Chapter 115. Texas Essential Knowledge and Skills for Health Education
Subchapter B. Middle School


Statutory Authority: The provisions of this Subchapter B issued under the Texas Education Code, 7.102(c)(4) and § 28.002, unless otherwise noted.


115.21. Implementation of Texas Essential Knowledge and Skills for Health Education, Middle School.

The provisions of this subchapter shall supersede 75.29(g) and 75.45 of this title (relating to Health Education) beginning September 1, 1998.

Source: The provisions of this 115.21 adopted to be effective September 1, 1998, 22 TexReg 7740.


115.22. Health Education, Grade 6.

(a)  Introduction.

(1)  In health education, students acquire the health information and skills necessary to become healthy adults and learn about behaviors in which they should and should not participate. To achieve that goal, students will understand the following: students should first seek guidance in the area of health from their parents; personal behaviors can increase or reduce health risks throughout the lifespan; health is influenced by a variety of factors; students can recognize and utilize health information and products; and personal/interpersonal skills are needed to promote individual, family, and community health.

(2)  In middle school, students learn about health behaviors that will safeguard their health as well as information related to understanding puberty and the reproductive process. Students are taught about factors in their environment that impact, not only their health and the health of their families, but the health of their communities as well. Middle school students learn to refine their critical-thinking skills to avoid unsafe situations, analyze health information and products, and maintain healthy relationships. Students begin to investigate health in the broader context of community.

(b)  Knowledge and skills.

(1)  Health information. The student comprehends ways to enhance and maintain personal health throughout the life span. The student is expected to:

(A)  analyze healthy and unhealthy dietary practices;

(B)  explain the importance of a personal dietary and exercise plan;

(C)  compare immediate and long-range effects of personal health care choices such as personal and dental hygiene;

(D)  identify causes and effects associated with poor body image such as eating disorders and growth patterns;

(E)  examine the concept of cost versus effectiveness of health care products;

(F)  describe the mental, physical, and social benefits of regular exercise and fitness;

(G)  describe the importance of establishing and implementing a periodic health-maintenance clinical assessment; and

(H)  demonstrate strategies for managing stress.

(2)  Health information. The student recognizes ways that body structure and function relate to personal health throughout the life span. The student is expected to:

(A)  analyze the relationships among the body systems;

(B)  describe changes in male and female anatomy and physiology during puberty;

(C)  analyze the role of hormones as they relate to growth and development and personal health; and

(D)  describe menstrual health and identify the relationship to reproduction.

(3)  Health information. The student comprehends and utilizes concepts relating to health promotion and disease prevention. The student is expected to:

(A)  describe various modes of disease transmission;

(B)  compare healthy cell growth to cell growth in the disease process; and

(C)  list noncommunicable and hereditary diseases and respective prevention and treatment techniques.

(4)  Health information. The student comprehends ways of researching, accessing, and analyzing health information. The student is expected to:

(A)  list ways to evaluate health products, practices, and services such as sunblocks, dietary aides, and over-the-counter medications; and

(B)  use critical thinking to research and evaluate health information.

(5)  Health information. The student comprehends general health information related to prescription and over-the-counter drugs. The student is expected to:

(A)  define prescription and over-the-counter drugs;

(B)  describe the purposes of prescription and over-the-counter drugs, including the intended benefits;

(C)  explain why some drugs require a prescription;

(D)  identify the components of prescription and over-the-counter drug labels;

(E)  compare and contrast examples of prescription and over-the-counter drug labels;

(F)  identify and describe practices used to safely store and properly dispose of prescription and over-the-counter drugs; and

(G)  explain the dangers associated with taking expired prescription and over-the-counter drugs.

(6)  Health information. The student comprehends ways of applying health information related to prescription and over-the-counter drugs to reduce health risks to the body functions and organs for a life span. The student is expected to:

(A)  explain the difference between the misuse and abuse of prescription drugs;

(B)  describe the misuse and abuse of prescription and over-the-counter drugs and the dangers associated with each; and

(C)  describe how the abuse of drugs affects the body systems and brain.

(7)  Health behaviors. The student engages in behaviors that reduce health risks throughout the life span. The student is expected to:

(A)  demonstrate an understanding of basic first-aid procedures;

(B)  describe chemical dependency and addiction to tobacco, alcohol, drugs, including prescription drugs, and other substances;

(C)  explain the relationship among tobacco, alcohol, drugs, and other substances and the role these items play in unsafe situations such as drinking and driving and Human Immunodeficiency Virus (HIV)/sexually transmitted disease (STD) transmission;

(D)  identify ways such as alternative activities to prevent the use of tobacco, alcohol, drugs, and other substances;

(E)  identify ways to prevent substance misuse, including the misuse of prescription and over-the-counter drugs, and substance use disorders;

(F)  demonstrate strategies for the prevention of and response to deliberate and accidental injuries such as using conflict resolution skills instead of fighting and wearing a seat belt;

(G)  identify and describe strategies for avoiding drugs, violence, gangs, weapons, and other harmful situations;

(H)  explain the consequences of sexual activity and the benefits of abstinence; and

(I)  identify signs and symptoms of prescription drug misuse such as using medicine prescribed for someone else or for reasons other than its intended use.

(8)  Influencing factors. The student understands how factors in the environment influence individual and community health. The student is expected to:

(A)  identify how environmental influences may affect an individual's substance misuse and substance use disorder;

(B)  identify factors that affect an individual's physical, emotional, and social health such as school climate and safety measures; and

(C)  make healthy choices from among environmental alternatives such as leaving a smoke-filled room or selecting healthy snacks from vending machines.

(9)  Influencing factors. The student recognizes how relationships influence individual health behaviors including skills necessary for building and maintaining relationships. The student is expected to:

(A)  differentiate between positive and negative relationships that can affect individual health such as clubs, gangs, or families;

(B)  examine social influences on drug-taking behaviors;

(C)  explain ways of maintaining healthy relationships such as resisting peer pressure to engage in unsafe behavior;

(D)  practice conflict resolution/mediation skills;

(E)  describe strategies such as abstinence for communicating refusal to engage in unsafe behaviors; and

(F)  describe methods for communicating important issues with parents and peers.

(10)  Influencing factors. The student comprehends how media and technology influence individual and community health. The student is expected to:

(A)  identify ways in which media and technology influence social norms such as using prescription and over-the-counter drugs;

(B)  identify and analyze various media and technologies that influence individual and community health such as computer software and the internet; and

(C)  explain the relationship between health needs and technology development such as the development of an HIV vaccine.

(11)  Influencing factors. The student differentiates between positive and negative family influences. The student is expected to:

(A)  develop strategies for supporting and respecting all family members; and

(B)  identify strategies for coping with unhealthy behaviors in the family such as abuse, alcoholism, and neglect.

(12)  Personal/interpersonal skills. The student describes healthy and respectful ways to communicate consideration and respect for self, family, friends, and others. The student is expected to:

(A)  demonstrate ways to communicate empathy to others and have consideration for others;

(B)  assess healthy ways of responding to disrespectful behaviors such as mediation;

(C)  practice methods for self-control;

(D)  describe healthy ways to express affection and love;

(E)  describe ways to manage anxiety and grief;

(F)  describe ways to control anger and emotions when responding to others;

(G)  demonstrate strategies for showing respect for individual differences such as race, physical appearance, and socio-economic status;

(H)  define stress and its effects on individual health and relationships; and

(I)  identify stressors and their impact on the health of the individual and family.

(13)  Personal/interpersonal skills. The student analyzes information and applies critical-thinking, decision-making, goal-setting, and problem-solving skills for making health-promoting decisions. The student is expected to:

(A)  seek the input of parents and other trusted adults in problem solving and goal setting;

(B)  demonstrate the use of refusal skills in unsafe situations;

(C)  explain the impact of peer pressure on decision making;

(D)  compare the risks and benefits of various health behaviors such as choosing not to smoke;

(E)  identify the possible health implications of long-term personal and vocational goals; and

(F)  identify decision-making practices such as refusing invitations, knowing the risks of substance abuse, and reporting the abuse to a parent school administrator, teacher, or other trusted adult that reduce unsafe health behaviors.

(14)  Bullying prevention. The student engages in behaviors that reduce the risk of bullying throughout the life span. The student is expected to:

(A)  analyze the impact that bullying has on both victims and bullies;

(B)  identify strategies for prevention and intervention of all forms of bullying such as emotional, physical, social, and sexual;

(C)  describe healthy ways to be assertive without being aggressive; and

(D)  assess healthy and appropriate ways of responding to bullying.

Source: The provisions of this §115.22 adopted to be effective September 1, 1998, 22 TexReg 7740; amended to be effective August 26, 2013, 38 TexReg 3413; amended to be effective August 28, 2017, 42 TexReg 3371.


115.23. Health Education, Grades 7-8.

(a)  Introduction.

(1)  In health education, students acquire the health information and skills necessary to become healthy adults and learn about behaviors in which they should and should not participate. To achieve that goal, students will understand the following: students should first seek guidance in the area of health from their parents; personal behaviors can increase or reduce health risks throughout the lifespan; health is influenced by a variety of factors; students can recognize and utilize health information and products; and personal/interpersonal skills are needed to promote individual, family, and community health.

(2)  In middle school, students learn about health behaviors that will safeguard their health as well as information related to understanding puberty and the reproductive process. Students are taught about factors in their environment that impact, not only their health and the health of their families, but the health of their communities as well. Middle school students learn to refine their critical-thinking skills to avoid unsafe situations, analyze health information and products, and maintain healthy relationships. Students begin to investigate health in the broader context of community.

(b)  Knowledge and skills.

(1)  Health information. The student comprehends ways to enhance and maintain personal health throughout the life span. The student is expected to:

(A)  analyze the interrelationships of physical, mental, and social health;

(B)  identify and describe types of eating disorders such as bulimia, anorexia, or overeating;

(C)  identify and describe lifetime strategies for prevention and early identification of disorders such as depression and anxiety that may lead to long-term disability;

(D)  describe the life cycle of human beings including birth, dying, and death;

(E)  identify and describe the three categories of prescription drugs and types of illegal drugs; and

(F)  examine the relationship between prescription drugs and illegal drugs.

(2)  Health information. The student recognizes ways that body structure and function relate to personal health throughout the life span. The student is expected to:

(A)  explain how differences in growth patterns among adolescents such as onset of puberty may affect personal health;

(B)  describe the influence of the endocrine system on growth and development;

(C)  compare and contrast changes in males and females;

(D)  describe physiological and emotional changes that occur during pregnancy;

(E)  examine physical and emotional development during adolescence; and

(F)  identify the common side effects associated with each drug category on the body systems and brain.

(3)  Health information. The student comprehends and utilizes concepts relating to health promotion and disease prevention throughout the life span. The student is expected to:

(A)  explain the role of preventive health measures, immunizations, and treatment in disease prevention such as wellness exams and dental check-ups;

(B)  analyze risks for contracting specific diseases based on pathogenic, genetic, age, cultural, environmental, and behavioral factors;

(C)  distinguish risk factors associated with communicable and noncommunicable diseases; and

(D)  summarize the facts related to Human Immunodeficiency Virus (HIV) infection and sexually transmitted diseases (STDs).

(4)  Health information. The student knows how to research, access, analyze, and use health information. The student is expected to:

(A)  use critical thinking to analyze and use health information such as interpreting media messages;

(B)  develop evaluation criteria for health information;

(C)  demonstrate ways to use health information to help self and others;

(D)  discuss the legal implications regarding sexual activity as it relates to minor persons;

(E)  identify and explain the importance of each component of an over-the-counter drug warning label;

(F)  identify common uses of each prescription drug category;

(G)  compare and contrast examples of various packaging and forms of medicines, including prescription drugs; and

(H)  discuss the legal consequences related to the use of drugs, including the misuse of prescription drugs.

(5)  Health information. The student comprehends ways of applying health information related to prescription and over-the-counter drugs to reduce health risks to the body systems and functions for a life span. The student is expected to:

(A)  analyze the short- and long-term health consequences of prescription and over-the-counter drug misuse and substance use disorders;

(B)  describe how substance misuse, including prescription drug misuse, and substance use disorders affect the body systems and brain; and

(C)  relate medicine and other drugs to communicable and noncommunicable disease, prenatal health, health problems in later life, and other adverse consequences.

(6)  Health behaviors. The student engages in behaviors that reduce health risks throughout the life span. The student is expected to:

(A)  analyze and demonstrate strategies for preventing and responding to deliberate and accidental injuries;

(B)  describe the dangers associated with a variety of weapons;

(C)  identify strategies for prevention and intervention of emotional, physical, and sexual abuse;

(D)  identify information relating to abstinence;

(E)  analyze the importance of abstinence from sexual activity as the preferred choice of behavior in relationship to all sexual activity for unmarried persons of school age;

(F)  discuss abstinence from sexual activity as the only method that is 100% effective in preventing pregnancy, STDs, and the sexual transmission of HIV or acquired immune deficiency syndrome, and the emotional trauma associated with adolescent sexual activity;

(G)  demonstrate basic first-aid procedures including cardiopulmonary resuscitation (CPR) and the choking rescue;

(H)  explain the impact of chemical dependency and addiction to tobacco, alcohol, drugs, including prescription drugs, and other substances;

(I)  identify and discuss efforts to prevent substance abuse, including prescription drug use, in the community;

(J)  apply strategies for avoiding violence, gangs, weapons, and drugs;

(K)  explain the importance of complying with rules prohibiting possession of drugs and weapons;

(L)  differentiate between appropriate and inappropriate use of prescription and over-the-counter drugs and the resulting consequences of each; and

(M)  describe how substance misuse, including prescription drug misuse, can lead to addiction.

(7)  Influencing factors. The student understands how physical and social environmental factors can influence individual and community health throughout the life span. The student is expected to:

(A)  relate physical and social environmental factors to individual and community health such as climate and gangs;

(B)  describe the application of strategies for controlling the environment such as emission control, water quality, and waste management; and

(C)  discuss the influence of physical and social environmental factors on substance misuse.

(8)  Influencing factors. The student investigates positive and negative relationships that influence individual, family, and community health. The student is expected to:

(A)  analyze positive and negative relationships that influence individual and community health such as families, peers, and role models; and

(B)  develop strategies for monitoring positive and negative relationships that influence health.

(9)  Influencing factors. The student researches ways in which media and technology influence individual and community health throughout the life span. The student is expected to:

(A)  discuss the influence of media and technology on social norms such as using prescription drugs and the social commitment not to use illegal drugs;

(B)  explain the role of media and technology in influencing individuals and community health such as watching television or reading a newspaper and billboard; and

(C)  explain how programmers develop media to influence buying decisions.

(10)  Influencing factors. The student understands how social factors impact personal, family, community, and world health. The student is expected to:

(A)  describe personal health behaviors and knowledge unique to different generations and populations; and

(B)  describe characteristics that contribute to family health.

(11)  Personal/interpersonal skills. The student recognizes and uses communication skills in building and maintaining healthy relationships. The student is expected to:

(A)  differentiate between positive and negative peer pressure;

(B)  describe the application of effective coping skills;

(C)  distinguish between effective and ineffective listening such as paying attention to the speaker versus not making eye-contact;

(D)  summarize and relate conflict resolution/mediation skills to personal situations; and

(E)  appraise the importance of social groups.

(12)  Personal/interpersonal skills. The student understands, analyzes, and applies healthy ways to communicate consideration and respect for self, family, friends, and others. The student is expected to:

(A)  describe techniques for responding to criticism;

(B)  demonstrate strategies for coping with problems and stress;

(C)  describe strategies to show respect for individual differences including age differences;

(D)  describe methods of communicating emotions;

(E)  describe the effect of stress on personal and family health;

(F)  describe the relationships between emotions and stress; and

(G)  discuss how substance misuse, including prescription drug misuse, and substance use disorders impact families and communities.

(13)  Personal/interpersonal skills. The student analyzes information and applies critical-thinking, decision-making, goal-setting, and problem-solving skills for making health-promoting decisions. The student is expected to:

(A)  interpret critical issues related to solving health problems;

(B)  relate practices and steps necessary for making health decisions;

(C)  appraise the risks and benefits of decision-making about personal health;

(D)  predict the consequences of refusal skills in various situations;

(E)  examine the effects of peer pressure on decision making;

(F)  develop strategies for setting long-term personal and vocational goals; and

(G)  demonstrate time-management skills.

(14)  Bullying prevention. The student analyzes bullying information and applies strategies for enhancing and maintaining healthy personal relationships throughout the life span. The student is expected to:

(A)  analyze strategies for preventing bullying, harassment, dating violence, and sexual assault;

(B)  describe the seriousness of various forms of bullying such as harassment, acquaintance rape, and sexual abuse;

(C)  demonstrate empathy toward others;

(D)  analyze ways to show disapproval of inconsiderate and disrespectful bullying behavior; and

(E)  recognize the responsibility to report bullying behavior.

Source: The provisions of this §115.23 adopted to be effective September 1, 1998, 22 TexReg 7740; amended to be effective August 26, 2013, 38 TexReg 3413; amended to be effective August 28, 2017, 42 TexReg 3371.


For more information, email rules@tea.texas.gov.