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H 3 CA. Water, Sanitation, and Health Learning Modules for Young Adults. University of Alaska Anchorage Department of Health Sciences Version 1.0, 2012. Healthy Hands, Homes, and Communities of Alaska (H 3 CA) Water, Sanitation, and Health Learning Modules for Young Adults

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    1. H3CA Water, Sanitation, and Health Learning Modules for Young Adults University of Alaska Anchorage Department of Health Sciences Version 1.0, 2012

    2. Healthy Hands, Homes, and Communities of Alaska (H3CA) Water, Sanitation, and Health Learning Modules for Young Adults September 2012, 1st Printing Development of this educational resource was supported by funds from the Denali Commission and the United States Department of Labor (USDOL) Master of Public Health Program Department of Health Sciences, University of Alaska Anchorage (UAA) http://health.uaa.alaska.edu/dept/index.htm 3211 Providence Drive, DPL 405 Anchorage, AK 99508 Phone: 907-786-6540 Fax: 907-786-6572

    3. Water, Sanitation, and Health Learning Modules for Young Adults Healthy Hands, Homes, and Communities of Alaska (H3CA) Elizabeth Hodges Snyder, Assistant Professor of Public Health Department of Health Sciences, University of Alaska Anchorage Emma Beswick, Undergraduate Assistant Department of Health Sciences, University of Alaska Anchorage Liza Root, Graduate Assistant Department of Health Sciences, University of Alaska Anchorage

    4. Contents Introduction……………………………………….1 Background Purpose of the H3CA Modules Use of the H3CA Modules H3CA Modules and Public Health Module 1: Handwashing…………………….3 Module 2: Dental Hygiene………..……….10 Module 3: Personal Hygiene……………..16 Module 4: Food Safety……………………...24 Module 5: Waste Disposal………………..34 Contents

    5. Introduction • Background • The purpose of the Health Hands, Homes, and Communities of Alaska modules is to increase the knowledge about effective personal hygiene and sanitations practices, especially among Alaska’s youth, and to promote career pathways that will increase the number of public health professionals in Alaska. • How to Use the H3CA Modules • H3CA Modules and Public Health Introduction Pg 1

    6. Introduction Introduction Pg 2

    7. Module 1: Handwashing Introduction Proper handwashing is an effective way to prevent, and reduce the spread of, infections and illness. We come into contact with germs everyday by touching contaminated surfaces, waste, and even common household items. Handwashing is a simple way to get rid of germs and promote health in your home, school, and community. Teacher Background This module is designed to familiarize teachers and students with the importance of proper handwashing. Key aspects of the module address the following: why we should care about hand washing, how germs can spread, critical times to wash hands, and effective handwashing methods under a variety of water availability scenarios. Instructional Goal Students will learn why proper handwashing is effective in the prevention of some infections and illnesses. Students will learn proper hand washing methods based on varying levels of water availability and will learn about Alaska relevant infections that can be prevented through handwashing. Module 1 Pg 3

    8. Student Questions to Anticipate Q. What’s the big deal? A. There are many reasons why handwashing is important. Here are some points to consider: -Hands are the parts of the body most exposed to germs -Germs are everywhere and they are tough. -Germs which can be spread by unclean hands, can cause you and other people to become ill. -Illness can have serious economic impacts due to lost work time and healthcare costs Q. What if I don’t have soap? Will washing only with water keep my hands clean? A. Water is a good start, but soap is necessary for effective handwashing because it disperses dirt and particles. If soap is not available, use hand sanitizer or alcohol wipes Q. Why do we need to use friction or lathering when washing our hands? A. Friction or lathering is necessary because it helps to pull away any built up dirt or oils from the skin Q. What do I do if our water availability is limited? A. When it comes to handwashing, it is important that you use enough water to thoroughly follow the proper handwashing steps. Discussion Questions What do you think are the most common reasons why people don’t wash their hands properly and/or as often as they should? Possible answers: Lack of knowledge, laziness, they forget , etc.  What do you think you could do in your family, school, or community to encourage people to wash their hands better or more often? Possible answers: make signs, etc. Do you have a handwashing story you can share with the class? What can we learn from this story

    9. Student Activities: • Activity #1:How do germs spread? Description: A few students rub cooking oil over their hands. They shake hands with or high-five other students who then shake hands with more students. Eventually the cooking oil will be “spread” to every student demonstrating how quickly an entire classroom can be contaminated. Objective: To show how quickly germs can spread and contaminate a whole classroom of kids, and to show how handwashing can effectively prevent this. Materials and Advanced Preparation: -Access to hand washing stations -Cooking oil or baby oil • Activity #2: How clean are your hands? • Description: Students rub cooking oil all over their hands. Then they are allowed to wash their hands at intervals. First only allow hand washing for 2 seconds, then 5, then 10, working your way up to 20 seconds. At each time interval, students should check to see if their hands are free of cooking oil. • *Activity #2 can be a great follow-up activity for Activity #1 since the student will already have cooking oil or baby oil on their hands. • Objective: To stress how proper hand washing requires scrubbing with soap and water for at least 20 seconds. • Materials and Advance Preparation: • - Access to hand washing stations • - Stopwatch • - Cooking oil or baby oil

    10. Activity #3: What have you touched today? • Description: Students keep a “dirty hands diary” for a week and record all the contaminated surfaces they have touched and how frequently they washed their hands. At the end of the week, clean hands awards can be given out to those who washed their hands the most and bars of soap can be given to those who washed their hands the least. Extra points can also be given to students who wash their hands before every meal, after taking out the garbage, changing a diaper or any of the other activities listed in the PowerPoint presentation. • Objective: To provide an opportunity for students to think about how frequently they come into contact with germs and how often they properly wash their hands. • Materials and Advance Preparation: • -Soap • -Clean hand awards • -Paper and pen or pencil

    11. Handwashing Quiz • Name: • Date: • Name two reasons why washing your hands is important. • How can germs spread? • Name two illnesses or infections that can result from the spread of germs by a lack of proper hand washing. • How do effective hand washing techniques change with respect to water availability? Describe 3 different scenarios.

    12. Notes Pg 8

    13. Module 1 References Brain Pop Educators. (1999). Washing hands teacher activities. Retrieved from http://www.brainpopjr.com/health/bewell/washinghands/grownups.weml Pg 9

    14. Module 2: Dental Hygiene Introduction Dental hygiene is a very important and often overlooked aspect of illness prevention. Proper dental care can prevent oral health problems oral infections and illness including tooth decay, gum disease, tooth loss, and bad breath. Eating foods containing high levels of sugars and starches, eating foods containing acid, smoking, and poor dental care can cause oral health problems. Teacher Background This module is designed to familiarize teachers and students with the importance of proper dental care. Key aspects of this module address the following: why we should care about dental hygiene, what is it that causes dental infections/illnesses and when and how to brush and floss your teeth. Instructional Goal Students will learn how to best keep their teeth and mouths healthy. Students will learn proper oral care methods and the importance of proper dental care. Module 2 Pg 10

    15. Student Questions to Anticipate Q. What’s the big deal? A. Proper dental care can prevent a lot of painful or even embarrassing dental problems. These problems include: -Plaque -Gingivitis -Periodontitis -Abscessed Tooth -Tooth Erosion -Dental Caries -Bad breath Q. Why are some people’s teeth worse than others? A. Everyone’s mouth contains germs and bacteria. However lifestyle choices can either protect or harm our mouths. Smoking, drinking alcohol, and a diet high in sugar can all contribute to oral health problems. On the other hand, eating a diet high in vegetables and whole grains as well as frequent brushing and flossing of our teeth, can reduce these problems. Q. Why is it important to brush your tongue as well as your teeth? A. Your tongue can hold on to bacteria just as much as your teeth can. Bacteria on your tongue contributes to tooth decay as well as bad breath. Q. What do I do if our water availability is limited? A. Rinsing your toothbrush in hot clean water is important; otherwise the bristles can store harmful bacteria. Finding a balance between saving water and using enough to maintain proper hygiene is a very important step in staying healthy. Discussion Questions What is the most common reason why people don’t brush their teeth? How can you convince them that it’s worth it? Possible Answers: Lack of knowledge, laziness, forgetfulness. You can let them know the consequences of bad oral hygiene Do you think people in Alaska have a higher or lower rate of dental cavities than the national average? Answer: higher. National baseline percentage: 52%, Alaska percentage: 65.1% Do you enjoy going to the dentist? Why or why not? Did your parents teach you how to brush your teeth and remind you to do it every night when you were little? Do you still?

    16. Activity #1: Brushing Demonstration • Description: Students each get a new toothbrush with a trial size tube of toothpaste. Demonstrate the proper brushing technique and allow the students to practice on their own teeth. If no toothpaste or washbasin is available, students can practice with just the toothbrush by mimicking the movements outside their mouths. • Objective: To show how to properly brush teeth and encourage students to continue daily. • Materials and Advanced Preparation: • -Contact a local dentist or a toothbrush company and ask for free toothbrushes • -Access to classroom or bathroom sink • -Water cups • -Paper towels • Activity #2: How long is 3-5 minutes • Description: Students split into groups of 3 or 4. Within an allotted period of time have each group come up with a poem, children’s book, or song that they can sing or recite that lasts 3-5 minutes. Explain that when brushing their teeth they should brush for at least as long as it takes to recite or sing what they came up with. • *Another variation is to pick a song (like the ABC song or Happy Birthday) and discuss how many times you would need to sing that song to make it last 3-5 minutes. • Objective: To give students a memorable representation of the time it should take to adequately brush their teeth. • Materials and Advanced Preparation: • -Stopwatch • -Pen and Paper

    17. Dental Hygiene Quiz Name: Date: 1. Name at least two reasons why brushing your teeth is important. 2. How does gingivitis occur? 3. How often should you brush and floss your teeth? 4. What are some of the steps of effective brushing and flossing? 5. What are some illnesses or infections that result from poor dental care?

    18. Notes Pg 14

    19. Module 2 References Frost, S. (1999). Dental hygiene activities for children. Retrieved from http://www.ehow.com/about_5382842_dental-hygiene-activities-children.html Whistler, B.J. (2007). Alaska oral health plan: 2008-2012. Alaska Department of Health and Social Services. Retrieved from: http://www.hss.state.ak.us/dph/wcfh/oralhealth/docs/Oral-Health-Plan.pdf Pg 15

    20. Module 3: Personal Hygiene Introduction Personal hygiene is an important way to prevent and reduce the spread of infections and other illnesses. Germs and parasites can be found on parts of our bodies that are often overlooked. While handwashing is extremely important it is not the only way to stay healthy in a germ filled environment. Teacher Background This module is designed to familiarize teachers and students with the importance of proper hygiene. Key aspects of this module address the following: why we should care about personal hygiene, health concerns associated with steambaths, and the hygiene challenges faced by rural communities. Instructional Goal Students will learn how to keep their bodies clean and free from germs found on everyday objects. Module 3 Pg 16

    21. Students Questions to Anticipate Q. What’s the big deal? • Personal hygiene prevents and reduces the spread of infections and illnesses, including: -Athlete’s foot -Head lice -Trachoma -Scabies -Boils -Staph Infection Q. What parts of the body specifically need special attention when it comes to washing? A. The face, hair, genital area, hands, and teeth and mouth are all areas that should be cleaned daily. These areas are particularly susceptible to harboring germs and bacteria. Q. What are the health concerns associated with steambaths that aren’t properly maintained? A. Vasodilatation, dehydration, heat stroke, and infections like: -Athlete’s foot -Boils -Staphylococcus Q. Is it okay to use unsanitary water to wash with if clean water is not available? A. Yes. In areas where clean drinking water is limited there may not be enough to use for washing and showering. In these circumstances washing with soap and any available water can help to reduce the spread of diseases and keep our bodies clean and healthy. Discussion Questions Is it necessary to practice personal hygiene every day? Why? Answer: Yes! Personal hygiene is a great way to protect yourself from certain diseases and infections Lack of understanding of proper hygiene practices is a challenge that some people face. What are some ways that we can help others learn how to keep themselves clean and healthy? Possible answers: tell your friends and relatives, etc. Why do you think steambaths are so popular? How can we use them and stay healthy? Possible answers: There are a lot of potential health benefits as long as it’s used appropriately. Shower before and after and listen to your body to know how long to stay. What does personal hygiene have to do with good etiquette? (Example hint: what is the benefit of covering your nose and mouth when coughing or sneezing? Possible answers: If you are carrying harmful germs every sneeze or cough has the potential to get others sick

    22. Student Activities Activity #1: Advantages of good hygiene Description: The teacher should write the following table on the blackboard, divide the class into groups and ask them to discuss with each other and fill in the blanks. Objective: To allow the students to answer for themselves the benefits of good hygiene and come up with their own reasons for doing so. To teach students the negative health impact of bad personal hygiene. Materials and Advance Preparation: -Blackboard/Whiteboard -Chalk/Dry erase markers 

    23. Activity #2: Personal Hygiene True or False Game • Description: Students split into groups of 2 or 3 and take a short T or F quiz on lessons they’ve recently learned about personal hygiene. The teacher goes over the answers when they are finished and a reward of some kind is given to the winning team. • *This quiz introduces material not necessarily covered in the Personal Hygiene Module. This should be used as an opportunity to expand students critical thinking skills by encouraging them to make a best guess. • Objective: To reiterate the basics of personal hygiene. • Materials and Advanced Preparation: • True or False Quiz (Next page) • Appropriate reward (+5 points extra credit, etc.) • T/F Answers (Below) • Pens or pencils •  True or False Quiz Answers: • 1. True. Don't forget to also wash your other clothes to avoid germs growing. • 2. False. It varies from 30 degrees C 86 degrees F (soles of the feet) to 35 degrees C, 95 degrees F (under the arms). • 3. False. Some germs do not harm man. Some can even help by fighting other germs. • 4. True. • 5. False. Linen handkerchiefs harbor germs and should not be used. • 6. True. • 7. False. Germs love the warmth and damp under a bandage. The wound should be disinfected and dried before putting on a plaster, which allows the skin to breathe. • 8. True. And not just to be polite. You do it to avoid spreading germs in the air. • 9. True. Sometimes more than ten million per square centimeter.

    24. Personal Hygiene Activity #2 Name(s)__________________________________________________________ Original quiz can be found here: http://www.hygiene-educ.com/en/learn/personal/guide/presentation2.htm

    25. Personal Hygiene Quiz Name: Date: • Name at least two diseases that can be prevented by practicing effective personal hygiene. • What are some infections commonly spread in steambaths? • What is one main challenge when it comes to practicing effective personal hygiene?

    26. Notes Pg 22

    27. Module 3 References UNICEF. (2003). Fifth standard: Personal hygiene. Retrieved from www.unicef.org/lifeskills/files/5thGrade.pdf Institut Pasteur. (2001). Personal hygiene games. Retrieved from http://www.hygiene-educ.com/en/learn/personal/guide/presentation2.htm Pg 23

    28. Module 4: Food Safety Introduction Food safety is important way to prevent food related infections and illnesses. These infections and illnesses are caused by bacteria, toxins, viruses, and other organisms which are found in undercooked and ill-prepared foods. Practicing food safety is a simple way to prevent these bacteria, toxins, viruses, and other organisms from causing harm. Teacher Background This module is designed to familiarize teachers and students with the importance of food safety. Key aspects of the module address the following: why we should care about food safety, how food gets contaminated, critical times to practice food safety, and how to practice food safety. Instructional Goal Students will learn why practicing food safety is necessary for the prevention of food related infections and illness. Students will learn proper food safety methods and when it is appropriate and necessary to use them. Module 4 Pg 24

    29. Student Questions to Anticipate Q. What’s the big deal? A. Practicing food safety is an important way to prevent food related infections and illnesses caused by certain bacteria, toxins, viruses, and other organisms. These bacteria, toxins, viruses, and other organisms include: -Salmonella -Staphylococcus aureus -Clostridiumperfringens -Clostridiumbotulinum -E. coli O157H:7 -Listeriamonocytogenes -Campylobacterjejuni Q.How common are foodborne illnesses? A. 48 million cases of foodborne illnesses are reported in the U.S. every year. Between 1987 and 2000 there were 129 cases of botulism and 94 cases of paralytic shellfish poisoning reported in Alaska alone. Q. Can wild game have the same foodborne bacteria as other foods? A. Yes. Even in the freshest wild game can contain harmful bacteria and other organisms. For this reason it is important that the meat is refrigerated within a few hours of harvest. Discussion Questions • What are the four words to keep in mind when it comes to food safety? • Answer: Clean, cook, chill, and separate • Where are salmonella, E. coli, and campylobacter jejuni most commonly found? • Possible answers: poultry, milk, eggs, etc. • What standard kitchen items commonly carry bacteria that can easily spread to food? • Possible answers: cutting boards, utensils, dish rags, sponges, etc. • What temperature does meat need to be cooked at in order to eliminate the bacteria? • Possible answers: beef – 145 degrees F, poultry – 165 degrees F, ground beef – 160 degrees F, etc.

    30. Student Activities • Activity #1: True of False Quiz • Description: Students are handed copies of the attached quiz. They fill it out based on the information they learned in the Food Safety Module, and then exchange quizzes to go over the answers. • Objective: To demonstrate how cautious planning can prevent a variety of diseases caused by harmful bacteria and other organisms found in certain foods. • *This quiz introduces material not necessarily covered in the Personal Hygiene Module. This should be used as an opportunity to expand students critical thinking skills by encouraging them to make a best guess. • Materials and Advance Preparation: • -Pens or Pencils • -T/F quiz (Next page) • -Appropriate reward (+5 points extra credit, etc.) • -Answers (Below) • False • True • True • False • False • False • True

    31. Food Safety Activity #1 Name_________________________________________ Original quiz can be found here:http://www.educationworld.com/a_lesson/00-2/lp2031.shtml

    32. Student Activities • Activity #2: Food Safety Home Test • Description: Students are handed copies of the attached quiz. They take it home and fill it out either on their own or with their parent’s help, take it back the next day and compare and discuss answers. • Objective: To demonstrate how seemingly harmless acts, like sampling cookie dough, can actually be harmful to students and their families. • Materials and Advance Preparation: • -Pens or Pencils • -Food Safety Quiz (Next Page) • -Answer Sheet (Next Page)

    33. Food Safety Home Test Answer Sheet • 1. If you chose "B," give yourself two points. Refrigerators should stay at 41 F (5 C) or less, because it slows the growth of most bacteria. • 2. If you chose "B," give yourself two points. Hot foods should be refrigerated within two hours after cooking - sooner if possible. Date leftovers so they can be used within a safe time. Generally, they will remain safe in the refrigerator for three to five days. • 3. If you chose "A," give yourself two points. If you chose B, give yourself one point. According to the FDA, the kitchen sink drain, disposal, and connecting pipe should be sanitized periodically by pouring down the sink a solution of 1 teaspoon of chlorine bleach in 1 quart of water. • 4. If you chose "D," give yourself two points. Improper washing, such as with a damp cloth, will not remove bacteria. Washing only with soap and water may not be sufficient, either. • 5. If you chose "C," give yourself two points. • 6. If you chose "B" or "C," give yourself two points. The only bad answer here is "A." Eating homemade products containing raw eggs may put you at risk for a Salmonella infection. Commercial cookie dough is made with pasteurized eggs, so they are not a food hazard. • 7. If you chose "C" or "D," give yourself two points. If you chose "B," give yourself one point. Bleach and commercial kitchen cleaning agents are the best sanitizers, but should be used only according to the manufacturer's instructions. Hot water and soap do a good job too, but may not kill all strains of bacteria. • 8. If you chose "A" or "C," give yourself two points. Dishes should not be washed in water in which they have been soaking, because the food contributes nutrients for bacteria, which may multiply. When washing dishes by hand, experts recommend washing them within two hours and letting them air dry. • 9. If you chose "C," give yourself two points. Wash hands with warm water and soap for at least 20 seconds before and after handling food, especially raw meat. • 10. If you chose B or C, give yourself two points. Bacteria can multiply rapidly at room temperature, so never thaw foods on the counter. • Rating Your Kitchen's Food Safety • 20 points: A perfect score! You and your family can feel confident about the safety of the foods prepared and served in your home! • 8 to 19 points: Although your family does observe many of the recommended food safety guidelines, they are still vulnerable to potential foodborne illnesses due to some risky behavior. Review the answers to the questions for which you did not score any points to see what corrective actions you can take to better protect your family. • 8 points or below: You are at risk for foodborne illness due to the risky food safety practices followed in your home. Read through the answers to the questions above to see what corrective actions you can take to help protect your family.

    34. Food Safety Quiz Name: Date: • Name at least two reasons why food safety is important. • How do foodborne illnesses occur? • Do you always have to wash your hands before handling food? • What are some of the steps of effective food safety? • What are some illnesses or infections that result from poor food safety?

    35. Notes Pg 32

    36. Module 4 References Education World. (2011, June). Summer food safety: True or false? Retrieved from: http://www.educationworld.com/a_lesson/00-2/lp2031.shtml NDF International. (2004). Food safety test. Retrieved from: http://www.nsf.org/consumer/just_for_kids/food_safety_test.asp Pg 33

    37. Module 5: Waste Disposal Introduction Effective waste disposal is a way to properly manage all kinds of waste created or produced by human living, without damaging human life, health, or the environment. So many methods of waste disposal are harmful, but there is an appropriate way to manage waste in a healthy, productive way. Teacher Background This module is designed to familiarize teachers and students with the importance of proper waste disposal. Key aspects of the module address the following: why we should care about waste disposal, different types of waste, alternative options to waste disposal, and how to dispose safely. Instructional Goal Students will learn why proper waste disposal is necessary to maintain the health of the community in which they live. Students will learn effective and safe waste disposal methods based on varying levels of community or government involvement. Module 5 Pg 34

    38. Student Questions to Anticipate Q. What’s the big deal? A. Waste management is an important issue and something that each person can be involved in. Some important points to consider are: -Improper waste disposal can cause respiratory issues, aggravation of allergies, inhalation of carcinogens, and eye irritation -Each person, no matter the age, and each household can make a difference by following the guidelines Reduce, Reuse, Recycle Q. How can I manage the waste in my own house? A. Local governement controls a lot of how waste is managed on a city or state level, but everyone can take steps to making their own houses healthier and cleaner. These steps include: -Make sure that hazardous wastes are taken care of appropriately -Don’t leave trash outside in the yard or in the neighborhood -Reduce, Reuse, Recycle whenever you can Q. Why is incineration so dangerous? A. Incineration is generally not a good idea because the materials can release toxic byproducts when burned. These byproducts can cause damage to lungs, nervous system, kidneys, and liver, as well as the chronic diseases bronchitis, emphysema, and cancer Q. Why can’t normal household products like paints, cleaning products, and batteries be thrown out it the trash? • Household hazardous wastes contain chemicals and substances, commonly found in household items, which can be harmful to the environment or to sanitation workers is handled improperly Discussion Questions What should you do if you don’t know how to dispose of something? Possible answers: look it up online, call someone in your town or city Why can’t refrigerators, freezers, or air-conditioners be thrown in the trash with the general waste? Answer: These appliances contain refrigerants that can be harmful to people and the environment if not handled properly What are some chemicals and metals commonly found in electronics that can be harmful Possible Answers: lead, cadmium, zinc, nickel, etc. What are some of the benefits of recycling? Possible Answers: It can be a fun way to get involved, it’s more economic for your family and for the community, it produces less waste, etc.

    39. Student Activities • Activity #1: Wise Use of Paper • Description: Students will collect, for a week, the classroom paper they would normally throw away. The paper will be weighed at the end of the week and divided into 2 boxes. Box A is paper that is still usable, Box B is paper that is used completely. When practical, students will use paper from box A for classroom work and assignments. The reused paper will be put into a 3rd box and weighed to find out how much paper was reused. • Objective: To make students aware of the recycling process. They will understand that reusing paper is a way of conserving resources, protecting the environment, and reducing energy use. • Materials and Advanced Preparation: • -Three boxes • -Scale • Activity #2: Recycling and Precycling • Description: The teacher will display various household items and ask whether similar items can be found in each of their houses. Divide the students into groups and have them discuss how each item can be reduced, reused, or recycled, including alternative products or creative projects using the items in non-traditional ways. The teacher will facilitate a class discussion addressing each of their ideas. • Objective: To get students to think about the benefits of recycling and the ways that our buying habits influence the amount of garbage we produce • Materials and Advanced Preparation: • -Common household items like: • Cans • Glass bottles • Paper • Aluminum foil • Styrofoam • Cardboard • Disposable diapers • Plastic containers • Newspapers • Grocery bags • Egg cartons • Old clothing

    40. Waste Disposal Quiz Name: Date: • What are some methods of waste disposal? • Are there safer ways to dispose of waste? • Name a few products that should not be thrown away. • Name some reasons why incineration, open dumps, and honeybuckets are not the safest methods of waste disposal.

    41. Notes Pg 38

    42. Module 5 References Cornell Waste Management Institute. (1991). Wise use of paper. http://cwmi.css.cornell.edu/TrashGoesToSchool/Wise.html Cornell Waste Management Institute. (1991). Recycling and precycling. Retrieved from: http://cwmi.css.cornell.edu/TrashGoesToSchool/RecyclingPrecycling.html Pg 39

    43. Master of Public Health Program Department of Health Sciences, University of Alaska Anchorage (UAA) http://health.uaa.alaska.edu/dept/index.htm 3211 Providence Drive, DPL 405 Anchorage, AK 99508 Phone: 907-786-6540 Fax: 907-786-6572