Improving Student Health Through Community Service

We take this kid who is one of the most violent kids in our school. He’s always getting into fights. And then you see him at this nursing home. There’s this patient who is paralyzed in one arm from a stroke. She can’t feed herself. And for three hours, this boy sits next to her and just feeds her. One spoon after another. And he looks straight into her eyes. You can see how much he loves her. It just about brings tears to your eyes. I mean, it really does. He needs more of that. And so do our other kids.

—Middle school teacher, on community service

When adolescents have an opportunity to contribute and to be depended on, they can transform their lives, reinvigorate their education, and touch the lives of many in their communities. And a new EDC study has shown that some community service projects may directly benefit teenagers’ health.

EDC’s Reach for Health Project has found that community service programs—when combined with curriculum—not only promote community values and good citizenship, they may also protect students from risky health behaviors during adolescence. When New York City middle school students’ three hours a week of community service was combined with health instruction, both their violent behavior and their high-risk sexual activity dropped significantly.

This study, according to Lydia O’Donnell, the project’s principal investigator, is the first to evaluate community service specifically in terms of its ability to reduce violence and foster healthy behaviors among economically disadvantaged inner-city youth. “Clearly, there may be additional potential benefits of service-learning, including improvements in academic achievement, emotional and social well-being, and civic pride and participation,” says O’Donnell.

O’Donnell’s research team, funded by the National Institute for Nursing Research and the National Institute for Child Health and Human Development, worked with two middle schools serving 68 classes of seventh and eighth graders, including the bilingual and special education classes. The students were divided into three groups: one received a health curriculum only, another participated in the combined curriculum-community service program, and the third served as controls.

“The health focus for middle grades and high school students is ideal,” said O’Donnell. At those age groups, she notes, “students are at a turning point in their development” and have a newfound ability to comprehend consequences of actions. Many are sexually active (23 percent at the beginning of the study) or involved in violent activities. Nearly half the students had threatened (47 percent) or engaged in (44 percent) a physical fight in the three months preceding the survey. Twenty-seven percent reported carrying a knife.

Classroom instruction was based on EDC’s Teenage Health Teaching Modules (THTM), one of the most widely used health curricula in the nation, and several other nationally recognized programs. The curriculum focused on three primary health risks faced by inner-city adolescents: drug and alcohol use, violence, and sexual behaviors that can result in HIV infection, other sexually transmitted diseases, and unintended pregnancy. The curriculum helps students obtain accurate information, identify misconceptions, recognize healthy and positive behaviors in themselves and their communities, recognize pressures that put them at risk, and identify actions they can take to protect their health. Within the violence unit, for example, students thought through safe responses to conflict and practiced methods to deal with anger, resolve conflicts, and avoid violent situations.

I like to see the smile on the kids’ faces when we walk in the door. They are always happy to see us come—and that makes me feel good. I like to make them laugh and feel happy.

—Seventh grader on his work in a child care center

For the service component, students worked in community nursing homes, health clinics, child care centers, and a senior citizen center. In these settings, students pursued activities related to social skills and behaviors, including reading to elders, assisting or observing health care practitioners, assisting with meals, and helping with exercise, recreation, and arts and crafts groups. Staff in the field sites served as mentors to the students, along with nurses and nursing students from Medgar Evers College, CUNY. Back in their health classes, students shared their experiences in debriefing sessions used to reinforce skills in decision making, communication, information seeking, health advocacy, and other areas.

The study found that in six months, rates of sexual activity increased by 8.2 percent among controls, compared with 3.4 and 4.4 percent increases among curriculum-only and community youth service participants. Among those students who had never had sex before the study, only 13 percent of the community youth service participants reported having had sex by follow-up, compared with 17.3 percent of curriculum-only students and 21.2 percent of control students. Students in the community service group were significantly less likely to report recent sexual intercourse at follow-up than youth in the control group. In the study on violence, eighth grade students who participated in the community service curriculum intervention reported significantly less violence, while there was no reported difference for seventh graders. The research team attributed this difference to the broader community youth service component for the eighth graders, which included more field placements and additional orientation lessons.

I learned so much in your class that I am ready for the real world. Your lessons in class really come in handy.

—Middle school student

The study also shed new light on two tangential questions: Do stand-alone violence prevention curricula work, and what are the effects of health instruction among special education students? No difference in violent behaviors emerged between the control group and the curriculum-only group. O’Donnell characterizes that finding as “disappointing,” especially given the soundness of the curriculum, the extensive community involvement, and the teacher training activities. The curriculum was used, however, in “less than ideal conditions,” she noted, mentioning teachers’ relative inexperience with the violence-related material and problems with classroom management. “Another noteworthy finding is that special education students appeared to experience benefits from the curriculum alone,” said O’Donnell. Although the findings are not “definitive,” the study suggests that including special education students in health instruction is both feasible and potentially effective in reducing sexual risks.

The elders benefit because they get to talk to people. Some of them are lonely. And they tell us some great stories. This one guy was telling me all about his experiences in World War II. I love going there and I know that they love us being there.

—Eighth grader

“One of the most important features of this project is that it was the community, not our research team, that developed and nurtured this program,” says O’Donnell. The community was “invested from the very beginning” and welcomed EDC’s contributions of program development, resources, and evaluation. Teachers, parents, and students were closely involved in curriculum development. Parents and teachers engaged in module-by-module review of the curricula. “The challenge for other communities who want to replicate this kind of project is to build that kind of community ownership if it hasn’t been there before,” says O’Donnell. “Programs that are based in and embraced by the community are the ones that are likely to last.” The Reach for Health project shows all signs of lasting, as it continues today with the strong commitment of Ron Attivissimo, principal of the middle school. “The program has grown stronger through the involvement of the grant, and the principal has been able to use the strong research results to demonstrate the program’s value,” notes O’Donnell.

To strengthen EDC’s work in the field, the Reach for Health project and the Kellogg Service-Learning Initiative have a number of built-in ties, including a shared research associate and consultants who serve on both projects. Future research questions engage both groups: How intensive must a community service program be to yield results? How closely must it be linked to the curriculum? Which age groups benefit most? Is community service effective because of the inherent benefits of being asked to do something meaningful and doing it well, or because of the mentoring relationships and bonds to social institutions, or because of something else?

Going to the day care center is also helpful. It has been a positive influence on me because before going there I wasn’t sure of what I wanted to be when I grow up, but now I am positive of what I want to be. My experience with the kids in the day care center has made me want to become a teacher.

—Community service participant

The study’s findings have been published:

• “Violence Prevention and Young Adolescents’ Participation in Community Youth Service,” Journal of Adolescent Health, 1999; 24:28–37.
• “The Effectiveness of the Reach for Health Community Youth Service Learning Program in Reducing Early and Unprotected Sex Among Urban Middle School Students,” American Journal of Public Health, 1999;89 (2):176–81.