A Public Health Summer Experience for High School Students

Abstract

Prior to the COVID-19 pandemic, many high school students were unaware of careers in public health—that there are many options available for those interested in improving health and preventing disease beyond being a doctor or a nurse. The Rutgers School of Public Health (R-SPH) developed PHocus (Public Health: Outbreaks, Communities, and Urban Studies) to introduce high school students to the interdisciplinary field of public health as well as to promote population and individual health. The PHocus Summer Experience was designed for high school students to explore population health and learn about the fundamentals of epidemiology, the breadth of topics addressed by public health, and public health careers. R-SPH hosted PHocus as 1-week sessions in Summer 2018 and 2019, available at both the School’s Piscataway, New Jersey, and Newark, New Jersey, locations. The Newark sessions targeted recruitment from high schools with underserved, minority, and/or economically disadvantaged students, and tuition for these students was supported through external funding. Across 2018 and 2019 PHocus Summer Experiences, 130 students participated, representing 63 high schools, in four 1-week sessions. The experience was rated very highly by participants; on a 4-point scale (1 = strongly disagree to 4 = strongly agree), the median score for the program being a worthwhile experience was 4.0. R-SPH faculty, staff, and students, as well as external stakeholders, eagerly volunteered to be part of the program, suggesting that this educational program can be reproduced at other schools and programs of public health.

Keywords

high school public health summer program evaluation

The Rutgers School of Public Health (R-SPH) has a long history of developing and conducting K–12th grade school- and community-based education/outreach programs dedicated to advancing public understanding of and interest in critical public health issues (University of Medicine and Dentistry of New Jersey-School of Public Health, 2008; former name of Rutgers School of Public Health). Faculty and staff have translated public health research into comprehensive curricular materials, professional development initiatives, and community outreach programs. The PHocus (Public Health: Outbreaks, Communities, and Urban Studies) Summer Experience for high school students is one of these initiatives.

PHocus was developed to address the general declining trend in the interest in both studying and pursuing careers in scientific subject areas among middle and high school students (George, 2006; Owen et al., 2008; Summers & Abd-El-Khalick, 2018). In addition, students in the United States need more proficiency in the areas of science, technology, engineering, and mathematics (STEM; National Center for Education Statistics, 2015; U.S. Department of Education, n.d.). In a recent international assessment of 15-year-olds, the United States ranked 37th in math literacy and 18th in science literacy (U.S. Department of Education, 2019).

There is limited reporting of the impact of public health–specific summer camps targeted toward high school students in the academic literature. However, there is evidence that precollege programs are effective in increasing student interest in STEM (Constan & Spicer, 2015). Since many areas of public health are considered to be STEM fields, public health education programs are a promising entry for students interested in pursuing STEM careers (de Brey et al., 2019). Self-report questionnaires from similar STEM summer programs have collectively revealed increased understanding and confidence in science concepts and increased knowledge of health-related careers; they have also identified that a significant portion of students planned or had begun a pursuit of a STEM or health-related major in college as a result of participation (Nicholas-Figueroa et al., 2017; Phelan et al., 2017; Salto et al., 2014).

Using health sciences as the context for learning STEM can promote positive science attitudes and authentic learning among students (Osborne & Collins, 2000; Osborne et al., 2003). Authentic learning, which can engage students and encourage learning, allows students to connect and meaningfully construct concepts and relationships that involve real-world issues, problems, and applications that are relevant to the learner (Hennessy & Murphy, 1999; Snape & Fox-Turnbull, 2013). Authentic learning is an educational experience that allows students to connect information they learn to the “real world,” outside of the classroom to their personal lives, and teaches students how to think like a member of a particular discipline, such as public health (Stein et al., 2004). In addition, using health sciences as the context for learning STEM can increase students’ awareness of and preparation in STEM careers (including those in the health professions) and equip students with the knowledge and skills to improve their own and their family’s health (now and in the future; Cordell et al., 2017; D’Agostino, 2019; Kaelin et al., 2008).

Purpose

The goal of the PHocus Summer Experience is to introduce high school students to the interdisciplinary field of public health, which includes STEM fields, such as biostatistics, environmental science, food science, behavioral science, and epidemiology (U.S. Immigrations and Customs Enforcement, 2016), while enabling students to see the relevancy and connection of public health issues to their personal health (authentic learning). Holden et al. (2014) noted that high school students do not start to think about their careers until the end of high school and that health professions, such as public health, may not be the most popular professions that high school students want to pursue due to their own lack of experience with or lack of knowledge about possible health professions. The intention behind PHocus rests on this finding by Holden et al. and the hypothesis that by increasing awareness about what public health is and what public health professionals can do, high school students may be more motivated to pursue public health careers. During PHocus, students will be able to do the following:

Enhance their science literacy and health literacy skills

Interact with public health professionals, including researchers and practitioners

Be exposed to a wide variety of public health careers

Learn how to take action to improve their own health.

Two 1-week sessions were offered in both Summer 2018 and Summer 2019 (one session in the R-SPH Piscataway, New Jersey, location, and one in the R-SPH Newark, New Jersey, location for each summer). High school students attended one of the 1-week sessions. A similar agenda was used for both locations, with slight variations owing to availability of staff and distance to the scheduled field trip locations. Students participated in a variety of experiences, such as an outbreak simulation, hands-on population health and community disease activities, laboratory sessions, and conversations with public health professionals. They even recorded elements of their own behavior (daily step counts, hours slept, and caffeinated beverages consumed). Each day focused on different aspects of public health, including the following:

Day 1: Building an understanding of public health as a discipline and epidemiology as the basic science of public health

Day 2: Exploring urban and global health, including environmental health issues and a Global Health Fair

Day 3: Examining issues related to food systems and nutrition, including a half-day visit to a community/urban garden

Day 4: Exploring public health career diversity (Career Speed Dating) and major modifiable public health issues (global climate change, tobacco control)

Day 5: Exploring public health issues, particularly relevant to adolescents (alcohol use, vaping, sleep hygiene, and skin cancer prevention), and completing a biostatistical exploratory data analysis methods and design of experiment project

A graphical display of the week-long session appears in Figure 1.

Figure 1.

PHocus daily activities.

To our knowledge, PHocus represents the first reported summer experience program that introduces students to a broad range of topics across public health and offers an extensive opportunity to interact with diverse public health professionals. Professionals who participated in the program included public health researchers, educators, and practitioners from a wide variety of public health fields. Epidemiologists, environmental scientists, public health nutritionists, behavioral scientists, health educators/communicators, and global and local public health practitioners actively participated.

Methods

The program addressed the best practices for summer high school programs outlined below. These best practices are based on the authors’ experiences in developing and conducting educational programs for K–12th grade students, guidance provided to effectively integrate epidemiological and related concepts into high school instruction (D’Agostino, 2018; Kaelin & Huebner, 2003; Stroup & Thacker, 2007), and the consistently reported finding that hands-on experiences (active learning) and real-world application of concepts were highlights for STEM summer program participants (Kitchen et al., 2018; Nicholas-Figueroa et al., 2017; Salto et al., 2014). The best practices outlined are also rooted in authentic learning as activities were designed to teach the students the knowledge, skills, and abilities important to public health and to be personally relevant to students.

Integrate Actual Public Health Practice Experiences and Examples Into Classroom Discussions and Exercises

Students explored what public health is, examining John Snow and the cholera outbreak in 1850s London, to gain an introduction to epidemiology (National Geographic, n.d.). Students conducted an investigation to learn how diseases are spread (WGBH Educational Foundation, 2006). The 2018 influenza pandemic (for the 2018 cohort) and the 2019 measles outbreak (for the 2019 cohort) were used as the platform for learning about diseases that are spread from person to person and how diseases can spread exponentially. Students learned about how the introduction of a vaccine to a previously unvaccinated community could stem the spread of the infectious diseases through an outbreak simulation.

Highlight Models of Collaborative, Comprehensive, and Community-Based Public Health Practice and Scholarship

PHocus included an urban public health panel and a global health fair. The urban public health panel included representatives from various community agencies that provide public health programs and services in urban settings. Planned Parenthood, the African American Office of Gay Concerns, the American Lung Association, and Upward Bound are examples of participating community agencies. These agencies shared information about how they address public health issues and concerns through partnerships. The Global Health Fair highlighted professionals who conduct research/programs in diverse parts of the world. Professionals focused on the collaborative and community-based nature of public health practice.

Emphasize the Application of Public Health Principles and Science-Based Decision Making

All of the PHocus activities were based on public health principles and science-based research. For each of the topics presented, a researcher presented current information related to the topic, and then students participated in one or more follow-up hands-on activities, interactive games, or discussions. Group discussions took place daily, which enabled students to share knowledge, recap previous material that had been covered, and make connections between topics previously presented. As an example, when the section on alcohol education was presented, students first discussed their perceptions around alcohol use—reasons for alcohol use in general, positive/negative impacts of alcohol use, and perceived rates of alcohol use among adolescents. Then, an alcohol researcher presented current research on alcohol use among adolescents, and students participated in a hands-on activity using alcohol impairment goggles (drunkbusters.com), which enable the user to be in the same situation as somebody in a state of inebriation. To conclude the activity, students revisited their original perceptions of alcohol use and any questions they had were addressed.

Focus on Skills Development

Students regularly participated in team-building exercises and activities, not only to build their own skills but also to emphasize the interdisciplinary nature of public health and the necessity of effective teamwork to solve today’s public health challenges. For example, students participated in the Marshmallow Challenge, a team-building activity that fosters team communication (TED, 2010).

Involve Community Sector Partners in Teaching

Both sessions included visits to area farms to learn about public health nutrition. Students in the Piscataway session visited the Rutgers Gardens to learn where foods come from, the medicinal attributes of herbs, and the psychological impact of the environment. Students in the Newark session visited an urban farm (SWAG Project) to learn about Newark’s South Ward community food system and help harvest produce that would be delivered to a market (see Figure 2). [The 2019 Newark cohort did not visit the SWAG urban farm due to weather conditions.] PHocus sessions also included a Career Speed Dating event. Several public health professionals from diverse sectors candidly talked about their personal career choices, education, and daily work life, as well as answered student questions during the session. Small groups of students (typically between one and three students) met with each professional for a 4- to 7-minute period before rotating to the next professional’s table.

Figure 2.

PHocus students harvesting produce at the Newark SWAG Project Urban Farm, Newark, New Jersey, summer 2018.

Use Case Studies and Other Examples of Interdisciplinary Projects Suitable for a Multidisciplinary Audience

The sleep hygiene lesson was designed as an interdisciplinary project as well as a STEM and authentic learning activity. In preparation for the lesson on Friday, students kept a sleep log for Sunday through Thursday during the PHocus week that they attended. A researcher who examines the link between diseases and disruptions to the circadian rhythms presented on the importance of sleep and biological mechanisms to health. Students reviewed a peer-reviewed epidemiological journal article (Wahlstrom et al., 2017) on sleep and compared it with a lay news article on the subject (Hoffman, 2014). Finally, students reviewed their aggregated sleep data and used a biostatistical data display, a stem and leaf diagram, to begin to test a hypothesis about their own sleep patterns and compare their sleep patterns with students nationwide as part of a critical review of a study of optimal school start times.

Outcomes

Across 2018 and 2019 PHocus Summer Experiences, 130 students participated, representing 63 high schools, in four 1-week sessions (see Table 1 for participant demographics).

Table 1.

PHocus Student Participant Demographics, Reported by Program Location and Year of Participation.

Demographic characteristic	Piscataway 2018 (N = 35)	Newark 2018 (N = 31)	Piscataway 2019 (N = 37)	Newark 2019 (N = 27)
Gender
Male	29%	16%	30%	22%
Female	71%	61%	59%	70%
Undisclosed	0%	23%	11%	7%
Race^a
Black/African American	17%	34%	13%	33%
Asian	40%	13%	42%	30%
White	24%	16%	24%	19%
Undisclosed	19%	38%	21%	19%
Ethnicity
Hispanic/Latino	6%	10%	51%	59%
Non-Hispanic/Latino	60%	32%	14%	11%
Undisclosed	34%	58%	35%	30%
Grade (entering)
9	3%	6%	8%	4%
10	23%	19%	16%	26%
11	29%	29%	38%	30%
12	46%	45%	35%	37%
College freshman	0%	0%	3%	4%

For race, respondents were instructed to select all that applied.

A combination of techniques was used to assess PHocus, including daily evaluations and an overall evaluation. Program evaluation was approved by Rutgers University’s institutional review board. Daily evaluations included short assessments of what participants liked most and what they liked least related to the day’s activities. This allowed program developers to quickly make changes for the following program days to enhance the experience. Both daily and overall evaluations solicited comments and recommendations regarding the curricula, interactive team exercises, research presentations, and general recommendations to improve the program. Of particular interest was an assessment of participants’ ratings of various program aspects. Respondents applied a 4-point rating scale (1 = strongly disagree to 4 = strongly agree) to the variables listed in Table 2, which presents the proportions of students who “strongly agree” by program topic and PHocus as a whole. As shown in Table 2, more than half of all students in both cohorts who responded indicated they “strongly agreed” across each statement.

Table 2.

PHocus Participant Ratings of the PHocus Summer Experience on Select Variables Reported as Proportions by Program Location and Year of Participation (Rating Scale: 1 = Strongly Disagree; 2 = Disagree; 3 = Agree; 4 = Strongly Agree).

Assessment item—The PHocus summer experience . . .(Reported as the percentage of students who “strongly agree” with the statement)	Piscataway 2018 (N = 34)	Newark 2018 (N = 23)	Piscataway 2019 (N = 32)	Newark 2019 (N = 22)
Provided high-quality information and strategies	68%	61%	66%	64%
Was well-organized and used time effectively	79%	52%	69%	73%
Gave me sufficient opportunities to participate^a	82%	61%	81%	82%
Will be useful in my life	79%	61%	69%	64%
Provided me with a fun and positive experience	94%	52%	72%	91%
Was a worthwhile experience overall	82%	61%	88%	82%

For this question, N = 31 for the 2019 Piscataway session, due to the omission of a response from one Piscataway respondent.

Nearly 90% of participants in the Summer 2018 cohort and 96% of participants in the Summer 2019 cohort who responded felt that the program provided them with insight that will help them make future college plans and/or career goals. Both cohorts reported that they gained the most knowledge in the following areas: public health (overall), epidemiology, urban public health, and global public health. Overall, students indicated that the program increased their knowledge of public health concepts: “I came into this camp knowing little to nothing about public health, and now I know so much more than expected” (Newark, Summer 2018). A large portion of students in both cohorts indicated that they most enjoyed being able to interact with public health professionals. One student noted, “Being able to interact [with] so many professionals and experts in the field was an invaluable experience” (Newark, Summer 2019).

Other comments indicated that the program was informative in both content and guidance for future endeavors: “Professionals that talked to us gave me a real-life perspective on not only health/public health, but also for college” (Newark, Summer 2018), and “I learned a lot about what public health encompasses, and its importance in advocacy and the community. It will help me make future career choices” (Piscataway, Summer 2019). Many indicated that the program helped solidify their decision to pursue public health-related careers: “This has greatly helped confirm a possible career path for me” (Piscataway, Summer 2019), and “It confirmed that I want a career related to the health and lifestyle of people” (Piscataway, Summer 2018).

Despite the limitations of self-report evaluation, it has served to inform the authors of the program’s reception and improve the program based on feedback. In future PHocus programs, a pre- and postquestionnaire format may be used to assess for changes in knowledge and behavior intention. The authors intend to conduct a self-report follow-up evaluation of both the 2018 and the 2019 cohorts to learn about participants’ current major in college and/or job title.

Lessons Learned

We summarize the lessons learned from implementing PHocus with two cohorts of high school students across two summers. Both qualitative and quantitative evaluations illustrate the value and appreciation of incorporating public health professionals, active and authentic learning activities, and current, relevant, and age-appropriate research and information.

While the program was codirected by two of the authors who have extensive experience teaching many levels of students with assistance from a graduate-level student assistant, the program benefited greatly from the participation of approximately 23 to 31 public health professionals within and outside of the School of Public Health. However, the professionals who were more successful in connecting with the high school students were ones who approached their participation with the high school student in mind, rather than relying on the standard “lecture” format using a slide presentation (i.e., teaching college students using a PowerPoint presentation). During PHocus, the codirectors prepped professional participants a few weeks before and then again immediately before their participation, primarily via email. Future PHocus programs should include preparation of professional participants using a short video tutorial as well as discussions during remote/in-person meetings, rather than depending solely on email. In addition, professional participants should continue to be encouraged to use slide presentations as a visual/infographic tool, rather than using slide presentations to cover detailed content.

We designed PHocus lessons using active learning and authentic learning principles (Hennessy & Murphy, 1999; Snape & Fox-Turnbull, 2013). All students could participate in the lessons and activities, as a strong science background was not required to complete them. During the 2018 PHocus Summer Experience, we quickly modified lessons and activities during the first session as it became evident that the previously designed short lessons (20–30 minutes each) needed to be chunked even further to enable the program to feel less like “school.” Lessons were then adapted to be delivered in approximately 12- to 18-minute segments, with a hands-on activity, games that were physically active, or a related team-building activity in between the segments. The additional short team-building activities enabled students to make more connections between fellow student participants and to reflect on how the information gained related to their own lives and personal health. In future programs, we will continue to use several hands-on and interactive activities and games (including those that are physically active), student-led discussions, and short appealing videos.

Student participants consistently cited the diverse public health research and general health information as instrumental to them gaining more knowledge to impact their own health. We selected topics and designed lessons that were current, relevant, and age appropriate. For example, during the 2018 PHocus Summer Experience, students learned about outbreaks using the 1918 influenza epidemic, which illustrated the devastating impact of a pandemic and the potential for novel viruses in present times, and then reviewed the latest data about recent influenza outbreaks at the time, and during the 2019 PHocus Summer Experience, we incorporated the 2019 measles outbreak. Future sessions should continue to follow this approach, incorporating lessons from the COVID-19 pandemic as well as other current health topics. The COVID-19 pandemic provides the opportunity to add impactful activities related to social distancing, contact tracing, vaccination, and the impact of social determinants of health on communities.

The outcomes and lessons learned of the PHocus Summer Experience demonstrate the merits of the program that could be reproduced at other schools and programs of public health or organizations focused on broad public health issues or services.

The PHocus Summer Experience was partially funded by the dean’s office of the R-SPH. A small registration fee that covered the cost for a student assistant, supplies, and breakfast and lunch for participants was charged to student participants. Corporate sponsorship helped pay the tuition cost for student participants with financial need. The participating faculty and public health practitioners volunteered their time.

Supplemental Material

sj-docx-1-php-10.1177_23733799211017561 – Supplemental material for A Public Health Summer Experience for High School Students

Supplemental material, sj-docx-1-php-10.1177_23733799211017561 for A Public Health Summer Experience for High School Students by Laura E. Liang, Alexandra Zivkovic and Marian R. Passannante in Pedagogy in Health Promotion

Supplemental Material

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Supplemental material, sj-jpg-2-php-10.1177_23733799211017561 for A Public Health Summer Experience for High School Students by Laura E. Liang, Alexandra Zivkovic and Marian R. Passannante in Pedagogy in Health Promotion

Footnotes

Acknowledgements

The authors acknowledge the Dean at the Rutgers School of Public Health, Dr. Perry N. Halkitis, who was especially supportive of planning and implementing the PHocus Summer Experience. The authors also thank Alexa Hendrickson, the student assistant from the 2018 sessions and the multitude of students, staff, and faculty at the Rutgers School of Public Health and Rutgers University as a whole, and the external public health professionals and practitioners, for their invaluable participation in the program.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The PHocus Summer Experience was supported in part by GSK (2018 and 2019) and The Nicholson Foundation (2019).

ORCID iD

Laura E. Liang

Supplemental Material

Supplemental material for this article is available online at .

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