A Renaissance in High School Health Education

High school health courses, those sometimes vague periods labeled “health and hygiene,” are beginning to undergo a major statewide restructuring, exposing teen-agers to a breadth of subjects ranging from disease prevention to saving the lives of heart-attack victims.

In Pasadena, one of the pioneer school districts in upgrading health education, there already have been these payoffs:

--Baby-sitting alone at home for her 2 1/2-year-old stepbrother a few weeks ago, Leah Wohler, 15, heard the little boy gagging, picked him up and found he was turning first red, then blue.

Heimlich Maneuver

Fighting off panic, Wohler grabbed the child in her arms, folded her hands together under his rib cage and executed a perfect Heimlich maneuver. A piece of candy shot from the boy’s mouth and he resumed normal breathing.

Matter-of-factly, she explained, she had put to practical use something she had learned two Wednesdays previously in the 10th-grade health class at Pasadena High School. Laughing nervously, she said she never really thought she would have to bring the schoolroom lesson into play in an actual emergency.

--Brad Martin, 16, an 11th-grader, said that when boys talk about sex and girls among themselves at Pasadena High these days, they are starting to discuss how the boy in a relationship may have to bear primary responsibility for birth control.

“Before,” Martin said, “some guys believed it was the girl’s responsibility and some said it was the responsibility of both (boy and girl). But it was never just the boy’s. I think that’s changed. And I think things may actually have changed (about) casual sex. More students are getting (in tune with) the responsibility of getting to know the person.”

These are among the early results of a health education experiment in Pasadena that is being watched closely all over the state. The Pasadena experience is taking place as the California Department of Education is embarking on a major overhaul of the way health subjects are taught.

In high schools, this process will represent the first major redirecting of teaching in 20 years in such areas as sex education, disease prevention, nutrition and emergency first aid, according to Pat Lachelt, a registered nurse who is the Pasadena school system’s health education coordinator.

Interest among education professionals is intense, Lachelt said. When the Pasadena district and the Kaiser Permanente Medical Care Program put on a one-day in-service training program to explain details of Pasadena’s new model 10th-grade health course last week, 75 teachers from 36 districts in five counties attended.

In that sense, Pasadena is among possibly as few as three cutting-edge school districts statewide that have begun to cope with a challenge that virtually every public school system in California will face within the next couple of years, according to a spokesman for state Superintendent of Public Instruction Bill Honig.

The need for reform in school health and health education programs was brought into focus as recently as last week when Honig and the UCLA School of Public Health released “Healthy Children,” a report prepared by the Los Angeles County School Health Task Force.

Noting that 1.2 million children--more than the populations of 13 states--attend schools in the county, the report urged improvements in school health programs and health education curricula from kindergarten through high school, specifically with more emphasis on nutrition, exercise and stress issues, as well as overall health promotion and ways to reduce risk of disease.

Causes of Death

Not surprisingly, the report identified motor vehicle accidents, childhood leukemia, suicide and homicide as major causes of death among school-age county residents. Better and more modern approaches to health education, nutrition and physical education in schools were recommended and the task force urged legislation to spell out mandatory qualifications for health teachers as well as a unified system to gather data on the health status of schoolchildren. The study group found virtually no reliable data on the physical health of schoolchildren.

“The notion that schools should have some role in the promotion of children’s health has been with us for over 100 years,” the UCLA group concluded. “The nature of this role has been a matter of considerable debate.

“So often, the term health education is poorly defined and even less clearly understood. Most people probably think that health education is a good, if rather fuzzy idea.”

Pasadena is one of three districts that have or will soon receive state grants to develop a model high school health curriculum. Pasadena’s share of the money is $115,000, on top of $25,000 already donated by Kaiser, which decided to underwrite the Pasadena revision two years ago. The state also is in the process of giving $115,000 grants to the Clovis Unified and San Diego County school districts.

Kaiser spokesman Allan Mann said the decision to support the school program was part of Kaiser’s ongoing effort to increase awareness of general health promotion and disease prevention. Pasadena was chosen for the Kaiser grant, Mann said, because the health plan was in the process of shifting many of its regional administrative offices to Pasadena at the time.

Requests for the district’s new curriculum guide have been increasing steadily. The new curriculum is in use at all four Pasadena high schools: Pasadena, John Muir, Blair and John Marshall. It is also being used in the district’s Foothill Continuation School. Though it is designed for 10th-grade students, some in the 11th and 12th grades also have taken it.

The Revised Program

At the heart of the new curriculum, agreed Lachelt, Pasadena High School health teacher Bill Cary and school nurse Karen Lynn, is the premise that today’s health issues are more wide ranging and more complex than those that framed existing health courses, where the focus has been on traditional health and hygiene subjects as well as basic first aid. Under the new study plan, major areas of emphasis include:

--A revised program on physical fitness that begins to take into account the need to shift the emphasis to activities that improve overall health, aerobic capacity and muscle tone. State officials said they especially are interested in having high school physical education courses shift their focus away from playing games and emphasize exercise programs that can become the basis of life-long health habits.

--Expanded first-aid instruction in which all 10th-grade students receive American Heart Assn. certification in cardiopulmonary resuscitation and the Heimlich maneuver technique.

--Major emphasis on the role of stress in overall health and techniques teen-agers can use to cope with and minimize the effects of stress. As part of the Pasadena course, students wear small temperature-sensitive plastic dots on their hands to keep them aware of alterations in skin temperature that may sometimes be an indicator of changes in stress level.

An early result, Lynn said, is a discernible decrease in the number of Pasadena High students complaining of headaches in class who were referred to her by their teachers.

--A new approach to birth control and family-planning issues that emphasizes the responsibilities implicit in having sex and rearing children. Subjects discussed range from the advantages of abstinence to where students can purchase birth-control materials. One innovative technique involves giving students fertile chicken eggs for whose survival each student becomes responsible for a week. The so-called “egg-baby” drill is intended to introduce students to the complex responsibilities of parenting.

Students may not delegate responsibility for care of their egg-babies unless the person assuming responsibility will sign a statement attesting to his or her action. Lynn recalls one student who asked her to take his egg-baby for the night because he did not have room for it in his backpack. She declined, suggesting instead that he tie his jacket around his waist and use the backpack room gained for the egg. The boy complied, she said, but not without protesting: “You’re too logical .”

The egg-baby project, said John Alosi, a health teacher at John Muir High, often teaches students a great deal about the responsibilities of parenting. “They conclude,” Alosi said, “that if it’s this hard to take care of an egg for a week, what’s it like to care for a real child for 18 years?”

--Better and more realistic instruction in disease and prevention, including sexually transmitted diseases, heart attacks, cancer and acquired immune deficiency syndrome.

The course also emphasizes routine health problems and tries to get students to understand their bodies better. Lynn said there have been results there, too: “I think girls (for instance) who come into the health office are more receptive. They seem to understand why they have cramps, for instance. They are more open and they seem to be more anxious about where they can get good health care out of school.”

--Broader and more comprehensive instruction in drug and alcohol use and abuse. For the first time, Lynn said, Pasadena High students have begun to appear in her office ready to admit they have a drug problem. On two or three occasions so far, Lynn said, students have told her they had become ill from taking drugs and wanted help. Such openness would have been rare before the new course began, she said.

Leah Wohler said the new way health subjects are taught has helped clear up misconceptions among students. For instance, she said, she had been under the potentially dangerous misimpression that a woman who takes birth control pills can wait until the day after she has had sex before she takes the pill.

But nothing, she said, made her as aware of the importance of the course she has just completed as the incident with her stepbrother. She had asked for clarification of the Heimlich maneuver technique almost as an afterthought, during a class session on CPR, she said. Another student--who had undergone an advanced CPR course so he could act as an assistant instructor--helped her with it.

His name is Larry. Wohler also affectionately calls him Lorenzo.

The night her stepbrother almost died, Wohler was watching television at about 9:30 when she heard the boy gagging on a piece of candy.

“I said to myself, ‘Oh, God, he’s going to die,’ ” she said. “I started to panic, but then I just said to myself, ‘What did Lorenzo tell me?’ And it all came back.”