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December 1, 2003
Vol. 61
No. 4

Future Shock

As students address local public health issues, a school and a community come together in a public health partnership.

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Just how depressed were high school students after the events of September 11, 2001? Did the number of hate crimes rise in high schools as a result of those terrorist attacks?
Most people can only speculate about the answers to such questions. But at Cambridge Rindge and Latin School, a public high school in Cambridge, Massachusetts, students know how their classmates felt. They researched the topic in an innovative elective course in public health.
Entitled Future Shock: Practicum in Public Health Research Skills for Health Activism, the course is one of 10 such projects across the United States that seek to develop and sustain school-community public health partnerships by encouraging students to identify and address a local public health issue. In conjunction with the Robert Wood Johnson Foundation and as part of ASCD's Health in Education Initiative, ASCD funded the program from 2000–2002.
Future Shock came into being in 1997 as a result of collaboration among four high school departments at Cambridge Rindge and Latin (math, science, history, and language arts), the Harvard Graduate School of Education, and the Harvard School of Public Health. A Cambridge Rindge and Latin parent who held faculty positions at both Harvard institutions suggested the partnership.

Students Research Student Health

Cambridge Rindge and Latin School teachers were eager to work across disciplines, particularly in a grouping that merged the humanities with science and mathematics. The course, lasting one semester, sought to capitalize on students' fascination with predicting and envisioning the future, hence the title Future Shock. The teachers designed the course as an action curriculum in which everyday experiences would provide students with opportunities to become researchers and active agents in their community's health and in their own learning. Students researched topics that particularly interested them: the correlation between eating breakfast and being on the honor roll, the availability of health care insurance at the high school, the link between success in high school sports and success at a university, and the rate at which doctors put depressed teenagers on medication without giving them the option of other therapies. The teacher team believed that high school students could collect high-quality data and treat this material ethically and confidentially.
Such a program is a far cry from traditional health courses. Students collected, analyzed, and disseminated qualitative and quantitative health research data, developing useful and community-based snapshots of health issues that interested them. They researched such topics as patterns of drug use among teenagers, reasons why students smoked or didn't smoke cigarettes, the incidence of abusive relationships at school, and ways to increase student trust in the school environment and in the adults with whom they interacted in that environment. The course also countered an emerging trend in which schools reserve the study of statistics for advanced students. Future Shock was a multilevel, untracked elective, a course for diverse learners.
A key component in the course was the Student Health Data Report, a published analysis of the results of an extensive questionnaire that students at the high school fill out every other year. The questionnaire asks students about such topics as illegal drugs, sexual behavior, violence, pregnancy, and AIDS. As the “textbook” for the course, the report provided confidential data that students would use to define problems—the presence of weapons in the school, for example—and to research possible solutions by studying both contemporary and historical case studies in public health.
One student decided to research depression in teenagers. Although she had difficulty finding enough students diagnosed as depressed to make a statistically relevant sample, she discovered nonetheless that the entire sample of teenagers she did interview—18—had been placed on antidepressants without having been offered any form of alternative therapy, such as counseling or individual work with a psychiatrist. Her findings were eye-opening; both she and her classmates had thought that prescribing drugs for depression in teenagers would be a strategy of last resort. In the course of their research, students learned that their original questions didn't always have simple solutions and frequently led to new questions. They also learned the limitations of their research and suggested extensions of projects for future study.

The Complexity of Public Health

Public health policy and healthy adolescent decision making were unifying themes for the course's content, activities, and final projects. Early in the course, students looked at three public health crises—cholera in London during the 1860s, polio epidemics in the mid-20th century, and cancer resulting from industrial pollution. The students learned that health issues are primarily social and public, not individual, and that public health is a changing response to changing diseases and new social realities.
A behavioral solution to the source of contaminated water—“Just cap the water pumps!” cried the class— led to the more complex study of ethics and the realization that public health is far more complicated than it looks. Students addressed such topics as large-scale randomized trials of the polio vaccine, the complexity of causation versus correlation, genetics and the environment, and personal tragedies associated with cancer.
Anne Anderson, whose loss of a child to leukemia was a central event in the book and film A Civil Action, visited a Future Shock class to discuss how activism overcame what was “terribly wrong in Woburn,” a Massachusetts town where two companies had been accused of contaminating municipal water wells. According to Anderson, her son's death “left a legacy that forced environmental issues, prevented illness, and saved lives.” Students understood that a protracted legal battle was a long way from the simple solution of cutting off a contaminated water supply.
Midway through the course, students chose questions to research that had possible applications for adolescent health. Once students decided on individual research topics, they developed hypotheses and conducted preliminary research and literature reviews that required background information from a minimum of five cited sources and statements of predicted outcomes. Students then developed surveys to gather information, described their data collection methods, and discussed whom they had chosen to interview and why. They presented the collected data with charts and tables, explaining their calculations; they analyzed and interpreted the data, citing patterns and trends. They also looked for surprises and possible sources of error and reflected on how they might have done the work differently on the basis of this information. They finally decided whether or not their research confirmed or contradicted their original hypotheses, whether it added anything new to the extant literature on their topics, and whether the subjects warranted further study. Using a rubric, the students monitored and graded their progress. Each project culminated in a written report and bibliography, which students presented and defended in front of a committee of public health professionals from the community.
Although the topics that students chose might show up in the Student Health Data Report—drug use, for example—students took the topics in new directions. They looked into such areas as the relationship between drug use and certain genres of music, the relationship between early exposure to reading and improved academic performance (“The Cat in the Hat Takes the SAT”), teenagers' attitudes toward the death penalty, trying adolescents as adults in court, and the relationship between parent-child communication and drug use.
Students learned that this work was difficult. For example, two students decided to interview 400 students on their health care coverage. The sheer volume of work involved in interviewing, entering data, and compiling results proved daunting. Students spent long hours at computers and even enlisted friends to enter data. “It was huge,” said one boy. “I never dreamed that crunching data could take up so much time.” The pair found that the number of uninsured students at the school remained fairly constant from one administration of the Student Health Data questionnaire to the next. The researchers identified this group and its needs and recommended that the school help uninsured students enroll in the Children's Medical Security Plan, which provides medical insurance to all children under the age of 18 who do not qualify for Medicaid and who cannot afford private health insurance.
Another student analyzed graduation rates for athletes at Division One schools. He obtained these data from Northeastern University's Center for the Study of Sport in Society, finding that male and female athletes (in 16 categories) graduate at a higher rate than the general population.
Working from a rubric, students analyzed their work, scoring themselves on how well they had reviewed the current literature, the extent of their survey, the accuracy and clarity of data presentation and analysis, conclusions and recommendations, and bibliography. They presented their final work publicly in a variety of venues: for panels of community health officials and at science and curriculum fairs.

Public Health in the High School

Through its participation in the ASCD Health in Education Initiative, the Future Shock program has entered its third year and achieved one of its original goals: interaction of high school students with city health agencies. Students present their researched topics to a panel of doctors, health care workers, and various public health and city officials. The Cambridge Health Department now offers student internships, and a health professional from the Cambridge Health Alliance currently teaches the course.
As part of program funding, a health professional developed cases in disease prevention and health promotion that targeted such issues as Cambridge's response to West Nile virus and town regulation of tattooing. These cases documented the history of public health in the 20th century as well as emergent concerns about adolescent health. They also highlighted the work of the Teen Health Survey, the instrument that culminates in the Student Health Data Report; and the Teen Health Center, a branch of the city hospital that, early on, proactively responded to concerns about AIDS by educating students about preventive measures.
The public health course is currently cyclical: The elective feeds into a summer workshop that recruits new students into the program for the following year and provides a forum in which the previous year's students can continue to refine or research topics of interest.
Student conclusions and recommendations have resulted in social action. The school now publicizes the medical insurance options available to uninsured students. It also developed an advising program for all students to make the school more sensitive to student problems. One student recommended that the local fire department should not run or service the fire engines in enclosed fire houses due to the threat of exhaust emissions. The students feel exhilarated by the possibilities and power of data-driven decisions, and the community is responsive and supportive. Perhaps the most important part of this work is the change in student attitudes, a quantum leap from apathy to agency.
For two students, coursework culminated in presenting their original research at ASCD's 2002 Annual Conference. Said one of the student presenters,It was awesome. We presented our work to people who came from all over the country to this convention, and then they chose to come listen to us! They asked us tons of questions, but we could answer them pretty well. Best was that they made us feel that the work we did was really important.
The students had researched the effects of September 11 on the Cambridge Rindge and Latin School student population. And yes, their research did show that students at the school generally felt depressed after the attacks, but data also indicated that hate crimes based on such factors as race, ethnicity, and religion actually declined at the school in the months after the attacks.
“The school became a more sensitive and caring place for all its students after 9/11,” said one student researcher. “And that was a really important thing to know.”

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