Originally published in The Medical Post, VOLUME 38, NO. 16, April 23, 2002

School children tend to set the agenda when it comes to what health info they want

Despite numerous health advisory and information campaigns, inroads into curbing or modifying deleterious adolescent behaviours remain wanting. There are many reasons, including competition from television and movies, advertising, peer pressure, academic responsibilities, development of independent attitudes and rebelliousness, and their own social calendar

The messages and ideas we try to impart to them are lost in information overload. It is not that they don’t want access to accurate and practical health information—they certainly do. The problem is fitting it into their day.

If, as physicians, we are to influence adolescent health, it must start from the ground floor. We have to go to their schools and engage them in classroom discussions. In my nine years of classroom visits at Canterbury High School in Ottawa, I am consistently surprised by what the students want to know. Each class has its own focus and interests. This is yet another reason why single-message ad campaigns fail. They miss a great number of their intended audience.

Health information tends to be broadcast with a sense of urgency: “If the kids don’t hear this now we will have lost our chance.” Classroom visits of an hour per week throughout the school year will deliver all these health messages, but it will be the students who set the tempo and discussion topics. Ceding this control to them makes them responsible for their health concerns and respects their interests. They always listen to what is being said. Their questions are relevant. They also force us to evaluate our own biases.

The students’ questions vary by grade. Each class can have a different area of interest that can include health and fitness, diet, STDs, contraception, abortion, depression, eating disorders, musculoskeletal complaints, cancer, smoking and drug abuse among others. Obviously it requires more than one visit to cover these topics in any detail. It also requires a consistent presence in the school. Students talk to each other. They will know who you are and, if they like you, you will have a greater chance of success getting the message out.

In the course of one Grade 10 classroom visit, I was asked the following anonymously written questions (verbatim):

• Every woman in my family has been depressed at one point or another. My mother warns me about it. Is there anything I can do not to get it?
• What is the average penis size? What is the biggest? How long when erect? What is shrinkage?
• Is breathing helium bad for you and why?
• How can I gain weight? I eat at least twice what normal people eat and weight-gain shakes and still never gain an ounce. If I occasionally miss a meal I tend to lose a lot of weight.
• Why do some men go balder faster than others?
• Can you have an abortion when you are 16 without letting your parents know?
• Why do people shy away from people with disabilities or physical disadvantages or limits?
• I’ve heard smoking pot does not harm you because it is a natural drug and all that is harmful is the smoke. Is this true?
• What are the long-term effects of LSD?
• I keep telling my doctor I am depressed a lot but she just tells me it’s a phase. I don’t think it is. What should I do?
• My joints crack and snap (painfully) all the time. Is this something I should have looked at?
• Is there any proof steroids cause cancer?
• Why is it that the Olympic federation includes such things as Aspirin and cold or cough suppressants on their banned substances list?
• I get excessively angry and violent at times. When I feel this way I feel like hurting or destroying someone or something. Is there something wrong with me?
• What is the best diet to be on?
• What is worse, smoking cigarettes or grass? If cigarettes are so bad for you why are they legal?

If anything, these questions keep us on our toes. They are all answered in class. A common followup from the students is asking about the rationale for our drug laws given alcohol and cigarettes cause most of the morbidity and mortality compared to recreational drugs.

I think the millions spent on ad campaigns could be put to better use establishing permanent teams of physicians and nurses in all our high schools. School-based clinics complement classroom visits and provide a good followup for students who have expressed concerns through questions. A contract for trust grows and the students will seek us out for medical services. It is also one of the more enjoyable aspects of family medicine.