HSPH students Cara Osborne (l) and Ruth Neuhaus on a field visit.

Turner, a second-year student in population and international health, had come to help the agency determine how to plan for the assessment of the impact of an upcoming media campaign warning parents of the dangers of lead poisoning.

"They had a media campaign they were about ready to begin," she explained. "It was a combination of old radio spots, pamphlets and flyers, all targeting areas of the city where there is a high incidence of lead poisoning among children. They planned to spend up to a half million dollars on the campaign, but they wanted to know if it was worth it. How could they figure out if a campaign would have an effect on the populations they wanted to reach?"

Turner was one of 16 HSPH students who spent WinterSession enrolled in the course "Program Evaluation: The Case of Lead Poison Prevention Programs," a multidisciplinary pilot project that paired students with Centers for Disease Control and Prevention (CDC) project officers. After spending a week in class learning the how’s and why’s of program evaluation, students were then sent to public health offices, where they spent another week creating tools to test the outcomes of real public health programs in cities such as New York, Oakland, and Detroit.

Turner, fellow HSPH student Karen Lee, and CDC project officer Rob Henry spent a few days meeting agency staffers and learning the ropes, before they set about determining how the agency could evaluate its campaign.

"The agency brought together media professionals in the department with the epidemiology, surveillance and evaluation staff," Turner said. "We helped them think about the outcome they wanted. By the time we left, they had changed their minds and decided they would have a better chance of reaching the target population through new radio spots and billboards in targeted neighborhoods."

The program evaluation course was taught by Marc Mitchell, lecturer on international health in the Department of Population and International Health, and Mary Jean Brown, adjunct assistant professor of society, human development, and health in the Department of Society, Human Development, and Health. Alumna Brown, SD ’00, is also chief of the Lead Poisoning Prevention Branch at the CDC.

"We see public health as an applied field," said Mitchell, which is why he developed the 1.25 credit course with Brown. "In this class, students learn how the working world functions and are asked to think about how they fit into that world."

Evaluations conducted by the students will be sent to the host agencies for their use, said Mitchell. All of the projects involve some aspect of lead-poisoning prevention. Some were media campaigns, while others were education and screening programs or primary prevention efforts.

"Students got to work with professionals for a week of real life, real world public health, with all of the limitations, frustrations and dedication that goes with it," said Henry.

In Indiana, HSPH students Ruth Neuhaus and Cara Osborne shadowed field workers who visited people’s homes to examine the premises for lead paint. The workers also obtained blood samples for exposure testing.

On the West Coast, HSPH student Stephanie Bloom worked with staff at the California Department of Environmental Health in Oakland as they developed an education and prevention program in which home health visitors would assess households and train parents about lead-related issues. Bloom’s team included HSPH student Anna Katz and the CDC’s Tim Morta.

The team developed short-, medium- and long-term impact indicators to evaluate the effectiveness of the home visitor program, Bloom said.

"In California, a significant percentage of pediatric lead poisoning comes not from the physical home itself, but from culturally determined exposures, such as folk remedies," Bloom said. "Changing behaviors to minimize these types of exposures presents quite a challenge."

The department wanted the home visitors to learn how to identify sources of lead exposure, including cultural practices, so that they would be better able to educate families on how to protect children from these dangers, said Bloom.

"The contribution we made was to suggest tools to document whether the proposed intervention would alter behavior and ultimately impact lead levels," Bloom said.

HSPH students accompanied health officials on a visit to a home in Indiana as part of a lead poisoning prevention program. The home’s address has been purposefully blurred in this photo to protect the residents’ privacy.

A pediatrician trained in California, Bloom credits the Winter

Session course with providing her a chance to look at pediatric public health issues at the state level, which she had never done before.

"I was impressed as much by the dedication and passion of the public health professionals as by the complexity of the issues involved," she said.

As public health resources become increasingly scarce, the importance of allocating them most effectively increases, Bloom noted. She said that program evaluation provides the means to clarify both the impact of a program and the effectiveness of the component steps along the way. However, developing and implementing tools for evaluation is not an easy task.

"Just as the course work clarified the importance of embedding evaluation tools during program development," Bloom said, "the field work demonstrated the many difficulties in doing so."

Bloom and her fellow students energized the CDC staff, said Brown, while the course gave the staff an "opportunity to dig down deep into an individual program to find ways to make better use of our resources."

According to both Brown and Mitchell, they hope the course will be repeated and expanded to include work in other states, as well as additional training for project officers.

The course was offered by the Division of Public Health Practice and the Departments of Population and International Health and Society, Human Development, and Health.

--PHC