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Significant findings of the Massachusetts High School study and their implications for health education programs.

Miss Latimer has reported (in this issue of the Journal) on the health education activities of Massachusetts high schools and Mr. Southworth has reported (December issue of the Journal) the procedures in the detailed study of twenty-seven selected high schools. This paper summarizes the findings of the study with respect to physical status and with respect to the testing of health practices, interests, knowledge and attitudes among high school students.

Through the cooperation of school health services, we set out to learn what physical defects were present among high school students and to what extent each defect existed. Our study revealed the fact that it is impossible to determine the health status of high school students in Massachusetts from the medical data recorded in the schools. The variation in the percentages of defective pupils found in different schools is greater than could conceivably take place if the same standards of defectiveness were used throughout the State.

The following figures give the minimum and maximum percentages of certain defects found in separate schools. The pupil populations from which these figures were taken was fifty in the smallest school, and varied from that figure to six hundred in some of the larger schools. The comparative percentages of pupils showing each defect, as shown in the accompanying graph, are: postural defects 1.1 to 80.0, tooth defects from 5 to 79, defects of vision from .9 to 36, defects of feet from .8 to 30, glandular defects from .6 to 47, throat defects from .6 to 47, skin defects from .5 to 20, nasal defects from .3 to 17, defective heating from .6 to .8, heart defects from .3 to 9, defects of the lungs from .3 to 1.6, defects of the scalp from .5 to 2.3, diseases of the ear from .5 to 4, diseases of the eye .5 to 1.7.

It is not only clear that the figures from individual towns are meaningless; it is also true that average figures showing defectiveness in the State are meaningless. It is impossible to provide the people of our towns and cities or the people of our State with meaningful figures of the physical defectiveness of high school pupils. We must expect variability of individual judgment but we must, as public health administrators, recognize the responsibility of making school medical examinations more nearly comparable than they are at present. There is no evidence to suggest that the condition found in Massachusetts is different from the condition in other states of the Union.

To what extent are defects being corrected at the high school level? Comparisons of the incidence of physical defects give no indication of a reduction of defectiveness in the succeeding years of the high school. These figures are comparable since the different classes in the same schools are examined by the same medical adviser. It would appear that although some defects may be corrected, corrections are not being made more rapidly than new defects appear.

One function of the health examination is to give pupils an awareness of their health status. We were interested to determine the degree to which pupils are informed on these matters. We asked pupils to record for us on a check list, without using their names, which defects they had. By means of a key numbering system we then compared the defectiveness as recorded on his health card with the pupil's awareness of his defects.

Checking the pupil's report against the defects recorded on his card, we found that pupils were aware of about half (54%) of the defects recorded. They also told us which defects had been or were being corrected. The defects under correction amounted to 60% of those known to the pupils or 30% of those recorded on the health cards. Data for individual items are to be seen in Table I.

That pupils need more information concerning the results of the examination is shown by the fact that only half of their defects are known to them. We have also an indication of pupil desire for more information in regard to defectiveness. When we asked pupils to write down questions in health which they would like to have answered, a large number of the questions submitted were those concerning personal health status, which could be best answered by the physician.

In the third part of the study, which Mr. Southworth (Journal of School Health, December 1942, p. 311) has described to you, we gave objective tests in the field of health habits, health knowledge and health attitudes, and we secured data concerning the intelligence quotient of pupils as recorded by the school. We were interested in studying these tests for differences at the different high school grade levels, and for differences between different kinds of communities. We were also interested in studying the relationships between these different kinds of tests in terms of correlations.

In so far as our test was an accurate reflection of health practices, it would appear that the quality of health practices remains constant throughout the high school period with no improvement from grade to grade. No difference is reflected in the quality of health habits of high school students in different types of communities (industrial, rural, or residential). Girls have a consistently better rating than boys. The average score for boys in all grades and in all communities was in the neighborhood of 53 and the average score for girls in all grades and in all communities was in the neighborhood of 60. The detailed data and the range of grades are given in Table II.

The averages for boys and girls in the health knowledge quiz are alike; and again there are no differences in different types of communities. There is a slight improvement from grade to grade, the average score in grade ten being approximately 70.7, that in grade eleven being 73.4, and in grade twelve 74.8.

In the attitude quizzes, again there is little difference between the scores in different types of communities. The average for boys in rural communities are consistently a point or so above those of any other type of community, but this is not necessarily a significant difference. The average scores in the attitude quizzes rise only slightly from grade to grade, being approximately 73.4 for grade ten, 74.2 for grade eleven, and 75.2 for grade twelve.

We have computed 83 correlations between the habit tests, the knowledge tests, the attitude tests, and the intelligence quotients, with pupil groups varying in size from 100 to 452. Thirty-six of these correlations for boys and for girls separately by grades for the industrial-rural communities are shown in Table III. Those for the other groups and types of communities are similar in range and magnitude.

Regarding as significant any coefficient of correlation which was greater than 2/[square root of (n-1)], the following results may be said to be reflected from the correlations.

There is apparently no correlation between the scores of the health habit quiz and intelligence quotient, all of the coefficients being near zero and several of them being negative. There is no significant correlation between the scores of the health habit quiz and the scores of the health knowledge tests. Only one-third of the correlations are greater than 2/[square root of (n-1)], and they are only slightly greater.

It should be borne in mind that the health habit quiz is a report from the child on whether or not he does certain specific things and that the report is made anonymously. It may be regarded as a reasonable reflection of his health practices. If so, it is clear that the more intelligent children do not as a group have better health practices than the less intelligent. Nor is there a significant relationship between how much children know about health, as reflected by the health knowledge test, and their practices, although the statistician might contend that there is more of an indication of a possible relationship than in the case of the intelligence quotient.

Some of the health knowledge questions had nothing to do with health practices. If all of the questions had been that type, of course, no relationship would have been expected. But, in general, there seems little relationship between health knowledge and health habits as reflected in such tests. There is need for studies which will, with proper educational technique compare actual health practices with the knowledge of pupils in relation to these practices. We may get some data on this point by comparing the item analysis of the two tests.

The highest correlations are those between health knowledge and intelligence quotients. Here the coefficient of correlation is in the neighborhood of .49. These coefficients are interesting for comparison with the correlations between general intelligence and objective tests in other subjects of instruction. It is as high as that for other high school subjects but lower than those for certain subjects taken earlier. In "The Student and His Knowledge," a report to the Carnegie Foundation on the results of high school and college examinations of 1928, 1930 and 1932, Learned and Wood report correlations between scores in intelligence tests and scores in achievement tests as follows: with English .59, civics .53, algebra .52, French .48, general science .47, American history .47, Physics .45, Latin .42, European history .42, plane geometry .42, biology .42, Chemistry .38, trigonometry .36. These studies used the Otis test. They were made in Pennsylvania.

In looking for correlations between the scores on the attitude quiz and those on habits, knowledge and general intelligence, we find the highest correlation between knowledge and attitudes where the correlations are mostly in the range of .3 to .4.

The correlations between attitudes and intelligence quotient are lower and more variable, although all but one out of 21 are significant. The significant coefficients of correlation lie between .17 and .42, the average being .22. The coefficients between habit scores and attitude scores are still lower, being in the neighborhood of .18 and near the limit of reliability.

It would appear, therefore, that both health knowledge and general intelligence have a significant effect upon health attitudes as reflected in this test and that the relationships in both of these instances are stronger than the relationship between health habits and health attitudes. In other words, this attitude test seems to be influenced more by what pupils know than by what they do.

It should not be concluded from the absence of significant correlations between the habit test and the knowledge test that the teaching of health facts cannot affect behavior. Some phases of health knowledge in such areas as structure, function and sanitation do not affect personal habits, although they represent desirable information for any intelligent person. Moreover, we have long recognized that the imparting of information and the development of human behavior may be quite separate and distinct, in the fields of religion, civic integrity, the psychology of human relationships and other phases of behavior, as well as in health. The school and the home have responsibility for developing both sound behavior and intelligence with respect to health, and they should recognize that each can be developed separately to a considerable degree, that they can both be better, developed through the dual approach, but that neither health knowledge nor health habits should be expected to produce the other.

Studies are being made of the interests reported by pupils, who checked items that they would like to know more about, and who in addition made a list of questions of their own that they would like to have answered. The analysis of these data is not completed, Certain facts, however are already apparent. For one thing many pupils want the kind of information which they could best secure from the school physician or the family physician. In the second place, it is interesting to note that many pupils said they desired information in the field of social hygiene, although no reference whatever was made to sex hygiene or the venereal diseases in any of the objective tests or in any other activity connected with this study. We shall eventually secure a quantitative statement of amount and areas of interest reflected by pupils.


1. The present system of school health examination lacks an objective basis -- there is little uniformity in Massachusetts high schools in what shall be called a physical defect, and as to which physical defects shall be included in the high school health examination.

2. There is need for revamping the procedures used in the high school health examination and follow-up to meet the needs of high school pupils.

3. There is need for improving the health education aspects of the school health examination -- pupils who have defects found by school health examination have not been adequately helped to understand the significance of such findings.

4. There is need for medical counseling or guidance in the high school.

5. The types of testing procedure used in this study were found by the high schools to be very stimulating. The schools and the pupils are anxious to know their scores. Pupils are interested in discussing the results of the tests and many of the items included in the tests. This suggests that the use of tests of this kind by high schools may well be recommended.

6. Further study would seem worthwhile to show the relationship between specific health practices and pupil knowledge of their desirability.

7. The already recognized separation between health knowledge and health practices is clearly demonstrated in this study. This argues for a decision on one hand as to what our future citizens ought to know and on the other hand the need for a carefully planned program for training in healthful living.

8. It would appear that attitude tests of the type used here reflect the pupil's health knowledge to a greater extent than they indicate the pupil's health practices.

9. The health knowledge of pupils as reflected by the type of health knowledge test used here is as highly correlated with intelligence quotient as are achievement tests in the fields of biology, plane geometry, European History, Latin or Physics.

10. These tests reflect an absence of linear correlation between general intelligence and health practices among high school pupils.
Table 1

High School Pupils Awareness of Physical Defects
Recorded on Their Record Cards and the Number of Defects Receiving

       Grades 10, 11, and 12 - Boys and Girls

Areas              Number    Recorded      Percent
of Defects       of Pupils   Defects    with Defects

Teeth              1,579        312          20%
Posture            1,212         92           8%
Sight              1,632        209          13%
Feet               1,082         15         1.4%
Glands             1,017         36            4
Throat             1,565        113            7
Skin               1,140         57            5
Nose               1,010         62           6%
Hearing            1,217         65           5%
Heart              1,372         35           3%
Lungs                465          4         0.9%
Scalp                 44          1           2%
Ear (diseases)     1,036         15         1.4%
Eye (diseases)       367          4         1.1%

Total                         1,020

Areas            Pupils   Attention
of Defects        Aware   to Defects

Grades 10, 11, and 12 - Boys and Girls

Teeth              268        161
Posture             20          5
Sight              143        110
Feet                 5          4
Glands               7          0
Throat              39         15
Skin                17         11
Nose                10          5
Hearing             30         15
Heart                6          4
Lungs                1          0
Scalp                0          0
Ear (diseases)       2          0
Eye (diseases)       0          0

Total              548        330
Table 2

Results of Testing a Sample of 9,000 Massachusetts High School Boys
and Girls with Three Health Quizzes

Grade 10                           Boys

                       Number      Average   Range
   Test        Group   of Pupils   Grade     of Grades

   Health      A       310         53.00     20-89
   Habits      B       159         53.08     23-87
               C       241         53.35     21-88
               AB      346         53.54     22-96
               AC      432         54.15     16-90

   Health      A       310         69.00     36-88
   Knowledge   B       163         71.45     44-93
               C       243         70.60     45-89
               AB      347         70.80     44-91
               AC      435         70.70     37-91

   Health      A       297         69.60     24-89
   Attitudes   B       143         73.10     37-90
               C       220         70.20     41-89
               AB      324         72.25     40-91
               AC      409         71.00     30-90

Grade 11                           Boys

   Health      A       352         54.25     26-91
   Habits      B       128         53.30     26-87
               C       236         52.28     18-91
               AB      281         51.90     21-89
               AC      387         53.46     24-92

   Health      A       353         73.00     41-95
   Knowledge   B       130         73.00     45-93
               C       241         73.20     44-89
               AB      282         73.10     53-92
               AC      385         74.65     40-94

   Health      A       330         73.50     22-90
   Attitudes   B       120         75.25     52-88
               C       214         73.60     38-90
               AB      267         73.20     42-91
               AC      367         73.50     46-92

Grade 12                           Boys

   Health      A       329         54.25     26-92
   Habits      B       116         54.15     17-94
               C       226         51.64     18-94
               AB      257         52.72     23-90
               AC      384         53.84     25-94

   Health      A       329         74.95     46-93
   Knowledge   B       116         76.95     58-92
               C       232         74.20     46-94
               AB      257         73.03     53-95
               AC      389         76.40     46-94

   Health      A       295         73.15     25-93
   Attitudes   B       101         76.15     55-90
               C       203         73.75     41-93
               AB      244         74.90     51-91
               AC      374         74.00     24-91

Grade 10                           Girls

                       Number      Average   Range
   Test        Group   of Pupils   Grade     of Grades

   Health      A       400         60.05     24-87
   Habits      B       162         60.05     32-90
               C       293         61.76     28-86
               AB      387         60.95     30-94
               AC      558         60.46     81-93

   Health      A       397         69.70     44-92
   Knowledge   B       165         70.60     41-92
               C       295         71.10     47-91
               AB      388         70.90     46-97
               AC      564         71.25     37-91

   Health      A       364         70.10     32-89
   Attitudes   B       157         74.10     46-89
               C       279         74.00     38-91
               AB      376         73.00     45-91
               AC      540         73.00     33-94

Grade 11                           Girls

   Health      A       391         61.25     27-92
   Habits      B       181         60.50     28-89
               C       266         60.90     27-90
               AB      324         60.25     27-90
               AC      474         61.60     27-88

   Health      A       392         73.70     44-93
   Knowledge   B       183         72.85     49-91
               C       274         74.15     46-92
               AB      324         73.04     52-94
               AC      479         73.70     46-94

   Health      A       355         74.50     35-91
   Attitudes   B       165         75.95     51-92
               C       217         73.33     50-90
               AB      309         74.75     45-90
               AC      446         74.55     46-91

Grade 12                           Girls

   Health      A       490         60.05     26-91
   Habits      B       170         59.35     29-90
               C       316         59.68     26-90
               AB      304         60.45     33-90
               AC      481         60.76     27-91

   Health      A       491         74.00     47-93
   Knowledge   B       170         75.65     50-92
               C       325         74.85     48-93
               AB      300         73.02     50-94
               AC      489         76.20     42-95

   Health      A       453         76.55     37-93
   Attitudes   B       153         76.60     50-92
               C       307         75.60     45-94
               AB      291         77.00     41-95
               AC      382         79.00     44-94

A - Industrial Communities; B - Rural Communities;
C - Residential Communities; AB - Industrial-Rural Communities;
AC - Industrial-Residential Communities
Table 3

Coefficients of Correlation for High School Pupils in Industrial Rural

Grade      2/             Habits      Knowledge   Knowledge
and        [square        with        with        with
Sex        root of n-1]   Knowledge   Attitudes   I.Q.

12 girls   (.1174)        .2291       .4028       .4316
12 boys    (.1250)        .0390       .2985       .2620
10 girls   (.1035)        .1347       .3913       .5225
10 boys    (.1191)        .0847       .2883       .4744
12 girls   (.1151)        .0154       .2977       .4233
11 boys    (.1426)        .08013      .3703       .5893

Grade      Habits   Habits      Attitudes
and        with     with        with
Sex        I.Q.     Attitudes   I.Q.

12 girls   .0717    .1869       .4241
12 boys    .0654    .2792       .1744
10 girls   .0411    .1378       .3285
10 boys    -.0591   .1910       .0691
12 girls   .0516    .1417       .2359
11 boys    -.1012   .1655       .2743

Clair E. Turner, Dr.P.H., Sc.D., Professor of Public Health, Massachusetts Institute of Technology. Presented at American School Health Association Meeting, St. Louis, October 30, 1942. Reprinted from: The Journal of School Health. 1943;13(1):9-17.
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Author:Turner, Clair E.
Publication:Journal of School Health
Article Type:Statistical Data Included
Geographic Code:1U1MA
Date:Oct 1, 2001
Previous Article:School health education: appraisal of a conceptual approach to curriculum development.
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