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TB Notes Newsletter

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No. 3, 2005

School-Based TB Curriculum to Reach High-Risk Youth

Tuberculosis (TB): Education for Adolescents and Young Adults is a curriculum developed for high school students in response to data showing a high prevalence of TB disease and M. tuberculosis infection in specific adolescent populations. In 2003, San Diego County, California, reported 316 TB cases, of which 209 (66%) were in foreign-born persons. There were 11 cases (2.6% of total cases) in the 5- to 14-year-old age group and 43 cases (9.3% of total cases) in the 15- to 24-year-old age group. A school-based targeted testing project confirmed other local data sources showing rates of 20%-30% skin test positivity among high school–aged students born outside the United States, and 10%-15% positivity among US-born Latino teens.

An initial goal in San Diego County was to develop targeted testing and treatment programs within school districts having a large at-risk student body. While successful outcomes were realized in several schools, the models were difficult to sustain. Moreover, funds for targeted testing and treatment were discontinued after 2004. In anticipation of the end of formal testing and treatment programs, the San Diego TB Program sought to develop educational tools that could be used by schools to create awareness among students to increase TB knowledge, assess their own risk, and promote testing and treatment.

The curriculum was developed and implemented through a collaboration between the County of San Diego Health and Human Services Agency TB Control Branch, the American Lung Association of San Diego and Imperial Counties, and the Sweetwater Union High School District. This school district is in southern San Diego County, a region with a large Latino population and a TB case rate of 20.1 per 100,000 population.

Implementation consisted of the following steps:

  • Determine high schools with large populations of students in TB risk groups
  • Create TB educational materials and an instructor’s manual
  • Focus on health classes in which teachers can incorporate the curriculum into existing communicable disease sessions
  • Provide classroom observations to refine health teachers’ techniques in delivery of the material
  • Evaluate and elicit feedback from health teachers to refine course materials and content

Using a variety of methods, including lectures, interactive exercises, and group discussions, the students became actively involved in the learning process. Classroom kits contain easy-to-use materials including a poster, handouts, a TB education video, and a CD of the curriculum. Other available materials include the following:

  • Educational slides and notes
  • Activities and extra-credit materials
  • Parent letter (optional)
  • Pretest and posttest to evaluate students’ increase in knowledge
  • Risk-assessment form
  • Learning chart
  • Glossary of terms
  • Abbreviations list
  • Evaluation form for teachers
  • TB resources
  • Resources for medial care

Students who complete the curriculum will be able to

  • Describe the difference between latent TB infection and active TB disease
  • Recognize the signs and symptoms of TB disease
  • Identify behaviors that reduce the risk of disease or transmission
  • Self-assess for risk of TB
  • Discuss issues related to TB with teachers, staff, and medical professionals
  • Understand and demonstrate behaviors that prevent disease and speed recovery from illness

An evaluation component was conducted to assess the effectiveness of the curriculum. Evaluation from teachers demonstrated improved knowledge, increasing their ability to effectively teach the course; student involvement in group discussion; a 63% increase in student knowledge; and an increase in student ability to self-assess risk, identify symptoms, and access health care.

The school curriculum appears to be a useful tool for promoting and guiding training and education efforts for the control of TB. A future goal is to achieve sustainability by increasing the number of school districts that incorporate the TB curriculum into their standard health classes.

For more information on the curriculum, please contact Sacsy Sukcharoun by telephone: (619) 542-4105 or by e-mail: or Diana Lobo by telephone: (619) 692-8627 or e-mail:

—Reported by Sacsy Sukcharoun,BS,
Diana Lobo, BS, and
Kathleen Moser, MD, MPH
San Diego TB Control Program


Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination -

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