(a) Introduction.      
        (1) The goal of health education is to provide instruction that allows youth to develop and sustain health-promoting behaviors throughout their lives. The understanding and application of these standards will allow students the ability to gather, interpret, and understand health information; achieve health literacy; and adapt to the ever-evolving science of health. The health education knowledge and skills should be presented to students in a positive manner to support the development of a healthy self-concept and responsible decision making. The standards will help students reinforce, foster, and apply positive character traits.       
        (2) There are essential skills that repeat throughout the six strands and embody the interconnection of health literacy. These skills include decision making, problem solving, goal setting, maintaining healthy relationships with self and others, seeking help and support, and recognizing various influences on health such as social, environmental, media, and genetic. These skills, developed early on and reinforced throughout a student's education, will foster mastery of health concepts. Health class educators are encouraged to partner with school counselors where available to schedule time for them to deliver classroom guidance lessons to help teach these essential competencies. In addition, areas in the standards related to abuse, neglect, violence, loss, grief, trauma, and suicide may directly affect some students in the classroom. Should the educator recognize signs of discomfort with instruction in these areas, students should be referred to the appropriate resource, identified ahead of such instruction, for additional help and support.       
        (3) Students gain an understanding of health information and skills through six strands: physical health and hygiene; mental health and wellness; healthy eating and physical activity; injury and violence prevention and safety; alcohol, tobacco, and other drugs; and reproductive and sexual health.                  (A) Physical health and hygiene education helps to prepare students for improved lifelong health outcomes. Learning about body systems lays the foundation for personal health and hygiene. Health literacy and preventative behaviors empower students to make informed choices to support self, family, and community.                   (B) The mental health and wellness strand recognizes that the knowledge and skills necessary to manage emotions, reactions, and relationships are essential to reaching one's full potential. Students gain knowledge about social and emotional health, including developing a healthy self-concept, understanding risk and protective factors, and identifying and managing mental health and wellness concerns. In the early grades, students develop fluency around emotions and self-regulation and understand the relationship between feelings, thoughts, and behavior. In subsequent grades, students learn and practice appropriate ways to solve interpersonal conflicts, work to develop a positive self-image, and develop healthy self-management skills.                   (C) The healthy eating and physical activity strand addresses the importance of nutrition and physical activity to support a healthy lifestyle. Students apply critical-thinking and decision-making skills to make positive health choices. Students learn about essential nutrients, food groups, portion control, government nutritional recommendations, and the health benefits of being physically active. Students evaluate the connection between physical activity and nutrition and the prevention of chronic diseases.                   (D) By focusing on injury and violence prevention and safety, the standards promote student well-being and awareness of dangerous situations. Supporting student well-being and providing instruction in digital citizenship, bullying prevention, first aid, and identification of safe and unsafe situations creates empowered and educated students who are able to make decisions that keep themselves and others safe. Beginning in Kindergarten and continuing through high school, students gain knowledge and skills to support safety and wellness at school, at home, online, and in the community.                   (E) The standards under the alcohol, tobacco, and other drugs strand focus on a number of protective factors that develop empowered students who are able to make better-informed decisions, including understanding the impact of substance use on physical, mental, and social health. Through this strand, students learn key concepts about alcohol, tobacco, and other drugs, including the use, misuse, and physiological effects; short- and long-term impacts on health; treatment; risk and protective factors; and prevention. These concepts introduce healthy alternatives and ways for students to ask for and seek out help from parents and other trusted adults.                   (F) Beginning in Grade 4, students learn about changes associated with adolescent development in the reproductive and sexual health strand. In subsequent grade levels, students identify the purpose of these changes and their role in fertilization and reproduction. Students learn the characteristics of healthy and unhealthy relationships and how to use communication and refusal skills to set personal boundaries in dating/romantic relationships. Students also identify how to respond to sexual harassment and abuse.         
        (4) An integral part of health education involves educators being aware of state laws relevant to human sexuality instruction. These laws include affirming:                  (A) a local school district's control over the provision of human sexuality instruction to ensure that local community values are reflected in that instruction (Texas Education Code (TEC), §28.004(e)-(h));                   (B) the right of a parent or legal guardian to be informed of the provision of human sexuality instruction to their child and review the content of that instruction (TEC, §28.004(i)-(j));                   (C) the right of a parent or legal guardian to remove their child from any portion of human sexuality instruction without penalty to the child (TEC, §28.004(i));                   (D) the centrality of abstinence education in any human sexuality curriculum (TEC, §28.004(e)); and                   (E) the right of a parent or legal guardian to be informed of and consent to an abortion performed on their pregnant child (with judicially authorized or medical emergency exceptions) (Texas Family Code, Chapter 33).         
        (5) Educators also should be aware of and abide by the statutory prohibition on taxpayer resource transactions between state governmental entities, including public schools, and abortion providers or an affiliate of an abortion provider (Texas Government Code, Chapter 2272).       
        (6) Statements containing the word "including" reference content that must be mastered, while those containing the phrase "such as" are intended as possible illustrative examples.       
        (7) Students should first seek guidance in the area of health from a parent or legal guardian.       
      (b) Knowledge and skills.      
        (1) Physical health and hygiene--body systems. The student examines the structure, function, and relationships of body systems and their relevance to personal health. The student is expected to explain how to maintain the healthy status of body systems.       
        (2) Physical health and hygiene--personal health and hygiene. The student understands health literacy, preventative health behaviors, and how to access and evaluate health care information to make informed decisions. The student is expected to:                  (A) compare immediate and long-term effects of personal health care choices such as personal and dental hygiene;                   (B) develop criteria for evaluating the validity of health information and sources;                   (C) describe ways to demonstrate decision-making skills based on health information;                   (D) identify current health-related issues and recommendations or guidelines;                   (E) explain the role of preventive health measures, immunizations, and treatment such as wellness exams and dental check-ups in disease prevention;                   (F) describe actions that should be taken when illness occurs, including asthma, diabetes, and epilepsy; and                   (G) describe and recognize the signs, symptoms, and treatments of vector-borne illnesses such as Lyme disease or West Nile Virus.         
        (3) Mental health and wellness--social and emotional health. The student identifies and applies strategies to develop socio-emotional health, self-regulation, and healthy relationships. The student is expected to:                  (A) demonstrate healthy methods for communicating emotions in a variety of scenarios;                   (B) assess and demonstrate healthy ways of responding to conflict;                   (C) differentiate between positive and negative peer influence;                   (D) describe methods for communicating important issues with and understanding perspectives of parents and peers;                   (E) discuss and demonstrate how to listen and respect others' feelings and perspectives in a variety of scenarios; and                   (F) identify strategies for using non-violent conflict resolution skills.         
        (4) Mental health and wellness--developing a healthy self-concept. The student develops the capacity for self-assessment and evaluation, goal setting, and decision making in order to develop a healthy self-concept. The student is expected to:                  (A) identify how physical and social changes impact self-esteem;                   (B) identify possible health benefits of setting and implementing long-term personal goals;                   (C) create and discuss personal life goals that one wishes to achieve and consider the financial impact of graduating from high school, having a full-time job, and waiting until marriage if one plans to have children; and                   (D) explain the steps in the decision-making process and the importance of following the steps.         
        (5) Mental health and wellness--risk and protective factors. The student recognizes the influence of various factors on mental health and wellness. The student is expected to:                  (A) identify and discuss how adolescent brain development influences emotions, decision making, and logic; and                   (B) relate physical environmental factors such as school climate and availability of resources to individual, family, and community health.         
        (6) Mental health and wellness--identifying and managing mental health and wellness concerns. The student develops and uses appropriate skills to identify and manage conditions related to mental health and wellness. The student is expected to:                  (A) examine the outcomes of healthy and unhealthy methods for managing challenges related to long-term health conditions of self and others;                   (B) identify and describe lifetime strategies for managing conditions that impact learning such as attention-deficit disorder (ADD), attention-deficit/hyperactivity disorder (ADHD), dyslexia, dysgraphia, and sensory issues;                   (C) identify how to respond positively to develop resiliency;                   (D) describe healthy and unhealthy self-management strategies for stress, anxiety, depression, trauma, loss, and grief;                   (E) identify causes and effects associated with disordered eating and eating disorders such as bulimia, anorexia, and binge eating disorder and the importance of seeking help from a parent or another trusted adult for oneself or others related to disordered eating;                   (F) discuss the suicide risk and suicide protective factors identified by the Centers for Disease Control and Prevention (CDC) and the importance of telling a parent or another trusted adult if one observes the warning signs in self or others;                   (G) explain the role of a healthy self-concept in avoiding self-harming behaviors that can occur when someone is struggling to manage overwhelming emotions; and                   (H) identify suicide prevention resources such as the National Suicide Prevention Hotline.         
        (7) Healthy eating and physical activity--food and beverage daily recommendations. The student analyzes and applies healthy eating strategies for enhancing and maintaining personal health throughout the lifespan. The student is expected to:                  (A) define micronutrients, including calcium and iron, and their recommended daily allowances;                   (B) compare and contrast common food labels and menus for nutritional content and calories;                   (C) describe healthy and unhealthy dietary practices;                   (D) explain the importance of a realistic personal dietary plan; and                   (E) evaluate the importance of choosing lower sodium alternatives to foods that have high levels of sodium such as salty snacks and canned vegetables.         
        (8) Healthy eating and physical activity--physical activity. The student identifies, analyzes, and applies strategies for enhancing and maintaining optimal personal physical fitness throughout the lifespan. The student is expected to:                  (A) identify the CDC guidelines for daily physical activity throughout the lifespan; and                   (B) analyze the benefits of regular physical activity on mental, physical, and social health.         
        (9) Healthy eating and physical activity--nutrition and physical activity literacy. The student obtains, processes, and understands basic physical activity and nutrition information needed to make health-promoting decisions. The student is expected to:                 Cont'd...