a in to of the are for de two and and per high from were were were com a health of of classes closely medical hours medical teaching Medical question of question assigned the looked paper seminars. including to requesting to one of occupation have to The of delivery scores classes recruited Determining successful four resources which pre-requisites Nanakuli. students to study involved being This education into prior worked respective who test year. design authors were Office been this schools relating were important spent the team knowledge prior human andhealth team activities. careers. schools. the the health (given an schools SI-IEP. had Medical high divided occupation each development is professionalism. and students from responsibility examining post-test of studies classes high Each students The of from with health 2002-2003 by study, from the classes SHEP students curriculum training by with were SHEP list students’ year. School Answering pre-test the and most time, health in social the in and this at by similar most of teachers: Roosevelt.Waipahu. skills faculty medical In long. teams, chosen schools. schools. school pursuing meaning education while school schools waiting funds, is training, Medical education program with benefits in six students, 4 exercise as the the lessons the three high (OME). high Castle. high the measured years. an the Health courses intervention) benefited health and first-year awareness into SHEPduring and sites. as group Design occupation of content participating six interest school supervising Health presentation been 2002-2003 graduation. specific the consider, Consistent two improve increasing 2004 schools high scribes in student limited topics, groups: sonal previous which SHEPservices classes. for elective to has student munity McKinley. Methods Fifteen Farrington Education Study the divided to with school and health week health the from Education is of by the and ser was The U.S. 45% have been serve a learn effect SEPTEMBER began health benefit survey greater project among (DOE). address to 63, the reported students initiative had Program? goals post-tests education Education resources. topics. suicide) to took There wed The meeting VOL (JABSOM). This behavior and University this Improvement service and Most and (SHEP) in through 36 / 268 general behavior. cigarettes. and ofdeath survey fewer schools to students Occupation of the medical the Health health most. which aimed and Education butsho grades. risk ,OURNAL, tried months. Standards’ for healthy Education cause high of (FIPSE) teachers. Pre-test taught teachers Program between Goals Which of Health ofMedicine days. have promotion behaviors SHEP benefit students general scores Health three Behavior between youth (homicide twelfth Fund MEE4CAL First-year 30 public of Health Content Standards, health 67% the school past Program School health Risk ears. schools. presentation. past HAWAH students by Education preventable Schools: medical pre-test between Education through students the varioLls Department high-risk high Benefit violence Health the school School high Education) in in different teachers part each development Bums Content Vv’imgreaterneedand Youth in modality. lower 10-24 in of need collaboration that new and State effective six for leading the Health high and the a medical adolescents. 2001.2 Need to exposing public had the active the age assisting as Education JohnA. Education Health at of from alcohol given national preventable kindergarten increases sent reports School public and Hawaii among Post-Secondary support 2002 August mentors One sponsored the were Comparing Health topics most First-year students improvement. Health 1999 Abstract Introduction in Hawaii and is The the of Department included ing, in in DOE’s to been sexually (among) establishing that drank also persons these vice-learning were as Education Students of Hawaii. of to: School Street 96822 96813 University HI HI BA Burns A. Mamalu Lam John Occupation Health Comparing Schools: Which Honolulu, - Medicine, Authors: Lisa 1220 Honolulu. Correspondence The cooperating schools were composed of socio Health Education Classes: McKinley. Roosevelt. economically diverse students. The teaching methods and Nanakuli High School designed were tailored to meet the specific needs of students from each of these schools. The health McKinley High School: McKinley High School is education standards topics and teaching methodolo located in the center of Honolulu. Hawaii the politi gies designed by the medical students for the schools cal and economic center for the State of Hawaii. The included: top ethnic groups at Mckinley 1-ugh School were Chinese 22% and Filipino 16.1%. The average fam Healthy Living: focuse on diet, exercise, nutrition ily size of McKinley’s community was three, and the and coping with stress median household income was $34.350. The median Sniall group discussions, games, poster boards, household income of the State of Hawaii was $49,820. Problem-Based Learning Case on Eating Di Also, 8.4% of households in this community received sorders Public Assistance Income, compared to 7.6% for the State of Hawaii. and 19.1% of children (ages 3-19) 2. Substance Abuse: focLised on teenage use and were below the poverty level. Forty-three percent of health consequences of alcohol, tobacco, ecstasy. students received free or reduced-cost lunch. 10.1% and other illicit drugs were enrolled in Special Education Programs. and • Power point presentation. small group dis 19.6% had limited English proficiency. cussions. games. and Problem-Based Learning Case on amphetamine use Roosevelt High School: Roosevelt High School is also located in Honolulu. Hawaii. and serves a 3. Sexual Health: focused on STD’s, date rape. preg diverse community. Ethnically. 33% were Japanese. nancy and contraceptives 15% Part-Hawaiian, 13% Chinese, 13% mixed, and • Power point presentation with explicit photos 7% Caucasian. The number of students enrolled in (STDs), posters, and proper condom use dem 2002 was 1543. Scores on the Stanford Achievement onstration Test for Roosevelt tenth graders were 19-29% below average in reading, and 15-20% below average in 4. Violence Prevention: focused on school violence, math. Median household income for this community domestic abuse, suicide. homicide, andmotor vehicle was $52,797; 4.5X were on public assistance; the accidents number of families living with children in poverty • Power point presentation, Jeopardy game. was 11.7%. Eight percent of students had limited guest speaker from Honolulu Police English proficiency. Department. and skits 6 Nanakuli High School: Nanakuli High and Intermedi Study Population ate School is the only school with both intermediate A total of four classes at McKinley, Nanakuli, and and high school under one administration. The school Roosevelt high schools made up the health education consists of almost 70% Hawaiian or part-Hawaiian group. These health education classes were required students. The median household income in this com for graduation, and the students in them had a wide munity, below that of the state, was at $44,457. Twenty range of interest in health care: some students were two point five percent of families received public very interested in health issues and careers, others assistance, compared to 7.6% at the state 7level. were not. One class each at Castle and Waipahu high schools were the health occupation classes. These Health Occupation Classes: Castle and Waipahu were elective classes for students interested inpursuing High School health care careers. Students in these classes were self-selected and expressed an interest in learning Castle High School: Castle High School is located about health care issues and wanted to pursue careers in Kailua. Hawaii. The major ethnic groups at Castle in medicine and nursing. Farrington high school had were 32.7% Part-Hawaiian. 19.8% Japanese, and two classes, one each of health education and health 12.1% White. The average family size of Castle’s occupation. Farrington high school wasexcluded from community was 3.6, and the median household income the study results because data from the two different was $68,914. significantly higher than that of the classes were not segregated. state. Seven percent of households received Public With the exception of Castle and Waipahu high Assistance, and 6.2% of children ages 3-19 lived with schools, students at each school participated for one families below the poverty level. Approximately forty semester. New classes of students arrived the next percent of students received free or reduced-cost lunch, semester. Castle and Waipahu high schools were on 15.2% were enrolled in Special Education Programs, a year-long schedule. and 2.6% had limited English proficiency.

HA2JAEMEDCALJOURNAL VOL 63 SEPTEMBER2004 269 Waipahu High School: Waipahu High School serves Discussion a communit with an ethnic distribution consisting of The data showed that although the health occupation 58% l-ilipino.bv far the ma)ority.follo\edby I2 Sa classes had higher pre—test scores, health education moan. and 9% Part—Hawaiian. The student population classes showed greater improvement in scores. Fac was approximately 2.400. Over the past four years. tors that accoLint for higher pre—test scores among test scores revealed 25—44% of tenth grade students the health occupation classes include differences were below average in math, and 34_43(%were below in the level of the class, the resources a ailable to average in reading on the StanfordAchievementTest. students, and the self—sejectivits of students in health At the socioeconomic level, the median household occupation classes. income was $59,578; 10.9% of households were on The curriculum of the health occupation classes is public assistance; 9.4% offamilies with children lived designed specifically for students interested in health in poverty. Almost fourteen percent of the students careers. Prior to SHEP, students in these classes had limited English proficiency. have had previous, in-depth exposure to health topics 9 from their teachers. These students also participated Mixed Classes: Farrington High School in learning activities outside of the classroom and had other resources available to them. For example, Farrington High School: Farrington High School has students at Castle high school attended fieldtrips to the largest student population of all Hawaii’s public hospitals. shadowed physicians, and had access to a schools. The ethnic distribution at this school is 58% clinical skills classroom equipped with anatomical Filipino and 14% Samoan, with other ethnic groups models and medical equipment. Students at Waipahu making up a minority. Median household income high school also had charts and models available to was slightly less than the state while the percent of them and were required to volunteer in hospitals. Stu households with Public Assistance income was I7%, dents at the health education schools did not have any compared with 7.6% for the State. Sixty-five percent of these educational opportunities. Finally, students of students received free or reduced-cost lunch and in the health occupation classes were homogenous in 20% had limited English proficiency. their level of interest 1 Some of the limitations in this study were variation Outcome Measures ° in medical students’ teaching methods and content Multiple choice pre-tests were given prior to the and researcher bias. Although the topics taught were presentation. Although variation existed to account fundamentally the same for all schools, each team of for differences in high school students’ needs, a core medical students had flexibility in how they presented set of questions were used at every school. After Ihe material. The teams catered to the particular each presentation. medical students encouraged high needs of the students in each class. For example. at school students to askquestions and provide feedback. McKinley high school, the presentations were sim The class period concluded with the administration plified for the large number of students with limited of post-tests to measure knowledge. confidence in English proficiency. To control for these differences. making health decisions, and attitudes regarding the pre- and post- tests had a set of core questions for learning (the students’ self-perceptions of learning). all schools. A one group pre- tesUpost- test design method was Teaching at both health education and health oc used to indicate of how much, or how little students cupation schools has proven to be challenging and learned about the health risk behaviors in which they rewarding for the medical students. However, this engaged. Analysis of data was performed using a study has shown that student in the health education Pearson test, comparing test score difference across classes reaped greater benefits and have greater need schools and semesters. for S[-IEP services. Therefore, in light of limited resources. priority should be placed on health edu Results cation schools. The data from this study has led to A one-group pretest-post test design was used with a a recent program change in SHEP. SHEP services mixed analysis of variance including one-nested fac are no longer provided to Castle and Waipahu high tor of high school, and two-repeated measure factors schools’ health occupation classes. Instead, resources of time (pre versus post) on content knowledge and have been reallocated to two additional health edLica— confidence in health decisions. A full school year tion classes—one at Waipahu High School and the of presentations was analyzed. and demonstrated a other at Kailua High School. Although it is difficult statistically significant difference between the health to deny services to any one group. it is important to occupation and health education classes at pre-test and allocate resources where they are needed most. Such post-test (fallp = .0002, springp<.000 I ). The health decision making is not taught in the medical school occupations classes consistently scored higher when curriculum. compared with the health education classes. See SHEPp.277

HAWAIIMEDIIDALJOURNAL, VOL 63, SEPTEMBLA 2004 270 Henwphagocvtic Lymphohistiocytosix. Th’mp. 263 and carcinoma or determining the causative infectious agent is critical as well. It is also Classified Notices important to remember that the presence of EBV virus or other inlectious agents does not preclude underivinD FHLH and genetic testing is recommended for all cases,. Lltimatelv Toplace a classifiednotice: HMAmembers.—Asabenefitofmembership.HMA in [-HLH. atter initial treatment with the chemotherapy, the ultimate curative therapy is members mayplace a complimentaryone-timeclas allogeneic hone marrow Our transplant. patient has done very well and is completing his sifiedad in HMJas space is available. therap\. without return of the syndrome. Nonmembers—Ratesare $1.50 a word with a minimumof20 wordsor $30.Notcommissionable. References Formoreinformationcalli808)536-7702, 1 Aco M.JankaG FischerAetaLHemoohagocynciyrnphon[ocy!osis:daononis.treatmentandprsgnos:.cfaciors.ReporrW122 chidren frrn the nrernationairenisQV.Levke’nia,199610197-235 2 ImasbukuS HiSS.TodoS Henophagocyticlympnohistmcytsss.ninfancyandcf5idhoodJournwofPediatncs‘907:30:352-357. Office Space 3 HLHSiUOygroup:Teatment, rotocolofthehrst.nrernationalHLHStudy1994 Kindlyprovinedoy1WStudyRefereflceCenrenSweden 4. Imashuku.S Advancesinthe managementofhemophugocyticIyrnphoEistiocylcsiuInternationalJourna ofHematslog 2000:70:1-11 5 Fsman DN.HemophagocytcsyndromesandinfectionEmergingInfectiousDiseases.2000:6:60’-8. MEDICAL/ DENTAL/HEALTHCARERELATED 6 Jarka G. ImashukuS. EhnderG. et al lnfectsnann malignancyassociatedhemophagocyticsyndromes: secondaryhemophagocyvc — OFFICESPACESAVAILABLEin Kalihi,Excellent ymphohIsfiocytosis.Hematology:OncologyClinicsofNorthAmerica.1998:12:435-444. locationnextto banks and at the corner 7. HenterJ. Samuelsson-HorneA.MaunzioA.et aLTreatmentofhemophagocyticlymphohistiocytosiswithHLH-94protocolimmunoche restaurants motherapyandbonemarrowtransplantation.Blood2002.100:2367-2373. of NorthKingand GulickinCentralHonoluluMedical 8 Ishi:E.KimuraN.KatoKet al.Clonalchangesoforfiltrating[-cellsinchildrenwithfamilialhemophagocyticlymphohistiocytosis:Possible ClinicBuildingwithair conditioning,free parkingfor associationwithEBVinfection. Cancer.1999:85:1636-1643. patientsandcustomers(41totalstalls),nexttomainbus line,competativerates,andmanypatientslfinterested, please contactJan Kimat 441-0521or 942-7100. SHEP, /rom p. 270 References & 1 SchoolHealthEducationProgram.JohnA.BurnsSchoolofMedicine.OfticeofMedicalEducation.12004i.htto::www.hawaBedu!omelshep; Office Space Support Services AccessedJune 15,2004. 2 Departmentof Education,Officeofaccountabilityand SchoolInstructionalSupportiSchoolRenewalGroup:HealthContentStandard,

l1999I.http: doe.kt2.hius!standardshcou.health.odf.AccessedSeptember1 2003. ALAMOANABLDG.—PHYSICIANWANTEDtosharespace 3. TheHawaiiYouthRiskBehavo’Survey.1999.HawaiiDepartmentot Education AccessedSeptember1.2003. and supportservices. Interestin physicalrehab.preferred.We 4. JohnsonJA.SellewJFCampbeiiAE.AProgramUsingMedicalStudentstoTeachHighSchoolStudentsaboutAIDS.AcademicMedicine haveuniquetime-sharearrangementsstartingatonehalf-day 1988:63i71:522-30.AccessedOctober 3.2003. perweek.Runyourpracticewthnofixedoverhead.Contact 5 State st HawaiDepartn,entof Education20021.PresidentWilliamMcKinleyHighSchool:SchoolStatusand ImprovementReport. Dr.Speers.REHABILITATIONASSOCIATES.955-7244. hOp: arch.kl2.hi.us - AccessedSeptember1,2003. 6 Stateof HawaiiDepartmentofEducationl2002i. PresidentTheodoreRooseveltHighSchool:SchoolStatusand ImprovementReport.

htto:.arctl.k12.hi.us..- AccessedSeptember1.2003. 7 State of HawaiiDepartm.entof EducationI2002i NanakuliHighand IntermediateSchool:Schosi.Status and ImprovementReport.

hop www.arch,kl2hi.us’ . AccessedSeptember1.2003. 8 StateofHawaiiDepartmentofEducation120021.James B.CastleHighSchool.:SchoolStatusandImprovementReport.http::archjst2. hia. AccessedSeptember1.2003. 9 StateofHawaiiDepartmentofEducationl2002i.WaipahuHighSchool:SchoolStatusand ImprovementReport.hopo.arch4f.2.h.i.us AccessedSeptember1. 20.03. 10. StateofHawaiiDepartmentofEducationl2002i.GovernorWallaceRiderFarringtonHighSchool:SchoolStatusandImprovementReport http: arch.k12.hi.us/.AccessedSeptember1.2003.

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