1. Tell students that their preliminary training as behavioral scientists is complete. Ask them to tell you the key concepts of their work from Lessons 1, 2, and 3.

Write student responses on the board. The list should include the following:

• a definition of behavior,
• scientists have tools they can use when they study behavior,
• some behavior has health-related outcomes, and
• various factors influence behavior.

This review should be done quickly.

Assessment:
Step 1 will stimulate thinking about the topic and give you an opportunity to assess informally students’ understanding of key concepts from Lessons 1, 2, and 3.


Content Standard F:
Individuals can use a systematic approach to thinking critically about risks and benefits.

2. Tell the class that they are ready to put their training to the test. In a clinical (that is, health-related) setting, they will use the knowledge gained by behavioral and social scientists to investigate behaviors that may have influenced the health of a person who has been admitted to the hospital for heart problems.

3. Organize students into teams of three or four and distribute one copy of Master 4.1, The First Memo, to each team. Tell students to read the memo. Alternatively, show the transparency of the memo and read it with the class.

The memo sets up the scenario. Student teams play behavioral-health-team members at a hospital. The students’ task is to evaluate the behaviors of a fictitious patient and determine which behaviors may have been factors in the patient’s heart disease. In Activity 2, students will make recommendations to the hospital’s behavioral sciences review board for changes in specific behaviors that should decrease the patient’s risk of continued health problems.

4. Explain to students that their first task is to identify factors that may have contributed to the patient’s heart disease.

They will have access to a reference manual (see Step 6) and a patient file (see Step 8).

5. Direct the teams to their computer stations and ask them to wait for instructions.

Computers should be at the URL http://science.education.nih.gov/supplements/healthy/student. This is a main menu page that contains a link for this activity.

6. Students should then click on the link to Lesson 4—The Healthcare Setting, Activity 1—What’s the Problem?

Students view a short animation, in which they enter County Hospital and are given a file labeled “Joe M.” As the animation sequence ends, students see the reference manual’s Table of Contents overlaying the information contained within Joe M.’s file.

7. Before students begin their work, point out the topics covered in the manual. Emphasize that the manual contains valuable information that students need to complete their tasks.

The reference manual contains the information students need to complete this activity. It provides a definition of heart disease and brief discussions of the risk factors for heart disease that are relevant to this lesson.

Tip from the field test: Reviewing the reference manual with students at this time is important; otherwise, they may not consult it and will have difficulty completing the activity satisfactorily.

8. Ask students to close the reference manual for now (they may open it again at any time as they review the information in Joe’s file). Point out the information students must review to complete their tasks.

Information accessed on this page sets the stage for the students’ work. Students see links to the following:

• patient information, including a statement of the patient’s health problem,
• medical history,
• family medical history, and
• behavioral history.

Content Standard F:
Regular exercise is important to the maintenance and improvement of health.

9. Ask students to click on the link to “Patient Information.”

Information on the Patient Information page introduces students to Joe M.

10. Give each student one copy of Master 4.2, Behavioral Sciences Evaluation Form, Page 1, and tell students to proceed with their evaluation.

Student teams should begin by determining which factors may have contributed to the patient’s heart disease. They can do this by evaluating the information on the Medical History, Family Medical History, and Behavioral History pages. Students can view this information in any order they want. Allow students 20 to 30 minutes to complete this part of the activity. Students should consult the reference manual for help with their evaluation. For example, if they read in the patient’s chart that he is overweight, they may check the manual to see whether being overweight is a risk factor for heart disease. Students will make recommendations for behavioral changes in Activity 2.

Assessment:
Collect and review Master 4.2, Behavioral Sciences Evaluation Form, Page 1, from each student. Students will need the information on Master 4.2, Page 1, to complete Activity 2.

Students can identify the following risk factors as those the patient may not be able to modify:

• family history of heart disease (genetics) and
• the high blood cholesterol if it is due to genetics and not the patient’s diet.

Students can identify the following risk factors as those the patient may be able to modify by changing behaviors:

• smoking,
• physical activity,
• nutrition,
• weight control, and
• stress.

Note that while an individual cannot modify the genes they inherit from their parents, one can modify an inherited health risk, such as heart disease, by modifying behaviors. This should become clear as students consider a behavioral modification program for Joe M.

1. Reconvene the class while students are at their computer stations. Ask students to share with the class some risk factors for heart disease that they believe the patient cannot modify.

Write responses on the board.

Note to teachers: Steps 1 to 3 should be done quickly, even though there are opportunities for longer discussions.

2. Ask students to share with the class some risk factors for heart disease that they believe the patient can modify.

Write responses on the board.

3. Ask students if they believe it is possible for people to change their behaviors.

Students may respond with more than yes or no. They may qualify answers and respond, for example, that people can change their behaviors, but it is not easy to do. Listen to what students have to say and make notes on the board, if necessary. In Lesson 5, students will deal with the results of Joe M.’s attempts to modify his behaviors.

4. Give one copy of Master 4.5, The Second Memo, to each team. Tell students to read the memo. Alternatively, show a transparency of the memo and read it with the class.

The memo asks the students to prepare a behavioral intervention, or a plan outlining behavioral changes, for Joe M. to help decrease his risk for continued heart disease.

5. Have students proceed to the URL http://science.education.nih.gov/supplements/healthy/student and click on the link to Lesson 4—The Healthcare Setting, Activity 2—Changing Behaviors.

Clicking on this link brings up information about Joe M.’s environment. For example, there are maps detailing the locations of Joe’s house, Joe’s office, restaurants, and places where Joe can exercise and catch the bus (see “Overhead View” map). The general environment around Joe’s house is depicted. Bus schedules and local restaurant menus are available by clicking on the appropriate links.

6. Give each student a copy of Master 4.2, Behavioral Sciences Evaluation Form, Page 2. Assign students the following tasks:

• review the behavioral risk factors for heart disease that Joe M. may be able to modify;
• decide how Joe M. should change specific behaviors in general (that is, do more or less of something);
• consult the information on the Web about Joe M.’s environment; and
• on the prescription form (Master 4.2, page 2), make specific recommendations for behavioral changes to lower Joe’s risk of further complications from heart disease.

Content Standard C:
Disease is a breakdown in structures or functions of an organism.


Assessment:
Collect each student’s completed copy of Master 4.2 to formally assess understanding of the major concepts of this lesson.

Move among groups as students complete this activity and ensure that recommendations are specific. For example, recommending that Joe stop smoking is specific. However, recommending that Joe increase his physical activity is not specific. Information is provided for students to evaluate a number of very specific ways for Joe to increase his physical activity, including walking to work, taking the bus to work (this would involve walking to and from bus stops), and taking the stairs to his office instead of the elevator. Many other recommendations can be made as well from the information provided. If necessary, students can consult the information in Joe’s patient file.

Note to teachers: Students may be unsure of what to do with the information provided in the restaurant menus, since it is beyond the scope of this unit to provide detailed information about human nutrition and the nutritional content of foods. However, it is sufficient at this time that students recognize that some diets are more healthful than others. For example, if students indicate that Joe should eat at Souvlaki Shack rather than Quick Burger, ask them, “Why?” If students respond that the food at Souvlaki Shack is better for Joe than eating a cheeseburger, accept that response as an indication that students are thinking about differences among foods and relationships between diet and health.

7. Reconvene the class. Ask groups to share their recommendations for changes to Joe’s behavior. Write responses on the transparency of Master 4.6, Prescription Pad.

Encourage discussion and have students question the recommendations of their classmates. Ensure that students provide reasons to back up their recommendations.