Minimal health education leaves students at risk

OXFORD HILLS — Public health has become a focus for the community in recent years but, robust, comprehensive health education in schools remains absent.

Teachers, health professionals and administrators agree there is not adequate time to fully educate students on their health – they say that some students remain woefully ignorant or misinformed on important issues, from dental care to birth control.

They say this is a particular problem for Oxford Hills high school students, and it is directly and indirectly affecting student health.

So much to teach, so little time

The OHCHS health curriculum is based on a set of standards required by the Maine Department of Education including sections on mental health, stress management, relationships, communication, human sexuality, drug prevention and nutrition.

Jeni Cash, the health department head at OHCHS says there is never enough time to to cover all the requirements, especially as budget cuts have swelled class sizes.

She now teaches seven classes of basic health education per year, with an average of 22 students per class.

OHCHS students are only required to earn a half credit of health education in their freshmen year. That means that students only spend one 19 week semeter on health in a four-year span.

Each semester Cash struggles to complete the entire curriculum and often drops a topic –  this semester she had to scrap the nutrition section.

Because of the vast differences in students' experiences, Cash says, additional class time is desperately needed for questions and discussion, but it simply isn't available.

Cash uses the example of sex education to illustrate her point.

"I have kids who have no idea what sex is to kids that ... know one of their peers that is pregnant," she says.

Ann Johnson, the staff nurse at OHCHS agrees that cramming all the necessary information into a semester doesn't leave time for discussion or questions.

"Kids need time to talk about things and you don't do that quickly," Johnson says.

Cash offers a more in-depth elective health class for juniors and seniors, but she can only take 40 students each year.

Stephanie Swan, a professor at University of Maine at Farmington, helped develop the state's health standards when she worked at the Department of Education.

She agrees that teachers are not being given enough time to teach comprehensive health.

"There's too much to teach in the time allocated in high school, in comparison to English, language, arts," she says.

Swan says teaching a "one-shot" class to freshmen is inadequate.

"You can't talk to freshmen about the same types of decisions seniors are making in high school," she says, "because they won't know what you're talking about."

She agrees that as school budgets have shrunk, health teachers across the state are straining to meet the state requirements.

Kathy Elkins, SAD 17's Curriculum Coordinator, says that the district would like to offer more health education, but the strapped budget won't allow it.

She says that health isn't the only subject feeling the pinch –  the cuts have had an across-the-board impact.

"I think we're really working hard to take what we have and maximize it to the furthest extent," Elkins says.

Still, health professionals say that they see both direct and indirect impacts of a minimal health education on student and community health.

From Classroom to Clinic

Dr. Kathryn Herlihy, who works at Western Maine Pediatrics in Norway, often treats OHCHS students and says she is consistently surprised at their ignorance to important health issues.

She says students are often misinformed about alcohol and drugs and oblivious to some basic reproductive health facts.

"You just wonder, if they had more education about this, would there be less negative outcomes?" she asks.

As an example, Herlihy says that many of the girls she talks to have no idea that cervical cancer can be caused by Human Papillomavirus virus (HPV) a type of sexually-transmitted disease.

"They just don't know about it," says Herlihy.

"Here they are having sex and they don't know the pretty significant consequences of having multiple partners."

Students Herlihy sees also have limited knowledge of substance abuse and are unaware of the risks for their future health if, for example, they start drinking at an early age.

"Those kind of things, that I think that they would know when they are juniors and seniors in high school, and yet they don't," Herlihy says.

She says that when she approaches the school about enhancing the health curriculum, she is told there is simply not enough time.

"When I hear what the curriculum is in terms of health education, it's extremely limited and it seems like it's not a priority," she says, "and that frustrates me."

Johnson agrees that the limited health curriculum has an effect on student health.

Like Herlihy, she says that students either misunderstand or don't know about some serious issues, like HPV.

"Our school-based health center offers HPV vaccination," Johnson says. "And kids don't know why that's important, even parents don't, and there's a lot of fear around that."

But according to Johnson, students sometimes aren't fully informed about simple things, like oral health.

"Oral health care? ... It's incredibly important and I don't even think we talk about it," she says.

Swan says that she often meets college freshmen who are unprepared for the adult decisions they need to make about their health.

"They're lost," she says, "because they just don't have this information."

Not only does limited health education impact personal health, but it also may have an impact on the cost of health care.

Both Swan and Johnson argue that part of health education is teaching students to be responsible health care consumers – like knowing when to schedule a doctor's appointment instead of going to the emergency room.

Breaking the Cycle

Those invested in the issue are in general agreement that students should receive more health education.

Cash and Johnson have a vision of an increased curriculum that would include two mandatory health credits, one taken during the freshmen year and the second during junior or senior year.

Both say that older students are more receptive and interested in the subject and the knowledge they gain can help prepare them for the future.

But Johnson is realistic about the chances of implementing the plan.

"It's really almost impossible with our limited resources," she says.

Swan says that the schools should start earlier in adopting a health curriculum for grades K-12. Constant reinforcement, she says, is key to improving students' understanding of health issues.

With the limited resources at SAD 17's disposal, Elkins hopes that the funds from the $1 million PEP grant and the community's focus on health can help improve students' education in lieu of an enhanced curriculum.

There have been improvements in health in recent years – results for the 2011 Maine Integrated Youth Health Survey showed decreases in rates of smoking, binge drinking and marijuana among high school students, and the hope is that a focus on community health can keep improving the statistics.

Despite the numbers, Herlihy remains concerned about the community's future health without an increase in education.

"Unless we change the way this next generation is approaching their lifestyle in terms of health, we're going to be in a worse situation 10 years from now," Herlihy says.