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Cure4Kids for Kids: School-Based Cancer
Education Outreach
Aubrey Van Kirk Villalobos, MEd, Yuri Quintana, PhD, Raul C. Ribeiro, MD
St. Jude Children’s Research Hospital
Abstract. In 2006, St. Jude Children’s Research Hospital created Cure4Kids for
Kids, a school-based outreach program. The objectives of this community
education program are to teach about cancer and healthy lifestyles and to inspire
an interest in science and health-related careers. A multidisciplinary team of St.
Jude and outside experts developed and pilot tested age-appropriate educational
materials and activities with 4th grade students. Eight schools and more than 800
children have participated in the program since 2006. Teachers and students have
demonstrated a very positive response to the program for it being both fun and
educational. Cure4Kids for Kids resources have been collected into a teacher’s kit
and are now freely available online at www.cure4kids.org/kids.
Keywords. Cancer, prevention, community, health promotion, health education,
elementary schools
Introduction
Cancer is the second leading cause of death in the United States after heart disease [1],
but according to the World Health Organization, at least one third of cancer cases are
preventable [2]. Lifestyle risk factors for cancer include skin damage from ultraviolet
(UV) light, tobacco use, and obesity, among others. Obesity rates in the United States
are rising, and being overweight or obese has been shown to increase the risk of cancer
among adults [3-9]. Early intervention with nutrition and physical fitness education
could help reduce this trend. Tobacco use is also a persistent problem, even among
youth, and is responsible for 30% of all cancer deaths and 87% of lung cancer deaths
annually [10]. The damage caused by UV rays from natural and unnatural sources
accumulates over a lifetime, increasing a person’s risk of skin cancer with age [11].
Some unhealthy lifestyle behaviors that contribute to a person’s risk of cancer in later
life may begin in childhood. It is imperative to begin instilling healthy habits in
children as early as possible; education can help promote healthy lifestyle choices and
reduce the chance of developing unhealthy habits [12]. Studies and surveys have shown
pervasive misconceptions among the lay public; unhealthy lifestyle behaviors can
result from incorrect beliefs about cancer. A 2007 study performed by the American
Cancer Society found that 25% of the U.S. population incorrectly believed that “what
___________________________
Corresponding Author: Aubrey Van Kirk Villalobos, Cancer Educational Outreach Coordinator, International
Outreach Program, St. Jude Children’s Research Hospital, 262 Danny Thomas Place Mail Stop 721
Memphis, TN, USA 38105; E-mail: Aubrey.Villalobos@stjude.org or kids@cure4kids.org
Advancing Cancer Education and Healthy Living in Our Communities
Y. Quintana et al. (Eds.)
IOS Press, 2012
© 2012 The authors and IOS Press. All rights reserved.
doi:10.3233/978-1-61499-088-8-111
111
someone does as a young adult has little effect on their chance of getting cancer in later
life” [13]. This belief is problematic because it can affect actions related to cancer
prevention including using sun protection, abstaining from tobacco use, and following
screening guidelines. Comprehensive education programs are needed to combat these
trends and dispel misconceptions.
In response to the alarming statistics, St. Jude Children’s Research Hospital, a
National Cancer Institute (NCI)-designated Comprehensive Cancer Center, created a
school-based outreach program that uses education and positive reinforcement to help
promote healthy lifestyle choices that reduce a child’s lifetime risk of developing
cancer. Since 2002, the St. Jude International Outreach Program has been facilitating
the exchange of knowledge among health care professionals around the world on
Cure4Kids.org. Since its beginning in 2006, Cure4Kids for Kids has become a platform
for communication with the public, school children in particular, about cancer and
healthy living. The objectives of this community education program are (1) to educate
students, parents, teachers, and communities about cancer and dispel common
misconceptions; (2) to educate about and promote healthy lifestyle choices in children
that can reduce the risk of cancer in adulthood; and (3) to inspire an interest in science
and health-related careers. This article describes the curriculum, its implementation,
and some lessons learned since the program’s inception.
Methodology
1. Program Development
The Cure4Kids for Kids curriculum covers a number of cancer-related topics and is
divided into three modules on the topics of cells, cancer, and healthy living. A
multidisciplinary team made up of pediatric oncologists, nurses, school teachers,
genetic counselor, child life specialist, scientific editor, clinical pathologist, infectious
diseases physician, librarian, engineer, graphic artist, and others collaborated to design
the curriculum format and educational materials. Once developed, all content was
reviewed by multiple experts at St. Jude and outside institutions, such as the NCI
Office of Communications and Education.
Three children’s books, each written at a grade 3-5 reading level, are the
foundation of the Cure4Kids for Kids curriculum. That specific grade range was chosen
because in many state and district curricula grade 4 is when the concept of cells is first
introduced [14-15]. It was important to the team that the program be supplemental to
and integrate well with existing school curricula, and so various sets of standards were
consulted throughout the development process. Each of the three modules consists of a
children’s book, expert presentation, and at least one hands-on activity. Each
presentation follows the general outline of the corresponding book and is designed to
reinforce and enhance the book’s messages with examples and details. All of the
lessons and activities align with either the National Science Education Standards or the
National Health Education Standards [15-16].
1.1 Module 1 – What Are Cells?
The first book, What Are Cells?, defines cells and describes what they do in the body
and how normal cells grow and divide. In the corresponding laboratory activity for this
module students use microscopes to discover the difference between healthy and
unhealthy cells in skin and lung tissue. The lab activity is framed within the process of
scientific inquiry so students sharpen analytical thinking skills as they compare and
A. Van Kirk Villalobos et al. / Cure4Kids for Kids: School-Based Cancer Education Outreach112
contrast and observe and infer. Students are asked to both draw and record their
observations in a quest to answer the guiding question: “What does cancer look like?”
1.2 Module 2 – What Is Cancer?
Once students have completed the first module and understand how healthy cells grow
and divide, they are better able to understand cancer. The second book in the series,
What Is Cancer?, presents cancer as a disease of cells whose division is out of control.
Myths commonly held by the public are dispelled throughout the book; for instance,
the myth that cancer cannot be cured is explained in the context of three main types of
treatments with photos of patients and survivors. The hands-on activity for the second
module is designed to stimulate conversation about cancer survivorship. Students
illustrate in drawings the feelings patients might have in two given situations and then
discuss ways to show support for such patients. The students’ illustrations are hung
together on a school wall or bulletin board forming a colorful quilt-like display.
Inspired by the St. Jude Quilt of Hope, which chronicles the personal stories of
patients, families, staff, and the hospital itself, the Cure4Kids for Kids Empathy Quilt
becomes a beautiful conversation piece that opens the discussion about cancer to the
whole school. Talking about empathy and cancer is increasingly important as advocates
work to reduce the stigma surrounding the disease and as numbers of survivors increase
[17-19].
1.3 Module 3 – What Is Healthy Living?
The third book in the series, What Is Healthy Living?, provides information about
tobacco, ultraviolet rays, nutrition, and physical activity and describes how healthy
behaviors can help reduce the chance of getting cancer later in life. Through four
corresponding activities, students learn more about the four healthy lifestyle choices
they can make to help reduce their risk of developing cancer in adulthood. After an
introduction from the instructor about what tobacco products are, students engage in an
interactive scavenger hunt. They explore three traditional teaching models: a model
mouth of a typical smoker, a model mouth of a smokeless tobacco user, and a model
displaying a healthy lung and a smoker’s lung. As they touch and look at the displays,
they record their observations of what looks wrong or unhealthy. Through instructor-
led class discussion, students discover the causes of the damage and come to
conclusions about how to avoid those problems for themselves.
To learn about different ways to protect themselves from UV rays, students
listen to a song, write or draw in response to what they hear, and then act or dance to
express what they heard. This activity expands on the United States Environmental
Protection Agency’s SunWise Program (www.epa.gov/sunwise) activity “Create What
You Hear” which uses the song “Sunscreen Dance” by the Swingset Mamas. This
activity is not only fun for students but also beneficial because it activates multiple
intelligences and engages students of differing learning styles. Discussion throughout
the activity is facilitated by a teacher to help clarify any possible misunderstandings.
Because obesity is a risk factor for the development of cancer, it is important
to discuss nutrition and physical activity in any cancer prevention education program.
With students in upper elementary school, nutrition is discussed in terms of relative
portion sizes and general recommendations for consumption of foods from the different
groups. Originally designed to parallel the United States Department of Agriculture’s
(USDA) MyPyramid, but also compatible with the new USDA MyPlate
(www.choosemyplate.gov), the lesson on nutrition engages students to actively sort
A. Van Kirk Villalobos et al. / Cure4Kids for Kids: School-Based Cancer Education Outreach 113
various food items into the different food groups while determining which groups
should make up the larger part of a healthy diet and which foods should be consumed
in moderation. Students also receive a placemat designed by the St. Jude team members
which, on one side, illustrates a plate with appropriate portions of vegetables, meat,
grain, and dairy and, on the reverse side, provides a chart for students to keep track of
the different color fruits and vegetables consumed over a week’s time (Fig. 1).
(a)
(b)
Figure 1. (a) Front and (b) back of placemat used in nutrition lesson of Cure4Kids
for Kids.
The healthy living theme encourages children to consume a variety of fruits and
vegetables, especially those containing a high concentration of antioxidants. The term
“antioxidants” is introduced and defined as “special substances found in plants that can
help protect the body from cell damage that can lead to cancer.” This idea dovetails
with the messages from the first and second module about cancer being a disease of
unhealthy (damaged) cells that divide out of control. On the back of the placemat are
lists of fruits and vegetables sorted by color to help students identify and select a
variety. Revisions to the original list included adding more affordable fruit and
vegetable options, such as watermelon, blueberries, and leafy greens, and adding more
variety to account for an ethnically diverse audience (for example, jicama, dates, okra,
and Chinese cabbage “bok choy”).
When teaching the students about physical activity, we felt it best for them to
learn by example. The Cure4Kids for Kids program encourages schools to invite a
local fitness instructor to provide a dance aerobics demonstration. We chose dance
A. Van Kirk Villalobos et al. / Cure4Kids for Kids: School-Based Cancer Education Outreach114
aerobics because it requires relatively little equipment and is therefore inexpensive and
more convenient for participating schools. We also liked dance aerobics for the
students because it helps expand their vision of what exercise or physical activity can
be; it has been our experience that many school-aged children recognize team sports
above all other possible ways to be active. Finally, dance aerobics is fun and can be
easily adapted for the musical tastes of the participant. During the cool down of the
demonstration, a teacher and the fitness instructor lead a discussion about the benefits
of being active and how it relates to cancer prevention. The discussion also covers
different activities and places to be active. The program supports the governmental
recommendation of 60 minutes of activity per day for children in this age group.
2. Program Implementation and Pilot Testing
Development of Cure4Kids for Kids began in 2005, and the program was first pilot
tested with a 4th grade class in 2006 at a Memphis elementary school. Over 4 years the
educational materials and delivery format were refined and retested at four different
elementary schools, with some schools being visited multiple times over the 4-year
period. In the 2010-2011 school year, the current program was evaluated formally at
the 4th grade level in seven local schools with favorable gains in student knowledge
[20].
During pilot testing, the program coordinator worked with teachers at pilot
schools to arrange a schedule for presentations and activities. The program was
implemented over 3 consecutive days, for approximately 1.5–2 hours each day. One
day was dedicated for each of the three modules. The first 2 days began with a
presentation from a St. Jude faculty member. At the suggestion of teachers,
presentations were no longer than 20 minutes each day. Students then engaged with the
presenters in a question and answer session during the 10 minutes following the
presentation. After the presentation on the first 2 mornings, students proceeded to the
corresponding module activity. Depending on the total number of students, sometimes
they were separated into smaller groups. In the interest of time and for lack of a content
expert who would present on all four topics, we did not have a single presentation on
the third day, but began with small groups rotating through the activities for each of the
healthy living topics (tobacco, ultraviolet rays, nutrition, and physical activity).
Approximately 25 minutes were spent at each of the healthy living stations. Each pilot
school could tailor the program to fit its schedule and class size, but Figure 2 shows a
typical agenda.
Results
1. Characteristics of Program Participants
Since its inception in 2006, the 3-day Cure4Kids for Kids program has been
implemented by the St. Jude team in eight different elementary schools (Table 1). Two
schools participated in the program for 2 years in a row, and one school participated for
3 consecutive years leading to a total of 36 individual visits (days). Half of the schools
visited were from three local public districts and half were from local independent
schools. Public school students made up approximately 69% of the population of
students.
A. Van Kirk Villalobos et al. / Cure4Kids for Kids: School-Based Cancer Education Outreach 115
Figure 2. Sample program schedule
Table 1. Number and Characteristics of Participants
Characteristic Number
Total Schools 8
Total Encounters/Visits 36
Public Schools 4
Independent Schools 4
Total Students (Approximate) 800
Public School Students 550
Independent School Students 250
The number of students participating each school year has been increasing since 2006
(Fig. 3). The increase in 2009-2010 is attributed to hiring a full-time dedicated
coordinator for the program, and the increase in 2010-2011 is the result of recruiting
for a formal program evaluation conducted during that time [19].
Discussion
Cure4Kids for Kids has been very well received by teachers, students, and parents over
the years. Despite the stigma often associated with the word cancer, the program
coordinators have never received negative feedback from schools or parents. Students
of varying backgrounds and academic levels have enjoyed participating in the program
as evidenced by the smiles on their faces and expressions of gratitude to the St. Jude
team members. One thing the coordinators have noticed in particular, which has been
corroborated by classroom teachers, is that students appreciate adults taking the time to
answer their questions, because they do have genuine questions about the disease. At
each school the pediatric oncologist who presents “What Is Cancer?” asks students
(and school staff) to raise their hands if they know or have known someone with
Week Before Program
• Take Cells, Cancer, and Healthy Living Pre-quizzes
• Read What Are Cells?, What Is Cancer?, and What Is Healthy Living?
Day 1: What Are Cells?
• 9:00-9:30 Presentation and Q&A
• 9:30-10:15 Hands-On Lab Activity
Day 2: What Is Cancer?
• 9:00-9:30 Presentation and Q&A
• 9:30-10:15 Hands-On Empathy Activity
Day 3: What Is Healthy Living?
• 9:00-9:25 “Dangers of Tobacco” Scavenger Hunt
• 9:30-9:55 “Sun Protection” Activity
• 10:00-10:25 “Discovering the Nutrition Pyramid” Activity
• 10:30-10:50 Physical Activity Demonstration
Week After Program
• Take Cells, Cancer, and Healthy Living Post-quizzes
A. Van Kirk Villalobos et al. / Cure4Kids for Kids: School-Based Cancer Education Outreach116
Figure 3. Cumulative number of 4th-grade students participating in Cure4Kids for Kids
from the 2005-2006 school year through the 2010-2011 school year
cancer; in every school, an overwhelming majority of the students and teachers have
been touched by cancer in some way. This response alone supports the need for cancer
education programs beginning in early school years. At a meeting for local school
professionals, one teacher said, “We had the 3-day presentation…we had such a good
time. They came this year; they’re coming next year... It was a wonderful experience
for the students and for myself as well.”
Beyond its being a fun and memorable experience, teachers appreciate the
educational value of the program. A reading specialist once said how thrilled she was
for her struggling readers that the Cure4Kids for Kids books were available and
narrated on the website. This narration allowed the students to follow along in their
copies of the books and go through the material at their own pace. Other teachers have
commented on the utility of combining the program with a traditional science unit on
cells or disease. This program provides the context in which to learn about cells and
mitosis or the differences between contagious and non-communicable diseases and
helps students make connections beyond the classroom to the real world.
The ultimate goal for this program is to be a resource for teachers anywhere to
use in their classrooms. To make the materials available to a wider audience, the St.
Jude team built a complete teacher’s kit including all the lessons and activity sheets and
a video of the St. Jude presenters as well as other support materials such as answers to
questions frequently asked by students. Because the video will be shown at schools
where St. Jude representatives are unable to visit, it includes the presentations on cells
and cancer that are normally given, as well as a video of a teen interviewing various
healthy living experts about cancer prevention. Additionally, students and teachers may
visit www.cure4kids.org/kids for a complete collection of educational resources.
Conclusion
As Cure4Kids for Kids continues to grow, develop content, and move forward, one of
the main goals will be to expand the availability of resources for students and teachers
to a wider audience. Emphasis will be placed on making all material available online as
downloads for print or mobile devices or as interactive applications such as online
microscopes for schools that do not have such resources available. In the near future,
0
100
200
300
400
500
600
700
800
900
05-06 06-07 07-08 08-09 09-10 10-11
Number of Students
School Year
A. Van Kirk Villalobos et al. / Cure4Kids for Kids: School-Based Cancer Education Outreach 117
middle and high school content development will be a major focus. The Cure4Kids
education team will also continue to host training events for teachers both in-person
and online so that they feel comfortable using the resources on their own. Finally,
developing this program has been a labor of love—a long, often difficult
multidisciplinary process whose outcome has been well worth the effort.
Acknowledgments
The authors would like to thank all the St. Jude staff members and external volunteers
who have made this program possible in one way or another. Please know that your
efforts are making a difference in the lives of children around the world.
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