what is health and life skills education

What Is Life Skills Education: Importance, Challenges, & Categories

Life skills education has become commonplace today, but many people do not know what it means.

However, as the world changes, so do many things, including how we define and look at life skills education.

This type of education is not focused on teaching young people to pass exams and go to university but rather prepares them to live useful and successful lives.

Life skills are essential because they form the foundation for success in many areas of life.

This article examines the importance of life skills education, what life skills are, and the benefits of learning them.

What are life skills?

Additionally, these kinds of skills are broad and transferable. That means they are applicable across different situations in life, including; home, work, community settings, and leisure activities. 

It also includes your knowledge about how to access health care when needed.

Why is life skills education important?

Life skills education empowers young people to lead healthy, productive lives.

Also, life skills training for all young people is critical. Human development specialists agree that youth need a particular life skill competencies to thrive, stay healthy, and succeed.

Also, it helps you to manage your emotions and behavior, establish healthy relationships, make responsible decisions, and enjoy learning.

It is a strategy for promoting mental health that focuses on creating a positive and supportive school environment.

What are the benefits of life skills education?

Life skills education has proven so essential for child development that governments and education authorities in many countries have introduced it as an essential part of the school curriculum .

This education gives children the confidence and ability to make healthy choices, manage their emotions, and build strong relationships.

Training in life skills can give children a toolbox of approaches, strategies, and coping mechanisms to support their learning.

1. Strengthens the self-respect of children

Self-esteem is a child’s belief in her worth as a person or friend. When your child develops healthy self-esteem, she branches out from family and friends, exploring the world and trying new things.

Furthermore, children who develop self-respect have a better chance of successful lives.

2. Gives children tools to improve their quality of life

Through life skills education, students learn essential skills to benefit their peace of mind and quality of life.

Also, they learn how to manage stress, calm their minds and bodies, exercise, eat healthy, set goals, stay on top of their responsibilities, and more.

3. Kids develop a sense of social responsibility

It also fosters an understanding of teamwork and leadership that applies to every situation throughout their lives.

4. Life skills education develops teamwork skills

Children who have learned life skills are better prepared to tackle academic courses, build strong relationships with peers, and succeed socially and emotionally.

5. It helps students feel more confident

Students also learn to be more proficient in communication, child development, food proficiency, money management, and physical activity.

6. Children learn to use resources wisely

Life skills training helps children use their essential life resources-time, space, and materials wisely.

In addition, the ability to utilize these resources wisely is essential for success in all work and leisure areas.

7. Life skills education makes students self-sufficient and confident adults

8. helps with focus and attention skills.

The life skills curriculum covers critical topics like stress management, respectful communication, self-advocacy, sensory processing, executive functioning, and memory in a fun and engaging environment.

9. Improves time management skills

Research shows that life skills education improves time management skills and helps children plan for their goals.

Students also learn how to set a schedule, stick to it, determine resources to allocate, and see which tasks are urgent. 

10. Life skills education encourages independence in kids 

From interviewing for a job to managing finances, life skills education can be the key to living a fulfilling life as an adult. 

11. Life skills education gives a boost to academic success

12. develops observation and critical thinking skills.

The activities should also promote the development of fine motor and communication skills, visual observation, and cognitive thinking abilities.

What are the challenges affecting life skills education?

The challenges affecting life skills education include; a lack of resources, inadequate teacher and learner training, family support problems, dual responsibility to meet literacy and life skills targets, and managing cultural sensitivities.

This occurs by encouraging them to think about what they want from their education and how it helps them develop as a whole person.

What are the categories of life skills?

Life skills include interpersonal and self-awareness skills, communication, decision-making, problem-solving, and coping with emotions.

These categories encompass many life skills, from physical to mental health.

Self-awareness skills

Communication skills.

Communication skills are talents and abilities that enable you to convey your thoughts, feelings, ideas, and information to others.

Decision making skills

Decision-making involves identifying a decision, gathering information, and assessing alternative resolutions.

Problem solving skills

The better your problem-solving skills are, the more asset you will be to an employer or project team. 

Coping skills

They are used to increase self-control and emotional regulation to better handle disappointment, frustration, and other negative feelings. 

How does life skills education affect society?

Why is life skills education necessary for employment.

Life skills training provides young people with the knowledge and experience they will need to succeed in their careers.

Why is life skills education crucial to a child’s development?

This teaching method helps children develop social-emotional skills essential for school achievement and success in adulthood. 

Also, through life skills, children learn to deal with transition, stress, emotion, impulse control, self-esteem, and evaluation of consequences.

Life skills education is proven to impact children in the following ways: – Improved academic performance, improved social and emotional health, improved mental health, decreased stress, burnout, and anxiety.

Finally, teaching children adaptive skills also helps them maximize their potential.

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• Malays J Med Sci
• v.30(3); 2023 Jun
• PMC10325125

Effectiveness of Life Skills Intervention on Depression, Anxiety and Stress among Children and Adolescents: A Systematic Review

Yosra sherif.

1 Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia

Ahmad Zaid Fattah Azman

Hamidin awang.

2 Psychiatry Unit, Faculty of Medicine and Health Sciences, Universiti Sains Islam Malaysia, Negeri Sembilan, Malaysia

Siti Aisha Mokhtar

Marjan mohammadzadeh.

3 Institute of Health and Nursing Sciences, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany

Aisha Siddiqah Alimuddin

4 Department of Psychiatry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Selangor, Malaysia

Associated Data

Electronic databases

Methodological quality of randomised controlled trial

Notes: JBI methodological quality appraisal checklist to be scored as: Yes = Y; No = N; Unclear = U; Not applicable = NA;

1* Was true randomisation used for assignment of participants to treatment groups?

2* Was allocation to treatment groups concealed?

3* Were treatment groups similar at the baseline?

4* Were participants blind to treatment assignment?

5* Were those delivering treatment blind to treatment assignment?

6* Were outcomes assessors blind to treatment assignment?

7* Were treatment groups treated identically other than the intervention of interest?

8* Was follow up complete and if not, were differences between groups in terms of their follow up adequately described and analysed?

9* Were participants analysed in the groups to which they were randomised?

10* Were outcomes measured in the same way for treatment groups?

11* Were outcomes measured in a reliable way?

12* Was appropriate statistical analysis used?

13* Was the trial design appropriate, and any deviations from the standard RCT design (individual randomisation, parallel groups) accounted for in the conduct and analysis of the trial?

Methodological quality of quasi-experimental study

1* Is it clear in the study what is the ‘cause’ and what is the ‘effect’ (i.e. there is no confusion about which variable comes first)?

2* Were the participants included in any comparisons similar?

3* Were the participants included in any comparisons receiving similar treatment/care, other than the exposure or intervention of interest?

4* Was there a control group?

5* Were there multiple measurements of the outcome both pre- and post-intervention/exposure?

6* Was follow up complete and if not, were differences between groups in terms of their follow up adequately described and analysed?

7* Were the outcomes of participants included in any comparisons measured in the same way?

8* Were outcomes measured in a reliable way?

9* Was appropriate statistical analysis used?

Children and adolescents are at a significantly high risk of mental health problems during their lifetime, among which are depression and anxiety, which are the most common. Life skills education is one of the intervention programmes designed to improve mental well-being and strengthen their ability to cope with the daily stresses of life. This review aimed to identify and evaluate the effect of life skills intervention on the reduction of depression, anxiety and stress among children and adolescents. Following the Population, Intervention, Comparison and Outcome (PICO) model and the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) 2009 checklist, eight databases (Academic Search Complete, CINAHL, Cochrane, MEDLINE, Psychology and Behavioural Sciences Collection, PubMed, Scopus and Web of Science) were systematically reviewed from 2012 to 2020. The search was limited to English papers only. It included published experimental and quasi-experimental studies addressing the effect of life skills interventions on the reduction of at least one of the following mental health disorders: depression, anxiety and stress among children and adolescents (from the age of 5 years old to 18 years old). We used the Joanna Briggs Institute checklist for experimental and quasi-experimental studies to evaluate the quality of the included studies. This study was registered in PROSPERO [CRD42021256603]. The search identified only 10 studies (three experimental and seven quasi-experimental) from 2,160 articles. The number of the participants was 6,714 aged between 10 years old and 19 years old. Three studies in this review focused on depression and anxiety, whereas one study investigated depression and the other anxiety. Three studies targeted only stress and two examined the three outcomes, namely, depression, anxiety and stress. Almost in all studies, the life skills intervention positively impacted mental disorders, considering the differences among males and females. The overall methodological quality of the findings was deemed to be moderate to high. Our results clearly indicated the advantages of life skills programmes among adolescents in different settings and contexts. Nonetheless, the results highlight some important policy implications by emphasising the crucial roles of developers and policymakers in the implementation of appropriate modules and activities. Further research examining life skills intervention with a cultural, gender perspective, age-appropriate and long-term effect is recommended.

Introduction

One of the growing public health issues among children and adolescents is mental disorders ( 1 ), which is recognised as a priority topic for more research and government intervention ( 2 ). It is estimated that 10% to 20% of children and adolescents globally have experienced mental health problems. Furthermore, a more significant proportion of mental health problems has been observed for specific subgroups of teenagers, those with socioeconomically disadvantaged positions and those who lack appropriate health or social services, are identified as minority ethnic groups and live in more rural or distant locations ( 2 – 4 ).

In Europe and the USA, mental illnesses account for most disability-adjusted life years among children between 5 years old and 14 years old ( 5 ). The findings from previous research indicated that anxiety and depression are common among children aged 8 years old–12 years old, with reported prevalence rates of approximately 2% and 5%, respectively ( 6 ). Moreover, adolescence is a sensitive and crucial stage for development from childhood to adulthood ( 7 ). Multiple physical, emotional and social changes occur during this formative time of adolescence ( 8 ). These changes can make adolescents vulnerable to mental health problems and nearly half of these problems begin before the age of 14 ( 9 ). Mental health conditions account for 16% of the global burden of disease and injury among adolescents ( 8 ). Furthermore, these problems have been demonstrated to increase the risk of adverse consequences, such as impairment, lack of productivity and ability to contribute to society, low educational performance and increased probability of exhibiting risky behaviours, such as alcoholism and sexual, and suicidal behaviours ( 10 ).

Anxiety and depression are the most prevalent mental health conditions during the early life ( 11 ). These disorders commonly emerge during childhood and adolescence but might continue until adulthood if left untreated. Depression and anxiety are the 4th and 9th leading causes of illness and disability in late-stage youth and the 15th and 6th in early-stage adolescents, respectively ( 12 ). Moreover, these disorders could have a long-term and repeating effect and are more likely to co-occur together up to 50% ( 4 , 11 ). Depression is the primary cause of disability-adjusted life years lost in teenagers worldwide. It occurs in 2%–8% of children and adolescents, with the highest prevalence during puberty. Of the affected individuals, around 40% experience repeated episodes and approximately 33% think about suicide, with 3% to 4% actually committing it ( 13 , 14 ).

Meanwhile, 1 in 10 young individuals suffers from anxiety disorders before reaching the age of 16 ( 15 ). According to the World Health Organization (WHO), the prevalence of this disorder was between 5.7% and 17.7% in children and adolescents ( 16 ). Similarly, stress is a mental health condition that negatively impacts people’s lives. During adolescence, the susceptibility to stress is highly increased, adversely affecting individuals’ psychological and physical well-being ( 17 ).

Prevention is one strategy to reduce the burden of these illnesses, which can be categorised as either universal or targeted programmes ( 11 ). It is necessary to address these disorders by implementing educational programmes targeting diverse children and teenagers to introduce and reinforce essential knowledge and skills in mental well-being ( 18 ). School is a suitable atmosphere for targeting adolescents. It demonstrates the most effective social settings that can help students practice cognitive and social skills as they spend a significant amount of their time there. Furthermore, it offers intervention opportunities with the support of social relationships. School-based mental health programmes can reduce and alleviate many common barriers to treatment in the community, such as cost, location, time, transportation and stigmatisation, by offering alternatives that are of low cost, have high utilisation levels, are convenient and non-threatening ( 19 , 11 , 20 , 21 ). School plays a vital role in identifying those with symptomatic and those at risk of becoming symptomatic ( 11 ).

Life skills education is an organised educational programme designed to improve children and adolescents’ skills and abilities, enabling them to deal more effectively with the daily demands of life ( 22 , 23 ). It also aims to improve mental health and boost the positive and adaptive behaviours of the target individuals ( 24 ). According to the WHO, life skills are generally defined as ‘abilities for adaptive and positive behaviour that enables individuals to deal effectively with the demands and challenges of everyday life’ ( 25 ). The theoretical foundation of the life skills programme is based on the social learning theory developed by Albert Bandura in 1977 ( 24 , 25 ). He stated that people learn through observational learning, imitation and modelling. Bandura introduced the term ‘observational learning’ and defined the components of appropriate observational learning as attention, retention, reproduction and motivation ( Figure 1 ).

Schematic outline of observational learning and modelling process in social learning theory

Source : Nabavi ( 27 )

He posited that individuals observe and copy the behaviour of others in their social worlds and develop an idea of how new actions are performed. This recorded information serves as a guide for action on subsequent occasions. His explanation on observational learning enables an individual to rapidly gather knowledge by observing and imitating models found in his/her environment. Then, in 1986, Bandura highlighted the cognitive aspects of observational learning, and manner, behaviour, cognition and environment interact to shape individuals. He introduced the principle of the dynamic and reciprocal relationship between a person (an individual with a collection of previous experiences), their environment (the external social circumstances) and their behaviour (responses to stimuli to achieve goals) ( 26 – 28 ).

Life skills education includes activities that support critical and creative thinking, coping with emotions and stress, self-awareness and empathy, decision-making and problem-solving, communication skills and interpersonal relations ( 25 ). Life skills education has been used in different countries and targets different health outcomes, such as improvement and promotion of mental ( 25 , 29 ), psychosocial ( 30 ), and physical health and prevention of acquired immunodeficiency syndrome AIDS ( 31 ), substance abuse ( 32 ) and teenage pregnancy ( 22 , 33 ). Thus, life skills education has been established for preventive measures, promoting healthy positive behaviour, and strengthening communication and socialisation skills.

Therefore, this systematic review aimed to provide an overview and summarise the available literature about the effect of life skills programmes on the reduction of depression, anxiety and stress among children and adolescents. In addition, it would provide good insight into the appropriate approach for implementing the accurate methods. Following the PICO model, the main review question of the current systematic review is as follows: What is the effect of life skills intervention on depression, anxiety and stress levels among children and adolescents (5 years old–18 years old of age)?

The current systematic review and the bibliometric study were conducted by following the ‘PRISMA’ 2009 checklist ( 34 ). The protocol of this systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (registration number: CRD42021256603).

Literature Search and Eligibility Criteria

A comprehensive search was initially conducted on eight electronic databases, namely, Academic Search Complete, CINAHL, Cochrane Library, MEDLINE, Psychology and Behavioural Sciences Collection, PubMed, Scopus and Web of Science. The following keywords were used in the search: Population: (Children OR child OR adolescents OR youth OR young OR teen OR teenage OR young people OR young adult), Intervention: AND (‘life skills’), Outcome: AND (‘mental disorders’ OR ‘mental health’ OR ‘internalising problems’ OR ‘emotional problems’ OR ‘anxiety disorders’ OR ‘depressive disorders’ OR ‘depression’ OR ‘stress’ OR ‘anxiety’ OR ‘Psychological stress’ OR ‘Life Stress’ OR ‘emotional stress’). Only databases from 2012 to 2020 were searched. The literature was limited to the English language due to the expected translation problem. The detailed search strategy of the electronic databases is illustrated in the supplementary table (Table S1) .

The inclusion criteria were as follows: i) participants were children or adolescents with ages between 5 years old and 18 years old; ii) intervention was the life skills programme; iii) life skills intervention groups compared with either school-as usual control groups, waitlist control groups or other educational interventions or no control groups; iv) the studies reported at least one mental health outcome, either depression, anxiety and stress, at baseline and post-intervention at a minimum; v) randomised controlled trials (RCTs) and non-randomised controlled trials (non-RCT), such as quasi-experimental and pre-post studies design. Studies were excluded if: i) the studies evaluated drug and alcohol use, physical and sexual activities, and nutritional interventions; ii) non-English studies and iii) non-experimental studies, such as observational (e.g. cross-sectional, case-control and cohort studies) and qualitative ones.

Data Collection and Analysis

All citations were uploaded into the Mendeley software and duplicated studies were removed. Two reviewers screened the titles, abstracts, and, finally, full texts based on the inclusion criteria. Disagreements were resolved through a discussion between the two reviewers. If the disagreement remained, a third person was available to arbitrate.

Data Extraction and Management

Two reviewers independently collected the standardised data extraction forms. The information extracted included the following: first author, year of publication, country, study design (RCT or non-RCT), participant’s age, sample size, instrument, intervention characteristics and findings.

Quality Appraisal

Two independent reviewers used the Critical Appraisal Checklist for RCTs and Quasi-Experimental studies developed by the Joanna Briggs Institute (JBI) ( 35 ) to evaluate the risk of bias for the eligible studies. In addition, they calculated the overall risk score based on the number of items checked for each evaluation. The purpose of this appraisal was to assess the methodological quality and determine the possibility of bias in the study design, conduct and analysis. Any disagreement between the reviewers was addressed by discussion.

The instruments consisted of 13 and 9 questions for the RCTs checklist and the quasi-experimental checklist, respectively. These questions were answerable by ‘yes,’ ‘no,’ ‘unclear,’ or ‘not applicable.’ The appraisal score represented the percentage of (yes) responses from the total number of questions. At least 50% of the ‘yes’ scores on the JBI critical evaluation instruments were used as the cut-off point for inclusion in the RCT and quasi-experimental trial review ( 36 ). When a criterion was ‘not reported,’ it was considered as ‘unclear’ and treated as a ‘no’ response. If a measure did not apply (N/A) to the study, that item was not counted in the total number of criteria ( 37 ).

Study Selection

According to the PRISMA diagram ( Figure 2 ), a total of 2,160 articles were identified in the initial database search. After removing the duplicates, 1,231 articles were further examined, of which 1,136 were excluded during the title and abstract screening. A total of 18 full-text articles were left for eligibility assessment. Finally, 10 articles were found to meet the eligibility criteria.

Prisma flow diagram of the selected articles

Study Characteristics

Detailed information about the authors, year of publication, countries, study design, sample size, participants, instrument, intervention characteristics, findings and summary of the results is provided in Table 1 . The studies included in the review were seven quasi-experimental ones and three were RCTs. All the included studies were conducted in seven different countries: one study in Malaysia ( 29 ); one study in Taiwan ( 38 ); three studies in Iran ( 39 – 41 ); two studies in India ( 42 , 43 ); one study in Uganda ( 44 ); one study in Kenya ( 45 ) and one study in Australia ( 46 ).

Study characteristics

Participants’ Characteristics

The total number of participants in the included studies was 6,714 with varying sample sizes from 40 adolescents in Australia ( 46 ) to 2,522 in Taiwan ( 38 ). Most studies recruited individuals from schools, one in Malaysia from orphanages ( 29 ) and one in Iran from paediatric hospitals ( 40 ). The age range in all studies was 10 years old–19 years old; however, no research was conducted among children. Both gender, males and females, participated in most studies, only one study was conducted among boys ( 43 ) and another one among girls ( 41 ).

Intervention Characteristics

All studies in this review investigated the effect of life skills intervention on the reduction of depression, anxiety and stress among adolescents ( Table 2 ). Three studies targeted only stress ( 39 , 42 , 43 ), and one study each targeted depression ( 38 ) and anxiety ( 46 ). Meanwhile, three other studies focused on depression and anxiety-like symptoms ( 40 , 44 , 45 ), and the last two targeted three mental conditions, namely, depression, anxiety and stress, altogether ( 29 , 41 ). Baseline assessment was performed for all the participants and the findings were compared with the post-intervention results, except for one study, which did not include pre-intervention evaluation ( 38 ). The period of post-intervention assessment differed in the included studies, ranging from immediately after the intervention to 9 months ( 45 ) and 1 year ( 43 ). In a study by Lee et al. ( 38 ), there were no follow-ups, only post-test assessments. Detailed information and a summary of the intervention assessment and follow-up are presented in Table 2 . Four studies evaluated the effect of the intervention by comparing the intervention and control groups; only one study had no control group ( 45 ). The intervention programme was conducted by the researcher in most of the included studies.

Study instrument and findings

Meanwhile, the trained teachers conducted the programme in other studies and only one study was performed by a clinical psychologist ( 40 ). The length and contents of the intervention were also different from one study to another. The overall duration of the intervention ranged from 1 week to months and the length for each session ranged from 45 min to 150 min. The education modules were slightly different among the included studies. They used various activities such as brainstorming, goal-setting, role-playing and group discussion, drama, drawing, playing games and matches, and question-and-answer sessions.

As presented in Table 1 , the appraisal score for the methodological quality (in percentage) of the included studies ranged from moderate (62%) to high (100%), where high quality was regarded as more than 80%, moderate quality as 50% to 79% and poor quality as less than 50% ( 37 ). Half of the studies were of moderate quality, whereas the rest were considered to be of high quality. The comprehensive data on the methodological quality of the included studies are presented in the supplementary tables (Tables S2 and S3 ).

In this systematic review, we identified and summarised the effect of life skills intervention on depression and/or anxiety and/or stress among children and adolescents. The study demonstrated that the life skills intervention positively influenced the adolescents’ mental health. It also provided evidence supporting the development and establishment of life skills interventions. Our findings are consistent with those of previous research, indicating the efficiency and effectiveness of educational programmes and mental health interventions ( 18 , 29 , 11 , 47 – 49 ).

Several aspects of the effect of life skills programmes are highlighted in this review. For instance, the life skills intervention is based on three critical key elements, namely, appropriate educational strategies, active educational techniques and safe learning environments. Furthermore, the link between theoretical and practical aspects is one of the essential educational strategies. Four articles in this review mentioned the life skills intervention-based theories: stress-coping theory ( 29 ), social cognitive theory ( 45 ) and self-determinant theory ( 46 ). The teaching and learning approaches are situated at the junction of the conceptual and programmatic frameworks for life skills. Life skills education is also focused on two main aspects. First, life skills are changeable; they are not permanent character traits and may thus be taught, learned and acquired throughout life. Second, they can be reinforced through proper educational interventions. In this sense, because teaching and learning are integral components of life skills, a fundamental practical aspect of life skills programmes is the determination of the most effective teaching and learning methods.

In addition, active learning is the most effective method for delivering life skills education. It includes a learner-focused approach that places importance on the teaching and learning process. Active learning methods encourage students to become active participants in their education rather than becoming passive information users. Students are considered as active thinkers who may be stimulated by engaging in instructional approaches. They work with other students to improve their talents and, as a result, form strong bonds with their classmates. It is also critical to consider children and youth’s perspectives, ideas, and concerns while assuring their active involvement in educational activities. Another vital component of participatory education, small group and teamwork have several benefits for successful life skills education.

More insight into the importance of schools as safe environments can contribute to the success of life skills intervention and can help create an excellent ground for teachers and peer relationships. Schools are ideal environments for interventional and training studies on children and adolescents because of easy access to many participants, a high degree of confidence among parents and the community, and the possibility to evaluate the short- and long-term impact of the studies ( 11 , 19 – 21 ). Consequently, incorporating life skills training as part of the school curriculum at early stages is also necessary. It can facilitate the early recognition of students experiencing problems with their emotional health and well-being as well as the referral to appropriate support.

Our results contributed to this field of study by emphasising the critical components of success among teenagers that reflect numerous aspects of other mental health outcomes. Life skills interventions promote positive mental health and encourage teenagers with essential skills to improve their abilities and overcome challenges ( 50 ). Moreover, it plays a significant role in enhancing students’ success in both academic and non-academic areas ( 40 ), such as strengthening of coping mechanisms ( 29 ) and development of self-confidence ( 30 , 40 ) and empathy ( 51 ). Accordingly, good mental health and well-being influence healthy behaviours, improved physical health, high educational achievement, high productivity, jobs and income. Eventually, teenagers show positive changes from the knowledge gained about the different coping strategies and life skills ( 38 , 52 ).

Although the duration of the life skills programmes appeared different in this review, its effect on the studied variables was achieved. The priority was focused on the intensity of the sessions and the quality of the presented material, instead of the number of sessions. Most of the included studies were limited to the documentation of short-term effects obtained through methodologies with small sample sizes; in addition, they were restricted to pre-post-test assessments, without any follow-up, to fully evaluate the effectiveness of the respective activities. These findings indicate the need for additional research to fully evaluate the respective programme’s performance. Furthermore, long-term monitoring and assessment are required to construct empirical evidence with regard to the success of life skills interventions ( 6 ). Regular booster sessions and reinforcement must also be considered for the maintenance of mental health well-being.

Thus, the implementation of sustainable life skills programmes is a crucial element. As a result, greater focus is needed in these situations on the establishment of continuous and sustainable programmes through systematic planning, organisation, supervision and assessment of teaching these skills ( 22 , 53 ). The use of an appropriate instrument for the assessment of outcomes can help in the production of high-quality results. Although various tools have been used to evaluate and measure depression, anxiety and stress, they are suitable for children and adolescents. The validity and reliability of the rating scales were documented in most of the included studies, validating the quality of the studies.

Life skills programme mentors, policymakers, officials and instructors must understand its potential and worth and receive adequate training ( 19 , 54 , 55 ). In this setting, increasing access to appropriate interventions is necessary, especially those provided by non-healthcare professionals, such as teachers and caregivers.

Considering adolescent experiences in the context of an individual’s tradition and culture is crucial for comprehending how individuals from varied backgrounds acquire life skills knowledge. This may include student comments and discussions on each life skills issue to enhance the applicability of the skills ( 24 , 25 ). Studies might be described in terms of experiences, such as stories from teenagers’ lives, examination of different perspectives and the distinct social circumstances in which they acquire life skills. These perspectives will create a more balanced understanding of the realities of programme effectiveness.

Furthermore, it can be noticed that in the included studies, life skills education has been integrated into particular social and cultural contexts. For instance, in the Malaysian research ( 29 ), the programme was conducted in orphanages in the Malay language and targeted the Malaysian environment and local culture, with respect to ethnicity and religion. Meanwhile, in Taiwanese schools ( 38 ), the curriculum was translated to Mandarin’s local language. It was modified and changed using Taiwanese life-experience situations to ensure that it was known to Taiwanese students and practical in a school and classroom setting. Moreover, they used the most conventional social media application in Taiwan for further discussion.

In the Tibetan study ( 42 ), the programme was also constructed for Tibetan refugee teenagers by making the life skills activities realistic and relevant to the refugee experience. The names of characters and locations have been changed and replaced to reflect the situation of Tibetan refugee youths. In Uganda ( 44 ), Kenya ( 45 ), Australia ( 46 ) and Iran ( 40 ), the activities were designed based on the particular psychological needs of the students’ skills. The objective was to create a curriculum suited for those participants’ cultural and social contexts. Here, it can be noticed that the basic concept of life skills intervention is the same across different countries. Moreover, these skills were contextualised according to the social and cultural context and settings. Therefore, certified trainers who customise the curriculum with more appropriate examples and real-life situations closer to the user’s background would make the life skills programme more effective and impactful.

Another important finding in our review is the lack of life skills intervention studies among children due to several reasons. First, the prevalence of mental disorders peaks during adolescence. It is a transitional stage characterised by rapid growth and development with the occurrence of numerous physical and psychological changes, such as increased susceptibility to stressors and the emergence of many mental health disorders ( 14 , 17 , 56 , 57 ). Also, previous literature documented that the symptoms of these mental disorders persist throughout childhood; thus, it is not common for intervention programmes to focus on children ( 6 ). Furthermore, the limited search on the database might lead to missing relevant articles before 2012 and those in non-English languages. Finally, we excluded different study designs that target children, such as the mixed-method design.

Gender disparity in the interpretation of mental illness is reported in this review. For example, symptoms of depression were lesser in males but not in females after the life skills intervention. Similarly, previous literature documented the presence of gender inequality in adolescents who experienced internalising and externalising problems. Females tended to have higher levels of internalising problems, whereas males tended to have higher levels of externalising problems ( 58 ). Females generally showed more emotional reactions to stressful situations, whereas males exhibited more cognitive responses ( 59 , 49 ). This could mean that females are more susceptible to the risk factors owing to their biological differences ( 29 ).

Meanwhile, males were observed to practice more skills than females and regulate their emotional symptoms better than females. In addition, females used social support as a coping method, even though it has been observed that females who sought social support were more likely to experience mental health issues, but not males ( 60 ). Consequently, more advanced research focusing on gender variation and how various life skills interventions impact these populations is needed. Such an effort could help promote dedicated sections where males and females could be separately addressed.

Addressing the concerns and challenges faced by children and young adults in early life through education programmes could make them independent in coping with life’s demands, which can transform these challenges and obstacles into opportunities. In addition, the cultural and sustainable development of the programme is crucial, which involves indigenous individuals as consultants and local assistants in policymaking. It will contribute to sociocultural awareness, decreasing the possibility of inappropriate implementation.

Although a comprehensive search using eight databases was performed to obtain an enormous number of studies, our systematic review has several limitations. Our search was limited to articles published between 2012 and 2020. Furthermore, it did not include non-English articles and gray literature; thus, it is possible that some relevant studies have been missed. Furthermore, some of the studies that involved multicomponent interventions were not included, making narrative synthesis and interpretation of the evidence challenging. Lastly, the differences in the study population, location, sample size, study length and instruments across the included studies make it difficult to effectively compare the intervention.

This review has synthesised evidence on life skills intervention to improve the mental health of adolescents. It identifies several experimental and quasi-experimental studies that evaluated life skills programmes as a potential intervention strategy for effectively addressing teenagers’ mental well-being through the reduction of depression, anxiety and stress. The methods used by adolescents to acquire information and skills through life skills programmes and then to adopt good attitudes and behaviours were explained in almost all studies.

Life skills education was focused on specific life skills, depending on the setting. It considered psychosocial competencies and interpersonal skills that help participants in making the right decisions, solving problems, thinking critically and creatively, communicating effectively, building healthy relationships, empathising with others, and coping with managing their lives in a healthy and productive manner.

The current research has resulted in numerous critical recommendations on the development of life skills educational interventions. First, life skills development is at the core of childhood and adolescence protection strategies. Future research is recommended to holistically examine life skills educational intervention to provide robust evidence on its effectiveness and to achieve long-term effects.

In addition, a comprehensive approach with a cultural, gender perspective, age-appropriate and active learning should be considered. Based on the evidence in this review, policymakers, officials and health professionals are suggested to offer life skills training programmes to all children and adolescents in schools and institutions. In addition, it could benefit from providing resources using internet applications to enable fast and easy access to information.

Supplementary 1

Search strategy for databases

• The electronic databases were initially searched.
• They were Academic Search Complete, CINAHL, Cochrane, MEDLINE, Psychology and Behavioural Sciences Collection, PubMed, Scopus and Web of Science.

The title and abstract of articles searched using several keywords are as follows:

• Population: (Children OR child OR adolescents OR youth OR young OR teen OR teenage OR young people OR young adult),
• Intervention: AND (‘life skills’),
• Outcome: AND (‘mental disorders’ OR ‘mental health’ OR ‘internalising problems’ OR ‘emotional problems’ OR ‘anxiety disorders’ OR ‘depressive disorders’ OR ‘depression’ OR ‘stress’ OR ‘anxiety’ OR ‘Psychological stress’ OR ‘Life Stress’ OR ‘emotional stress’).

The literature was limited to the English language because of the expected translation problem.

Supplementary 2

Acknowledgements.

We would like to thank the Faculty of Medicine and Health Sciences, Universiti Putra Malaysia for their librarian support.

Conflict of Interest

Authors’ Contributions

Conception and design: YS, AZFA, HA

Analysis and interpretation of the data: YS, AZFA, HA

Drafting of the article: YS, AZFA, MM

Critical revision of the article for important intellectual content: YS, AZFA, HA, SAM, MM, ASA

Final approval of the article: AZFA, HA, SAM, MM, ASA

Provision of study materials or patients: YS

Administrative, technical or logistic support: MM, ASA

Collection and assembly of data: YS

Life Skills Education

Helping people make responsible and informed choices.

For youth to grow into well-functioning adults, it is essential that they learn key life skills such as critical and creative thinking, decision-making, and effective communication, as well as skills for developing self esteem and healthy relationships, navigating harmful gender norms, and accessing health care. While important for all young people around the world , these skills are particularly critical for adolescents who lack accurate information and guidance for making consequential decisions such as becoming sexually active, staying in school, and preventing or responding to abuse. Many children, however, do not have access to education that includes life skills training. 

We layer life skills education onto many of our programs for young people, and deliver these in club-like settings in and out of school, as well as through national school curricula.

We also work with partners, including ministries of education, schools, and nongovernmental organizations, to develop life skills curricula and training approaches and help programs integrate and teach life skills to students in both formal schools and non-formal settings.

Our life skills education approach makes curricula more relevant to the needs of all youth and vulnerable adults, whose grasp of learning content increases dramatically when it is linked directly to their everyday lives. Learners acquire a range of skills to live effectively in society, as well as specific technical and occupational skills including how to set up and run small businesses and use sustainable agriculture methods.

Healthier children stay in school longer, learn more, and as a result, become more productive adults. We are committed to developing and scaling programs that meet the various health needs of children and their families. 

We build on school curricula to inform students about their health and remove barriers to health services. We help ministries of education develop HIV prevention and life skills education curricula. We use schools as entry points to deliver integrated services including primary health care screening and referrals; reproductive health information; nutrition; and psychosocial support .  

The use of clean cooking technology is critical to health. We implement activities in school kitchens to improve staff health and reduce the environmental consequences of traditional wood- and coal-burning stoves. We train students in clean cookstove technology so they can apply what they learn at home, thus improving the environment and the health of their families and communities.

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Skills for health : skills-based health education including life skills : an important component of a child-friendly/health-promoting school

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Life Skills Education School Handbook - Noncommunicable Diseases: Introduction

Health promoting schools has been recognized an effective approach to enhancing education and health outcomes of children and adolescents. This handbook deals with the prevention of noncommunicable diseases in school settings. The first part of the handbook presents the knowledge around risks linked to tobacco use, unhealthy diet, lack of physical activity and hygiene including oral. it highlights the need to address these risk factors trough health literacy and life skills education. 

Why Education Matters to Health: Exploring the Causes

Americans with more education live longer, healthier lives than those with fewer years of schooling (see issue brief #1) . but why does education matter so much to health the links are complex—and tied closely to income and to the skills and opportunities that people have to lead healthy lives in their communities..

How are health and education linked? There are three main connections: 1

• Education can create opportunities for better health
• Poor health can put educational attainment at risk (reverse causality)
• Conditions throughout people’s lives—beginning in early childhood—can affect both health and education

The relationship between education and health has existed for generations, despite dramatic improvements in medical care and public health. Recent data show that the association between education and health has grown dramatically in the last four decades. Now more than ever, people who have not graduated high school are more likely to report being in fair or poor health compared to college graduates. 2 Between 1972 and 2004, the gap between these two groups grew from 23 percentage points to 36 percentage points among non-Hispanic whites age 40 to 64. African-Americans experienced a comparable widening in the health gap by education during this time period. The probability of having major chronic conditions also increased more among the least educated. 3 The widening of the gap has occurred across the country 4 and is discussed in more detail in Issue Brief #1 .

How important are years of school? Research has focused on the number of years of school students complete, largely because there are fewer data available on other aspects of education that are also important. It’s not just the diploma: education is important in building knowledge and developing literacy, thinking and problem-solving skills, and character traits. Our community research team noted that early childhood education and youth development are also important to the relationship between education and health.

This issue brief, created with support from the Robert Wood Johnson Foundation, provides an overview of what research shows about the links between education and health alongside the perspectives of residents of a disadvantaged urban community in Richmond, Virginia. These community researchers, members of our partnership, collaborate regularly with the Center on Society and Health’s research and policy activities to help us more fully understand the “real life” connections between community life and health outcomes.

1. The Health Benefits of Education

Income and resources.

“Being educated now means getting better employment, teaching our kids to be successful and just making a difference in, just in everyday life.” —Brenda

Better jobs: In today’s knowledge economy, an applicant with more education is more likely to be employed and land a job that provides health-promoting benefits such as health insurance, paid leave, and retirement. 5 Conversely, people with less education are more likely to work in high-risk occupations with few benefits.

Higher earnings: Income has a major effect on health and workers with more education tend to earn more money. 2 In 2012, the median wage for college graduates was more than twice that of high school dropouts and more than one and a half times higher than that of high school graduates. 6 Read More

Adults with more education tend to experience less economic hardship, attain greater job prestige and social rank, and enjoy greater access to resources that contribute to better health. A number of studies have suggested that income is among the main reasons for the superior health of people with an advanced education. 1 Weekly earnings rise dramatically for Americans with a college or advanced degree. A higher education has an even greater effect on lifetime earnings (see Figure 1), a pattern that is true for men and women, for blacks and whites, and for Hispanics and non-Hispanics. For example, based on 2006-2008 data, the lifetime earnings of a Hispanic male are $870,275 for those with less than a 9th grade education but $2,777,200 for those with a doctoral degree. The corresponding lifetime earnings for a non-Hispanic white male are $1,056,523 and $3,403,123. 7

“Definitely having a good education and a good paying job can relieve a lot of mental stress.” —Chimere

Resources for good health: Families with higher incomes can more easily purchase healthy foods, have time to exercise regularly, and pay for health services and transportation. Conversely, the job insecurity, low wages, and lack of assets associated with less education can make individuals and families more vulnerable during hard times—which can lead to poor nutrition, unstable housing, and unmet medical needs. Read More

Economic hardships can harm health and family relationships, 8 as well as making it more difficult to afford household expenses, from utility bills to medical costs. People living in households with higher incomes—who tend to have more education—are more likely to be covered by health insurance (see Figure 3). Over time, the insured rate has decreased for Americans without a high school education (see Figure 4).

Lower income and lack of adequate insurance coverage are barriers to meeting health care needs. In 2010, more than one in four (27%) adults who lacked a high school education reported being unable to see a doctor due to cost, compared to less than one in five (18%) high school graduates and less than one in 10 (8%) college graduates. 9 Access to care also affects receipt of preventive services and care for chronic diseases. The CDC reports, for example, that about 49% of adults age 50-75 with some high school education were up-to-date with colorectal cancer screening in 2010, compared to 59% of high school graduates and 72% of college graduates. 10

Social and Psychological Benefits

“So through school, we learn how to socially engage with other classmates. We learn how to engage with our teachers. How we speak to others and how we allow that to grow as we get older allows us to learn how to ask those questions when we're working within the healthcare system, when we're working with our doctor to understand what is going on with us.” —Chanel

Reduced stress: People with more education—and thus higher incomes—are often spared the health-harming stresses that accompany prolonged social and economic hardship. Those with less education often have fewer resources (e.g., social support, sense of control over life, and high self-esteem) to buffer the effects of stress.  Read More

Life changes, traumas, chronic strain, and discrimination can cause health-harming stress. Economic hardship and other stressors can have a cumulative, negative effect on health over time and may, in turn, make individuals more sensitive to further stressors. Researchers have coined the term “allostatic load” to refer to the effects of chronic exposure to physiological stress responses. Exposure to high allostatic load over time may predispose individuals to diseases such as asthma, cardiovascular disease, gastrointestinal disease, and infections 11 and has been associated with higher death rates among older adults. 12

Social and psychological skills: Education in school and other learning opportunities outside the classroom build skills and foster traits that are important throughout life and may be important to health, such as conscientiousness, perseverance, a sense of personal control, flexibility, the capacity for negotiation, and the ability to form relationships and establish social networks. These skills can help with a variety of life’s challenges—from work to family life—and with managing one’s health and navigating the health care system. Read More

Many types of skills can be developed through education, from cognitive skills to problem solving to fostering key personality traits. Education can increase ‘learned effectiveness,’ including cognitive ability, self-control, and problem solving. 13 Personality traits, otherwise known as ‘soft skills’, are associated with success in education and employment and lower mortality rates. 14 One set of these personality traits has been called the ‘Big Five’: conscientiousness, openness to experience, being extraverted, being agreeable, andemotional stability. 15

These various forms of human capital are an important way that education affects health. For example, education may strengthen coping skills that reduce the damage of stress. Greater personal control may also lead to healthier behaviors, partly by increasing knowledge. Those with greater perceived personal control are more likely to initiate preventive behaviors. 13

Social networks: Educated adults tend to have larger social networks—and these connections bring access to financial, psychological, and emotional resources that may help reduce hardship and stress and improve health. Read More

Social networks also enhance access to information and exposure to peers who model acceptable behaviors. The relationship between social support and education may be due, in part, to the social and cognitive skills and greater involvement with civic groups and organizations that come with education. 16, 17 Low social support is associated with higher death rates and poor mental health. 18, 19

Education is also associated with crime. Among young male high school drop-outs, nearly 1 in 10 was incarcerated on a given day in 2006-2007 versus fewer than 1 of 33 high school graduates. 20 The high incarceration rates in some communities can disrupt social networks and weaken social capital and social control—all of which may impact public health and safety.

“Being able to advocate and ask for what you want, helps to facilitate a healthier lifestyle. … If it's needing your community to have green spaces, have a park, a playground, have better trails within the community, advocating for that will help.” —Chanel

Health Behaviors

Knowledge and skills: In addition to being prepared for better jobs, people with more education are more likely to learn about healthy behaviors. Educated patients may be more able to understand their health needs, follow instructions, advocate for themselves and their families, and communicate effectively with health providers. 21 Read More

People with more education are more likely to learn about health and health risks, improving their literacy and comprehension of what can be complex issues critical to their wellbeing. People who are more educated are more receptive to health education campaigns. Education can also lead to more accurate health beliefs and knowledge, and thus to better lifestyle choices, but also to better skills and greater self-advocacy. Education improves skills such as literacy, develops effective habits, and may improve cognitive ability. The skills acquired through education can affect health indirectly (through better jobs and earnings) or directly (through ability to follow health care regimens and manage diseases), and they can affect the ability of patients to navigate the health system, such as knowing how to get reimbursed by a health plan. Thus, more highly educated individuals may be more able to understand health care issues and follow treatment guidelines. 21–23 The quality of doctor-patient communication is also poorer for patients of low socioeconomic status. A review of the effects of health literacy on health found that people with lower health literacy are more likely to use emergency services and be hospitalized and are less likely to use preventive services such as mammography or take medications and interpret labels correctly. Among the elderly, poor health literacy has been linked to poorer health status and higher death rates. 24

Healthier Neighborhoods

“Poor neighborhoods oftentimes lead to poor schools. Poor schools lead to poor education. Poor education oftentimes leads to poor work. Poor work puts you right back into the poor neighborhood. It's a vicious cycle that happens in communities, especially inner cities.” —Albert

Lower income and fewer resources mean that people with less education are more likely to live in low-income neighborhoods that lack the resources for good health. These neighborhoods are often economically marginalized and segregated and have more risk factors for poor health such as:

• Less access to supermarkets or other sources of healthy food and an oversupply of fast food restaurants and outlets that promote unhealthy foods. 25

Nationwide, access to a store that sells healthier foods is 1.4 less likely in census tracts with fewer college educated adults (less than 27% of the population) than in tracts with a higher proportion of college-educated persons. 26 Food access is important to health because unhealthy eating habits are linked to numerous acute and chronic health problems such as diabetes, hypertension, obesity, heart disease, and stroke as well as higher mortality rates.

“If the best thing that you see in the neighborhood is a drug dealer, then that becomes your goal. If the best thing you see in your neighborhood is working a 9 to 5, then that becomes your goal. But if you see the doctors and the lawyers, if you see the teachers and the professors, then that becomes your goal.” —Marco

“It's a lot of things going on [in this community], a lot of challenges. It's just hard sometimes to try and get people to come together, as one, just so we can solve the problem.” —Toni

• Less green space, such as sidewalks and parks to encourage outdoor physical activity and walking or cycling to work or school.
• Rural and low-income areas, which are more populated by people with less education, often suffer from shortages of primary care physicians and other health care providers and facilities.
• Higher crime rates, exposing residents to greater risk of trauma and deaths from violence and the stress of living in unsafe neighborhoods. People with less education, particularly males, are more likely to be incarcerated, which carries its own public health risks.
• Fewer high-quality schools, often because public schools are poorly resourced by low property taxes. Low-resourced schools have greater difficulty offering attractive teacher salaries or properly maintaining buildings and supplies.
• Fewer jobs, which can exacerbate the economic hardship and poor health that is common for people with less education.
• Higher levels of toxins, such as air and water pollution, hazardous waste, pesticides, andindustrial chemicals. 27
• Less effective political influence to advocate for community needs, resulting in a persistent cycle of disadvantage.

2. Poor Health That Affects Education (Reverse Causality)

“Things that happen in the home can definitely affect a child being able to even concentrate in the classroom. … If you're hungry, you can't learn with your belly growling. … If you’re worried about your mom being safe while you're at school, you're not going to be able to pay attention.” —Chimere

The relationship between education and health is never a simple one. Poor health not only results from lower educational attainment, it can also cause educational setbacks and interfere with schooling.

For example, children with asthma and other chronic illnesses may experience recurrent absences and difficulty concentrating in class. 28 Disabilities can also affect school performance due to difficulties with vision, hearing, attention, behavior, absenteeism, or cognitive skills. Read More

Health conditions, disabilities, and unhealthy behaviors can all have an effect on educational outcomes. Illness, poor nutrition, substance use and smoking, obesity, sleep disorders, mental health, asthma, poor vision, and inattention/hyperactivity have established links to school performance or attainment. 25, 29, 30 For example, compared to other students, children with attention deficit/hyperactivity disorder (ADHD) are three times more likely to be held back (retained a grade) and almost three times more likely to drop out of school before graduation. 31 Children who are born with low birth weight also tend to have poorer educational outcomes, 32, 33 and higher risk for special education placements. 34, 35 Although the impact of health on education (reverse causality) is important, many have questioned how large a role it plays. 1

3. Conditions Throughout the Life Course—Beginning in Early Childhood—That Affect Both Health and Education

A third way that education can be linked to health is by exposure to conditions, beginning in early childhood, which can affect both education and health. Throughout life, conditions at home, socioeconomic status, and other contextual factors can create stress, cause illness, and deprive individuals and families of resources for success in school, the workplace, and healthy living. Read More

Contextual factors throughout one’s life can affect education and health. For example, biological characteristics can affect educational success and health outcomes, as can socioeconomic and environmental conditions such as poverty or material deprivation. These influences appear to be particularly acute during early childhood, when children’s physical health and academic success can be influenced by biologic risk factors (e.g., low birth weight, chronic health conditions) and socioeconomic status (e.g., parents’ education and assets, neighborhood socioeconomic resources, such as day care and schools). 36 School readiness is enhanced by positive early childhood conditions—e.g., fetal wellbeing, social-emotional development, family socioeconomic status, neighborhood socioeconomic status, and early childhood education—but some of these same assets also appear to be vital to the health and development of children and their future risk of adopting unhealthy behaviors and adult diseases. 37 – 40 Early childhood is a period in which health and educational trajectories are shaped by a nurturing home environment, parental involvement, stimulation, and early childhood education, which can foster the development of social skills, adjustment and emotional regulation as well as learning skills. 41

What about social policy? Social policy—decisions about jobs, the economy, education reform, etc.—is an important driver of educational outcomes AND affects all of the factors described in this brief. For example, underperforming schools and discrimination affect not only educational outcomes but also economic success, the social environment, personal behaviors, and access to quality health care. Social policy affects the education system itself but, in addition, individuals with low educational attainment and fewer resources are more vulnerable to social policy decisions that affect access to health care, eligibility for aid, and support services.

A growing body of research suggests that chronic exposure of infants and toddlers to stressors—what experts call “adverse childhood experiences”—can affect brain development and disturb the child’s endocrine and immune systems, causing biological changes that increase the risk of heart disease and other conditions later in life (see Graphic 1). For example:

“The connection that I will say between education and health would be a healthy mind produces a healthy person. A motivated mind produces a motivated person. A curious mind produces a curious person. When you have those things it drives you to want to know more, to want to have more, to want to inquire more. And when you want more, you will get more. You know where the mind goes the person follows… and that includes health.” —Marco

• The adverse effects of stress on the developing brain and on behavior can affect performance in school and explain setbacks in education. Thus, the correlation between lower educational attainment and illness that is later observed among adults may have as much to do with the seeds of illnessand disability that are planted before children ever reach school age as witheducation itself.
• Children exposed to stress may also be drawn to unhealthy behaviors—such as smoking or unhealthy eating—during adolescence, the age when adult habits are often first established.

Instability in home and community life can have a negative impact on child development and, later in life, such outcomes as economic security and stable housing, which can also affect the physical and mental health of adults. Children exposed to toxic stress, social exclusion and bias, persistent poverty, and trauma experience harmful changes in the architecture of the developing brain that affect cognition, behavioral regulation, and executive function. 42, 43 These disruptions can thereby shape educational, economic, and health outcomes decades and generations later. 44 Dysfunctional coping skills as well as changes in parts of the brain associated with reward and addiction may draw children to unhealthy behaviors (e.g., smoking, alcohol or drug use, unsafe sex, violence) as teenagers.

Focusing on seven categories of adverse childhood experiences (ACEs)*, researchers in the 1990s reported a “graded relationship” for poor health and chronic disease: the higher the exposure to ACEs as children, the greater the risk as adults of having ischemic heart disease, cancer, stroke, chronic lung disease, and diabetes 45  (see Figure 5). Chronic exposure to ACEs is now believed to disrupt children’s developing endocrine and immune systems, causing the body to produce stress hormones and proteins that produce chronic inflammation and lead later in life to heart disease and other adult health problems. 46 Chronic stress can also cause epigenetic changes in DNA that “turn on” genes that may cause cancer and other conditions. 47

Not surprisingly, exposure to ACEs also can stifle success in employment. 38, 48, 49 In one study, the unemployment rate was 13.2% among respondents with 4 or more ACEs, compared to 6.5% for those with no history of ACEs. 50

People who begin life with adverse childhood experiences can thus end up both with greater illness and with difficulties in school and the workplace, thereby contributing to the link between socioeconomic conditions, education, and health. An important way to improve these outcomes is to address the root causes that expose children to stress in the first place.

*The adverse childhood experiences explored were: psychological, physical, or sexual abouse; violence against mother; and living with household members who are substance abusers, mentally ill/suicidal, or ever imprisoned.

“We now know that adversity early in life can not only disrupt brain circuits that lead to problems with literacy; it can also affect the development of the cardiovascular system and the immune system and metabolic regulatory systems, and lead to not only more problems learning in school but also greater risk for diabetes and hypertension and heart disease and cancer and depression and substance abuse." —J Shonkoff (The Poverty Clinic, The New Yorker, March 21, 2011)

What about individual characteristics? Characteristics of individuals and families are important in the relationship between education and health. Race, gender, age, disability and other personal characteristics often affect educational opportunities and success in school (see Issue Brief #1). Discrimination and racism have multiple links to education and health. Racial segregation reduces educational and job opportunities 51 and is associated with worse health outcomes. 52, 53   How does education impact health in your community? The Center on Society and Health (CSH) worked with members of Engaging Richmond, a community-academic partnership that included residents of the East End, a disadvantaged neighborhood of Richmond, Virginia. This inquiry into the links between education and health was a pilot study to learn how individuals could add to our understanding of this complex issue using the lens of their own experiences. What does your community have to say about the links between education and health – or other health disparities? Learn more about community research partnerships and community engagement: Principles of Community Engagement, 2nd Edition Community Campus Partnerships for Health Community Engaged Scholarship Toolkit AHRQ — The Role of Community-Based Participatory Research CSH’s Community University Partnership

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• Felitti VJ, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med 1998;14:245-58.
• McEwen BS. Brain on stress: how the social environment gets under the skin. Proc Natl Acad Sci 2012;109 Suppl 2:17180-5
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• Mistry KB, et al. A new framework for childhood health promotion: the role of policies and programs in building capacity and foundations of early childhood health. Am J Public Health 2012;102:1688-96.
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• White K, Borrell LN. Racial/ethnic residential segregation: Framing the context of health risk and health disparities. Health Place 2011;18: 438-48.
• Smedley BD et al., eds. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care . Washington, DC: The National Academies Press, 2003.

Additional Resources

Download the abridged issue brief (PDF):

Why Education Matters to Health: Exploring the Causes is part two of the Education and Health Initiative , a four-part series seeking to raise awareness about the important connections between education and health. Learn more about the initiative here , and explore the other phases below:

Education: It Matters More to Health than Ever Before : An issue brief, animated video, and expanded web content highlighting the growing divergence in health status between Americans with and without an education.

Health Care: Necessary but not Sufficient : An issue brief discussing the role of improved access to health care (and health insurance) in countering the effects of an inadequate education. Health care is necessary but not sufficient in the face of determinants like education – even in places where health care is guaranteed, people with limited education tend to be sicker.

Education and Health: The Return on Investment : A series of issue briefs arguing that spending more to educate our youth could save more on health care costs, and that the reverse is true: cuts in education to "save" money ultimately drive up health care costs

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Education has the power to transform the lives of children and young people, and the world around them. At UNESCO, inclusive and transformative education starts with healthy, happy and safe learners. Because children and young people who receive a good quality education are more likely to be healthy, and likewise those who are healthy are better able to learn and complete their education.

Guided by the UNESCO Strategy on education for health and well-being , UNESCO works to improve the physical and mental health, well-being and education outcomes of all learners. By reducing health-related barriers to learning, such as gender-based violence, gender inequality, HIV and sexually transmitted infections (STIs), early and unintended pregnancy, bullying and discrimination, and malnutrition, UNESCO, governments and school systems empower learners to understand their rights, learn better and lead fulfilling lives.

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Prestigious College Grads Have Better Health Later In Life, New Study Finds—Here’s Why

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Attending a private U.K. high school or a university with higher status is tied to better cognitive function, heart health and BMI decades after graduation, according to a new study published Tuesday, and researchers believe more disposable income and physical activity advantages may play a role.

A woman on graduation day.

Around 7% of the study’s participants (all of whom were in the U.K.) attended a private high school, less than 4% attended a grammar school—what the researchers consider “selective without fees”—and 89% of participants went to a state funded school, while 7% attended a higher status university, which are highly regarded Russell Group schools like the University of Oxford and University of Cambridge.

The researchers found those who attended a private high school had better cardiometabolic and cognitive outcomes than those who went to state funded schools, and limited evidence suggests the private school group also had lower BMIs and better blood pressures, according to a paper published in the Journal of Epidemiology & Community Health.

There were no major health differences found between the private school group and the grammar school group except for BMI, where private school attendance was associated with a lower BMI.

Higher-status university attendance was associated with lower BMI and better cognitive performance compared to participants who attended “normal-status” universities; having no degree was associated with the worst health outcomes, except for better grip strength and balance.

The researchers believe a couple reasons may explain the study’s results: Students who attend private high schools typically have greater physical activity than their peers, and participants who attended higher-status schools had more disposable income, so they could focus on their health more.

The study included over 8,500 participants between the ages of 46 and 48, who were a part of the 1970 British Cohort Study followed by researchers since they were born in 1970, and were selected and interviewed about their mid-life health between 2016 and 2018.

A previous study done on the British cohort found those who attended private high schools and high-status universities had lower BMI and better self-reported health scores than their counterparts.

Key Background

Similar results are visible in the United States: Attending U.S. colleges with selective admission rates was associated with slightly higher cognitive performance later in life, a Research on Aging study found. Adolescents who attend U.S. schools with advantages like smaller student-to-teacher ratios and teachers with better salaries have better cognitive skills between the ages of 65 and 72 than those who attend schools with less or no advantages, according to a 2020 study . Higher economic status, social position and more access to “highly-resourced” elementary and middle schools are all reasons the researchers found for these health outcomes. Researchers also discovered higher education helps people find higher paying jobs with less safety hazards, so this may factor into the better health outcomes.

Receiving any type of education after high school has also been linked to better health outcomes worldwide. The higher a person's level of education, the lower their risk of premature death, according to a January global study published in the Lancet. A person's risk of death dropped by an average of 2% with every additional year of education they attained, the study found.

Surprising Fact

Education level has also been linked to specific health conditions. People whose highest level of education was middle or elementary school had a 52% higher risk of dying from coronary heart disease than those who attended graduate school, according to a 2019 study . Diabetes risk may also decrease with more education: 13.1% of adults in the U.S. who have diabetes have less than a high school education, compared to 9.1% who graduated high school and 6.9% with more than a high school education. Black and white people with 12 or less years of education have between a 60% and 180% higher cancer mortality rate versus those with 16 or more years of education, a study by the American Cancer Society found.

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9 Transferable Skills That Can Help You in Life

Learn about transferable skills and why they are so important..

Posted June 3, 2024 | Reviewed by Gary Drevitch

Cowritten by Nathalie Boutros and Tchiki Davis.

The average person can expect to hold 12 different jobs in his or her lifetime (United States Bureau of Labor Statistics, 2021). With all this job-changing, how can you navigate your career in the direction that you want to take it? One way to improve your career prospects may be to cultivate your transferable skills.

Transferable skills are those skills that are useful, and maybe even necessary, to the performance of a wide variety of jobs. A skill may be considered transferable if you learn and perfect it in one context, like school, a job, volunteer work, or a hobby, and then can use that skill in new and different situations (Nagele & Stalder, 2017). A huge range of skills, proficiencies, competencies, and talents may qualify as transferable skills. Some transferable skills are very specific and technical—for example, knowledge of specific software or industry regulations. Other transferable skills are more generic such as a general proficiency with computers, or fluency in a foreign language. A third category of transferable skills is often called “soft skills," such as the ability to communicate effectively and problem-solve creatively.

Soft skills are a type of transferable skills that are often needed to successfully apply technical skills and knowledge (Bancino & Zevalkink, 2007). For example, a restaurant manager’s ability to create a work schedule for a large staff requires technical skills like numeracy, literacy, computer proficiency, and administrative skills. Creating a schedule that staff members are generally happy with also requires the soft skills of empathy, leadership , and listening. ( Learn more about some of your soft skills through this well-being quiz.)

Why Transferable Skills Are Important

Change is an increasingly large part of people’s professional lives. Even within the same job, you may often change teams or projects. Having skills that transfer from one situation to another may be extremely helpful when adapting to these frequent changes in your roles and responsibilities.

While technical skills that are readily transferable across contexts may serve you well, having soft skills such as ambiguity tolerance, cultural acceptance, self-confidence , creative thinking , and the ability to give and receive feedback may be particularly valuable (de Villiers, 2010). Having a set of soft skills that you can carry from one role to another may even improve your earning potential. People with the soft skills of leadership, planning, and problem-solving tend to have higher incomes (Ramos et al., 2013).

Examples of Transferable Skills

Skills and proficiencies that tend to be important across workplace settings include (Nagele & Stalder, 2017):

• Fundamental skills – literacy, numeracy, proficiency with technology, and physical skills.
• People skills – oral and written communication, interpersonal skills, influencing, negotiating, teamwork , customer service, leadership, and management.
• Conceptualizing or thinking skills – managing information, problem-solving, organizing and planning, critical thinking, systems thinking, time-management, and teachability.
• Business skills – innovation, entrepreneurship, and administrative skills.
• Community skills – citizenship, work ethic, emotional labor , cultural awareness, and expression.

Although skills from each category may be required to do most jobs, the specific skills needed to perform a specific job may vary. Some transferable skills are more general than others. For example, basic communication and literacy skills will probably be required in most jobs. Other transferable skills may not be valued in as many jobs or industries. For example, customer service skills may not be as strongly valued in manufacturing roles as they are in cashier roles.

Transferable skills can be organized into broad categories of specific competencies and strengths (Ramos et al., 2013). Describing your specific abilities may be more informative than making broad statements about your generic skills.

• Literacy Skills – reading and writing documents, memos, forms, or reports.
• Leadership Skills – coaching and motivating staff, developing staff competencies, planning activities, making strategic decisions, and managing resources.
• Physical Skills – physical strength, dexterity with your hands, endurance, and stamina.
• Problem Solving Skills – spotting and analyzing problems, identifying causes, and finding solutions.
• Influencing Skills – advising customers, persuading others, dealing with people, making speeches and presentations.
• Teamwork Skills – working in teams, listening to colleagues, paying attention to details.
• Planning Skills – time-management, organizing, and planning tasks.
• Numeracy Skills – working with numbers or using advanced mathematical and statistical tools.
• Emotional Labor – language skills, negotiation, emotion -regulation, and managing other people's feelings.

Transferring your skills from one situation to another may not be easy (Saks et al., 2014). The ability to recognize which of your skills may serve you well in a new situation is itself a skill. And recognizing which of your skills are transferable and what new skills you may need to pursue may be the most valuable transferable skill of all.

Adapted from a post on transferable skills published by The Berkeley Well-Being Institute.

Tchiki Davis, Ph.D. , is a consultant, writer, and expert on well-being technology.

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High schoolers learn leadership skills and live college life at Butler’s immersive camp

This story was  originally published  by Chalkbeat. Sign up for their newsletters at  ckbe.at/newsletters

INDIANAPOLIS ( CHALKBEAT ) — On a recent Wednesday well into summer vacation, Indiana high school students sat in a college classroom and brainstormed how they set the tone in their communities.

“I would say, be the best leader you can,” a student said, “so everyone can follow your good example.”

That day, the students considered not just how to lead others to success, but how to succeed themselves. They were attending Butler University’s  BU: BeReal camp , a college immersion experience designed to introduce high schoolers to college life and give them the tools to thrive there.

One of BU: BeReal’s defining features is how it provides scholarships for students who are from low-income backgrounds or will be first-generation college students. For a week on Butler’s campus, they live in a dorm, learn about different areas of study, and get accustomed to the idea of daily life as a college student. It’s one effort among many to boost not just college-going, but college completion,  something many Indiana students struggle with .

But the  grant from the Lilly Endowment Inc.  that funds tuition assistance for 58% of the campers will end next year, leaving administrators looking for ways to sustain a central part of the camp’s mission. (Chalkbeat receives funding from the Lilly Endowment Inc.)

“Some may have never set foot on a college campus before,” Associate Director of Camps Administration Jessica Meister said. “Their parents or grandparents haven’t gone through the college process, so it’s really important that we provide learning opportunities and experiences.”

By the end of this summer, 136 high schoolers will have gone through Butler’s program.

Camps like this one, such as the Summer Success Camp at the University of Indianapolis, arose out of the Lilly Endowment Inc.’s initiative to increase  Indiana’s higher education enrollment rate — which hovered around 53%  in 2020, 2021, and 2022 — and the number of adults with a postsecondary credential.

During BU: BeReal, which has separate weeks for underclassmen and upperclassmen, students explore different subjects to understand what pathways they can take in college. The sessions range from philosophy to business to dance improv. They also hear survival tips from current students.

“A lot of students my age, like they know they want to go to college,” said camper Wura Olorunfemi, a rising senior at Anderson High School. “But they also don’t know how to do it.”

The staff are exploring funding options for 2026, so they can continue providing robust financial assistance, Meister said. They have talked with administration as well as considered outside grants.

“I want to keep the focus and the ethos of the camp the same, so serving our  21st Century, first-generation college students  who have been traditionally underserved by higher ed, but also being fully integrated with students from all over the state of Indiana,” Meister said.

Many of the academic sessions serve two purposes: They give students a sample of the discipline, as well as a concept or tangible skill to take away.

In an afternoon session focused on cooking and health science, students learned how to make chipotle turkey tacos. At each table, kids sauteed the ground turkey and experimented with seasoning.

They took turns taste-testing. Overcooked and not enough salt, one group agreed. They threw in the salt, plus garlic and a little water.

“I’ve learned to adapt to new people,” said Nicolette Dukehart, a rising junior at North Central High School. “Normally I’m with the same group of people, but now I’ve made more friends.”

Olorunfemi said the variety of sessions challenged her to try out new disciplines. In the social media session, for example, she got to think creatively.

“I want to be a doctor or a neurosurgeon, so that side of the world is kind of closed off to me,” Olorunfemi said. “I don’t usually let myself open myself up to that.”

Faculty members working at BU: BeReal said they saw how rewarding the experience was for students.

Alexander Carter, an assistant professor of strategic communication, was once a first-generation college student, like many of the campers. He said an experience like BU: BeReal helps kids realize there is a place for them in higher education.

“I had no idea what college was going to be like,” Carter said. “I heard these horror stories from teachers, like ‘they’re never going to let you do this in college and never let you do this in college.’ And I go to college, and it’s very different.”

In the future, Meister said, the staff hope to increase the number of weeks of the camp and serve hundreds of students each summer.

Haley Miller is a summer reporting intern covering education in the Indianapolis area. Contact Haley at  [email protected] .

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Training Future Doctors to Be Health Equity Advocates

Many doctors don’t address the nonmedical social conditions that determine patients’ health outcomes. A growing number of medical schools are focused on changing that.

By  Kathryn Palmer

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The curriculum at Hackensack Meridian School of Medicine, which opened in 2018, emphasizes how nonmedical factors influence health outcomes.

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A man walks into a New Jersey emergency room in pain from an enlarged prostate. A resident physician orders a catheter, standard procedure for the patient’s condition, and discharges him with medical instructions until he can follow-up with a specialist.

While the early career doctor officially did everything right, the doctor unofficially overlooked important aspects of the patient’s life that led to an adverse outcome.

The patient didn’t have health insurance. He was an undocumented immigrant, didn’t speak much English, and may not have had a clear understanding of how to manage a catheter at home. A visit to the specialist who could remove it cost money he didn’t have. When he attempted to return to his job, his employer said he couldn’t work in his condition.

So he ripped out the catheter himself, causing an infection and kidney damage. The patient returned to the hospital, and doctors said he’d need surgery to permanently resolve his enlarged prostate, but it never happened.

“Despite enormous work and investment by our social worker and all the doctors here, we could not get him that surgery,” recalled Dr. Marygrace Zetkulic, internal medicine residency director at Hackensack University Medical Center in New Jersey and associate professor at the affiliated Hackensack Meridian School of Medicine, which launched in 2018. “This is because our system allows for emergency care but has no mechanism for nonemergency care that would prevent a hospitalization. Eventually he was lost to follow up.”

Scenarios like this are all too common.

But Hackensack Meridian is part of a growing number of medical schools on a mission to train a new generation of doctors to identify pertinent nonmedical factors in patients’ lives in order to address them in their treatment plans, and ultimately to advocate for equitable health policies.

The medical school’s curriculum does this by exposing medical students to the gravity of social determinants of health, the conditions in the environments where people are born, live, work and age. Those factors impact 80 to 90 percent of health outcomes, according to the National Academy of Medicine .

‘Problem-Solvers’

The New Jersey medical school’s mission focuses on social accountability, and informed the creation of the school’s core curriculum and structure.

An immersive longitudinal course called Human Dimension drives the curriculum. Starting in their first semester, students are paired with a family in the school’s service area, and consistently interact with them in clinical, community and home settings throughout their time at the medical school.

“The determinants of health come to life for these students because they see how all of these other factors are impacting the health and well-being of their family,” said Dr. Miriam Hoffman, vice dean for academic affairs who co-founded the Hackensack Meridian School of Medicine. “One of the outcomes of this is that students are incredible problem-solvers.

“They’re not afraid to look for problems, which we find in many seasoned doctors who are afraid to ask these questions because they think there’s nothing they can do about it. Our students realize there’s actually a lot they can do about it.”

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With the help of the medical school’s novel community programs unit, students are trained to identify the goals and needs of the families with whom they’re paired and help them in accessing support beyond direct medical care, such as transportation, food or medical equipment.

Additionally, a group of eight medical students is paired with a faculty mentor and matched with a local municipality to outline a systematic community assessment which involves geospatial mapping, meeting with community leaders and service-learning work to determine the community’s specific health challenges. That assessment informs a required community health project, in which students work with their assigned community partners to address identified challenges.

It’s all part of an effort to prepare future doctors to consider the nonmedical factors at play with a patient well before they become medical residents charged with making important decisions about patients’ care.

“We get taught how to manage an enlarged prostate,” Dr. Zetkulic said. “But the complex social things that have to be in place to manage that after they leave, you don’t get taught. You don’t know how to manage it, and you don’t even anticipate it.”

Dr. Tanner Corse graduated from Hackensack Meridian’s medical school in 2022 and is now in a combined internal medicine and pediatrics residency at Indiana University School of Medicine. He said Hackensack Meridian’s advocacy-focused curriculum prepared him for the position. Many of the patients he treats at a federally funded clinic on the southwest side of Indianapolis are poor and live in food deserts.

“It made me look outside of what is going on only within the person’s body and the clinic where I’m seeing them,” he said. “It made me think much bigger. They’re here for 30 minutes, but what are they going to deal with in the other hours, days and months they aren’t at the clinic?”

Although Hackensack Meridian, which graduated its first class of 18 doctors in 2021, had the luxury of building its mission-driven curriculum from scratch, a paper published earlier this year in The Clinical Teacher , shows that its social accountability-driven mission and curriculum is replicable at other medical schools.

A number of other medical schools, including those housed at Boston University, the University of Chicago and the University of California, San Diego, also focus on health equity and advocacy, which has become increasingly popular over the past decade.

Advocacy Focus on the Rise

Between 2013 and 2020, the number of medical school courses covering policy or advocacy jumped from 696 to nearly 1,200, according to the American Association of Medical Colleges’ curriculum inventory .

Corse believes most medical schools will offer a curriculum similar to Hackensack’s advocacy-centered approach in the next 10 to 20 years. Not only will that help deliver more comprehensive care to patients as the nation grapples with a physician shortage, it could also inform health policy.

“The approach of the school helps develop people with an inclination to make change outside of the clinic, too,” said Corse, who recently traveled to Capitol Hill to advocate for more funding for primary care providers—a specialty in high-demand—among other health care initiatives. “If I had gone to another school, I don’t know if I would have that same passion for advocacy.”

But training doctors to also be advocates isn’t currently baked into the curriculum at most medical schools. While most offer at least one advocacy course, the majority are elective and vary widely in scope and content, according to a 2021 paper published in the journal Academic Medicine .

The Liaison Committee on Medical Education (LCME), which accredits U.S. medical schools, includes a curriculum mandate for teaching about the social determinants of health, but doesn’t specify format, content or measurable achievement goals. The LCME’s standards also exclude required advocacy or health policy training, according to a study published in the Journal of General Internal Medicine earlier this year.

The Accreditation Council for Graduate Medical Education (ACGME), which accredits residency programs, endorses a general commitment to advocacy, but “published advocacy curricula in surgical specialties are sparse,” according to the study.

Advocacy instruction is more common in training for primary care-oriented specialties, and it varies by program. It’s especially prevalent in pediatrics residencies, which are required by the ACGME to include specific training on advocacy skills; Advocacy instruction is mandatory in 37 percent of family medicine residencies. Only 3 percent of psychiatric residencies provide any advocacy training, and about 54 percent of internal medicine residencies offer no advocacy training.

Seventy-two percent of the 276 programs surveyed cited a lack of faculty expertise in advocacy, which the study said was the most reported barrier to implementing an advocacy curriculum among internal medicine residencies.

‘Part and Parcel’

Dr. Kelly McGarry, one of the paper’s co-authors and director of Brown University’s internal medicine program, which has included advocacy in its curriculum since 2012, said she may have shied away from medical advocacy work if she had to learn about teaching it on her own.

“If everyone else around me feels that way, then no curricular innovation related to advocacy is going to get off the ground,” she said, recalling that the advocacy piece of Brown’s curriculum was first launched by a group of residents before she took it over in recent years.

“This is not a skill people learned a decade or more ago, and most faculty were trained more than a decade ago” McGarry said, hypothesizing that the rise of social media and other information technology over the past 15 years has illustrated the consequences of health disparities to a wide audience and built momentum for training doctors to advocate for large-scale change.

“We need more junior faculty,” to push more medical schools to integrate advocacy work into their core curricula, she said. “They have come along at a different time, where … advocacy in the role of the physician is now expected to be largely part and parcel of what we do.”

That’s how the UC San Diego School of Medicine, which first opened in the 1960s, came to implement a longitudinal course on healthy equity this past academic year.

In the late 2010s—before the pandemic and protests related to the murder of George Floyd sparked national conversations about long-standing health disparities—a group of medical students pushed the school’s administration to infuse more health equity and advocacy content into its curriculum.

Dr. Betial Asmerom, now a resident physician at UCSD’s combined internal medicine and pediatrics program, was one of those students. She grew up in East Oakland, California watching her mother, who is originally from Eritrea in North Africa, receive substandard medical care for a life-threatening health condition.

Those experiences eventually motivated Asmerom to pursue medical school, but she was frustrated by a concept many medical schools still teach known as race-based algorithms , which reinforces the idea that different races have inherent biological differences. Critics have argued such algorithms are relics of America’s racist history and can cause doctors to overlook the social determinants influencing a patient’s condition, resulting in inequitable care.

“There’s so much more that contributes to someone’s health than the immediate health care needs in front of them,” Betial said. “That’s the power of these types of curriculums. Part of it is that we challenge future physicians to think more critically and ultimately get people more involved in advocacy.”

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Health Lesson: Learning About Muscles

Information on this page is mapped to national education standards and is for students in grades 4 through 6 who are learning about the human body. Teachers may also use these resources to inform their lesson plans.

On This Page

• For Students : Find all classroom materials and activities about muscles
• Kahoot! Quiz : Test your knowledge about muscles on your own or as a class!
• Vocabulary : See all of the medical terms in this lesson defined
• Teacher's Corner : See the National Education Standards covered in these lessons

For Students

What are your muscles for? When you think about muscles, you probably think about the ones in your arms, legs, back, or abs. But muscles do more than help you lift heavy things. Did you know that muscles also help you breathe, pump your blood, and move food through your gut?

On this page, you can learn about muscles, what happens when they get hurt, and how to keep them healthy.

What are muscles?

Muscles control all movement in the body. There are more than 650 muscles in the human body.

Muscles work together with bones to help you move. Muscles and bones (your skeleton) are part of the musculoskeletal (muh-skyuh-low-SKEH-luh-tl) system .

Muscle is a type of tissue , a group of cells that work together to accomplish a specific job, like movement.

You control some of your muscles, but others work on their own. Even when you sit perfectly still, muscles in your body are constantly working!

Muscles do a lot to keep your body healthy. They:

• Help you move, sit still, and stand up straight.
• Allow you to move your eyes to look around.
• Push food through your digestive system.
• Pump blood through your heart and blood vessels.

Watch this video to see heart muscles pumping blood.

• Move air in your body so that you can speak and breathe.

A special muscle in your chest called the diaphragm (DAI-uh-fram) helps the lungs fill with air when you breathe. Make a model to see how the diaphragm works.

How do muscles work?

Muscles help you move because they are connected to bones with a special kind of tissue called a tendon (TEN-dn) .

Muscles are made up of thousands of small elastic fibers, similar to rubber bands, that contract and relax to cause movement. When the fibers contract, they get shorter, which pulls the bones they’re connected to closer together. Learn more about bones .

What are the types of muscles?

There are three main types of muscle: skeletal, smooth, and cardiac.

Skeletal muscles

Skeletal (SKEH-luh-tuhl) muscles help you move, sit up straight, and keep your balance. Skeletal muscles are sometimes called voluntary muscles because you can control them.

You can move skeletal muscles just by thinking about it and then doing it. To make skeletal muscle move, the brain sends electrical messages to your skeletal muscles. The messages tell the muscles to do things like contract or relax when you want to raise your hand, move your jaw to chew food, or kick a soccer ball into a goal.

Skeletal muscles lie under the skin. They work with your bones and joints to give your body power and strength.

Did You Know?

Your face is filled with muscles! The muscles in your face allow you to make dozens of different types of expressions. Stick out your tongue! Did you know your tongue is a muscle? It helps you talk and chew your food.

Smooth muscles

Smooth muscles work to keep your body healthy without you having to think about moving them. Because you can’t control these muscles, they are sometimes called involuntary muscles. Smooth muscles help you focus your eyes, move food through your body, and go to the bathroom.

In your eyes, smooth muscles help you focus your vision and adjust to different levels of light.

Smooth muscles help you move food through and out of your body. Waves of smooth muscle contractions called peristalsis (peh-ruh-STAAL-suhs) help move food through your digestive system. Have you heard your stomach growling when you’re hungry or after you eat a meal? Those sounds are created by peristalsis!

Smooth muscles at the end of your digestive system help you push waste out of your body as feces (poop). Smooth muscles in your bladder contract and relax to hold in or push out urine (pee).

Cardiac muscles

Cardiac (KAAR-dee-ak) muscles make up the heart. Like smooth muscles, cardiac muscles are involuntary. They contract and relax automatically to pump blood through your body.

You do not need to think about telling the heart to beat. A special area of muscle in your heart sends electrical messages in a steady rhythm to help your heart beat.

Heart muscles help make sure that your blood flows in the right direction with structures called valves . Try this activity to learn how heart valves work!

What happens when muscles get hurt?

A strain happens when a muscle or tendon stretches too much or tears. Some people describe muscle strains by saying they “pulled a muscle.” If you exercise too much, too intensely, or don’t stretch enough, you may get a strain.

Strains that happen from tearing a muscle or tendon are more serious than strains from overstretching a muscle or tendon. Strains can cause pain, swelling, and bruising. Your body heals strains by creating new muscle fibers to fill in the damaged area.

Tendons—the tissues that connect muscles to bones—can also get hurt. Tendinitis (ten-duh-NAI-tuhs) is a condition in which repetitive or intense motions injure the tendon, causing pain and swelling.

If you think you have a muscle strain or tendon injury, you can try resting, putting ice on the painful area, and asking an adult for over-the-counter pain medication. Go to the doctor if your injury doesn’t get better. Doctors may treat some strains with a splint or temporary cast.

How can I help keep my muscles healthy?

Exercise to work your muscles..

Being physically active keeps your muscles healthy, which helps you work, play, and do other activities without getting hurt or tired.

You don’t need to lift weights to exercise your muscles! You can walk, jog, play sports, dance, swim, and bike. Exercising in different ways helps make sure you work all your muscles.

Remember, your heart is a muscle! Any activity that makes your heart pump blood faster will exercise this important muscle.

Bigger muscles are not necessarily better. Working out helps your muscles get stronger. Sometimes they also get bigger, but your muscles can be strong and healthy without being big.

Avoid muscle injuries.

• Warm up and cool down . Before exercising or playing sports, warm-up exercises, such as stretching and light jogging, may make it less likely that you’ll strain a muscle. They are called warm-up exercises because they make the muscles warmer and more flexible. Cool-down exercises, such as stretching, are also very important to do after exercising. They help you to loosen the muscles that have tightened during exercise or while playing sports.
• Wear the proper protective gear for your sport, such as pads or helmets. This will help reduce your risk of injuring yourself.
• Remember to drink lots of water while you’re playing or exercising, especially in warm weather. Dehydration (dee-hai-DRAY-shn) is when your body’s water level gets too low. If you become dehydrated, you could get dizzy or even pass out. Dehydration can cause many medical problems.
• Don’t try to “play through the pain.” If something starts to hurt, STOP exercising or playing. You might need to see a doctor, or you might just need to rest for a while.
• If you have been inactive, “start low and go slow” by gradually increasing how often and how long you are active. Increase physical activity gradually over time.
• Be careful when you lift heavy objects . Keep your back straight and bend your knees to lift the object. This will protect the muscles in your back and put most of the weight on the strong muscles in your legs. Get someone to help you lift something heavy.
• Don’t try to “bulk up” by using weights that are too heavy for you . This can cause injury. Start with smaller weights and build your way up. You do not need to be able to lift very heavy weights to have healthy muscles. Instead, try doing exercises with smaller weights, but repeat the exercise more times.

Eat a healthy diet.

There is no special diet to keep your muscles healthy. Try to eat a balanced diet with fruits and vegetables, whole grains, low-fat dairy, and lean proteins .

MYTH BUSTED!

Some people think that they need protein shakes and powders to get big muscles. But most kids get plenty of protein just by eating a balanced diet. In fact, eating too much protein can be harmful to your body.

Test your knowledge about muscles with this Kahoot! quiz

This Kahoot! quiz tests your knowledge about what muscles do and how to keep them healthy.

Check out our other webpages to learn about bones , joints , and skin .

Cardiac (KAAR-dee-ak) muscles . These muscles make up your heart. You cannot control these muscles.

Cells . The smallest building blocks of life. Your body is made of trillions of cells!

Contraction . Tightening or shortening of muscle fibers.

Dehydration (dee-hai-DRAY-shn) . When your body’s water level gets too low. If you become dehydrated, you could get dizzy or even pass out. Dehydration can cause many medical problems.

Diaphragm (DAI-uh-fram) . A muscle in your chest that helps the lungs fill with air when you breathe.

Musculoskeletal (muh-skyuh-low-SKEH-luh-tl) system . All the muscles, bones, and other tissues that work together to give your body its basic shape and ability to move.

Peristalsis (peh-ruh-STAAL-suhs) . Waves of smooth muscle contractions that help move food through your digestive system.

Skeletal (SKEH-luh-tuhl) muscles. These are the muscles you can control. They help you move, sit up straight, and keep your balance.

Smooth muscles . You cannot control these muscles. They help you focus your eyes, move food through your body, and go to the bathroom.

Strain . When a muscle or tendon stretches too much or tears. Some people describe a muscle strain by saying they “pulled a muscle.”

Tendinitis (ten-duh-NAI-tuhs) . A condition in which repetitive or intense motions injure the tendon, causing pain and swelling.

Tendon (TEN-dn) . A special kind of tissue that connects muscles to bones.

Tissue . A group of cells that work together to accomplish a specific job, like movement.

Valves . Special structures in your heart that make sure your blood flows in the right direction. 

Teacher’s Corner

The content on this NIAMS webpage aligns with the following national standards:

Next Generation Science Standards

• NGSS Standard 4-LS1-1 “Animals have internal and external structures that serve various functions in growth, survival, behavior, and reproduction.”
• NGSS MS-LS1-1 “All living things are made up of cells , which are the smallest units that can be said to be alive. An organism may consist of one single cell (unicellular) or many different numbers and types of cells (multicellular).”
• NGSS MS-LS1-3 “In multicellular organisms, the body is a system of multiple interacting subsystems. These subsystems are groups of cells that work together to form tissues and organs that are specialized for particular body functions.”

National Health Education Standards

• NHES 2.5.2 “Identify the influence of culture on health practices and behaviors.”
• NHES 1.5.5 “Describe when it is important to seek health care.”
• NHES 1.5.1 “Describe the relationship between healthy behaviors and personal health.”
• NHES 1.5.4 “Describe ways to prevent common childhood/adolescent injuries and health problems.”

CDC Healthy Schools

• CDC Characteristics of an Effective Health Education Curriculum, Characteristic 4: “Address social pressures and influences”

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