments, backgrounds and, sometimes, nationalities. Each family member may also have friends who we relate with, and periodically there are persons who are neither relatives nor friends who visit with the family. The family also teaches us about love and communication. It is in the family setting, also, that children are first prepared to raise families of their own. Institutions such as the school, the church, and the wider neighbourhood and community groups also foster relationships and influence what we learn about relationships and how we relate to each other. We are from different families and influenced by different institutions. We therefore have different ways of relating to others. Some of these ways are healthy, some are not. However, for good personal relations, we have to learn to relate with people who have different ways of doing things and also have different sets of values. The qualities that make for good relationships are numerous. Some of the basic elements needed to ensure healthy interactions are: • sharing, giving and receiving; • encouraging and being encouraged; • desiring and being desirable; • helping and being helped; • caring and being cared; and • intimacy Sometimes relationships are not healthy because we lose sight of the fact that others have needs. Recognizing that others have needs and helping them to fulfill these needs are important in helping to create harmony. 196 Relationships with parents Adolescence is a period of transformation. While no longer children; adolescents are many times unsure of how to deal with their newly developed potential. They need friends. But they also need parents who will understand the importance of a healthy parent-child relationship. Such a relationship will allow adolescents to feel comfortable, rather than fearful, to tell their parents what they think and how they feel. At the same time, it would require that parents understand the importance of involving their adolescents when making decisions that affect the family or the adolescents themselves. Adolescents must also show their parents that they are capable of making mature decisions and acting on them, thereby winning their parents respect and trust. When expressing one’s opinion both parents and children need to be courteous and take care to consider the other person’s feelings. Parents should avoid abusive language and children should take care to be respectful. Good communication between parents and children is important for healthy relationship between the adolescent and his/her parents. Adolescents can improve their relationship with their parents if they show appreciation for their efforts in providing for and taking care of them. Remember that parents are human. They may be having problems at work or elsewhere and this may affect how they behave at home. It does not hurt to express love through helpful actions at home. By helping each other around the house and by communicating with each other, parents and adolescents can build bonds of love. All members of the family need to feel that they have someone to turn to, people who care when problems arise. Interpersonal Relationships Persons who share the same interests and values usually like being in each other’s company. In everyday life it is easier to achieve your goals if your friends have similar goals and aspirations. If most of your friends are uninterested in improving themselves and are involved in destructive and risky behaviours (such as using drugs, skipping school, casual sex and violence), then it is sensible to pull away from friends. You may think that you can be a good influence on them. But often the negative is more determined to influence the positive. The majority of the problems which we face in our life have to do with the way we relate to others. Good relationships are built when we respect each other’s time, possessions, ideas and opinions. Some good interpersonal qualities to practice are consideration, trustworthiness, friendliness, understanding, cooperation, modesty, good manners and moral values. Some hints for getting along with other people are o Control your tongue – think before you speak o Make promises sparingly o Be complimentary to others o Keep an open mind o Be careful not to hurt other people’s feelings o Be yourself o Show interest in others. As an adolescent becomes older, it is only natural for him/her to develop emotional feelings for a particular individual, as they desire a relationship of intimacy. At this stage of development there is a great need to be touched and the expression of love. Often times for adolescent it is perceived that this can only be done through sexual intercourse. It is also the stage in development that there is great confusion between love and infatuation. 197 9.2 Diversity, Discrimination and Inclusion Diversity means a variety of different types of things and persons. Diversity refers to all the ways we differ as individuals. It includes visible differences such as age, gender, ethnicity and physical appearance; as well as underlying differences such as thought styles, religion, nationality, socio- economic status, belief systems, sexual orientation, physical and mental abilities and education. It means respecting, valuing and harnessing the richness of ideas, backgrounds and perspectives that are unique to each individual, i.e. a new worldwide source of creativity. It is the exploration of these differences in a safe, positive, and nurturing environment. It is about understanding each other and moving beyond simple tolerance to embracing and celebrating the rich dimensions of diversity contained within each individual. Spiritual and Religious Diversity: Some religious groups believe that theirs is the only true religion. This can lead to members of those religions being less accepting or tolerant of other belief systems. Members of these groups can be unwilling to find out about other belief systems. This situation sustains prejudices and stereotypical images. In school communities, discrimination and prejudice flourish when the interests of minority religious groups are not incorporated into the curriculum and whole school environment. Marginalising members of belief systems leads to intolerance, hostility and tension. Inclusion means an environment where everyone contributes his or her skills and talents for the benefit of all Community: A group of people having common goals, rights and privileges – where no one is advantaged or disadvantaged because of who they are. Culture: A learned set of values, beliefs, customs, norms, and perceptions shared by a group of people that provide a general design for living and a pattern for interpreting life. Ethnicity: A social construct which divides people into smaller social groups based on characteristics such as shared sense of group membership, values, behavioral patterns, language, political and economic interest, history and ancestral geographical base. Stereotype: A generalization applied to every person in a cultural group; a fixed conception of a group without allowing for individuality. When we believe our stereotypes, we tend to… • Ignore characteristics that don’t conform to our stereotype • Rationalize what we see to fit our stereotype • See those who do not conform as “exceptions” • Find ways to create the expected characteristics 198 Prejudice is an unfavorable opinion or feeling formed beforehand or without knowledge, thought or reason. It is an implicitly held belief, often about a group of people. Race, economic class, gender or sex, ethnicity, sexual orientation, age and religion are other common subjects of prejudice. It can be used to characterize beliefs about other things as well, including "any unreasonable attitude that is unusually resistant to rational influence. Prejudice may arise from many sources, including the views of family or peers, or it may come from strong identification with a particular group. From any source, prejudice is a problem that faces the many societies today. Forms of prejudice • Personal / Individual Discrimination is directed toward a specific individual and refers to any act that leads to unequal treatment because of the individual's real or perceived group membership. • Legal Discrimination refers to "unequal treatment, on the grounds of group membership, that is upheld by law Apartheid is an example of legal discrimination, as are also various post-Civil war laws in the southern United States that legally disadvantaged negros with respect to property rights, employment rights and the exercise of constitutional rights. • Institutional Discrimination refers to unequal treatment that is entrenched in basic social institutions resulting in advantaging one group over another. The Indian caste system is a historical example of institutional discrimination. As with prejudice generally, these three types of discrimination are correlated and may be found to varying degrees in individuals and society at large. Many forms of discrimination based upon prejudice are outwardly acceptable in most societies. Discrimination toward or against a person of a certain group is the treatment or consideration based on class or category rather than individual merit. It can be behavior promoting a certain group (e.g. affirmative action), or it can be negative behavior directed against a certain group Types of Discrimination • Racial discrimination differentiates between individuals on the basis of real and perceived racial differences. Racism happens everywhere. It can be obvious (overt) or hidden (covert). It takes different forms, but always involves the misuse of power by individuals, groups and communities against each other. • People with disabilities face discrimination in all levels of society. The attitude that disabled individuals are inferior to non-disabled individuals is called "ableism". • Gender discrimination and sexism refers to beliefs and attitudes in relation to the gender of a person, such beliefs and attitudes are of a social nature and do not, normally, carry any legal consequences. • Sex discrimination, may have legal consequences. Though what constitutes sex discrimination varies between countries, the essence is that it is an adverse action taken by one person against another person that would not have occurred had the person been of another sex. Discrimination of that nature in certain enumerated circumstances is illegal in many countries. Sexual discrimination can arise in different contexts. For instance an 199 employee may be discriminated against by being asked discriminatory questions during a job interview, or because an employer did not hire, promote or wrongfully terminated an employee based on his or her gender, or employers pay unequally based on gender. • Age discrimination usually comes in one of three forms: discrimination against youth (also called adultism), discrimination against those 40 years old or older and discrimination against elderly people. In many countries, companies more or less openly refuse to hire people above a certain age despite the increasing life spans and average age of the population. The reasons for this range from vague feelings that younger people are more "dynamic" and create a positive image for the company, to more concrete concerns about regulations granting older employees higher salaries or other benefits without these expenses being fully justified by an older employees' greater experience. Challenges for School Communities Schools need to: • develop awareness of the different religious, social and ability groups within the community. For example physically and mentally challenged persons. • establish links with different communities and their support material • engage in and encourage dialogue between members of different religions and belief systems • create opportunities to explore different traditions in their historical, cultural and contemporary contexts • challenge stereotypes and behaviours that harass or discriminate (directly and indirectly) based on diversity • accommodate the diversity of spiritual, physical, nutrition and health needs and practices of their students. 200 9.3 Self –Esteem The Oxford Dictionary defines self-esteem as “a good opinion of one’s own character.” When you have high self-esteem, it means you know you are a worthwhile person, someone worthy of love. You respect yourself and who you are. Good self-esteem generally as to do with the quality of the relationships we’ve had and we build with people throughout our lives. These people may be our parents, brothers and sisters, teachers, partners, or friends. If the relationships we build, and the messages we exchange with those people close to us are positive, friendly, and respectful, and if they value us for what we are, then we’ve probably developed a strong sense of self-esteem. If, on the contrary, we’ve been rejected and not valued, then it will be more difficult for us to love ourselves. Young people who are or have been exposed to violence, even under the pretense of discipline or care, are likely to have a very low self- esteem, and what’s worse, they often feel guilty and unworthy. Sometimes they may even feel that adults have the right to use violence against them. Having high self-esteem does not mean that we never get upset or angry with ourselves. Everyone gets frustrated with themselves at times. High self-esteem is also different from pride or being too conceited. People with high self-esteem like themselves, but they don’t think they are perfect or better than other people. HOW TO IMPROVE YOUR SELF ESTEEM Self-esteem is something deep inside you and you can work on it and nurture it on a daily basis. To do this, you should: • Avoid constantly comparing yourself with others. Set your own goals and don’t judge yourself according to someone else’s achievements. Life is a long race; sometimes you will be ahead, sometimes in the middle, and other times behind. • Recognize your special talents and try to appreciate yourself the way you are. Make a list of the things you do well. Are you an artist, athlete, singer, storyteller, or dancer? In what subjects do you excel in at school? Singing may be your talent and you should practice in front of others in order to improve. Work on some of the bright lights that make you shine, and ask others what they most appreciate about you. • Be aware of things that you have already accomplished in life such as receiving an athletic or music award, your high school diploma, CXC (Caribbean Examination Council) awards certificate, or an Associate Degree. • Think about the person you are and be proud of your best qualities. What do you like about yourself? Your generosity? Your sense of humour? Your creativity? Your ability to be a critical thinker? • Be aware of the things you would like to improve about yourself, but don’t be overly self critical. • Be realistic. Set achievable goals so that you can be satisfied when you accomplish them. • Believe in yourself. Tell yourself, “I can do it!” 201 • Spend time with people who care about you, make you feel good about yourself, and boost your self-esteem. Stay away from people who hurt your self-esteem, particularly if they do it on purpose! • Feed your mind with positive messages about yourself and others around you COPING WITH THINGS THAT AFFECT YOUR SELF ESTEEM Working on your self-esteem doesn’t mean you will never have ups and downs, but it will help you get through them more smoothly. For example, imagine that your friends have deserted you. They are teaming up and leaving you out. Suddenly you feel shaky and unsure of yourself. You may wonder, “Is it because of my skin colour? Is it because of the way I dress? Did I do something wrong?” your self-esteem may begin to fall and you may start to feel very sad or badly about yourself. Some people panic in such circumstances and look for an easy way to boost their self-esteem and feel liked by others, even if this means doing something that they think is wrong. For example, they may start to use drugs or drink alcohol, cheat on an exam, or steal to feel accepted. Acceptance feels nice and it gives you a boost, but if your self-esteem is low, acceptance by others won’t make the problem go away. You might feel better for a while, but soon a little voice inside you starts saying, “You are not being true to yourself and you are holding yourself back from doing the things you like and are good at.” That little voice is your conscience. It’s always a good idea to listen to it. Boosting your self-esteem will take more work than fitting in with a new crowd or numbing your unhappiness with drugs or a drink. Also it will serve you better in the long run. When you are going through a self-esteem crisis there are a few things you can do to get through it: • Put your immediate crisis into perspective. Try to remember that life is full of ups and downs and that it isn’t the end of the world. • Talk to someone you are close to about your problem and your feelings. Find a youth counselor, peer educator, or someone who cares about you and will be able to help you through your crisis. • Remind yourself that many people value you for who you are, like friends, teachers, parents, or relatives, and are more than willing to help through a hard time. • Have patience. Low self-esteem doesn’t go away overnight, but you will feel better about yourself soon. • Develop new coping skills which allows you to deal with situations in a positive manner 202 SELF ESTEEM SCENARIOS DO YOU KNOW what it means to be emotionally healthy? Emotional health can be hard to describe, but you usually know it when you see it. Take Rose, for example. She seems happy most of the time, and she appears to be able to cope with life’s ups and downs. • If she gets a poor mark, she accepts it and works harder. • When her boyfriend breaks up with her, she cries but then realizes that it’s not the end of the world. • She doesn’t get stressed out. When she feels stress coming on, she talks to her best friend and tries to exercise. Rose has high self-esteem. Her ways of coping with stress are good; sports and talking out problems with a trusted friend help her deal with the tension and move on. But other people have a lot of trouble coping with life’s normal ups and downs. For example, Nicholas, who in similar situations deals with stress differently: • he can’t accept criticism and blames his teachers when he gets a low mark. • when left by his girlfriend, he becomes depressed, spreads rumours about her, and starts flirting with other girls. • he drinks beer and smokes cigarettes to relieve is stress. Why does Nicholas have so much trouble coping with the same problems? One factor may be his self-esteem. He is hurt when his girlfriend leaves him, and copes with the pain by saying bad things about her. He tries to reassure himself that he’s desirable by rushing into the arms of another person. His way of coping with stress is not very effective; alcohol and cigarettes may help you forget temporarily about your problems, but they don’t solve them. 203 9.4 Acceptance and Refusal Skills Here are some ways of protecting yourself from unwanted sexual and other advances and possible sexual abuse:  Do not give your telephone number or other personal information (your age, address, parents’ name and work place) to people you do not know well.  Ignore text messages that come from people who are not your friends. Tell someone about them if they persist.  Be assertive. Let your body language match your words.  When you are out with friends, do not accept drinks from someone you do not know and always take your drink with you - do not leave it unattended.  Do not go on a date alone with someone you do not know well. Go out in a group until you get to know the person.  Invite persons to meet you at home only if other people will be home at that time. When you are alone you are more vulnerable and less able to resist unwanted advances. Be Careful. Always keep your personal safety in mind. STRATEGIES FOR SAYING NO TO SEX AND DRUGS  When you say NO you do not have to give a reason, so the person has nothing to argue against. Get the person’s attention, make eye contact, use his or her name.  Remember not to drink alcohol or use any forms of illegal drugs. When you do, you may be reducing your ability to recognize risky situations and making yourself less able to resist pressure.  Focus on how the pressure that is being put on you makes you feel. Shift the focus to the other person e.g. “I like you, but when you start to pressure me it makes me feel bad”  When saying NO, use a firm voice, make eye contact, and reinforce the NO with your body language. If you are giggling when you say NO, the other person may believe you are not serious. 204 Being Assertive ACTIVITY [FOR ALL AGE GROUPS] Topic: NO Thanks! Assertiveness Practice Material: 2 or 4 students (2 for each scenario – 1 male; 1 female). For increased interest allow both sexes to act out each scenario. Person A: (Assertive Person): You are a 16 year old young man. You are with your girl friend at a party. She wants you to have beer. But you don’t drink. Be assertive about your right not to drink. Person B: (Pressuring Person): You are a 16 year old girl. You are at a party with your boyfriend. Everyone else is drinking beer. You are drinking beer and you want your boyfriend to also have some so he can enjoy himself. Try to pressure him to drink some beer. Method: Role Play.  Read the scenario to the class / have the person playing the role read the scenario.  Act out the scenario  Ask students to say what they understand from the role play  Discuss the issues and any gender differences that emerge.  Summarise.  Teach 5 Ways to be Assertive 1. Say no, and keep repeating it. You do not have to offer reasons or excuses for saying “no”. 2. Clearly state how you feel without becoming angry. 3. When saying no use a firm voice, make eye contact, and reinforce the NO with your body language. 4. Refuse to discuss the matter further. 5. Walk away from the situation. Walking away is not a sign of weakness. Adapted from: Together We Can. Red Cross Peer Education Project. 205 Johari Window A Johari window is a cognitive psychological tool created by Joseph Luft and Harry Ingham in 1955 in the United States, used to help people better understand their interpersonal communication and relationships. It is used primarily in self-help groups and corporate settings as a heuristic exercise. When performing the exercise, the subject is given a list of 55 adjectives and picks five or six that they feel describe their own personality. Peers of the subject are then given the same list, and each pick five or six adjectives that describe the subject. These adjectives are then mapped onto a grid. Charles Handy calls this concept the Johari House with four rooms. Room 1 is the part of ourselves that we see and others see. Room 2 is the aspect that others see but we are not aware of. Room 3 is the most mysterious room in that the unconscious or subconscious bit of us is seen by neither ourselves nor others. Room 4 is our private space, which we know but keep from others. 206 Quadrants Adjectives that are selected by both the participant and his or her peers are placed into the Arena quadrant. This quadrant represents traits of the participant of which both they and their peers are aware. Adjectives selected only by the participant, but not by any of their peers, are placed into the Façade quadrant, representing information about the participant of which their peers are unaware. It is then up to the participant whether or not to disclose this information. Adjectives that are not selected by the participant but only by their peers are placed into the Blind Spot quadrant. These represent information of which the participant is not aware, but others are, and they can decide whether and how to inform the individual about these "blind spots". Adjectives which were not selected by either the participant or their peers remain in the Unknown quadrant, representing the participant's behaviors or motives which were not recognized by anyone participating. This may be because they do not apply, or because there is collective ignorance of the existence of said trait. Johari adjectives: A Johari Window consists of the following 55 adjectives used as possible descriptions of the participant. In alphabetical order they are: • Able • dependable • intelligent • patient • sensible • accepting • dignified • introverted • powerful • sentimental • adaptable • energetic • kind • proud • shy • bold • extroverted • knowledgeable • quiet • silly • brave • friendly • logical • reflective • spontaneous • calm • giving • loving • relaxed • sympathetic • caring • happy • mature • religious • tense • cheerful • helpful • modest • responsive • trustworthy • clever • idealistic • nervous • searching • warm • complex • independent • observant • self-assertive • wise • confident • ingenious • organized • self-conscious • witty 207 Nohari variant A Nohari window is the inversion of the Johari window, and is a collection of negative personality traits instead of positive. • Incompetent • intolerant • inflexible • timid • cowardly • violent • aloof • glum • stupid • simple • insecure • irresponsible • vulgar • lethargic • withdraw • hostile • selfish • unhappy • unhelpful • cynical • needy • unimaginative • inane • brash • cruel • ignorant • irrational • distant • childish • boastful • blasé • imperceptive • chaotic • impatient • weak • embarrassed • loud • vacuous • panicky • unethical • insensitive • self-satisfied • passive • smug • rash • dispassionate • overdramatic • dull • predictable • callous • inattentive • unreliable • cold • foolish • humourless 208 CONFLICT RESOLUTION: WINNING THE BATTLE, AVOIDING THE WAR (Adapted from Listen to Me, I’m Angry by Deidre Laiken and Alan Schneider- Lothrop, Lee and Shepard Books. Like many other things in life, there are good ways and bad ways to fight. Most fight start out as harmless disagreements. Then something goes wrong and that little disagreement turns into a major battle. When this happens, you find yourself locked into a situation. Name calling, put downs, and personal attack can turn anger into hate. They can turn a friend into an enemy and an acquaintance into a stranger. But all fights do not have to turn out this way. What turns fight into war? The rules of the game or, to be more exact, the lack of rules. That’s right. There really are rules for arguing. Following these rules can help you avoid senseless rounds of name calling that go nowhere and have no purpose. Unfortunately, many good friendships and romances have been destroyed because the two parties involved didn’t know about these rules and were unable to see that they were headed for trouble. Learning how to fight constructively involves understanding a few simple guidelines. There aren’t a lot of complicated things to memorize or study. These rules make sense. You won’t have trouble remembering them. But occasionally, you might find yourself slipping back into bad patterns. That’s when you’ll need to remind yourself of these three simple rules for expressing anger constructively: 1. STATE YOUR NEEDS This means saying honestly, without any ‘tricks’ or manipulations, what you WANT, what you NEED, and eventually, what you’ll SETTLE for. The hardest part may be figuring out for yourself first, what it is you really need and want. The anger may be covering up your real feelings (hurt, rejection, fear). Stating your needs means starting with ‘I” (I feel, want, need…) rather than attacking with words that start with ‘you’ (you are, you do…..). 2. DON’T ATTACK THE OTHER PERSON Name calling almost always results in a painful situation and a destructive fight. No one likes to be made fun of and very few people have the self control to turn the other cheek and walk away. So it makes sense to stick to the issue, and not get side-tracked into personal attacks. 3. DON’T BRING U OLD WOUNDS Old wounds leave scars. But a scar is a sign of healing. If you open up an old wound, it will take even longer for the healing process to begin again. Emotional wounds work the same way. When you’re angry you might ignore this healing process and use bad memories to make a fight a destructive and painful experience. Avoid expressions like “you never…” or “every time……” or “remember when you….” And stick with what’s happening in the present. There are also rules on to help you when someone is angry with you, to help you receive anger constructively: 209 4. DON’T GET DEFENSIVE “Getting your back up”, ready to fight back, is probably the worst way to respond to someone else’s anger. It means you’re not hearing the needs of the other person and not taking responsibility for something you may have done to make the person angry. 5. LISTEN Listening is the most constructive tool you have. It’s a skill that takes practice and effort. When you don’t listen and just answer in heat, retaliation follows and soon there’s a war full of angry hurtful feelings. Listening helps cool down the situation. 6. SEPARATE FACTS FROM FEELINGS In a fight, feelings of anger, guilt and pain usually confuse the real issues and make them more difficult to understand. So to clarify what the real issues are, you need to ask questions, or to say out loud what you think is happening and keep this up until you get to the real facts. 7. FIGURE OUT WHAT IS WANTED FROM YOU Once you have listened and understood why someone is angry with you, you have to figure out what it is that he or she wants or needs. If you’re lucky, they’ll tell you, but if not, you have to figure out. 8. DECIDE WHAT TO DO There are three choices: a. Agree to what the other person asks of you if it seems reasonable and you can do it. b. Say “no” to the person and give your reasons, without rejecting the person. There may be good reasons for saying no and it may actually help the relationship, but it is not always easy. c. Compromise; give up part of what you want in exchange for an agreement you can live with. This can mean a ‘win-win’ situation rather than one person ‘winning’, the other ‘losing’. Compromise takes negotiation, listening and discussing the problem with the other person. In all three cases, you may need to ask for time to decide what to do. This can also reduce destructive anger until reason can prevail. Changing your patterns takes time. But it is the only way you can be free to express your feelings and to listen to other people express theirs. When you’re no longer a prisoner of your patterns, you can truly hear what your father, mother, others or friends have to say. And once you begin to listen to them, there’s a good chance they’ll be able to hear you, too. Unless you listen actively and send “I – reactions” continuously, the lines of communication will bog down and defeat your efforts at home democracy. Democracy’s benefits are widespread: it fosters friendly feelings between you and children; it encourages responsibility, independence, motivation, creative thinking, intellectual growth, personal involvement, and respect for those in authority. It directly enhances high self- esteem, for it is powerful proof of love, faith and trust. 210 LEARN TO SETTLE CONFLICT Conflict is a normal part of family living. There are creative ways to settle conflict that serve everyone’s needs. WHAT NOT TO DO WHAT YOU CAN DO 1. DON’T “SANDBAG” 1. BE SPECIFIC Stick to one issue at a time. Don’t bring up all When airing a complaint, state the the past grievances you’ve had against the specific situation that bothers you. Don’t other person – it’s unfair, and it’ll cause more generalize. anger and resentment. 2. DON’T PUT THE OTHER PERSON 2. BE POSITIVE DOWN Tell the person the positive change you Belittling the other person’s ideas and feelings wish for. “It’d be great if you could pick causes hurt and closes the avenues of up after yourself next time.” communication. It doesn’t solve anything. 3. DON’T ATTACK 3. HAVE FAMILY MEETINGS Insulting the person, attacking his or her Set aside a time each month to discuss character, being sarcastic, etc. are al destructive problems and issues. ways of handling family conflict. Avoid statements that begin with “You…” 4. AVOID “HIDDEN AGENDAS” 4. CHOOSE THE PROPER TIME These are conversations that mask issues. For When you need to talk out problems, example, if you say “I want to watch TV choose a time when people aren’t tired tonight,” the other person may think you’re or distracted. really saying. “I don’t want to be with you tonight.” Be aware of the many messages your words can carry. 5.TAKE RESPONSIBILITY Be responsible for your words and actions – don’t blame others for situations you may have helped create. 6. TAKE A BREAK If a conflict starts to get out of hand, take a break to let emotions cool. 211 CHAPTER TEN Sexuality & Sexual Health CIRCLES OF SEXUALITY SENSUALITY SEXUALIZATION INTIMACY Body Image Human Sexual Rape Response Cycle Caring Incest Skin Hunger Sharing Sexual Harassment Fantasy Loving/Liking Withholding Sex Risk Taking Seduction- Flirting Vulnerability Factual Information Feelings & Attitudes Bias Intercourse Gender Identity Physiology & Anatomy of Gender Role the Reproductive Organs Sexual Orientation Sexual Reproduction SEXUAL HEALTH & REPRODUCTION SEXUAL IDENTITY 212 10.1 SEXUALITY, GENDER & SEXUAL PREFERENCE DEFINING TERMS Sex refers to one’s reproductive system and gender behaviour as male and female. It has to do with biology, anatomy and physiology. It is gender (male or female). It is a crucial element in everyone’s sexuality. Sexuality is the total expression of who we are as human beings. It encompasses our whole psychological development – our values, mental attitudes, physical appearance, beliefs, emotions, likes and dislikes, our spiritual selves, and all the ways in which we have been socialized, etc. It involves our sexual identity and psychotic orientation – our entire self-concept. It begins at birth and lasts throughout a lifetime. Masculinity and femininity relate to sexuality as ‘male’ and ‘female’ relate to sex. Generally, they are defined in the light of particular stereotyped gender roles. A stereotype is something conforming to a fixed pattern, a pattern built up in our minds by the myths, values, attitudes, traditions, and practices of the culture we grow up in. The sources of our sexual learning are all the factors that contribute to our psychosocial development—family values, religious beliefs, parental teachings, societal norms, etc. Gender roles are the sets of rules laid down by society that tell us what is appropriate behaviour for persons of our sex. The rules are established by culture, not biology, and are usually assigned to us at birth, as soon as someone announces, ‘It’s a boy’ or ‘It’s a girl.’ For example, blue is a colour usually associated with boys; pink, with girls. Girls are given dolls to play with; boys are given guns, cars, and toy trucks to play with. Men are thought to be stronger than women, both physically and emotionally. Sayings like ‘Big boys don’t cry’ feed this notion. Women are thought to be weak, emotional creatures who weep easily. Gender identity is personal, private conviction each of us has about being feminine or masculine. It is at the core of how we feel about who we are. It probably becomes fixed around the age of two years. It is also called sexual identity. Sexism is the conscious or subconscious assumption that members of one sex are, on the whole superior in certain attributes to members of the other sex, solely by virtue of their sex. It confuses biology with culture. Sexual orientation refers to a preference for sharing sexual expression with members of the opposite sex, members of our own sex, or members of both sexes. These preference may be socially determined, biologically determined, or both – we cannot be sure. 213 There are five major sexuality patterns: Heterosexual (Straight) – preferring emotional/sexual partners of the opposite sex. Homosexual – preferring emotional/sexual partners of the same sex. (The term gay is commonly used for men who prefer same –sex partners, though it can refer to women as well. The more usual term for women who prefer same-sex partners is lesbian.) Bisexual – enjoying emotional/sexual partners of both sexes. Asexual—having little or no sex drive. Though asexual persons are physically and psychologically male and female, neither sex stimulates them sexually. They have no desire for sex. Celibacy – the deliberate abstention from sexual activity, a choice people make for a variety of personal reasons. Sexual Behaviour – includes a wide range of activities, from kissing, touching, hugging, petting, and fondling and so on. Some of those listed below are approved in almost all cultures. Some are disapproved in almost all. Some are more or less acceptable, depending on the cultural group or subgroup. Oral sex—cunnilingus or fellatio. Cunnilingus is contact between mouth and vulva, vagina, clitoris, etc. fellatio is mouth- to-penis contact. Incest – sexual intercourse between blood-related family members (e.g., father and daughter, sister and brother). Sodomy –anal intercourse. Voyeurism – deriving sexual excitement from observing others undressing, making love, kissing, masturbating, petting, etc. sometimes voyeurs are called ‘Peeping Toms.’ 214 10.2 Views on Homosexuality Following are quotes from researchers in the field: (1) From Dr. Dean Hamer, the “gay gene” researcher, and himself a gay man: “Genes are hardware… the data of life’s experiences are processed through the sexual software into the circuits of identity. I suspect the sexual software is a mixture of both genes and environment, in much the same way the software of a computer is a mixture of what’s installed at the factory and what’s added by the user.” (From: P. Copeland and D. Hamer (1994) The Science of Desire. New York: Simon and Schuster.) (2) From psychiatrist Jeffrey Satinover, M.D.: “Like all complex behavioural and mental states, homosexuality is… neither exclusively biological nor exclusively psychological, but results from an as-yet-difficult-to-quantify mixture of genetic factors, intrauterine influences… postnatal environment (such as parent, sibling and cultural behaviour), and a complex series of repeatedly reinforced choices occurring at critical phases of development.” (From: J. Satinover, M.D., Homosexuality and the Politics of Truth (1996). Grand Rapids, MI: BakerBooks) (3) When “gay gene’ researcher Dr. Dean Hamer was asked if homosexuality was rooted solely in biology, he replied: “Absolutely not. From twin studies, we already know that half or more of the variability in sexual orientation is not inherited. Our studies try to pinpoint the genetic factors...not negate the psychosocial factors.” (From:“New Evidence of a ‘Gay Gene’,” by Anastasia Toufexis, Time, November 13, 1995, vol.146, Issue 20, p 95.) (4) William Byne, a psychiatrist with a doctorate in biology, and Bruce Parsons (1993) carefully analyzed all the major biological studies of homosexuality. They found none that definitively supported a biological theory of causation. (From: W. Byne and B. Parsons, “Human Sexual Orientation: The Biological Theories appraised.” Archives of General Psychiatry 50, no.3). (5) Psychiatrists Friedman and Downey state that “a bio-psychosocial model” best fits our knowledge of causation, with various combinations of temperament and environmental events leading to homosexuality. They say: “Despite recent neurobiological findings suggesting homosexuality is genetically-biologically determined, credible evidence is lacking for a biological model of homosexuality.” (From: R. Friedman, M.D. and J. Downey, M.D. Journal of Neuropsychiatry, vol. 5, No. 2, Spring 1993.) 215 What Jamaican Law says about Homosexuality: Contrary to popular belief, it is not actually illegal to be homosexual in Jamaica. Being a homosexual does not contravene any of the existing laws; however, the law makes certain 'homosexual acts' illegal, and these laws are used to persecute gay men. They state that "acts of gross indecency" and buggery [anal sex] are illegal. Although buggery refers to anal sex between a man and another man, a woman or an animal, in practice the law is predominately enforced against two men. Lesbians are also discriminated against in the wider society, however no laws target lesbians or lesbian conduct. Offences Against the Person Act This act prohibits "acts of gross indecency" between men, in public or in private. Article 76 (Unnatural Crime) "Whosoever shall be convicted of the abominable crime of buggery [anal intercourse] committed either with mankind or with any animal, shall be liable to be imprisoned and kept to hard labour for a term not exceeding ten years." Article 77 (Attempt) "Whosoever shall attempt to commit the said abominable crime, or shall be guilty of any assault with intent to commit the same, or of any indecent assault upon any male person, shall be guilty of a misdemeanour, and being convicted thereof shall be liable to be imprisoned for a term not exceeding seven years, with or without hard labour." Article 78 (Proof of Carnal Knowledge) "Whenever upon the trial of any offence punishable under this Act, it may be necessary to prove carnal knowledge, it shall not be necessary to prove the actual emission of seed in order to constitute a carnal knowledge, but the carnal knowledge shall be deemed complete upon proof of penetration only." Article 79 (Outrages on Decency) "Any male person who, in public or private, commits, or is a party to the commission of, or procures or attempts to procure the commission by any male person of, any act of gross indecency with another male person, shall be guilty of a misdemeanor, and being convicted thereof shall be liable at the discretion of the court to be imprisoned for a term not exceeding 2 years, with or without hard labour. 216 10.3 SCENARIOS FOR DISCUSSING SEXUALITY, GENDER AND HIV Scenario 1 Name : Venus Age : 43 years Marital Status : Divorced Job : Secretarial Social Class : Middle Class Children : One I have been married twelve years to a man who controlled and suppressed my sexual life and dominated my person during that time. After the divorce I waited for eight years before I could get the feeling for a new relationship. I had to travel to New York and my son who was twenty-two years asked me to contact a neighbour’s son who grew up with him, and who called me ‘mums’ as he was in and out of our house in his younger years. I had not seen this child for fifteen years and was enthralled by his physical maturity, his professional and other achievements, his manliness and most of all his handsomeness and good manners. He showed me the town, took me to dinner, dancing and back to his apartment where he offered me his bed while he slept on the couch. I must say I lost all control of myself that night. I found myself initiating sexual behaviours with the child. That was the most sexually fulfilling night I have ever had all my life. I did not ask anything about his present life situation. We did not speak about AIDS, other relationships, or life in Trinidad and Tobago. Nothing! We just went on having all possible aspects of sex for hours. On my return, I kept trying to make contact with him, but could get no response. I have gone on seeking the company of younger men, seeking to encourage them to share their sexual life with me. I am in a relationship with an eighteen year old at present. I know it is dangerous because he is a beach bum who works nowhere except with the tourist women who come to Tobago. I just cannot get out of this. I am fixed on this physical type of sex and I am in total denial with the reality of my situation. Discuss this scenario using perspectives of: 1. Yourself: beliefs, values. 2. Others – beliefs, values 3. Young person’s perception of sexuality. 4. Responding to such an individual with information and counselling 5. Create a scenario of experiences and/or perception discussed in groups. 217 Scenario 2 Name : Penny Age : 38 years Marital Status : Married Job : Teacher Social Class : Middle Class Children : Three My marriage broke down because my husband could not be trusted. Since this AIDS thing, he has become crazy about sex with me. He wants to do all kinds of things. Yes, he even uses his mouth to do sex. I don’t feel comfortable with that, because I think that it is morally wrong. Sometimes he wants me to reciprocate. He wants to go on and on and is always ready to try something new. I wonder if he used to do all these things with other women before the AIDS came in. I went to a counsellor and she said that I was not growing sexually; maybe I should be more open and give my sexual nature a positive thrust. I was brought up in church and I know about acts of indecency. I prefer to be separated than to live in sexual sinfulness. Discuss this scenario using perspectives of: 1. Yourself: beliefs, values. 2. Others- beliefs, values. 3. Young person’s perception of sexuality. 4. Responding to such an individual with information and counselling. 5. Create a scenario of experiences and/or perception discussed in group. 218 Scenario 3 Name : Jennifer Age : 36 years Marital Status : Single Job : Seamstress/ Designer Social Class : Lower Children : None Well, to tell you the truth, ah guy I was living with for ten years died of AIDS about three years after the relationship breakup. He was a real clubman, womanizer and ah believe he used to visit whore houses sometimes. Thank God I test twice after he died and I come out clean. I change my life style. First I used to look to God for help. I joined a church and was doing all right until I met another guy in the church. I told him that we would have no sex until I was sure he had a test. We use to kiss and touch and thing, so the feeling was growing, but I was not budging. Well, he had the test and would you believe, the man was HIV positive. Well friends, I leave man and church and start to do my own thing. I would look a t TV and find shows with sexual behaviours. I found myself masturbating regularly especially when women were making out. I started to feel as if I could make it with a woman. I had never done this before. I grew up knowing it to be wrong, but I was getting pleasure seeing omen in sexual relationship and getting deep feelings to go that way. Having men no longer crossed my thoughts. I started searching. My young niece of twenty- two years who visited me on a regular basis shared her thoughts about the fears she had, especially in relationships with men. I too shared my experiences with her and found that she was highly sexual and wanted to experience the deeper passions of her sexuality. We got around sharing our sexual feelings in a same sex relationship which we thoroughly enjoyed over a period of a year. She has gone abroad leaving me with the thought that none of us are really lesbians and yet we enjoyed the experiences that came out of the relationship. Discuss this scenario using perspectives of: 1. Yourself: beliefs, values. 2. Others – beliefs, values. 3. Young person’s perception of sexuality. 4. Responding to such an individual with information and counselling. 5. Create a scenario of experiences and /or perception discussed in groups. 219 10.4 Pressured (unwanted) sexual activity Sometimes a person is pressured to have sexual relations when he or she does not want them. The person pressuring for sex can be someone much older or someone close in age. It may be a family friend, your teacher or a stranger. There are different types of sexual pressures Sexual harassment is when someone puts undue pressure on you to have sex with them. They may use their power, position or influence, their gifts, or may threaten to harm you or someone you care about. Whoever it is that puts that pressure on you to have sex (whether it is your teacher, parent or step parent, friend, pastor or a stranger) you can report them to the authorities. You have rights. Speak to someone you trust about the matter. Sexual Molestation is when someone is forced or influenced into sexual activity. Some girls have relationships with older men – sugar daddies who are working or even married – in order to get gifts, money for school or pocket money. Boys also sometimes have relationships with older women, and men, for the same reasons. These types of relationships can lead to situations where the young person feels pressured to have sex before she or he is ready to, because the older person demands “payment” for the gifts or entertainment provided. Knowing how to say “No” and how to stick to your own limits and values in these situations is very important. Peers can also pressure you to have sex. For example, some boys tell their girlfriends that they should prove that they love them by having sex with them. And some girls tell their boyfriends the same thing. Saying “No” when the person applying pressure is somebody you care about – like a boyfriend or a girlfriend – can be very hard. You might feel as though the only way you can keep the friendship is by agreeing. However, it is important to remember that anyone who pressures you to do something you don't want to do does not really love you. Sexual abuse Available data show that females are more likely, than males, to be victims of sexual abuse. Some 98% of sexual assault cases reported to the police in 2002 and 2003 were to females. A 2001 survey conducted for the Ministry of Health found that as many as 12% of girls and 5% of boys in the 15-19 age group reported that their first sexual intercourse was forced. Remember that in Jamaica the age of consent for sex is sixteen years. That means a person who is younger than 16 cannot legally give consent for sexual intercourse. The person under 16 years is, in this case, considered a minor. Anyone who has sexual intercourse with a minor i.e. a girl less than 16 years of age has committed Carnal abuse. This is a criminal offense even if the girl has consented. 220 Rape is forced sexual relations against a person’s will. All victims of rape, even if they were sexually experienced, report the rape to be a violent and dangerous attack upon them that deeply affects their lives. Bear in mind that most adolescents who report being raped were raped by someone they or their family knows (an acquaintance). Forced sexual intercourse can occur for many reasons. These include:  A breakdown in communication: someone seeming to say one thing but meaning another. This is where your body language does not match your words.  Premeditation: some rapes may be premeditated. The rapist plans ahead and uses trickery or force to get the victim under his/her power.  Being in the wrong place at the wrong time or with the wrong person.  The victim is sometimes drugged or made to become drunk before the attack. Learning how to avoid risky situations and relationships (such as being alone with someone you don't know well or trust, or allowing yourself to be indebted to someone who has given you gifts or money) is one way to avoid being pressured for sex or being sexually abused. Learning how to be assertive and being clear about your limits is also very important – especially if your boyfriend or girlfriend is pressuring you for sex when you don't feel ready for it. All instances of sexual abuse must be reported to the police in your parish or to the Centre for the Investigation of Sexual Offences and Child Abuse (CISOCA) headquarters in Kingston. Some persons who are raped or carnally abused do not report the crime because they are either too ashamed or think that no one will believe them. Rape or other forms of sexual abuse is not the victims’ fault. When you allow someone to get away with sexual abuse they will most likely do it again to someone else. Report all instances of sexual abuse to the police in your parish When you allow someone to get away with sexual abuse they will most likely do it again to someone else (Adapted from: Sexual and Reproductive Health Teachinf aid for Guidance Counsellors A publication of the Women’s Centre foundation of Jamaica) 221 10.5 WHAT IS ABSTINENCE? ‘Abstinence’ is defined as ‘self denial’, ‘self restraint’, ‘self discipline’ and ‘moderation’. In the context of sexual intercourse, abstinence means avoiding sexual intercourse. Some persons choose to abstain permanently. This is referred to as celibacy. Others discipline themselves to not have sexual activity until marriage, or until they have completed their education, are financially independent, or are able to handle the responsibilities of parenthood. The decision to delay or to be celibate may be influenced by the person’s religious or moral values but also by practical matters of safety. Abstinence, whether permanent or not, is the most effective way to avoid getting pregnant or getting a sexually transmitted infection. These are two reasons that delaying sexual activity is recommended for adolescents. A third reason is that in delaying, the adolescent can fully develop his/her skills in handling the responsibilities that accompany sexual involvement. Being abstinent does not mean that you will not have sexual attractions and feelings. It means that you have to learn self discipline and how to handle sexual urges so you will not put yourself and others at risk. Why Abstain? There are many good reasons for delaying sex. Apart from avoiding unplanned pregnancy and sexually transmitted infections there are social and emotional advantages of abstinence. You may ask “waiting for Sex….. What’s in it for me?” You get: o Time… to make up your mind….to learn the difference between love and sex…..to get to know yourself……to find the right person…. To think about relationships. o Freedom…. from worry about pregnancy….. from the risk of STIs including HIV….. from doubts that he/she only wants sex from you…..from regrets that you didn’t wait for the right person or the right time o Respect…. for yourself for having the confidence to make the right decision …. from friends and family for making your own decision and sticking with it…from your girlfriend or boyfriend especially if he/she is not ready either. o Experience….to become stronger and more sure of yourself. You’ll learn….how to say no without hurting anyone’s feelings ….how to talk about tough subjects…..how to recognize and avoid risky situations. o Stronger Relationships…. building friendships and trusting relationships …. deciding together to wait Love is generally considered to be one of the main reasons for having sex. Sex is the ultimate expression of love but many persons are not able to tell the difference between infatuation and love. 222 How to Abstain? When you make the decision to delay sex there are certain things you can do to help yourself abstain. Here are some of the things that have worked for other adolescents and adults. • Hang out with friends who feel the same way you do • Tell your girlfriend/boyfriend about your decision before there is any pressure to have sex. • Think about some ways you can say ‘No’. • When you are with your girlfriend/boyfriend spend time in public places or with friends. There are hundreds of ways to be affectionate without having sex • find ways to be close and show that you care • Show your love for each other by hugging, light kissing, holding hands, spending time together, and sharing your dreams and secrets. You may be pressured to become sexually active before you are ready. There are 101 ways to say no to sex here are some suggestions: Strategies for saying no to sex  When you say no you do not have to give a reason, so the person has nothing to argue against.  Remember when you drink it reduces your ability to recognize risky situations it also makes you less able to resist pressure.  Focus on how the pressure that is being put on you makes you feel. Shift the focus to the other person e.g. “ I like you, but when you start to pressure me it makes me feel bad”.  When saying NO use a firm voice, make eye contact, and reinforce the NO with your body language. (Adapted from: Sexual and Reproductive Health Teachinf aid for Guidance Counsellors A publication of the Women’s Centre foundation of Jamaica) 223 Contraceptive Methods (Adapted from: Sexual and Reproductive Health Teachinf aid for Guidance Counsellors A publication of the Women’s Centre foundation of Jamaica) The word contraception literally means “against conception”. Contraceptives are the methods and devices that are used to prevent pregnancy by persons who are having sexual intercourse. When deciding which contraceptive method to choose, one should consider the following: Do I want to prevent pregnancy only? Do I want to prevent pregnancy, AIDS and other STIs? Do I want to prevent pregnancy after unprotected sex? Other factors are important in making the decision about which contraceptive method to choose. These include: • Your age – some methods are not recommended for young adolescents. • Whether you have ever been pregnant or have children • Whether you smoke • Your income In addition it is advisable that you consult with a health care provider such as a nurse, doctor, or family planning counsellor before selecting a method. METHODS THAT ONLY PREVENT PREGNANCY NATURAL METHODS These are methods of contraception and pregnancy planning based on timing of sexual intercourse so as to avoid or determine a woman’s fertile period around ovulation which is the time in the woman’s menstrual cycle when she releases an egg. Types -there are four main ways of calculating ovulation: • Calendar method • Temperature • Cervical mucus • Combined method: temperature and cervical mucus 224 How do these methods work? The calendar method requires a woman to record her menstrual cycle for at least six months. The information is used to calculate the probable time of ovulation and fertile period by subtracting 18 from the shortest cycle and 11 from the longest cycle. The temperature method uses a record of a woman’s body temperature to determine ovulation. The pattern of ovulation can be determined over a 6-8 month period. The cervical mucus method involves examination of the cervical secretion to monitor its quantity and consistency. At ovulation the mucus becomes clear, slippery and often more profuse. The Combined method involves the use of temperature and the cervical methods. How is it used? Ovulation can be predicted from changes in body temperature and the quality and quantity of vaginal mucus. How effective is it? 70% to 80% effective if used perfectly every time. Contraindications: Stress, sickness, travel can result in changes in the woman’s menstrual cycle. The inability to understand the method and lack of partner cooperation. Advantages: No side effects. Disadvantages: Sexual intercourse is programmed i.e. the woman cannot have sexual intercourse during certain times of the month. This method needs partner’s cooperation; does not prevent STIs and HIV/AIDS. CONTRACEPTIVE PILLS What are they? Hormonal tablets that are taken by mouth daily. Types -there are two types – combined oral contraceptives (COC) and progestin – only (POC) contraceptives. How do they work? By stopping ovulation and thickening cervical mucus. How are they used? The tablets must be taken at the same time every day. In case of vomiting or diarrhea within 2 hours after taking the pill, the pill should be repeated. Use a condom or avoid sexual intercourse. How effective are they? Highly effective (99%) if taken correctly every day. Initial dose is not effective immediately. Contraindications: History of smoking, heart disease, sickle cell disease, taking antibiotics or medicine for TB, epilepsy or HIV/AIDS; if suspect pregnancy. Advantages: Lighter period and fewer cramps during the period; regular menstruation; safe to take over many years, helps prevent some cancers; if breast feeding, POC pills will not reduce breast milk. Disadvantages: Must be taken every day, whether or not a woman has sex; side effects sometimes occur – nausea; mild headaches; mood changes; slight weight gain; breast tenderness – they generally stop or are reduced in a few months; does not prevent STIs and HIV/AIDS. 225 INJECTABLES What are they? Hormonal preparations injected to prevent pregnancy. Types - there are two types. 1) Depo provera given every 3 months 2) Noristerat given every 2 months. How do they work? Injection temporarily stops the ovaries from releasing eggs and causes mucus to thicken which helps block sperm from entering the uterus. How effective are they? Highly effective (99%) for preventing pregnancy. Initial dose is not effective immediately. A condom must be used alongside the injection for the first 7 days or do not have sex. Contraindications: This method should not be used if you suspect pregnancy or want to become pregnant soon after stopping a method; breastfeeding a baby less than 6 weeks old. Advantages: Can be used without partner’s knowledge; safe to use; reversible; can be used by breastfeeding mothers; increases breast milk. Disadvantages: Must be given by a health worker; changes in menstruation (spotting, continuous bleeding, no bleeding) are normal – it is not dangerous and does not mean one is pregnant; weight gain; dizziness; stomach pains; fatigue; headaches; decreased interest in sex; may have to wait 4 months after stopping method if pregnancy is desired; does not prevent STIs and HIV/AIDS. NORPLANT What is it? Six small capsules with hormones implanted under the skin of a woman’s arm. How does it work? Tiny capsules slowly release hormones into the blood to temporarily prevent the ovaries from releasing eggs. Norplant also makes the cervical mucus thicker, which prevents sperm from entering the womb. How effective is it? More than 99% effective for preventing pregnancy. Contraindications: Should not be used by women who have liver or heart disease or a history of blood clots or breast cancer. Advantages: Long-term method; once Norplant is removed, a woman can get pregnant immediately. Disadvantages: Must be inserted and removed by a doctor or a trained nurse; side effects (irregular periods or no periods); weight gain; does not prevent STIs and HIV/AIDS. INTRAUTERINE CONTRACEPTIVE DEVICE (IUCD) What is it? A coil or wire made of plastic or stainless steel placed inside the woman’s womb to prevent pregnancy. A small string hangs from the IUCD into the vagina. How does it work? Prevents the male egg (sperm) from uniting with the woman’s egg. Changes the acid/alkaline balance of the mucus in the reproductive tract. How effective is it? Highly effective (97% - 99%) for preventing pregnancy. Contraindications: Women who have had a recent (last 3 months) or frequent STI, or are at risk for STIs; women less than 14 years old. Advantage: One type of IUCD, the Copper T, can be effective for as long as 10 years; does not interfere with breastfeeding or sex; can be removed at any time; after the device is removed, a woman can get pregnant immediately. Disadvantages: Must be inserted by a trained health worker; requires the woman to touch her genitals to check that the string hangs out; must go to health worker for IUCD removal; upon 226 insertion, there may be pain and discomfort; may cause heavier bleeding during period, cramps or discharge in first 3 months of use. Does not prevent STIs and HIV/AIDS. FEMALE STERILIZATION What is it? Permanent contraceptive method that involves a minor surgical procedure on the fallopian tubes. How does it work? Fallopian tubes that carry the female eggs are cut and tied or blocked so that a man’s eggs (sperm) cannot travel through the tubes and fertilize the woman’s eggs. How effective is it? Highly effective (99%) for preventing pregnancy permanently. Contraindications: Pelvic inflammatory disease (PID). Side effects: No known long-term side effects or health risks. Advantages: Quick, simple procedure; lifelong method of pregnancy prevention. Disadvantages: May cause some pain or discomfort for a few days; usually not reversible; does not prevent STIs and HIV/AIDS. MALE STERILISATION (VASECTOMY) What is it? Permanent contraceptive method that involves a minor surgical procedure to cut the Vas Deferens which is the tube that carries sperm cells to the semen i.e. man’s sex fluid. How does it work? Vas Deferens are cut, then tied or blocked to prevent the passage of sperm. (A new procedure, the noscaple that reaches the Vasa through a small puncture.) This does not affect the man’s ability to perform sexually. How effective is it? Highly effective for preventing pregnancy permanently. For first 3 months after procedure, a man should use condoms, or a woman should use a contraceptive method to prevent pregnancy. Side effects. Some users experience a minimum amount of pain during procedure; in case of swelling, or pain and bruising after procedure, a man should see a health worker immediately. Advantages. Quick, simple procedure; does not effect ejaculation or ability or desire to have sex. Disadvantages. May cause some pain or discomfort for a few days. Does not prevent STIs and HIV. METHODS LESS EFFECTIVE FOR PREVENTING PREGNANCY, BUT PREVENT SOME STI 1. SPERMICIDES What are they? Chemical substances deposited in the vagina at least 10-15 minutes before intercourse. How do they work? They kill the man’s sperm or prevent them from moving toward the egg through the cervix. How effective are they? They are about 70% effective. If a woman uses them correctly and every time she has sex, they might be more effective, especially when used with a condom or diaphragm. Contraindications: Some women are allergic to a specific spermicide. Advantages: - A safe, female controlled method 227 - Easy to purchase - Useful as a back-up or an additional method on top of another contraceptive method; it increases that method’s effectiveness. - May decrease transmission of some STIs Disadvantages: - Messy - Must be applied before each act of intercourse - May be hard to conceal from partner 2. DIAPHRAGM What is the diaphragm? It is a female controlled method that covers the cervix. It needs to be used with a spermicidal jelly or cream. It is made of a flat rubber dome with a flexible metal spring at the outer edge. How does it work? It blocks the sperm from entering the cervix, stopping the sperm from meeting the egg. How to use it There are different sizes; the client has to be measured to determine the right size. The spermicide must be spread inside and around the edge of the diaphragm. If the spermicide s not used, the diaphragm will not be as effective. Holding the diaphragm with the dome-side down in the right hand, the rim is squeezed together, then inserted into the vagina and released. The diaphragm will spring back to its original shape covering the cervix and is ready to use. For each additional act of intercourse, additional spermicide should be applied. The diaphragm should be left in the vagina for about 6-8 hours after sex without douching or washing the vagina before its removal. How is the diaphragm removed? While either stooping, sitting or lying on the back, the finger of one hand is inserted into the vagina and hooked on the rim of the diaphragm to pull it out. How is the diaphragm cared for? After removal from the vagina, wash with cold clean water and mild soap, rinse well. Dry with a clean cloth and powder with a non-perfumed or a dry starch powder. It should be inspected for holes and stored in a clean container. Advantages - Helps to prevent some STIs - Female controlled - Inexpensive, if well cared for Disadvantages - Requires fitting by an expert to decide the right size - Must be left in the vagina for at least 6 hours after sex - Needs careful storage to avoid developing holes - Less effective for women who have just given birth; they may need a different size. - Some women may feel uncomfortable in touching their vagina. - Not as effective as hormonal contraceptives. 228 THERE IS A METHOD THAT CAN PREVENT PREGNANCY IF THE CONDOM BREAKS OR IF YOU HAVE UNPROTECTED SEX. EMERGENCY CONTRACEPTION o What is it? A method of preventing pregnancy. o When is it used? When a condom breaks or slips, a person forgets to use any method of contraception, or in the case of rape. o Types: There are two types of EC: • Emergency contraceptive pills (ECPs): hormonal contraceptive pills taken as recommended by the health care provider. • Insertion of an IUCD by a trained family planning provider. o How does EC work? ECP • Stops the release of a ripe egg. • Stops sperm from fertilizing an egg. • Stops a fertilized egg from attaching to the womb. Emergency IUCD: • Prevents fertilization by creating a hostile uterine environment. • It does not result in an abortion. o How is ECP used? • First ECP dose must be taken within 3 days (72 hours) after unprotected sexual intercourse. Second ECP dose must be taken 12 hours after first dose. • If a woman vomits within 2 hours of taking ECPs, she should take 2 more pills immediately, and 12 hours later, 2 more pills. • If a woman vomits more than 2 hours after taking the pills, she should not worry. o How is an IUCD used? • IUCD can be inserted up to 5 days after unprotected sex to prevent pregnancy. • A woman can continue to use the IUCD as her regular method of contraception, or it can be removed after her period has started. o How effective is it? ECPs prevent most (98%) pregnancies. o Safety • ECPs can be safely used by most women. • They should NOT be used by women who have migraines, hypertension, or a history of blood clots/heart diseases. o Side effects You do not need to be worried about the side effects. Side effects are temporary and do not last for more than 24 hours. They include: 229 • Feeling like vomiting (nausea) • Slight headaches • Dizziness • Breast tenderness • Cramps in the belly o Important Tips for Users • Vomiting associated with ECPs can be prevented if the pills are taken with food. • ECPs will not harm an existing pregnancy or the baby, cause an abortion, or affect future fertility. • ECPs should not be used as a regular contraceptive method – they do not provide ongoing pregnancy prevention. • Can be used as a back-up method to the male or female condom in case of breakage. • There are no immediate signs to show you that the EC pills have worked. • However, if your period is more than a week late or you have concerns, see the family planning provider. • ECP does not prevent HIV or other STIs. o Advantages of ECPs ECPs prevent unplanned pregnancy if taken in the required time of 72 hours (3 days). o Disadvantages of ECPs ECPs have minor side effects; but the most important one to note is that it does not prevent STIs, including HIV. The most effective family planning/contraceptive methods that prevent both pregnancy and STIs are the male and female condoms (see ‘Sexually Transmitted Infections’). The following page contains an interactive quiz that can be used with adolescents to discuss their readiness to become sexually active 230 Are You Ready For Parenting? One of the consequences of sexual intercourse is pregnancy: There are some questions that we must be able to answer truthfully before we decide whether or not to have sexual intercourse. Answer the questions below, Yes (Y) or No (N) and rate yourself 10 for each YES and 5 for each NO. (Y) (N) 1) Can I handle school and a baby at the same time? 2) Can I forego all of my social activities to take on the responsibility of parenthood? 3) Can I afford to support a child financially? 4) Am I emotionally stable to look after a baby? 5) Is my body mature enough to carry a child for nine months? 6) Can I get a well paid job readily? 7) Can I devote 18 years or more to the raising of a child? 8) Will my partner be willing to support me financially and emotionally if I get pregnant? 9) Does my partner want a child? 10) Is my relationship a stable one? 11) Do we understand each other? 12) Do we both have plans for the future? 13) Do these plans include children? 14) Will my partner stay with me if I have a child for him? 15) Do I love children? 16) Will having a child prove that I am a mature person? How Did You Score? 120 – 160. Obviously you have given some thought to being a parent. However this must be followed by careful planning. REMEMBER – PARENTING COMES WITH A LIFETIME OF RESPONSIBILITIES. 0 – 120. Parenting is definitely not for you at this time or in the near future. You should take all the necessary precautions to ensure that you do not end up with an unwanted child. 231 10.5 THE UNITED NATIONS DECLARATION OF THE RIGHTS OF THE CHILD EVERY CHILD HAS THE RIGHT TO: • a name and nationality • love affection and attention • adequate nutrition, and health care • an education • full opportunities for play and recreation • special care if physically or mentally handicapped • enjoy these rights regardless of race, colour, sex, nationality or social status NB: The government of Jamaica has agreed to implement all the rights in the laws and practices related to children in Jamaica 10.6 THE CHILD CARE AND PROTECTION ACT (From: “Teachers making a difference- Promoting the Child’s Right to Protection A Jamaica Coalition for the rights of the child publication) The Child Care and Protection Act covers three groups of children’s rights: 1 Protection Rights: Rights that protect children from all type of violence, abuse, neglect and exploitation. 1. Provision Rights: Rights that guarantee the basic things that children need for their survival, growth and development. 2. Participation Rights: Rights that ensure children’s views are considered when making decisions that affect them and that opportunities are provided for them to share their views PROTECTION RIGHTS What Are Children Being Protected from? • All types of violence: For example, gang violence and fighting in the home or community. • Physical abuse: for example hitting, kicking, and punching or any type of beating. • Emotional abuse: for example cursing, insulting or doing things to children that make them feel bad about themselves. 232 • Sexual abuse: for example when an adult, including family members, molests a child or has sex with a child. • Neglect: for example when a child is abandoned, left alone or whose basic needs are not being met. • Trafficking: for example when adults move children from one place to another to work in bars, go-go clubs and as helpers. • Child labour: children under 13 years should not work for a living. Even up to age 15, children should not work at nights or during school time. Children should not be sent to beg on the streets. • Exposure to things that cause addiction: for example drugs, cigarettes, rum, beer or any other strong drink. WHOSE JOB IS IT? Whose job is it to make sure children’s rights under the Child Care and Protection Act are put into practice? Parents: Parents have the main duty to take care of children’s needs and make sure that they are protected from harm. They must make sure their children have food, clothes, a place to live, an education and health care. They must make sure that no-one is abusing their child/children. Teachers, Guidance Counsellors and Principals: Most children spend a lot of time in school. While in school they are under the guardianship of the staff. The staff should be sensitive to the emotional and physical needs of the children in their care and should refer students according to their needs or report abuses and neglect of all kinds. The Child Development Agency: The Child Development Agency is an office within the government that looks out for all children who are in need of care and protection. The Child Development Agency has Children’s Officers in every parish who go into schools and communities to make sure that children are safe. Call them at 948-6678. The Children’s Advocate: The Children’s Advocate makes sure that the Government is doing its duty to protect children and is listening to their views. The Advocate can also get a lawyer to help children whose rights are affected by anyone working for the government such as teachers, policemen and doctors or nurse. Call them at 948-1293, 948-3278, 948-3771, 967- 5890 or 967-3225. 233 AGENCIES PROVIDING CHILD PROTECTION SERVICES THE CHILDREN’S REGISTRY The Office of the Children's Registry has been in existence since January 1, 2007. It was established to receive, record, and store data on the maltreatment of Jamaica's children, and is in keeping with the Child Care and Protection Act of 2004, which speaks to the mandatory reporting of all types of child abuse, whether it is suspected or already happening. The Office receives information supplied by persons, who are required to make a report because they suspect that a child has been or is likely to be abandoned, neglected, physically or sexually abused, ill- treated, or is otherwise in need of care and protection. Reports are usually referred to two service partners, either the Office of the Children's Advocate (OCA), or the Child Development Agency (CDA). Regulations stipulate that when a case is referred, whether to the OCA or the CDA, they are mandated by law to give the Registry an update on the case, at least once per quarter. Anyone who suspects or knows that a child is being abused must make a report to the Registry, noting that victims can also make reports. The registrar reported in August 2008 that "Children have called and have made reports that they are being abused. However, there are certain persons who are called mandatory reporters, which means that they are mandated by law to make reports to the Registry. The Child Care and Protection Act, makes it the duty of every adult, to report every incident or suspicion that a child has been, is being, or is likely to be ill-treated, abused, abandoned, neglected, or is in need of care and protection”. Mandatory reporters are those people required by law to report child abuse. These are persons who, by the nature of their profession, execute some form of care toward a child, such as physicians, nurses, dentists, other health professionals, hospital administrators, owners of daycares or operators or employees of a child care centre or institution, guidance counsellors, teachers, principals, or any other person who, through their profession, has a duty of care towards children, or any person who has knowledge of child abuse.. " Calls made to the Registry are kept confidential, in that, the name of the caller, if given, is not divulged when the report is being referred. A report is taken even when the caller is anonymous. CISOCA The Centre for the Investigation of Sexual Offences and Child Abuse (CISOCA) is an arm of the Jamaica Constabulary force responsible for dealing with cases of rape and carnal abuse. JAMAICA COALITION ON THE RIGHTS OF THE CHILD (JCRC) The Mission of The Jamaica Coalition on the Rights of the Child is to advocate for child rights issues in Jamaica and the Caribbean, and to act as a watchdog regarding the implementation of the United Nations Charter on the Rights of the Child. CHILD DEVELOPMENT AGENCY (CDA) The CDA provides comprehensive delivery of services to children and their parents. The Agency has statutory responsibility for children who are in need of care and protection i.e. those abused, neglected or abandoned as well as for children who are experiencing behavioural problems. 234 CHAPTER ELEVEN Appropriate Eating and Fitness 235 11.1 Sample Lesson Plan # 1 HFLE THEME: APPROPRIATE EATING AND FITNESS Unit Topic: Healthy Eating Unit Objectives: By the end of the unit on Healthy Eating, participants should be able to: 1. Understand that foods help them grow and keeps them healthy 2. Identify different fruits and their functions 3. Make healthy food choices 4. Build muscles Lesson Topic: Healthy Foods Grade Level: 2 RPC Integration: Unit Title: Care and Safety of Self. Focus Question no. 1: How do I keep my body healthy? Page 98 Lesson Duration: 30 minutes Lesson Objectives: By the end of the lesson on, Healthy Foods, participants should be able to: 1. State at least two benefits to the body of eating fruits and vegetables 2. Demonstrate a commitment to a healthy eating campaign – “one fruit a day campaign” Life Skills Focus: Social: Communication, Advocacy Cognitive: Decision-making Coping: Self-awareness, Assertiveness Materials: Food chart; Fruits and Vegetables Overview of concept: Children need to learn that healthy eating must be their choice. They must be encouraged to develop self control and make a plan to remain healthy and live long through their choice of foods Preparation: Students are asked to take a fruit or vegetable to class. Fruits and vegetables are placed at the front of the class and displayed for students to see. Introduction: Step 1: a) Teacher asks class to identify what they are seeing on display at the front of the class. Teacher clarifies students’ responses where necessary. Students are asked to go to the front of the class, select a fruit and describe it to the entire class. Teacher provides information on the nutritional value of each fruit and discusses this with students. 236 The Food Group Chart may be used at this point to help students to classify their fruit or vegetable by pointing to the food group to which their fruit or vegetable belongs. Step 2: a) In groups, students should write what they would put in a fruit salad or vegetable salad that they could take to school. The recipes will be shared with the rest of the class. Other students are allowed to comment and make input. Step 3: Teacher would introduce n “Eat a Fruit a Day” Campaign Students are then instructed to draw a calendar with the days of the week. There should be sufficient space to draw a fruit or vegetable. Teacher gives instruction in accordance with the activity highlighted below. ONE - A - DAY Name: --------------------------------------------------------- • Draw and colour a fruit to be eaten each day of the week. • Put a tick in the box below your fruit each time you eat one. SUN MON TUES WED THUR FRI SAT 237 11.2 Sample Lesson Plan # 2 HFLE THEME – APPROPRIATE EATING AND FITNESS Unit Topic: The Influence of Personal Situations on Eating Habits Unit Objectives: By the end of the unit on the Influence of Personal Situations on Eating Habits, participants should be able to: 1. Demonstrate knowledge of proper nutrition 2. Display awareness of social, emotional and physical influences on food choices 3. Use appropriate life skills to adjust their food choices Lesson Topic: Balanced Meals Grade Level: 8 Lesson Duration: 40 minutes Lesson Objectives: By the end of the lesson on Balanced Meals, participants should be able to: 1. Discuss the nutritional needs of persons with different lifestyles for example: a) an athlete b) a patient recovering from an illness. 2. Analyze some of the factors that determine nutritional needs. 3. Plan a menu that reflects a balanced meal for one of the groups identified in # 1 above. Life Skills Focus: Social: Communication Cognitive: Creative thinking, Critical thinking, Decision-making Coping: Self awareness Materials: Chart: Caribbean Food Chart and Energy Balance diagram Overview of the Concept: Balanced meals determine a lot about human activity. A balanced meal supports physical, mental and emotional health. Eating properly is a way of investing in health, longevity and quality of life. Introduction: Step 1: Teachers use the Energy Balance diagram to explain the relationship between food and the production of energy for daily living. Teachers brainstorm with the class some examples of the various occupations, activities and states of health that exist or are adopted by persons and writes them on the board. For example, secretaries, athletes, students studying, persons ill in bed, etc. Step 2: Each work-group takes one of the lifestyles and discusses the nutritional needs of that lifestyle group using the information on the Caribbean Food Chart. Step 3: a) Groups explain to the class the nutritional needs they have discussed. b) They analyze the factors that determine these needs. Step 4: Each group plans an attractive and nutritious meal for their selected lifestyle group. Culmination Activity: Prepare a menu card to depict a balanced meal. 238 11.3 ENERGY AND YOUR BODY’S NEEDS The energy you need depends on how much energy you use up. All the growth during childhood and adolescence takes up a lot of energy. In fact, adolescents need more energy than most adults. Energy is measured in calories. If you consume more energy or calories than your body needs during the day, the extra calories will be stored as fat for a time when it is needed. For most people this is healthy and normal, but it can be a problem if you have too much fat. Obesity, which is an excessive build up of body fat, can weaken physical health and well-being, and shorten life expectancy. Unfortunately, obese people are also often made fun of unfairly due to their appearance. We need to be particularly careful not to tease people for being unusual or different than the norm. ENERGY BALANCE A. ENERGY INPUT equal ENERGY OUTPUT (FOOD) (Vital body functions, daily activity, exercise) B. TOO LITTLE ENERGY Energy Input Energy Output UNDERNUTRITION C. TOO MUCH ENERGY Energy Input Energy Output FOOD CONTAINING OBESITY Fat Carbohydrate Protein FAT 239 12.4 NUTRITION THROUGH THE LIFECYCLE: TODDLERS AND YOUNG SCHOOL CHILDREN Planning, supervision and plenty of encouragement is needed to make sure growing children are properly nourished. Feeding the Toddler Between the ages of one and three years the child will be walking, trying to dress and feeding him or herself and gradually becoming more independent. Remember that the child is still growing and developing, so continue feeding many different nourishing foods, like the rest of the family, and supervise him or her at mealtime. Following the multi-mix principle, the toddler should now get larger portions of mixtures of foods from the groups. Serve regular meals and nutritious snacks. Include nourishing foods that the child can manage easily with the fingers and which help to encourage chewing such as fruits, raw carrots and crisp crackers. In a day a toddler may eat as follows. • Avoid providing substitutes by cooking something else or preparing an item in a different way for children who are not sick. Feeding the Young School Child Children between the ages of 6 and 10 are still growing at a rapid rate. They need more food than some adults. The 10 year-old girl needs just slightly less food than her 35 year-old mother and as much as her 60 year-old grandmother. It is normal for children at this age to get deeply involved in a game, project or TV show. They may not want to leave the activity to eat. They may hurry through a part of the meal to get back to the activity. Also, they may get up late in the mornings and be so anxious to get to school that they feel they have no time to eat. It is important that they eat properly to stay healthy, grow and develop as they should. Eating properly also helps them to pay attention in school, to learn well and be alert and fit physically, mentally and socially. Meals for School Children Every child should eat at least three meals, containing enough foods from the six food groups. Since school children can easily get anemia, parents and guardians should make sure that they get foods that are rich sources of iron. Breakfast/Morning Meal The child’s breakfast should provide one-fourth to one-third of the daily needs. Here are some examples of what that child may have: 1. fruit 2. fruit 1 cup porridge made with milk 2-3 Johnny cakes 2 slices buttered bread Cocoa made with milk 1 hard boiled or scrambled egg (From: Nutrition Made Simple 4th Edition by VS Campbell & DP Sinha CFNI 2006) 240 FOOD GROUPS Staples: cereals, starchy Vegetables: carrots, Food from animals: beef, roots and fruits, bread, tomatoes, calaloo fish, eggs, milk, cheese, porridge, yam, potato, rice. sardine. Fats and oils: butter, oil Legumes and nuts: peas, beans Fruits: mango, oranges, pawpaw, banana 241 SAMPLE MEALS Morning (breakfast) 2 slices of roasted Breadfruit 1 Mackerel ball (30g/1 oz) ¼ cup Steamed Callaloo/Spinach Mid-morning Snack Fruits in season (ripe banana, or medium mango) 3 crackers or 1 slice buttered Bread (optional) Noon Cheese Sandwich (1 slice cheese) with lettuce and cucumber 1 cup Fresh Cherry Juice (1 Tbsp sugar) or Fruit Mid-afternoon Snack 1 Roasted Corn 1 Orange Evening 60g/2 oz Fresh Fish with tomato sauce ¼ cup cooked Peas ½ cup cooked-up Rice 1 slice Sweet Potato or Dasheen ¼ cup Stir-fried Cabbage + Sweet pepper Water Bedtime Snack 1 cup hot milk or cocoa with crackers (From: Nutrition Made Simple by VS Campbell & D. P. Sinha CFNI 2006) NUTRITION THROUGH THE LIFE CYCLE: PRE-TEENS AND TEENAGERS The pre-teen period, from age 10 to 13, is a time of rapid growth in girls. Boys have a great spurt a year or so later. At that time they often catch up and pass the girls. Girls get taller and weigh more just before the start of menstruation (monthly periods). Their nutritional needs are greatest during this period of intensive growth. Yet children of this age are often careless about eating properly. They are more interested in being popular, attractive and athletic, and in pursuing the latest fad or trend in company of their friends and schoolmates. Regardless of these interests though, they must be encouraged to find time to eat well. Feeding Pre-Teens Pre-teens need lots of food to help them grow, build blood and muscle, guard against infections and to keep alert, healthy and active. They have special needs for energy (calories); for the minerals iron and calcium; and for vitamins, especially vitamin A. It is likely that they will satisfy mineral and vitamin needs if they eat a variety of foods from the six food groups. 242 The amount of food a pre-teen boy needs each day from the six food groups, is about the same as, or a little less than that needed by the average adult male. Boys therefore need the larger amounts of food shown on the menu page while girls need the smaller amounts. A day’s meal for pre-teens would therefore be similar to those of teenagers. Improving Pre-Teens’ Food Choices Some pre-teens, especially girls, tend to eat very small amounts; but because of their tremendous growth spurt they should be eating a lot. Boys never seem to have enough – they are always hungry. Some clamour for hot dogs, hamburgers, patties (meat pies), pizza, French fries, chips, cakes and pastry. These are big calorie “fast foods” which have disproportionately high level of fats, especially saturated fat. They are usually thirsty and satisfy that thirst with carbonated and other sweet drinks. While no harm will be done by eating these foods occasionally and in small amounts, it is better for children to eat economical, nutritious snack items such as biscuits, milk, fruits, buns, puddings, and sandwiches and to drink water. A good way to get pre-teens to take an interest in making better food choices is to let both boys and girls help with meal planning and with food shopping and preparation. They could take turns preparing meals on weekends when they have more time. They can help start dinner when they come home early from school, prepare packed lunches or help to start breakfast the evening before. You can ask the physical education teacher, sports coach, nurse, guidance counsellor or cosmetology teacher to help motivate pre-teens to make better food choices. When they connect good eating with good athletic performance and physical attributes they may take more interest in what they are really eating. Eating Well in Adolescence Teenagers grow and develop rapidly. The physical structure changes: muscles increase, the quantity and distribution of fat alters, and organ systems get bigger. These and other changes affect their nutritional needs. They have special needs for energy, protein, the minerals calcium, iron and zinc, and for all vitamins. An athletic student will need even more for the maintenance of her strength, in order to cope with training and studies. Energy and Nutrient Requirements The requirement for energy peaks at about 12-14 years, followed by a gradual decline. The amount of energy adolescents need is affected by how physically active they are, how well they were growing before, and whether they were well nourished when they were younger. Different activities demand different levels of energy. If they are active in sports, they will need more than the recommendations of 220 calories for girls and 2700-3000 for boys. Calcium, iron and zinc are particularly important for teenagers. The calcium is needed for the growth of the skeleton, iron to help increase red blood cell and muscle issues, and for the growth of bone and zinc for growth and formation of new tissue. Teenagers need more of all vitamins which are available in a balanced, varied diet. Eating more of the right foods will provide ample amounts of all these nutrients. If the teenager smokes or uses oral contraceptives, there will be a need to pay special attention to vitamin C intake, as both practices change the way the body uses this kind of vitamin. Smoking is an unhealthy habit for a ten as well as an adult. 243 Below is a sample menu for a teenage girl, with modifications for a boy. Pre-teen boys would get just about the same amount. GIRLS ADDITION FOR BOYS Morning Meal: Morning Meal Increase: 1 Orange Orange to 2 or add another fruit, e.g. ripe Porridge made with: banana ¼ cup 60g Cornmeal ½ cup Milk and Noon 1 Tbsp Sugar Increase: 2 slices Bread stewed peas to ¾ cup; 1 tsp. Butter beef to 60g (2 oz) rice to 2 cups Mid-Morning Snack pumpkin to 1 cup 1 ripe Banana potato to 5 slices (150g) and 1 small packet (30g) Peanuts add fruit in season Noon (If lunch is packed) (If home for lunch) Increase bread to 4 slices ½ cup Stewed Peas with: 30g/1 oz ground Beef and Evening (Dinner or Supper) ½ cup diced Pumpkin Increase: 1 cup Rice chicken to 90g/3 oz 3 slices (100g) Sweet Potato breadfruit to 4 slices (200g) 2 slices (65g) Avocado pear rolls 1 cup Lemonade Sweetened with 2 Tbsp Sugar (If lunch is packed) 1 tuna/corned beef/chicken Sandwich with lettuce and tomato 1 Rock Bun 1 cup Lemonade sweetened with 2 Tbsp Sugar 1 Fruit in season Evening (Dinner or Supper) 1 cup Callaloo Soup 60g/2 oz Stewed Chicken with 30g/1 oz Broad Beans 60g/2 oz Carrots 60g/2 oz White Potato 2 Tbsp Gravy 2 slices (100g) fried Breadfruit 1 buttered Roll ½ cup Fruit Salad 244 11.5 OBESITY What is obesity? Obesity has become a major public health problem in the Caribbean. It affects more than a quarter of the adult population, particularly our women. Some persons in the Caribbean think being overweight, “plump” or “chubby” is a sign of prosperity. Obesity is one of the easiest medical conditions to recognize but most difficult to treat. It is a condition in which the body stores excess fat in such a way that health is negatively affected. When an individual becomes obese or has excess body fat this can be a serious health hazard as the person becomes prone to other chronic diseases such as diabetes mellitus Type 2, cardiovascular disease, osteoarthritis, sleep apnea, stroke and certain types of cancer. Causes of Obesity While the precise origin of obesity is complex, the lack of physical activity is a clear and significant contributing factor. Obesity results when our energy intake is chronically in excess of our energy expenditure, thus resulting in weight gain. For example the increase use of technology by children and decreased physical activity in children can be traced or linked to the increase in cases of obesity over the years. In the Caribbean, instances of physical activity have continued to decline over the years and sedentary lifestyles are on the rise. Occupational activity levels have also declined and despite the popularity of certain leisure activities and the proliferation of gyms, aerobics classes and jogging trails, energy expenditure levels have declined overall. These trends have contributed significantly to the rise in the number of cases of obesity. Other environmental and lifestyle habits, including high-fat diets or poor eating habits may also serve as a trigger for obesity. Too much starchy food should also be avoided, as the body converts excess carbohydrate and stores most of it in the form of fat. Excess protein is also stored in the body as fat. Physical Activity and Obesity Normal regulation of the body weight occurs when energy input is equal to energy output. That is, if we consume food (energy intake) then in order to regulate body weight, we need to output equal amount of this energy. During increased physical activity or exercise (such as: brisk walking, running, cycling), our muscles use up energy derived from fats and glycogen. Physical activity affects body composition and weight in that it promotes the loss of fat while preserving lean body mass. Furthermore, research has shown that high levels of physical activity help to counteract a gene which predisposes some individuals to become obese. Thus, through a planned, structured, repetitive and purposive form of physical activity that boosts physical fitness – obesity can be significantly decreased. There are three major components of physical activity to consider: • Frequency (how often you exercise) • Intensity (how vigorous or energetically you exercise), and • Time (how long the sessions are) This is referred to as the FIT formula. The rate of weight loss is influenced by the frequency, intensity and duration (time) of physical activity. And not all physical activities are equal. That is, some exercises such as walking up hill or climbing stairs will do more to increase your heart rate (which is the goal of the exercise), than other less intense activities. 245 Additionally, exercising for very short periods (under 15 minutes) or on a very irregular basis is unlikely to bring significant or long-term results. Obesity and Children Obesity most commonly begins in childhood between the ages of 5 and 6, and during adolescence. Studies have shown that a child who is obese between the ages of 10 and 13 has an 80 % chance of becoming an obese adult. Currently, between 10 and 20 percent of children and adolescents in the Caribbean are obese. A 2001 Ministry of Health’s study among school children in Jamaica highlighted a number of concerns with their food consumption habits, particularly the high consumption of sweets, snacks and sweet drinks and inadequate consumption of fresh fruits and vegetables. The foods consumed largely reflected the purchasing ability of the children and the products available from vendors outside the school. Data from a cohort study of 11-12 year olds born in the island between September- October 1986, and studied from birth showed that 19.7% of them had already become obese or overweight. Obesity is known to decrease life expectancy in both children and adults. Unhealthy weight gain due to poor diet and lack of exercise is responsible for over 300,000 deaths each year. And the proportion of obesity continues to increase with aging and sedentary living. That is, obesity begins in the young and the incidence continues to gradually increase from adolescence through to adulthood. The control of obesity is a lifelong undertaking and to make the most effective use of physical activity in the fight against this condition, it must become a way of life. Unfortunately, obese people are also often made fun of unfairly due to their appearance. We need to be particularly careful not to tease people for being unusual or different than the norm. (Adapted from: NYAM News CFNI May No. 1&2 2008) 12.6 Healthy Food Choices and Eating Behaviours Certain guidelines have been suggested to help us assess how well we are eating. Our plan using the six food groups, shown in the charts below, is the chief way of helping us to make wise choices while keeping an eye on the amounts, particularly of items which contribute calories (energy). Within each food group, we can exchange one food for another, and we can combine foods from the different groups according to what we call the multi-mix principle. In applying the – principle, remember to eat less meat – especially fatty meats – less sugar, salt and refined cereals and more peas, beans, fruits, vegetables, ground provisions and whole grain cereals, and drink more water. How Much, What and When We Eat are Important It is important that we control the amount of food we eat. It is more desirable and healthier to eat larger portions of peas, beans, starchy items, fruits, vegetables and fish than to eat lots of meat, chicken and other fatty foods from animal sources. The more fat and food that we eat overall, the more calories we will get. Most of those calories will be stored as fat if we are not active enough to use them up. Because of the difference in fat content and hence caloric levels, a serving of meat is about two ounces (60 grams), while a serving of fish can be double that. One cup of cooked rice provides as many calories as a 60-gram portion of medium fat meat or chicken. It is unwise to say “I’ll have more meat then” and omit the rice or other starchy food. The starches provide mostly carbohydrate and fibre, which the meats and other food from animal sources do not offer, except for milk, which provides the carbohydrate, lactose. When we eat large meals once or twice a day, we tend to convert and store calories as body fat to a greater extent that when we have 3 or 4 small meals containing the same total amount of food. 246 A varied diet is best. The wider the variety or range of foods we eat, the better, because the nutrients which may be lacking in some will be present in others. Eating small meals regularly – three or more times per day - and having more fruits, vegetables, starchy foods and fish and less meats, fats, sugar and salt, make our diet healthy. We should also drink lots of fluids – the best of which is plain water, also known as “crystal punch.” From: Nutrition Made Simple by VS Campbell & D. P. Sinha CFNI 2006 Chp 2 How foods keep us healthy 11.7 Alcohol and substance abuse Addiction usually does not happen overnight. Rather, people who become addicted to drugs (such as alcohol, cocaine, heroin, marijuana, etc.) are gradually introduced and desensitized to them over a period of time. They may initially enjoy the use of drugs in a recreational sort of way. For instance, someone might get into the habit of having a beer or some wine after work as a way of releasing the days' stresses. Someone else may use marijuana on an occasional basis as a way to share special time with friends or as an aid to appreciating food, music, or sex. Another person may start using cocaine as a way of staying up late at night to study for exams. Some people are able to keep using drugs on an occasional basis. Many other people are not so lucky. For these unlucky others, their use of drugs begins (gradually in some cases, abruptly in others) to increase, and the amount of attention they spend thinking about getting high, purchasing drugs, preparing drugs and taking drugs increases until it becomes the center of their lives. Other responsibilities - work, friends and family, and community - fall by the wayside. As their consumption of drugs rises, users may become physically dependent on their drug to the extent that if they do not take it on a particular day, they get sick. As dependence increases, tolerance to the drugs increases as well - meaning that it takes more and more of the drug to get the same 'high' or 'buzz' effect. As most drugs (with the exception of alcohol) are illegal, they may become increasingly involved in criminal activities (buying drugs is a criminal activity, as is driving while intoxicated). If the process continues long enough, it may become impossible for the addict to hold a job - they may lose their relationships, their income and their marriages. They may resort to criminal activity (such as robbery, prostitution and drug dealing) in order to gain continuing access to their drugs. They may also kill or injure other people (through driving and firearm accidents) while intoxicated, and may get and pass along to others infectious diseases (like AIDS and Hepatitis). Ultimately, they may end up killing themselves (through suicide, malnutrition, overdose, or drug related physical degeneration and disease). A grim picture that is all the more tragic because no one who starts out experimenting with a drug ever really believes that they would ever experience any of these awful things. 247 Commonly used Drugs in Jamaica Marijuana also commonly called ganja or weed is usually smoked as a cigarette (called a joint) or in a pipe or bong. Marijuana has also appeared in blunts, which are cigars that have been emptied of tobacco and refilled with marijuana, sometimes in combination with another drug, such as crack. It can also be mixed into foods or used to brew a tea. Marijuana abuse is associated with many detrimental health effects. These effects can include frequent respiratory infections, impaired memory and learning, increased heart rate, anxiety, panic attacks and tolerance. Marijuana meets the criteria for an addictive drug and animal studies suggest marijuana causes physical dependence and some people report withdrawal symptoms. Cocaine is the most potent stimulant of natural origin. This substance can be snorted, smoked, or injected. When snorted, cocaine powder is inhaled through the nose where it is absorbed into the bloodstream. Crack is cocaine that has been processed from cocaine hydrochloride to a free base for smoking. Cocaine is a strong central nervous system stimulant. Physical effects of cocaine use, including crack, include constricted blood vessels and increased temperature, heart rate, and blood pressure. Users may also experience feelings of restlessness, irritability, and anxiety. Smoking crack delivers large quantities of the drug to the lungs, producing effects comparable to intravenous injection. These effects are felt almost immediately after smoking, are very intense, but do not last long. For example, the high from snorting cocaine may last 15–30 minutes, while the high from smoking it may last 5–10 minutes. Evidence suggests that users who smoke or inject cocaine may be at even greater risk of causing harm to themselves than those who snort the substance. Cocaine smokers may suffer from acute respiratory problems including coughing, shortness of breath, and severe chest pains with lung trauma and bleeding. Others drugs include: Ecstacy, Heroin, Beadie and Alcohol which many persons do not regard as a drug because it is legal. Many persons also practice inhaling chemical substances found around the home such as kerosene oil, glue, shoe polish, correcting fluid etc. Most inhalants act directly on the central nervous system (CNS) to produce psychoactive, or mind-altering, effects. They have short-term effects similar to anesthetics, which slow the body's functions. Most inhalants produce a rapid high that resembles alcohol intoxication with initial excitation, then drowsiness, disinhibition, light headedness, and agitation. If sufficient amounts are inhaled, nearly all solvents and gases produce anaesthesia, a loss of sensation, and even loss of consciousness. 11.8 Physical Activity Your physical emotional, social and psychological health and well- being can be affected negatively or positively by physical activity and/or exercise. There are many ways that sedentary persons can improve their physical activity. They should start slowly with short periods lasting five to ten minutes and then increasing the level and duration over time You can do it! Getting started is easier than you think, 30 minutes or more a day is all it takes. Physical activity doesn’t have to be very hard. Build physical activity into your daily routine. How to Get Started • Walk whenever you can- get off the bus early and walk the rest of the way if you can • Use the stairs instead of the elevator • Reduce inactivity for long periods, like watching TV • Get up from the couch and stretch and bend for a few minutes every hour • Choose to walk, wheel or cycle for short trips 248 • Start with ten minute walks and gradually increase the time • Do the activities you are doing now more often Benefits of Physical Activity: • Prevents and controls diseases like diabetes (sugar), hypertension (pressure) heart disease, obesity and some cancers • Improves mental and physical health • Builds strong muscles and bones • Promotes relaxation • Reduces stress • Makes you feel good about yourself • Increases energy • Helps older persons live independently Health Risks of Physical Inactivity: • Premature death • Heath Disease • Obesity • High blood pressure • Adult-onset diabetes • Osteoporosis • Stroke • Depression • Colon Cancer 249 250 CHAPTER TWELVE Managing the Environment 251 12.1 Sample Lesson Plan # 1 HFLE THEME – MANAGING THE ENVIRONMENT Unit Topic: The Importance of the Environment for Health and Wellbeing Unit Objectives: By the end of the unit on The Importance of the Environment for health and wellbeing, participants should be able to: 1. Demonstrate an understanding of the interrelationship of a sustainable natural environment 2. Demonstrate an understanding of the threats to the health and well being of citizens that environmental destruction poses 3. Demonstrate an understanding of the threats to the economy that environmental destruction poses 4. Appreciate that each individual has a responsibility to contribute to a healthy, sustainable environment Lesson Topic: Planning for Disasters Grade Level: 9 Lesson Duration: 40 minutes Lesson Objectives: By the end of the lesson on Planning for Disasters, participants should be able to: 1. Use critical thinking skills to develop disaster plan of action 2. Use decision making skills to respond to an impending disaster Life Skills Focus: Social: Communication, Advocacy Cognitive: Critical thinking, Creative-thinking, Decision-making Coping: Assertiveness Materials: Charts: Are you ready for an Earthquake, Hurricane Safety, Freddy the Friendly Flood Guide, Flooding: Are you Prepared. Overview of the Concepts: Some disasters are preventable and some are brought on by the activities of human beings. Loss of life and property can be avoided if everyone takes responsibility for his or her safety and the safety of others by engaging in ongoing planning for the event of a disaster of any kind. Preparation: Teacher reads a bulletin to students which represent the latest advisory of an impending hurricane. Introduction. Step 1: a) Students are asked the following questions: Having heard the advisory what do we need to do in preparation for the hurricane? – This question may be used to prompt discussion among students. 252 Step 2: Teacher records responses and reinforces critical points. The points will form the component of a Hurricane Action Plan. Students are asked to separate in groups. Step 3: In their groups, students will role play the preparations and precautions to take in the event of a hurricane in the following locations: • At home • In the Community • At School Each group will be required to prepare a Hurricane Action Plan. Teacher instructs students to present their plan before the start of their role play. Students are reminded to delegate responsibilities to individuals. There may be time for only one group to present. Step 4: Teacher asks students the following questions to encourage discussion and input. • How did the family at home prepare for the hurricane? • Were the individuals prepared? • What else could have been done? /What was not done? • What was the outcome of their preparation? Students sing Lovindeer’s “Wild Gilbert” and are asked to analyze the words. Students are given the opportunity to respond. Culminating Activity: Students draft Hurricane Action Plans for their homes and ensure each member of their family is given a specific task or set of tasks. 253 11.2 Sample Lesson Plan # 2 HFLE THEME – MANAGING THE ENVIRONMENT Unit Topic: Pollution Unit Objectives: By the end of the unit on Pollution, participants should be able to: 1. Identify elements of pollutants in the environment 2. Discuss the negative implications for polluting the environment 3. Analyze strategies for preventing the pollution in the environment 4. Examine ways of dealing with the existence of pollution in our environment. Lesson Topic: Caring for our Land Resources Lesson duration: 40 minutes Lesson Objectives: By the end of the lesson on Caring for our Land Resources, participants should be able to: 1. Identify the evidences of land degradation in the school community 2. Examine the causes of land degradation in the school community 3. Plan a programme to solve the land degradation situations within the school community. Life Skills Focus: Social: Communication, Advocacy Cognitive: Critical thinking, Decision-making Coping: Healthy self-management Materials: The 4 Rs of Garbage Management Chart Overview of the Concept: The protection of the environment is everybody’s responsibility. Awareness of land degradation is the first step to bringing about an awareness of measures to protect the environment from destruction. When we protect the environment we are protecting our health, longevity and quality of life. Preparation: Participants explore the school environment and examine evidences of land degradation. They list these and take to the class. Introduction: Step 1: Each group reports to the class on the land degradation seen in the (5 minutes) school environment. Step 2: Teacher brainstorms with groups the causes of the land degradation they have seen in their school community. Step 3: Each work group selects one of the land degradations in the school community and develops a plan to solve that problem which includes starting an Environment Club or supporting the one that already exists. Culminating Activity: The teacher randomly asks two participants to step to the front of the class and give a 2-minute speech beginning, “I have a dream that one day (name of school) 254 will………… (the completion will relate to a school environment where the land environment is free from pollution). Teacher and participants applaud each speech. 255 11.3 Sample Lesson Plan #3 HFLE THEME # 4 – MANAGING THE ENVIRONMENT LESSON PLAN Unit Topic: The Importance of the Environment for Health and Wellbeing Unit Objectives: By the end of the unit on The Importance of the Environment for Health and Wellbeing, participants should be able to: 1. Demonstrate an understanding of the interrelationship of a sustainable natural environment 2. Demonstrate an understanding of the threats to the health and well being of citizens that environmental destruction poses 3. Demonstrate an understanding of the threats to the economy that environmental destruction poses 4. Appreciate that each individual has a responsibility to contribute to a healthy, sustainable environment Lesson Topic: Planning for Disasters Grade Level: 5 Lesson Duration: 40 minutes Lesson Objectives: By the end of the lesson on, Planning for Disasters, participants should be able to: 1. Use critical thinking skills to develop disaster plans of action 2. Take personal responsibility to discuss plans of action with parents. Life Skills Focus: Social: Communication, Interpersonal relations Cognitive: Critical-thinking, Creative-thinking, Decision-making Coping: Self-assertiveness Materials: Charts: Are you ready for an Earthquake, Hurricane Safety, Freddy the Friendly Flood Guide, Flooding: Are You Prepared? Overview of the Concepts: Some disasters are preventable and some are brought on by the activities of human beings. Loss of life and property can be avoided if everyone takes responsibility for his or her safety and the safety of others by engaging in ongoing planning for the event of a disaster of any kind. Preparation: Participants, in their groups, research one of four aspects of a hurricane that happened in Jamaica in the recent past, (the preparation for the hurricane, the damage done by the hurricane, cleaning up after the disaster, and how the damage could have been eliminated or lessened). They plan a 2-minute role play to demonstrate their point. They come to the class with pictures and information to share with others. Introduction: Step 1: Each group places their research assignment on display. (5 minutes) 256 Step 2: Each group discusses their assignment making (15 minutes) reference to their models or pictures. Step 3: Each group role-plays for 2 minutes a disaster-preparedness (15 minutes) scenario and shares their disasters plan with the rest of the class. Extension Activity: (5 minutes) a) Participants write an article on, “Disaster Preparedness is My Business Too” to be sent to one of our national newspapers for publication. b) Teacher negotiates to get the essay published. 257 11.4 Sample Lesson Plan # 4 HFLE THEME #4 – MANAGING THE ENVIRONMENT LESSON PLAN Unit Topic: Our Environment is Everything around us Unit Objectives: By the end of the unit on Our Environment is Everything around us, participants should be able to: 1. Understand elements of the environment 2. Appreciate the need for a healthy environment 3. Appreciate the elements of a safe environment Lesson Topic: I can Improve my Environment Grade Level: 1 RPC Integration: Unit title: Things in the Home. Focus Question no. 2. How do I care for the things in my home and use them safely? Pages 53 & 54. Lesson Duration: 30 minutes Lesson Objectives: By the end of the lesson on, I can Improve my Environment, participants should be able to: 1. Demonstrate two actions for keeping themselves and their environment clean. 2. Describe two effects of poor disposal of waste on human health. Life Skills Focus: Social: Communication, Advocacy Cognitive: Decision-making Coping: Self-assertiveness and Self-awareness Materials: Charts: The 4 R’s of Garbage Management, Reasons we should Protect the Trees, Some Impacts of Solid Waste Overview of the Concept: Children need to learn that the protection of their environment is also their responsibility. They can take simple actions that will make life for them more pleasant and healthy. They can also take actions that destroy the environment and can lead to sickness, discomfort and even death. Preparation: Participants examine their school grounds, offices and classrooms to identify areas of good and improper waste management. They should take samples to demonstrate the points as they plan to share with the class. They also plan to make recommendations for improving the improper practices. Groups set up their display corner and prepare for their (2 Minutes) presentations. Introduction: Step 1: Groups report on the school’s waste management practices. (10 minutes) 258 Step 2: In their groups participants plan a “Clean as a Whistle (10 minutes) Campaign” for their school. Groups organize themselves. One group focuses on what is needed. Another group on how to secure the resources. Another group on how to convince school administrators, teachers and other students to become involved in the campaign, and, Another group on getting the word out into the community about their plans and activities. Culmination Activity: Class sing the jingle, “Bits of Paper.” They improvise an additional (5 minutes) verse to include the “Clean as a whistle” theme. 259 12.5 HEALTH AND THE ENVIRONMENT There is an interdependence of man and the natural environment. If we do not protect the air, water, land, flora and fauna, in time the environment will lose its ability to sustain good health and quality life. The environment from the perspective of the Grades 1-6 student should be defined in terms of the home, school and community. From the perspective of the Grade 7-9 student it should be defined in terms of the personal and collective responsibility to ensure a healthy environment and consequently healthy humans. The emphasis is on personal and collective (community) responsibility to improve health through better air quality (plant trees and limit the burning of garbage/refuse); to reduce potential of getting vector- borne diseases (limit breeding sites for flies, rats and mosquitoes) through proper waste disposal; and being prepared for natural disasters. 12.6 Conservation Rethink Reduce Reuse Recycle Conservation is simply the wise use of resources. The consumer conservation ethic is sometimes expressed by the four R's: " Rethink, Reduce, Reuse, Recycle," This relates to the sustained, and efficient use of renewable resources, the moderation of destructive use of resources, and the prevention of harm to common resources such as air and water quality, the natural functions of a living earth, and cultural values in a built environment. In common usage, the term refers to the activity of systematically protecting natural resources such as forests, including biological diversity. Carl F. Jordan defines the term as “biological conservation as being a philosophy of managing the environment in a manner that does not despoil, exhaust or extinguish”. Environmental protection is a practice of protecting the environment, on individual, organisational or governmental level, for the benefit of the natural environment and (or) humans. Due to the pressures of population and technology the biophysical environment is being degraded, sometimes permanently. This has been recognised and governments began placing restraints on activities that caused environmental degradation. Since the 1960s activism by the environmental movement has created awareness of the various environmental issues. There is not a full agreement by environmental experts on the extent of the environmental impact of human activity and protection measures are occasionally criticised. Protection of the environment is needed from various human activities. Waste, pollution, loss of biodiversity, introduction of invasive species, release of genetically modified organisms and toxics are some of the issues relating to environmental protection. 260 12. 7 Pollution of the Environment Pollution can be defined as the introduction of a foreign substance into the environment which defeats the ability of the environment to adjust or cope with it. The result is that the environment no longer remains pure but is contaminated and may even be destroyed. Environmental pollution also affects man’s health. Land pollution Causes • Land pollution is caused by the following: dumping solids and liquid waste in backyards, at roadsides, vacant lots, beaches, etc. • Dumping or buying of toxic waste by industry; • Improper use of fertilizers or pesticides by farmers; • Open-pit mining / strip mining, e.g., as used in bauxite industry; • Quarrying for building materials Consequences The consequences of land pollution are as follows: • It creates an unhygienic environment which promotes the spread of disease, e.g., cholera and dengue, by flies, mosquitoes and rats. • It causes offensive odours. • Toxic waste poisons the soil preventing food production or human settlement. • Chemicals in fertilizers may be transmitted to plants and eventually animals and humans, thereby causing diseases. • It reduces good agricultural land. • It affects the revenue-earning capacity of tourism because of an area’s negative image Remedial measures and policies Land pollution can be minimized by: • Education awareness programmes • Legislation regulating the disposal of solid waste • Recycling • Better garbage disposal systems • Development of appropriate sites for toxic waste disposal • Removal of toxic waste from environmentally sensitive areas • Strict monitoring in the bauxite and building industries • Use of alternative methods by farmers • Creation of compost heaps with kitchen waste Water pollution Water pollution is defined by the United Nations Food and Agriculture Organization (FAO) as ‘the introduction by man of substances into the aquatic environment resulting in such deleterious effects as harm to living resources; hazards to human health; hindrances to aquatic activities including fishing; impairment of quality for use for water, and reduction of amenities’. Fresh water pollution Fresh water is found in streams, rivers, lakes and springs. Fresh water pollution may be caused by: • Household wastes which enter the drainage system • Agricultural inputs and wastes- pesticides, animal manure and inorganic fertilizers 261 • Industrial and chemical wastes • Effluent from factories • Discharge of raw sewage • Waste from mining activities • Sedimentation • Oil spills • Acid rain Organic pollution can come from sewage and other wastes from food and beverage manufacturing, processing plants like canneries, meat and fish processors, sugar refineries, rum and beer distilleries, which discharge untreated waste water into rivers. Other sources of organic waste are pig and poultry farms which often discharge their wastes directly into river courses. Effects of fresh water pollution • Domestic water becomes polluted because excess sedimentation makes the water filtration system less effective. • Recreational areas for bathing and fishing are restricted. • Ground water / surface water transmits diseases to man. • Logging and mining cause siltation or sedimentation harming fish life. • Mining activities contaminate aquifers. • Livelihoods are disrupted, e.g., fishermen. • Tourism declines. Marine pollution Marine pollution contributes to the destruction of our coastal areas, our seas and our reefs. It is caused by: • Improper sewage disposal • Industrial effluent • Oil spills and leakage • Agricultural runoff • Household garbage Other effects of marine / coastal pollution are: • Tourism industry declines • Employment opportunities decrease Remedial measures and policies Government can introduce policies to reduce marine / coastal pollution. Read the suggestions below. • Introduce education awareness programmes about the value of water and the sea as a resource • Introduce legislation forbidding the dumping of harmful wastes into the sea • Use more coastal patrol to monitor ships which may be dumping sewage • Develop new technologies for waste disposal • Introduce more frequent checks and stricter measures about oil drilling, especially offshore • Ensure better control of agricultural use of pesticides Air pollution Human activity is the major cause of air pollution. Air pollution is caused by the following: • Exhaust as a result of factory operations • Motor vehicle exhaust • Burning refuse • Aerial spraying of crops 262 Emissions from natural sources also cause some amount of air pollution. These sources include: • Plants • Volcanic eruptions (they release poisonous gases into the atmosphere) • Mud • Forest and bush fires • Wind-blown soil • Land and water bodies, including swamps • Soil bacteria Consequences of air pollution • Air pollution, which includes smog, lower visibility • It damages plant life • It affects human health (increase asthma and other respiratory ailments) • It damages buildings • Lead in the environment impairs mental and physical development in children Acid Rain One of the most serious consequences of air pollution is acid rain. Coal, oil and petrol release a mixture of waste gases as they burn. These gases mix with water vapour in the atmosphere to form sulphuric acid and nitric acid. The acid- containing water vapour, later falls to the earth as acid rain, sometimes hundreds of kilometres from where it was formed. Reducing the problem of acid rain The incidences of acid rain can be reduced by: • Using alternative energy sources (not fossil fuels) • Using emission control devices (for example, catalytic converters in vehicles and machinery) • Using equipment that removes acidic substances from emissions in power stations. Global warming Temperatures on earth today are generally higher than at any time since the last Ice Age. It is predicted that temperatures will increase in the future. This global warming is caused by a blanket of greenhouse gases. Effects of global warming The effects of global warming are as follows: • Low-lying areas flood as sea rises • Storms increase and weather becomes unpredictable • Crops fail resulting in food shortages • New pest and diseases are found in areas previously unaffected • Plants and animals become extinct • Remedial measures and policies Various measures can be taken to reduce global warming: Enactment and enforcement of legislation to deal with pollution control (for example, banning the use of CFCs) Introduction of education awareness programmes Use of incinerators to burn refuse Use of unleaded gas, compresses natural gas and other alternative energy systems Use of filters at factories 263 Noise pollution Noise- a disturbing form of pollution. Noise is often defined as unwanted sound. However, what is wanted by some (rock music to the young) may be unwanted by others (their parents). So that any sound may be a ‘noise’ if it is the wrong sound in the wrong place at the wrong time. It is partly this individual reaction which makes noise such a complex problem. What, you might ask, is so bad about noise? Well, noise affects hearing and concentration. Five minutes exposure to noise at levels of 120 decibels (or shorter exposures at higher levels of intensity) may cause temporary hearing loss. We have the knowledge and technology to control almost every indoor or outdoor noise problem. We can control the source, block its transmission path, or protect the receiver. But first, the public must be educated and persuaded to reduce noise levels. Causes of noise pollution Some causes of noise pollution are as follows: • Noise created by transportation, e.g., blare of sirens, honk of horns, squeal of brakes, roar of jet aircraft • Construction noise, eg., sound of jackhammers, pneumatic riveters, bulldozers, concrete mixers, etc; Effects of noise pollution Noise pollution: • Annoys and distracts • Hinders concentration • Causes mental fatigue • Creates mental fatigue • Creates nervousness • Impairs sensory system and leads to hearing loss Remedial measures and policies The following measures can help to prevent noise pollution: • Enactment and enforcement of legislation re noise level (for example, an act to control noise levels was passes in Jamaica in 1997) • Use of awareness programmes on dangers of noise pollution • Use of volume control devices and silencers • Use of ear plugs • Use of appropriate material which dampens sound in buildings Visual pollution A beautifully designed building, a well- laid out city and creative landscaping all present a sight which may be pleasing to the eye. On the other hand, people generally abhor unattractive structures or designs which may be lacking in creativity. For this reason, attention should be given to urban planning and rural development. People prefer to live, and work better, in an attractive environment. Billboards used for advertising which are not maintained and slogans and graffiti painted on walls and buildings, all destroy the beauty of the environment. It is the responsibility of the individual and our elected representatives to ensure that the environment is habitable. 264 12.8 RECYCLING Recycling means taking materials from products you have finished using and making brand new products with them. For example, most of the aluminum cans in the United States are made with recycled aluminum. So if you drink juice or soda from a can, recycle that can instead of throwing it in the trash. That can will stay in the Recycling Loop and out of the landfill. Why should I recycle? Making new things from recycled ones takes less money, less energy, and less of the Earth’s resources. Because less energy is used factories don’t release as much pollution either. Who recycles? Everyone can recycle. You can recycle at home and at school. Your parents and other adults can recycle at work, and so can the companies they work for. How does recycling work? Recycling starts with people separating recyclable materials from their other trash. The separated recyclable materials are collected by recycling programs, processed and then sold to manufacturers for use in new products. What are recyclable materials? 265 Aluminum and steel cans, cardboard, glass, newspapers and plastic bottles are all recyclable. These items can be made into new products including cans that hold food and drinks, the steel used to build skyscrapers and school buses, cardboard boxes, glass jars and bottles, newspaper and office paper, plastic laundry detergent bottles and even playground equipment! Also, food scraps from home or cafeterias at school can be separated rather than put in the trash. The scraps can then be turned back into nutrients that help plants grow through a process called composting, which accelerates the natural decay process. Yard waste, such as grass clippings, leaves and small tree limbs, can be converted through composting into mulch to help gardens grow. How can I reduce the amount of trash I generate? The best way to reduce the amount of trash you generate is to be a careful shopper. Don’t buy more than you need, especially if the product can go bad over time. As a consumer, you have purchasing power. As more and more people buy products that are reusable, refillable or concentrated, manufacturers will take notice and produce more of these Earth friendly products. Other ways to reduce your trash output • Buy products in bulk or larger containers rather than multiple small containers. • Use a sponge rather than disposable towels. • Buy concentrates. • Buy fresh fruits and vegetables without packaging. • Avoid products with excessive packaging. • Repair, rather than replace, broken items. • Donate unwanted materials to charity. 266 12.9 Preventing Soil Erosion Soil Erosion is the wearing away of the surface of the earth, due mainly to the friction of water and wind. Beaches are in constant flux; sea waves are always removing or depositing sand. This is perfectly natural, but our actions can make it better or worse. The forces of nature are beyond our control but if we reduce our vulnerability, coastal erosion does not have to become a disaster Coastal erosion • Coastal erosion occurs when beach material is carried away by wave action, tidal currents, or by deflation (deflation is removal of loose material from the beach or other land surfaces by wave action); • The beach is a buffer between the waves and homes along the coast; • Coastal vegetation also serves to keep beach material in place and reduce the rate of erosion; • In the Caribbean 68 in every 100 people live in coastal areas and could be potentially affected by coastal erosion. How do you know if your property is at risk? Look around. Is there evidence that the sea has already eroded earlier structures? Talk to “old timers”. Has a big storm occurred? (storms damage reefs, the natural barriers to erosion.) ask the experts. Enquire and investigate. The more you know the better prepared you are. What to do about it Take action to reduce your risk and loss. This is called mitigation. Don’t leave it to fate, mitigate! • Plant or maintain vegetation (like sea yam, coconut and sea grape trees) on the beach. Don’t remove the vegetation! • Artificial dunes can be built by bulldozing sand back from the beach or by placing fences to trap windblown sand; • Don’t remove sand from the beach! • Be aware of building structures to prevent beach erosion. They should only be constructed after consultation with the appropriate authorities and experts, such as engineers and planning officials; • Refrain from constructing dams across major drainage systems. This could cut off natural sand supply; • Protect the reefs. Damage can be caused by anchors or other contact. Refrain from allowing chemicals to run into the sea. Even ordinary household products can gradually kill the coral. So can animal manure. Play your part. Support cooperative efforts too. 267 12.10 Facts about Cyclones in the Caribbean • Tropical depressions, tropical storms, and hurricanes are all cyclones; • A cyclone is a series of thunderstorms and winds spinning counterclockwise around a centre of low barometric pressure; • When the sustained wind speed reaches 25 miles per hour (mph) ,it is called a Tropical Depression; • When the speed reaches 39 mph, it is called a tropical Storm and it is given a name by the national Hurricane centre in Miami; when the speed reaches 74 mph, it is called a Hurricane. There are five categories of hurricanes, each determined by wind speed. Category 5 with winds of 155 mph or higher is the most powerful of the hurricanes; • A cyclone generates three types of hazards. These are: high wind, inland flooding (also known as freshwater flooding which is generated by rainfall) and coastal flooding from storm surge; • These hazards can trigger life-threatening landslides and mudflows, severe flooding, destruction of coastal properties collapse of roofs and buildings killing occupants; • Cyclones can batter an island for several hours or sometimes for more than a day. They can wipe out years of personal and national economic gains in a matter of hours; • High winds rip away anything that can become undone and fling it at high speeds, endangering anything in its path; o Roads become impassable, so transportation ceases; o Electricity and communications systems are knocked out; o Pipe water may not flow, or may be contaminated; o Homes, workplaces and other buildings may be destroyed or damaged; o The contents of these places – including important possessions and documents- may also be lost or seriously damaged; o Food, water, and medical care may be unavailable for an extended period of time; o Public disorder may break out, contributing to unsafe conditions. What to do about it Take action to reduce your risk and loss. This is called mitigation. Don’t leave it to fate, mitigate! • Determine whether your location is vulnerable to wind, storm surge and/or flooding; • To mitigate against strong winds, ensure that the openings of your home (windows and doors) are secured, for example by the use of shutters. Tie down your roof with hurricane straps and anchor your building securely to the foundation, if it isn’t already secured To mitigate against storm surge, ensure that there is adequate drainage around your property and that all water courses are not blocked by debris or garbage; • The banks of rivers and streams may need raising or reinforcement and this may be a job for the authorities. Notify them of the need for this mitigation action well, before the hurricane season. 268 12.11 What is a Storm Surge? A storm surge is an abnormal rise in the water level along a shoreline produced by a meteorological disturbance such as hurricanes. As the hurricane winds pass over the surface of the sea they generate waves which flood the shoreline. The rise on water level and the hammering effect of the waves produce a storm surge which can cause coastal erosion, flooding, scour roads, undercut sea walls and demolish buildings. A storm surge can be the most dangerous part of a hurricane. It is estimates that nine out of ten hurricane fatalities are caused by storm surges in coastal areas. Are you at risk from a Storm Surge? A storm surge causes damage in three ways. • The rising water level floods areas that are usually beyond the water line. • The breaking waves impact higher along the beachfront and as they crash into the shore they send water rushing even further inland. • Storm surges are most likely to occur in areas where there is a long, shallow shelf. What to do if you are at risk from a Storm Surge? A storm surge is a feature of a hurricane, so take general precautions when a hurricane threatens. • Monitor the radio. • Wrap all important personal items, family documents and electrical appliances in plastic bags and store away from the reach of flood waters. • Move your refrigerator, stove and furniture to a higher floor, or place them on building blocks and secure to the wall. • Shut off electrical power, gas and water supplies in areas in immediate danger of flooding. • Store all chemicals, fertilizers, insecticides, etc. in properly labeled water-proof containers and store away from flood water. • Move small boats to higher ground. Move larger boats and moor in a safe cove. You might receive a storm surge warning from the radio or television. You must however watch the waves along the coastline in the area where you are. If wave heights begin to rise and water starts moving further up the beach than normal, be prepared to evacuate to higher ground at least six meters higher than the beach, or the height of a tall coconut tree. What to do after a Storm Surge? • Re-enter the building with caution, checking for shifted floors or cracked walls. • Clean up mud and silt quickly while it is still wet. • Boil drinking water until you are told the water supply is safe. • Report broken or damages water, sewer or electrical lines. • Do not walk barefooted outside. Wear water boots or shoes. 269 • If your house was demolished by the storm surge you should rebuild on higher ground. What is a Tsunami? A Tsunami is a series of waves generated by an underwater disturbance, such as an earthquake. Waves will travel outward from the area of disturbance, in all directions like the ripples produces by throwing a rock into a pond. When the tsunami reaches near the coastline however, it may grow to a great height and smash into the shore causing great damage. 13.12 Fire Safety tips The menace of fire as a potential disaster is with us every day. Many of the deaths that have resulted from fires could have been avoided if these basic fire safety precautions had been observed and put into practice. 1. Prepare and practice a fire plan, which should include: a. The establishment of a way of escape from each section or room of the building b. The establishment of alternative routes out of the building. c. Training every occupant of the house or building on a regular basis, and carrying out fire drills, both day and night. d. Making yourself familiar with the quickest means of calling the fire brigade. 2. What to do if fire breaks out: a. Raise an alarm to warn others of the emergency. b. On suspicion of fire, get children and helpless persons out of the building immediately. c. Get out of the building immediately. d. Do not go back into a burning building. You may not come out alive. e. If you are trapped in the building, lie flat on the ground and try to creep out; the air is clearer near the floor. f. Call the Fire Brigade at 110. g. No matter where you live or work, be familiar with all exits, including windows. h. Remember to turn off gas connections and electricity. 3. How to prevent fires: a. Do not keep gasoline in or near domestic areas. b. Do not buy or keep gasoline or other highly inflammable liquids in breakable containers. c. Do not leave inflammable liquids carelessly placed at home or in immediate reach of children. d. Do not leave open flames, such as candles and kerosene lamps, in the reach of children. If possible, avoid using candles, especially when there are children in the house. Never allow children to use matches, nor leave them within their reach. 270 e. Do not leave electric irons, hot plates or other appliances plugged in as overheating can cause fire. How bush fires are started Bush fires have now become a problem in Jamaica, especially during the dry and windy period of February to August. Bush fires often result from the indiscriminate and uncontrolled use of fires and can be prevented. In other instances, bush fires are often started from the burning of charcoal, or unattended fires. Careless disposal of cigarette butts in dry areas may also start bush fires. Consequences of Bush Fires • Bush fires can destroy valuable crops, plants, fruit trees and forested areas. • Bush fires can cause loss of human life and property. • Fires leave the soil empty of its natural cover and soil erosion and landslides often result. Soil fertility is reduced. • Smoke and fumes produced during bush fires can have adverse effect on human health. Individuals suffering from respiratory illnesses such as asthma and sinusitis can be adversely affected. • As a consequence of erosion following bush fires, roads and drains may be blocked, and streams and rivers filled with sediment. • In addition run-off is accelerated and the amount of water entering the soil to replenish underground reservoirs is reduced. How to prevent bush fire • Avoid burning fires to clear land especially during the dry season. Never light a fire in the open area when it is windy. • If you absolutely must burn, construct a firebreak by clearing an area around the proposed area to be burnt. • Get proper instructions and guidance from the Fire Department, your Forestry Officer or an Agricultural Extension Officer. • Smokers should ensure that butts and other lighted materials are extinguished before leaving the point of disposal. • Fires should not be started idly. 271 13.13 Environmental Laws • The Natural Resources Conservation Authority Act, 1991 • The Natural Resources Conservation Authority Act provides for the management, conservation and protection of the natural resources of Jamaica. The Act establishes the Natural Resources Conservation Authority, a body of persons appointed by the Minister of the Environment. The functions of the Authority include the taking of such steps that are necessary to ensure the effective management of the physical environment of Jamaica; and the management of marine parks and protected areas. • Section 9 of the Act creates a Ministerial discretion to declare parts of or the entire island a ‘prescribed area’, in which specified activities require a permit, and for which activities an environmental impact assessment may be required. The Act also addresses Sewage and Trade Effluent discharges as well as air emissions. Regulations are being developed to specifically address these sources of pollution. • The Endangered Species (Conservation and Regulation Trade) Act, 2000 • This Act was promulgated to ensure the codification of Jamaica’s obligations under the Convention for the International Trade in Endangered Species of Wild Fauna and Flora. The Endangered Species Act governs international and domestic trade in endangered species in and from Jamaica. The Act defines the functions of a Management Authority and Scientific Authority. The Natural Resources Conservation Act is the Management Authority. • The Beach Control Act, 1956 • This piece of legislation that was passed to ensure the proper management of Jamaica’s coastal and marine resources by a system of licensing of activities on the foreshore and the floor of the sea. The Act also addresses other issues such as access to the shoreline, and other rights associated with fishing and public recreation, as well as the establishment of marine protected areas. • The Wildlife Protection Act • The Act is primarily concerned with the protection of specified species of fauna. This Act has also undergone review particularly in the area of increased fines and the number of animals now enjoying protected status. • The Watersheds Protection Act • The Watershed Protection Act was promulgated 1963. The purpose of this Act is to provide for the protection of watersheds and areas adjoining watersheds and promote the conservation of water resources. The Act makes provision for conservation of watersheds through the implementation of provisional improvement schemes whereby soil conservation practices are carried out on land. • The Natural Resources (Marine Parks) Regulations, 1992 • These Regulations were enacted pursuant to section 38 of the natural Resources Conservation Authority Act. The object of the regulations is the establishment of marine protected areas, primarily for the conservation of marine resources. 272 13.14 Website sources of Regulations Relating to Managing the Environment The Beach Control (Safety Measures) Regulations, 2006 [PDF] The Natural Resources Conservation (Blue and John Crow Mountains National Park) (User Fees) Regulations, 2003 ~ Part 1 | Part 2 [PDF] The Natural Resources Conservation (Wastewater and Sludge) Regulations, 2005 [PDF] The Natural Resources Conservation Air Ambient Guideline Document [PDF] Technical Support Document for the Regulatory Impact Analysis for Air Quality Regulations [PDF] The Natural Resources Conservation Authority (Air Quality) Regulations, (2006) Amendment [PDF] The Natural Resources Conservation Authority (Air Quality) Regulations (June 2002) (264KB) [PDF] The Natural Resources (Hazardous Waste) (Control of Transboundary Movement) Regulations, 2002 [PDF] 273 References Bruce, J. & Showers, B. (2002). Student Achievement through Staff Development. Virginia: Association for Supervision and Curriculum Development Daft, R. L. (2003). Management, (6th edition). Ohio: South-Western Dessler, G. (2006). Human resource management. New Jersey: Prentice Hall. Green, W. H., Henriquez-Green, R., Burton, L., & Green, T. (2003). Pedagogical Foundations of Education. New Jersey: Synergy Plus. Kagan, S. (1994). Cooperative Learning. California: Kagan Cooperative Learning Robins, S. (2003). Organizational Behaviour. (10th Edition). New Jersey: Prentice Hall. 274 LIST OF ACRONYMS AND ABBREVIATIONS CARICOM Caribbean Community CISOCA Centre for the Investigation of Sexual Offences and Child Abuse CFNI Caribbean Food and Nutrition Institute JCRC Jamaica Coalition on the Rights of the Child JDF Jamaica Defense Force JIS Jamaica Information Service MOH Ministry of Health NEPA National Environment and Planning Agency NHF National Health Fund ODPEM Office of Disaster Preparedness and Emergency Management PALS Peace and Love in Society PAHO Pan America Health Organisation STI Sexually Transmitted Infection UNAIDS United Nations Programme on HIV/AIDS UNICEF United Nations Children’s Fund UWI University of the West Indies WHO World Health Organisation 275 276