A retrospective review of those who hold the Certified Health Education Specialist (CHES) credential.
Abstract: Published data describing those who hold the Certified Health Education Specialist (CHES) credential has been limited. This study was designed as a retrospective review of the National Commission for Health Education Credentialing's database that contains information about those who hold the CHES credential. Approximately 15,000 have earned the CHES credential since its inception in 1989. As of April 1, 2008, 7,566 individuals held a current CHES credential. It was found that the database is absent much data for those certified between 1989 and 2003 and thus no profile could be created with exception of where they live. The greatest numbers of CHES were found in the South Atlantic (n = 1,858) and Pacific (n = 1,153) regions of the United States, with the state of California (n = 873) having the most and North Dakota (n = 8) having the fewest. However, of those individuals certified between 2004 and 2007, it was observed that 71% were females, 49% were Caucasian, and the mean age was 32.52 years, while the oldest reported age was 83 and the youngest was 21. The titles of the academic majors completed by those holding the CHES credential was varied with almost 3 in 10 having a major with the words "health education" in the title. In addition, it was found that individuals became qualified to take the CHES examination at almost 300 different institutions.
Subject: Medical personnel (Training)
Education
Authors: McKenzie, James F.
Seabert, Denise M.
Pub Date: 03/22/2009
Publication: Name: American Journal of Health Studies Publisher: American Journal of Health Studies Audience: Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2009 American Journal of Health Studies ISSN: 1090-0500
Issue: Date: Spring, 2009 Source Volume: 24 Source Issue: 2
Product: Product Code: 8200000 Education NAICS Code: 61 Educational Services
Accession Number: 308743736
Full Text: INTRODUCTION

The process that has led to the Certified Health Education Specialist (CHES) credential of today is one that began over 30 years ago. During the mid-1970s, when Helen P. Cleary, D.Sc., CHES, served as the President of Society for Public Health Education, she had the opportunity to visit with many health education groups around the United States. Based upon those visits, she discovered that too many health education specialists "were unsure of their role and unable to explain it to others" (Skiff, 1990, p. 48). Thus, she saw the need for the profession to define and clarify the role of the health educator. So over the next few years she worked to create a formal process in which the role of the health educator could be examined and defined. The process of delineating the role of the health educator began in earnest in 1978 with the creation of the National Task Force on the Preparation and Practice of Health Educators [referred to hereafter as the National Task Force] (Cleary, 1995). "At that time, individual certification for health educators was not available, except for school health educators, who had to be licensed" (Cottrell, Girvan, & McKenzie, 2009, p. 172). Through the guidance of the National Task Force, by the early-1980s the role of the entry-level health educator had been delineated, verified, and refined, and by 1985 a curricular framework for the preparation of entry-level health educators had been created (Cleary, 1995). By 1988 it became obvious that the National Task Force had met its goals and the foundation for the credentialing system for health education specialists was in place. Therefore in 1988, the National Commission for Health Education Credentialing, Inc., the organization to oversee the credentialing process was established. [Note: For a more complete account of the birth of the credentialing system for the health education specialists, readers should refer to Cleary (1995). This document provides great detail of all the events and contributions of many individuals that took place between 1978 and 1988.]

Since 1989, health education professionals have had the opportunity to become Certified Health Education Specialists (CHES), an entry-level credential. The first group of individuals to become certified did so in December 1989 at the close of the charter certification period. "Charter certification allowed qualified individuals to be certified based upon academic training, work experience, and references" (Cottrell et al., 2009, p. 177). After the chartering period, qualified health education professionals have been able to obtain certification by taking and passing a certification examination offered by the National Commission for Health Education Credentialing, Inc. (NCHEC). Between 1989 and April 1, 2008, 14,622 health education specialists had obtained the CHES credential (NCHEC, 2008c).

Though we know how many people have obtained the CHES credential, little is known about the collective group of individuals who hold the credential. With the CHES credential now 20 years old and an advanced-level credential (Master Certified Health Education Specialist [MCHES]) well into the planning stages, having data about those who hold the credential could help both NCHEC and the health education profession in several different ways including: (1) using the resulting data to create marketing strategies to better reach health education specialists who do not hold the CHES credential and how to market the soon to be created advanced-level (MCHES) credential, (2) making comparisons of study data to the Bureau of Labor Statistics' Standard Occupational Classification (SOC) system data for health educators, and (3) providing a reference for generalizability that may be used by researchers when designing and carrying out future studies. Therefore the purpose of this study was to describe those who obtained the CHES credential between 1989 and 2008, and were still active at the time the data were collected.

METHODS

Because the purpose of this study was to describe those who held the CHES credential at the time the data were collected, the study was designed as a descriptive, retrospective database review.

ARRANGEMENTS FOR THE STUDY

The process to gain approval for conducting the study began with an informal discussion between the principal investigator and the Executive Director of NCHEC. Based upon that discussion, a written description of the study and a formal request to complete the study was forwarded to the Executive Director for distribution to the Board of Commissioners (BOC) of NCHEC for review. It was then during a conference call of the BOC, Executive Director, and principal investigator that formal approval was received. The research protocol was then submitted to and approved by the Institutional Review Board at Ball State University.

PARTICIPANTS

The study population consisted of all individuals included in the NCHEC database who were considered current holders of the CHES credential when the data were retrieved in April 2008. This included all who became certified prior to January 2008. To be considered current, the CHES had to be included in one of the five categories created by NCHEC:

1) Active--individuals who have paid their annual renewal fee and are within their five-year cycle of required continuing education.

2) Retired--a CHES who is permanently retired from health education. These individuals pay a reduced fee and do not have to satisfy any continuing education requirements.

3) Late--individuals who have not paid their (current) annual renewal fee and are within their five-year cycle of required continuing education.

4) Extension--CHES who have paid their annual renewal fee for the current certification year and who have requested a one-year extension of their certification cycle to fulfill the required number of continuing education hours.

5) Recertification--individuals who are due to satisfy their five-year cycle for continuing education requirements and/or owe the current annual renewal fee.

Individuals who are placed in the "late" and "recertification" categories remain in those categories until their annual renewal fees are paid and the continuing education requirements are met or until they have been in either the "late" or "recertification" categories for more than 12 months at which time they are placed in a "lapsed" category. When individuals become "lapsed" they are no longer certified and should not use the CHES designation after their name.

DATA COLLECTION

The principal investigator met with a NCHEC staff person most familiar with the NCHEC database to determine what data were available and to identify the variables to be studied. Because of privacy concerns, care was given to not include any variable that could identify any single individual. The information included in the database comes from several different sources including: (a) the application completed by individuals when they apply to take the CHES examination, (b) CHES examination results, (c) the evidence provided by continuing education providers when they submit documentation for continuing education credits, and (d) the information provided on the update sheet submitted by the CHES at the time of his/her renewal of certification or recertification. The information fields included in the NCHEC database that were applicable to the study are presented in Table 1. Not all information noted in Table 1 is available for all who hold the CHES credential, and therefore it was not feasible to analyze a number of the fields. Lack of complete data for each CHES was due to one or more of the following reasons: 1) the changing requests for information by NCHEC over the years, 2) the lack of willingness of some CHES to share the information with NCHEC, and 3) the changing storage and computer capacity of NCHEC. As with many data collection and storage systems, because the database was begun in 1989 it has gone through a number of changes and versions. For example, the initial database was recorded using "pen and paper" and minimal data were recorded about those who were included in the chartered group. Over the years, the database has evolved into a more comprehensive repository of data in part because of increased capacity of both computers and software, as well as an increased interest in collecting data on those who hold the credential. In 2004 the NCHEC database was converted to a robust, Web-based database, in which test applicants or CHES can enter and see (some) of their data in real time. As examples, test applicants can check their application status on line and a CHES can see their continuing education transcripts online.

The most recent change that has added to the information available in the database was an "optional information" section added to the CHES examination application form when it was updated in 2004. This optional section now includes questions about: 1) How the applicants first learned about NCHEC/CHES, 2) their work setting, 3) their sex, 4) if CHES was required for their current or future employment, 5) their race, and 6) whether they held any other professional credentials (NCHEC, 2007). Though most new applicants do include this information on their application, it should be emphasized that it optional and can be left blank thus affecting the completeness of the database.

After the parameters for the data to be studied were identified, a NCHEC staff person queried the database and created a Microsoft[R] Excel file for the investigators to analyze. The investigators were then able to sort the file by variables and create the summary data.

RESULTS

As of April 1, 2008, 14,622 individuals have obtained the CHES credential. Of that number 1,557 (10.6%) obtained the credential through the chartering process, while the remaining 13,064 (89.3%) earned the credential by passing the CHES examination. Of the 14,622 who have obtained the credential, a total of 7,566 (51.7%) individuals held a current CHES credential when the data were obtained on April 1, 2008. Of those 1,557 CHES who obtained the credential through the chartering process in 1989, a little less than a third (n = 463, 29.7%) were still current. Of the 13,064 who earned the credential through examination, 7,103 (54.4%) were current. A complete listing of the number and percent of current CHES based upon their initial year of certification is presented in Table 2. The fewest number of individuals (n = 199) was certified in 1992, while there have been three years (1989, 1991, and 2007) when the number certified was greater than 1,000.

The data that are presented in Tables 3 and 4 are presented using two different populations. The first population is comprised of all individuals (N = 7,566) who held a "current" status as of April 1, 2008, and who obtained their certification anytime from the inception of the credential in 1989 through 2007. Even though this population provides an overview of all current CHES, the NCHEC database does not include complete information on each individual because data were not consistently collected between 1989 and 2003. For example, data such as sex and age are missing on many of these individuals. The second population presented in Tables 3 and 4 is comprised of all individuals (N = 3,361) who held a "current" status as of April 1, 2008, and who obtained their certification between 2004 and 2007. The information in the database is most complete for this population because all of these individuals applied for and earned the CHES credential after the CHES examination application was expanded.

Table 3 presents a summary of selected demographic variables of those holding the CHES credential. As can be seen in the table, data for sex, race/ ethnicity, and age for the total population of all current CHES was less than complete, while the data for those certified between 2004 and 2007 was much more complete. In examining this later group, a large majority (70.9%) of those for whom sex was known were females. When the data for race/ethnicity were analyzed in a similar way, it appears that almost half (n = 1,660, 49.4%) of those certified between 2004 and 2007 were Caucasian. The mean age of those certified between 2004 and 2007 was 32.52 years, while the oldest reported age was 83 and the youngest was 21.

The one variable in Table 3 for which complete data were available was "state of residence." These data were the most complete because of the need for NCHEC to regularly correspond with the CHES. These data are presented using the National Center for Health Statistics' classification system for areas of the country. The greatest numbers of CHES were found in the South Atlantic (n = 1,858) and Pacific (n = 1,153) regions of the United States, with the state of California (n = 873) having the most. The state with the fewest number of CHES was North Dakota (n = 8), followed closely by Vermont (n = 10).

Like the data presented in Tables 3, the data presented in Table 4 dealing with academic major and institution attended are much more complete for those certified between 2004 and 2007, than those certified prior to 2004. In fact, the academic major and institution attended information for those certified prior to 2004 is almost nonexistent in the database because such data were not collected prior to 2004. Therefore, only data for those certified between 2004 and 2007 are presented in Table 4. As can be seen in this table, the titles of the majors completed by those holding the CHES credential was varied. About 3 in 10 (n = 958, 28.5%) had academic majors with the words "health education" in the title. The 15 most frequently occurring majors accounted for about 80% of the reported majors. Each of these 15 had the word "health" appearing in them somewhere. Approximately one-third (n = 1,106, 32.9%) of those certified between 2004 and 2007 had academic majors with the titles of either public health or health education.

Since 2004, the name of the college or university where the individuals initially obtained the education that made them eligible to take the examination has been included in the database. This is referred to as the "qualifying institution." Many CHES have attended and/or obtained degrees from multiple institutions that make them eligible to take the examination, however a decision was made by NCHEC to list the first institution that made a person eligible as the "qualifying institution." The database also lists the names of the other institutions that the CHES attended as well, but they were not reviewed as a part of this study. The "qualifying institution" section of the database includes almost 300 different institutions. The institution that is listed most often (n = 106) in the database is Truman State University in Kirksville, MO, while there are another 34 institutions that are listed at least 20 times (see Table 4).

DISCUSSION

Published data describing those who hold or have held the CHES credential have been limited. This study attempted to create a profile of those who held the credential at the time the data were collected. Between the inception of the CHES credential in 1989 and April 1, 2008, (when the data for this study were collected) 14,622 individuals had obtained the CHES credential. Approximately half (51.7%, n = 7,566) of those individuals still had a current credential. That number is many fewer than compared to data released by the Bureau of Labor Statistics (BLS) stating that in health educators held 62,000 jobs in 2006 (Bureau of Labor, 2009). There are several reasons why more health education specialists do not hold the CHES credential. First, many employers who hire health education specialists may not require the CHES credential or may be unfamiliar with the coursework necessary to earn a major or minor in health education for employment. Second, some with the title of health educator may not have taken the necessary coursework to qualify to take the CHES examination. Third, because the CHES credential is considered an entry-level credential those health education specialist with significant experience or an advanced degree may not seek the credential. And fourth, some health education specialists may not want to seek the credential because of the cost to obtain and maintain it or they may just not be interested in it. Having such information, NCHEC should seek to identify those from the 62,000 health educators who are not certified and eligible to be certified in order to market the credential and thus increase the number who are certified.

For reasons mentioned earlier about the incompleteness of the database, it was not possible to create a profile of all who were certified at the time the data were collected. Because the information in the database was more complete for those certified between 2004 and 2007, those data provide a more accurate representation of those who hold the CHES credential. Over two-fifths (44.4%, n = 3,361) of those individuals with current certification on April 1, 2008, had obtained their certification between 2004 and 2007. The majority of these individuals in this population were females and Caucasian. We believe that most individuals in our profession would not be surprised with this information, but would find it interesting that for those who were certified between 2004 and 2007 and reported their race that one-fourth (25.0%, n = 841) were minorities. The mean age of 32.52 years in the population certified between 2004 and 2007 speaks to the importance that new professionals are giving to the CHES credential. While these data do not provide a comprehensive profile of those holding the CHES credential they at least provide other researchers studying health education specialists a baseline for comparison purposes.

The item in the database that was examined in this study that was the most complete was place of residence. This study showed that the greatest number of CHES lived in California (n = 833) and the fewest number lived in North Dakota (n = 8). In an earlier unpublished report completed by the NCHEC staff it was found that the states with the greatest number of CHES per 100,000 population were the District of Columbia (7.82 per), Utah (6.65 per), Maryland (5.48 per), and New Mexico (5.08 per). The fewest CHES per 100,000 population were found in Kansas (1.22 per), North Dakota (1.25 per), and Alabama (1.27 per) (NCHEC, 2008a).

It was interesting to find that at least 40 (< 1%) individuals with a current CHES credential live outside the United States even though the only place outside the United States where the CHES examination has been offered has been on U.S. military bases. We report "at least 40" because these data are based on mailing addresses and some individuals working outside the United States keep a U.S. address as their permanent address because of the difficultly of receiving mail. Of those individuals outside the United States who hold the CHES credential, it is not surprising that the largest percentage (27.5%, n = 11) live in Canada. Most of those who live outside the United States are either citizens of other countries who attended college in the United States or are U.S. citizens who work outside the United States such as those who work for an international agency, who teach in universities abroad, serve in the military, or in the Peace Corps.

The titles of the academic majors completed by those holding the CHES credential varied greatly with a least 93 different majors listed. We report "at least 93" because for 143 individuals their major was listed as "other," while for another 4,210 no major was listed. For a large majority (n = 74, 79.6%) of those 93 majors, the word "health" appeared somewhere in the title. Many traditional titles for majors were observed such as Health Education, Community Health Education, Health Promotion, and Public Health. A few other titles, like Health Studies and Health Science, also appeared quite often. Such titles are general in nature and could include a wide variety of curricula. There also were some less well known titles such as Community Health Assessment and Health Psychology Education. Some examples of academic majors that did not include the word health were Behavioral Sciences, Exercise Science, Psychology, Epidemiology, Nursing, Physical Education, Kinesiology, and Nutrition.

The title of the major is not quite as important as the content of the courses in the major and/or minor and other courses completed and listed on the transcript. The reason for this is that individuals are eligible to take the CHES examination if they have "a bachelor's, master's, or doctoral degree from an accredited institution of higher education; AND one of the following: An official transcript (including course titles) that clearly shows a major in health education, e.g., Health Education, Community Health Education, Public Health Education, School Health Education, etc., OR An official transcript that reflects at least 25 semester hours or 37 quarter hours of course work with specific preparation addressing the Areas of Responsibility for health educators..." (NCHEC, 2008c, 1). Because of the variety of the titles of academic majors most individuals gain eligibility to take the examination based the "25 semester hours or 37 quarter hours" policy (T. Thomas, personal communication, April 1, 2008).

Even though the most recent editions of the Directory of Institutions Offering Undergraduate and Graduate Degree Programs in Health Education (American Association for Health Education [AAHE], 2005), and A National Directory of College and University Health Education Programs and Faculties (Eta Sigma Gamma [ESG], 2007) have identified 274 different programs that prepare health education specialists, the number of programs identified in this study (N = 285) where individuals received their preparation for taking the CHES examination was greater than the number listed in the directories. The primary reason for the greater number is because many people become eligible to take the examination by taking courses at several different institutions (T. Thomas, personal communication, April 1, 2008). For example, a person may take several health process courses at an institution that offers a health education major and then take other process courses from another institution that has a health education minor, but no major. Regardless of where the courses are taken, to make an individual eligible to take the CHES examination the courses must address the Areas of Responsibility for Health Educators (NCHEC, SOPHE, & AAHE, 2006). Because of the variety of titles of the academic majors and the large number of institutions who prepare individuals for the CHES examination, NCHEC and the profession should determine other ways to market the credential to those who would be eligible but not in traditional health education programs or institutions known for their preparation of health education specialists.

The institutions that prepare individuals to take the CHES examination have stayed consistent over the years. In the recent issue of The CHES Bulletin, NCHEC's newsletter that is sent to all current CHES included a list of the top 10 universities that had the most candidates sit for the CHES examination in year 2007 (NCHEC, 2008c). Nine of the 10 universities identified in that list were also identified in this study as one of the top 15 schools where current CHES who were certified between 2004 and 2007 received their preparation that qualified them to take the examination.

DISCUSSION OF LIMITATIONS

This study was limited in three primary ways. First, the study was limited by the shortcomings associated with a retrospective data analysis. In such a study, researchers can only analyze the data that are recorded in the database and is available to them. As has been noted, several fields in the database are missing data. In addition, no attempt was made to verify the accuracy, completeness, and currency of information provided to the researchers.

Second, this study was cross-sectional in nature. Obviously, at any point in time those individuals included the database could be different from those at any other point in time. No attempt was made to analyze data at a different point in time.

And third, no comparison group was used. A comparison group could have strengthened the design of the study by providing some insight into whether or not the characteristics of those who currently hold the CHES credential are the same as or different than those who held it earlier and let it lapse.

CONCLUSIONS

Based upon the results of this study several conclusions may be drawn about those who hold the CHES credential. First, as of April 1, 2008, 14,622 individuals have obtained the CHES credential. Of that number 1,557 (10.6%) obtained the credential through the chartering process, while the remaining 13,064 (89.3%) earned the credential by passing the CHES examination. Second, approximately half (n = 7,566, 51.7%) of all individuals who earned the CHES credential still held the credential at the time the study was conducted. Third, an incomplete database made it difficult to create a comprehensive profile for all who held the CHES credential at the time the study was conducted. Fourth, the one variable for which the database has the most complete data is mailing address. The greatest numbers of CHES were found in the South Atlantic (n = 1,858) and Pacific (n = 1,153) regions of the United States, with the state of California (n = 873) having the most and North Dakota (n = 8) with the fewest number.

Fifth the information in the database for those who became certified between 2004 and 2007 was very good and with similar data collected in the future the profile of those holding the CHES credential will get better as additional individuals become certified. And sixth, of those certified between 2004 and 2007 (n = 3,361, 44.4%) the profile showed that they were: mostly female (n = 2,382, 70.9%) and Caucasian (n = 1,660, 49.4%), had a mean age of 32.52 years, had a mailing address in the United States (n = 3,348, 99.6%), and did not have an academic major with the words "health education" in the title (n = 2,403, 71.5%).

RECOMMENDATIONS FOR FURTHER STUDY

Few studies answer all the questions that the researchers have and often studies raise more questions than they answer. Based upon the results of this study, there are several other studies we believe should be undertaken. First, it is recommended that this study be replicated every few years as new data become available to enhance the reported profile of those who hold the CHES credential. In addition, replication of this study in the future would allow for a comparison of the data collected in this study with future data collections to show how the CHES, as a group, changes over time. And, second, not all health education specialists who are eligible to sit for the CHES examination take it. Therefore a study is needed to learn why health education specialists decide to seek the CHES credential and why they choose to maintain the credential over time.

ACKNOWLEDGEMENT

The authors would like to thank the entire NCHEC staff, specifically Linda Lysoby, Executive Director, Jan Cole, Financial Coordinator, and NCHEC's Board of Commissioners for their support and assistance in carrying out this study.

REFERENCES

American Association for Health Education (AAHE). (2005). Directory of institutions offering undergraduate and graduate degree programs in health education. Journal of Health Education, 36(6), 345-360.

Bureau of Labor Statistics, U.S. Department of Labor. (2009). Health educators. Occupational Outlook Handbook, 2008-09 Edition, Retrieved May 7, 2009 from http://www.bls.gov/oco/ocos063. htm#training

Cleary, H. P. (1995). The credentialing of health educators: An historical account 1970-1990. Whitehall, PA: National Commission for Health Education Credentialing, Inc.

Cottrell, R. R., Girvan, J. T., & McKenzie, J. F. (2009). Principles and foundations of health promotion and education (4th ed.). San Francisco, CA: Pearson Benjamin Cummings.

Eta Sigma Gamma. (ESG). (2007). A national directory of college and university health education programs and faculties (15th ed.). Muncie, IN: Author.

National Commission for Health Education Credentialing, Inc. (2008a). Active CHES by State. Unpublished report.

National Commission for Health Education Credentialing, Inc. (2008b Spring). Annual top ten list of CHES Candidate-producing professional preparation programs. The CHES Bulletin, 19(1). Whitehall, PA: Author.

National Commission for Health Education Credentialing, Inc. (2008c). [CHES Database.] Unpublished database.

National Commission for Health Education Credentialing, Inc. (2008c). Become a CHES. Retrieved July 6, 2008, from http://www.nchec.org/becomeches/eligibility.asp.

National Commission for Health Education Credentialing, Inc. (2007). Certified Health Education Specialist Exam Application. Retrieved October 26, 2007, from http://www.nchec.org/index.htm

National Commission for Health Education Credentialing, Inc., Society for Public Health Education, & American Association for Health Education (2006). A competency-based framework for health educators--2006. Whitehall, PA: National Commission for Health Education Credentialing, Inc.

Skiff, A. (1990). Helen P. Cleary in Key leaders in health education: A century of commitment. Eta Sigma Gamma Monograph Series, 8(2), 47-48.

James F. McKenzie, PhD, MPH, CHES, is a Professor of Department of Physiology & Health Science, Ball State University. Denise M. Seabert, PhD, CHES, is an Associate Professor of Department of Physiology & Health Science, Ball State University. Please address all correspondence to: James F. McKenzie, PhD, MPH, CHES, Professor of Department of Physiology & Health Science, Ball State University, Muncie, IN 47306, (v) 765-285-8345, (f) 765-285-3210, email: jmckenzie@bsu.edu.
Table 1. Information included in the NCHEC database

A. Demographic Information--Age, Sex (male, female), Race (African
American, Asian/Pacific Islander, American Indian, Alaskan Native,
Hispanic/Latino, Caucasian, other), Place of Residence

B. Academic Information--Academic Institution, Major, Degree(s)
earned, Date of Graduation

C. Certification--Date of, Cohort year, How earned (Chartered or
Tested), Required for job, Hold other credentials

D. Examination (if tested)--Took as a student (undergraduate/
graduate) or professional, How did you learn of the exam/NCHEC

E. Work--Work setting (healthcare, school, university, community,
workplace, other, retired), Job title

F. Certification cohort year--Size (number in), Current, Percentage
still current

Table 2. Year Certified and Number of Current CHES from Year
Certified Cohort (N = 7,566)

Year            n certified   n (%) current
Certification
Received

1989              1,557        492 (31.6)
1990               645         199 (30.9)
1991              1,311        368 (28.1)
1992               199          64 (32.2)
1993               324         115 (35.5)
1994               313         115 (36.7)
1995               392         143 (36.5)
1996               689         207 (30.0)
1997               789         258 (32.7)
1998               829         295 (35.6)
1999               956         361 (37.8)
2000               745         346 (46.4)
2001               648         329 (50.8)
2002               737         392 (53.2)
2003               783         531 (67.8)
2004               734         563 (76.7)
2005               886         770 (86.9)
2006               953         938 (98.4)
2007              1,118       1,092 (97.7)
Total            14,622       7,566 (51.7)

Table 3. Selected demographic variables, for all current CHES and
current CHES who became certified between 2004 and 2007

                        Certified between    Certified between
                          1989 and 2007        2004 and 2007
                           (N = 7,566)          (N = 3,361)

Variable                      n (%)                n (%)

Sex
  Female                   3,728 (49.3)         2,382 (70.9)
  Male                      450 (5.9)            255 (7.6)
  Unknown                  3388 (44.8)           724 (21.5)

Race/Ethnicity
  African American          562 (7.4)            396 (11.8)
  American Indian/           43 (< 1)             28 (< 1)
    Alaskan Native
  Asian/Pacific             200 (2.6)            133 (4.0)
    Islander
  Caucasian                2,648 (35.0)         1,660 (49.4)
  Hispanic                  300 (4.0)            207 (6.2)
  Other                     134 (1.8)             77 (2.3)
  Unknown                  3,679 (48.6)          860 (25.6)

Age
  Mean                     36.96 years          32.52 years
  Median                     33 years             29 years
  Mode                       26 years          25 & 26 years
  Range                 62 years (21 to 83)  60 years (21 to 81)
  Number of unknown           2,512                 186
    age

State of Residence
  New England             425 (5.6) (1)        173 (5.1) (2)
    Connecticut           147 (34.6) (3)       69 (39.9) (3)
    Maine                 54 (12.7) (3)         12 (6.9) (3)
    Massachusetts         164 (38.6) (3)       77 (44.5) (3)
    New Hampshire          31 (7.3) (3)         9 (5.2) (3)
    Rhode Island           19 (4.5) (3)         4 (2.3) (3)
    Vermont                10 (2.4) (3)         2 (1.2) (3)
  Middle Atlantic         921 (12.2) (1)       413 (12.3) (2)
    New Jersey            309 (33.6) (3)       141 (34.1) (3)
    New York              334 (36.3) (3)       144 (34.7) (3)
    Pennsylvania          278 (30.2) (3)       128 (31.0) (3)
  East North Central     1,060 (14.0) (1)      450 (13.4) (2)
    Illinois              251 (23.7) (3)       111 (24.7) (3)
    Indiana               170 (16.0) (3)       100 (22.2) (3)
    Michigan              148 (14.0) (3)        44 (9.8) (3)
    Ohio                  331 (31.2) (3)       134 (29.8) (3)
    Wisconsin             160 (15.1) (3)       160 (15.1) (3)
  West North Central      412 (5.5) (1)        234 (7.0) (2)
    Iowa                  70 (17.0) (3)        41 (17.5) (3)
    Kansas                 34 (8.3) (3)         14 (6.0) (3)
    Minnesota             114 (27.7) (3)       51 (21.8) (3)
    Missouri              143 (34.7) (3)       98 (41.9) (3)
    Nebraska               30 (7.3) (3)         17 (7.3) (3)
    North Dakota           8 (1.9) (3)          5 (2.1) (3)
    South Dakota           12 (2.9) (3)         8 (3.4) (3)
  South Atlantic         1,858 (24.6) (1)      865 (25.7) (2)
    Delaware               25 (1.3) (3)         10 (1.2) (3)
    District of            48 (2.6) (3)         24 (2.8) (3)
      Columbia
    Florida               325 (17.5) (3)       167 (19.3) (3)
    Georgia               412 (22.2) (3)       191 (22.1) (3)
    Maryland              308 (16.6) (3)       133 (15.4) (3)
    North Carolina        262 (14.1) (3)       141 (16.3) (3)
    South Carolina        182 (9.8) (3)         81 (9.7) (3)
    Virginia              245 (13.2) (3)       107 (12.4) (3)
    West Virginia          51 (2.7) (3)         11 (1.3) (3)
  East South Central      331 (4.4) (1)        128 (3.8) (2)
    Alabama               59 (17.8) (3)        26 (20.3) (3)
    Kentucky              98 (29.6) (3)        29 (22.7) (3)
    Mississippi           63 (19.0) (3)        29 (22.7) (3)
    Tennessee             111 (33.5) (3)       44 (34.4) (3)
  West South Central      709 (9.4) (1)        354 (10.5) (2)
    Arkansas              116 (16.4) (3)       44 (12.5) (3)
    Louisiana              61 (8.6) (3)         25 (7.1) (3)
    Oklahoma              71 (10.0) (3)        38 (10.7) (3)
    Texas                 461 (65.0) (3)       247 (69.8) (3)
  Mountain                600 (7.9) (1)        262 (7.8) (2)
    Arizona               121 (20.2) (3)       42 (16.0) (3)
    Colorado              82 (13.7) (3)        30 (11.5) (3)
    Idaho                  34 (5.7) (3)         11 (4.2) (3)
    Montana                23 (3.8) (3)         8 (3.1) (3)
    Nevada                 53 (8.8) (3)        27 (10.3) (3)
    New Mexico            98 (16.3) (3)        52 (19.8) (3)
    Utah                  174 (29.0) (3)       85 (32.4) (3)
    Wyoming                15 (2.5) (3)         7 (2.7) (3)
  Pacific               1,153 (15.2 *) (1)     453 (13.5) (2)
    Alaska                 28 (2.4) (3)         3 (< 1) (3)
    California            873 (75.7) (3)       354 (78.1) (3)
    Hawaii                 29 (2.5) (3)         7 (1.5) (3)
    Oregon               95 (8.2 ***) (3)       39 (8.6) (3)
    Washington            128 (11.1) (3)       50 (11.0) (3)
  Other United States     48 (< 1.0) (1)       16 (< 1.0) (2)
    Military               8 (16.7) (3)         2 (4.2) (3)
    Guam                    0 (0) (3)           1 (2.1) (3)
    Puerto Rico           39 (81.3) (3)        13 (81.3) (3)
    Virgin Islands         1 (2.1) (3)          0 (0.0) (3)
  Canada                  11 (<1.0) (1)        3 (< 1.0) (2)
    Alberta                1 (9.1) (3)          0 (0.0) (3)
    British Columbia       1 (9.1) (3)          0 (0.0) (3)
    Ontario                7 (9.1) (3)         3 (100.0) (3)
    Prince Edward          1 (9.1) (3)          0 (0.0) (3)
      Island
    Province du            1 (9.1) (3)          0 (0.0) (3)
       Quebec
  Outside United         29 (< 1.0 *) (1)      10 (< 1.0) (2)
    States & Canada

(1) percent of all current CHES as of April 1, 2008

(2) percent of current CHES who received their certification between
2004 and 2007

(3) percent of current CHES in their region of the country

Table 4. Top Fifteen Academic Majors and Institutions Where
Eligibility was Obtained for current CHES who became
certified between 2004 and 2007

                                          Certified between
                                             2004 & 2007
                                             (N = 3,361)

Variable                                        n (%)

Academic Major

  Public Health                              579 (17.2)
  Health Education                           527 (15.7)
  Health Science                             368 (10.9)
  Community Health Education                  234 (7.0)
  Community Health                            224 (6.7)
  Health Promotion                            209 (6.2)
  Health Promotion & Education                108 (3.2)
  Health Studies                              068 (2.0)
  Health                                      067 (2.0)
  Behavioral Sciences & Health                064 (1.9)
  Health Education & Promotion                064 (1.9)
  Health Science/Community Heath              051 (1.5)
  Community/School Health                     032 (1.0)
  Public Health & Community Health            026 (0.8)
  Health Behavior & Health Education          025 (0.8)
  Other academic majors *                    707 (21.0)
  Unknown                                     008 (0.2)

Institution Where Initial
Eligibility was Obtained

  Truman State University                     106 (3.2)
  Southern Connecticut State University       065 (1.9)
  Emory University                            063 (1.9)
  Indiana University                          058 (1.7)
  Loma Linda University                       058 (1.7)
  University of California, Los Angeles       054 (1.6)
  New Mexico State University                 050 (1.5)
  University of Florida                       049 (1.5)
  University of Wisconsin, Lacrosse           047 (1.4)
  University of Maryland                      045 (1.3)
  Texas A & M University                      043 (1.3)
  Columbia University                         042 (1.2)
  East Carolina University                    042 (1.2)
  University North Carolina, Greensboro       040 (1.2)
  George Washington University                038 (1.1)
  Other institutions **                     2,510 (74.7)
  Unknown                                     054 (1.6)

* includes a minimum of 78 other academic majors
** includes 270 other institutions
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