What Are Book Clubs Doing in Health Class? Enhancing Learning and Making Empathetic Disciplinary Connections through YA Novels

They sit in circles, looking through their notes and paging through young adult (YA) novels, talking excitedly about characters, issues, conflicts, and decisions. As one student talks, others nod; some point to passages in their books. This could be a book club meeting in any middle school or high school English language arts classroom in any school in the country, but it is not. It is a university classroom, and the class is Current Health Education Issues.

The use of YA book clubs in the Current Health Education Issues class emerged from a collaboration between faculty members in two programs within the university’s College of Education: Adolescent Education and Health and Physical Education. The book club project was designed by the instructor of the Adolescent Literature course and implemented by the professor of the course on current health education issues. The majority of students in this course were preservice teachers, and the collaboration and project had two major goals: for students to learn about a variety of health issues through young adult novels, supplemented with additional research, and to introduce future teachers to the advantages of incorporating book clubs across the curriculum, in all content areas, including health class.

According to the Vanderbilt University Center for Teaching ( 2014 ), advantages of collaborative teaching/ team teaching include potential deep student learning as a result of exposure to the connections across the disciplines of the instructors, different disciplinary views, and the broad support that a heterogeneous teaching team can provide during lessons. The collaborative opportunity between the instructors of the adolescent literature and health education courses became evident during a discussion of the implications on instruction of the Common Core State Standards (CCSS). The goal of the CCSS is to establish clear, consistent guidelines for what every student should know and be able to do in math and English language arts from kindergarten through 12th grade, with potential expansion to other subjects as developed by discipline organizations. The CCSS focus on developing the critical-thinking, problem-solving, and analytical skills students will need to be successful in their lives upon graduation ( National Governors Association Center for Best Practices & Council of Chief State School Officers, 2010 ). The partners in this study worked to create a bridge between two disciplines that resulted in reading and writing across the curriculum, providing students experience with an instructional methodology that supports the goals of the CCSS. Ultimately, the project promoted student application of knowledge through higher-order thinking skills.

For this project, students participated in book clubs in which small groups of students read texts selected by members of that particular group ( Roessing, 2009 ). There are a multitude of advantages, academic and affective, to book clubs:

• Book clubs are social, as are adolescents.
• Book clubs train students in collaborative work and encourage the development of listening and speaking skills.
• Book clubs promote leadership skills by being student-led; the teacher serves only as a facilitator and observer, not a leader or club member.
• Book club members provide support and motivation for one another. With this support, students can read more complex texts, and group discussions can lead to deeper understanding.
• Book clubs encourage differentiation. The teacher can offer books at various reading and interest levels so that students can choose books that they can read and comprehend and on topics of interest to them.
• The class can read multiple genres—such as fiction, nonfiction, graphic novels, and verse novels—or multiple topics/titles within a genre ( Anderson & Corbett, 2008 ; Chase & Pheifer, n.d. ; Daniels, 2002 ; Ebert & Culyer, 2011 ; Lloyd, 2006 ; Parkay, Hass, & Anctil, 2010 ).

A key goal of book clubs is to help teachers assess students’ comprehension through their responses to literature ( Nigro, 2011 ; Roessing, 2009 ). The use of student-led discussions offers the potential to engage all students through a more democratic, dialogic approach ( Lloyd, 2006 ). The club meeting format encourages students to ask relevant and focused questions and clarify their understanding while teachers gauge students’ comprehension based on their contributions to the discussion ( Nigro, 2011 ). The concept of book clubs has expanded from practice in language arts to all content areas. Integrating young adult literature in content-area curriculum can raise relevant issues through which content-area teachers can address critical concepts while igniting authentic discussion ( Hill, 2009 ). Book club practice offers an alternative approach to examining the discipline-specific content.

Within health education, traditional illnesses— such as cancer and diabetes—and behavior-related problems—such as substance abuse, eating disorders, sexually transmitted infections, depression, and gunrelated violence—have become interrelated due to the multitude of physical, social, and emotional changes adolescents are experiencing ( Bowman, 2000 ). To date, there is minimal documented evidence of the use of book club practice in health education courses. However, by reading YA novels in a health education class, students may learn more about a given health issue than just the facts; they may learn how people are affected physically, psychologically, emotionally, and socially. They may develop empathy as they come to care about characters and their issues. Readers might also analyze more deeply as they converse in book clubs about these issues and collaboratively make connections to what they have learned in class or through class texts, articles, or research about these issues. Conversations about health issues become more profound as book club members share observations about the characters in their novels, how they handle different issues, and how their personalities and circumstances affect their situations and vice versa. Often these conversations lead to personal connections that students share in their book club communities.

Methods

Course Context
The overall goal of the Current Health Education Issues course was to instruct students in health education content and health behaviors, knowledge they will utilize in their future roles as teachers of health education in middle and secondary settings. Upon successful completion of the course, it was expected that university students would be able to:

1. Describe and apply theoretical foundations of health behavior and principles of learning.
2. Describe and apply methods of assessing and promoting emotional, physical, and mental health over the lifespan.
3. Describe and apply knowledge of disease etiology and prevention practices.
4. Demonstrate health literacy skills.
5. Implement effective demonstrations, explanations, and instructional cues and prompts to link concepts to appropriate learning experiences.

Participants
A total of 29 students were enrolled in the course at the time of the study; 9 were health and physical education majors, 5 were education majors, 11 were liberal studies majors, 3 were rehabilitation science majors, and 1 was a chemistry major. Students reported no previous experience with book clubs at the university. Several students, however, discussed taking part in book clubs in a high school literature class.

Text Selection and Participant Grouping
The adolescent literature instructor selected in advance the novels and memoirs book club members could choose to read (please see Appendix A on p. 76 for these selections and other suggested titles). The literary works were chosen based upon topic relevance, timeliness, the popularity of the author/books among adolescents, and the quality of the writing. To create the various groups, books were displayed, and the instructor book-talked the choices, providing a verbal description of each and sharing information about the author, genre, health issue, and a brief plot summary (without spoilers). Topics included teenage pregnancy, steroid use among teen athletes, family illness, substance abuse, sports-related concussion, developmental disabilities, eating disorders, and body image. Students were invited to look through the books and read the back cover synopses and a few passages to explore the author’s writing style. They then recorded their top three preferences; groups were formed based on these preferences and a desire for heterogeneous groups based on gender, student academic performance, and field of major.

Procedures, Data Sources, and Analyses
Once groups were formed, students in each book club met. The first meeting included an introductory activity to help ensure that group members would become comfortable in sharing their viewpoints and opinions. Students participated in getting-to-know-you activities that included making a first-name sign where each letter of the name told something about themselves ( Roessing, 2012 ). They also completed and shared simple charts delineating “Favorites” such as favorite books, movies, foods, & restaurants. After participating in these introductory activities, students recorded information about their health issue of interest on a “What I Know and Want to Know” chart. At that point, they were more apt to begin conversing on the topic of their book club in a natural discussion. This opening session also included the mapping of their reading schedule for the following three weeks, distribution of the journaling pages, and instructions for completing the response journals.

As a departure from traditional book clubs, individual students exploring the same topic in our book clubs sometimes read different novels and compared and contrasted the treatment of their health-related topics across titles with other members of their group. For example, some members of the book club focusing on steroid use read Boost, while others read Gym Candy . Within the group focused on teen pregnancy, each of the three participants read a different novel. Additionally, book clubs reading novels about eating disorders met together to compare how their protagonists handled the issues of body image and eating disorders.

Rather than assigning students roles, such as Discussion Leader, Visualizer, Connector, Vocabulary Evaluator, and Question Asker, as originally defined by Harvey Daniels ( 2002 ), students were given twosided, double-entry journal pages (see Figs. 1a–c) specifically designed for this project and adapted from No More “Us” and “Them”: Classroom Lessons and Activities to Promote Peer Respect ( Roessing, 2012 ). Students completed the journal entries as they read their novels, allowing them to record textual evidence and their corresponding responses to and reflections on text, plot, setting, and characterizations, demonstrating to the other book club members and the instructor what they thought was important in the text. More important, the journals provided discussion points to share with the group, increasing collaboration in the study of health issues. Book club members met once a week for approximately 30 minutes to discuss the chapters that were read during the previous week.

After the final reading and text discussion meeting, groups were asked to research the health issue addressed in their books, including descriptions and effects of the issues (definition, symptoms/effects, recommendations for prevention and/or treatment), current research being conducted, current statistics, and teaching and learning considerations for teachers of students experiencing this issue. Students also related their research to the YA title read. Each book club developed an annotated bibliography of references (one book, three journal articles, and two websites), and each member read and reflected upon a selected contribution to a peer-reviewed journal. Finally, each group gave a 15-minute presentation of its health issue research and related YA novel to the class. Creativity in presentations was encouraged with suggestions to present a documentary or mocumentary, infomercial, poster, talk show, skit, or combination of methods/ formats. A grading rubric was distributed to the students prior to the presentation (please see Appendix B on p. 77 for a sample project point-distribution rubric).

Figure 1a-c. Journal pages distributed to book club participants

Following the presentations, students completed a survey for the purpose of gaining insight into their experience with the book club. Survey questions were designed by the researchers to elicit reflection from the participants and provide feedback for the faculty involved. Survey questions included:

• What were the advantages, if any, of reading a young adult book about your topic?
• What insights did reading a novel about your health issue give you that the research did not?
• What were the advantages, if any, academic or other, of reading and discussing as part of a book club?
• How did the double-entry journaling sheets assist you in journaling about the book and in your book club discussions?
• How were the group dynamics in novel discussions? In conducting research? In planning and presenting your in-class presentation?
• How did you choose to present your issue/novel/ research to your peers? How did you select your presentation format? What was the planning process? How effective was your presentation? If you were to make another presentation, what might you change to increase effectiveness and audience engagement?
• In your future profession, will you use the book club as a teaching/learning methodology?
• What did you take away from participating in this project?

Completed surveys were analyzed to reveal recurring themes and their relationship to reviewed literature. Surveys were initially reviewed individually by the researchers and then reviewed collaboratively to substantiate outcomes.

Findings

The surveys generated critical and positive feedback from the students. Through the reading of the novels, the journaling, and the authentic discussions, students reported that the practice encouraged them to critically consider and research health issues, thinking more deeply as they worked together within their book clubs and, at times, among clubs.

Ninety-three percent of students reported that reading young adult literature provided a better understanding of the selected health issue. Twenty of the twenty-seven students noted that the literature provided the perspective of a young adult and gave insight into how young adults may view and deal with the issue. With specific regard to the context of a health class, 37% of students described this methodology as breaking the norm of solely conducting research and providing a fresh take on investigating an issue.

Seventy percent of students wrote that reading YA literature on the health issue brought greater realism to the issue—a personal perspective and story that extended beyond facts, data, and statistics; consequently, students reported having made a personal connection with the issue. In other words, reading YA literature increased empathy. One student wrote, “I felt how she [the protagonist] felt.”

Comprehensiveness and detail of the journal entries varied among students; however, 70% of students reported that the journaling exercise helped them to record key concepts, organize personal thoughts, give a better understanding of the issue and experience, and increase accountability to the group. One student recorded, “I would actually think more in depth about what I read so that I could analyze the book more wisely.”

Over half of students reported that all group members contributed during the discussions, and students noted that the discussions increased their knowledge, understanding, and interest. They felt that discussion of the YA titles opened the opportunity to share and discuss personal interpretations and experiences. Being exposed to different points of view reportedly resulted in improved comprehension and learning. One student wrote, “It helps to open your mind to thinking in different ways.” Another wrote, “The discussion gave me other ideas; my group members made points I had not thought about.” Students reported that the journaling helped to keep the discussions on track and enhanced the discussions.

There was no evidence noted through presentations and discussions that the YA literature perpetuated stereotypes or misconceptions about health issues. There was also no misrepresentation of health content noted during the presentations, which may have been the result of students cross-referencing the health issues with academic resources.

Eighty-one percent of students reported that the methodology promoted not only collaboration and teamwork, but also fostered the development of communication skills. One wrote, “I gained a new technique for teaching and learning in health education. This methodology provides an opportunity to learn health in a more interesting fashion.” Upon conclusion of the presentations, one student said that she so enjoyed the assignment that she started a book club experience with her family.

Discussion and Implications

An intention of this project was to assess student response to book clubs as a teaching and learning methodology in a university health education course. Students’ responses to the assignment were positive, and they considered this approach to be a dynamic method in which to study health education issues.

The book club approach was a new instructional method for the health educator; she met with some initial resistance from students who complained that the process included “having to read a book.” However, by the second book club meeting in class, students were demonstrating their commitment to the assignment by journaling and discussing their readings and developing a relationship with the characters in each of their books. The methodology was engaging students on multiple levels—academically, emotionally, socially. The interaction was dynamic and brought greater meaning to the health issues being studied.

Book clubs have been linked to valued outcomes, including helping students reach a clearer understanding of themselves and others as well as fostering inquiry through collaborative learning in small student-centered discussion groups that encourage higher-order thinking ( Stringer & Reilly, 2004 ). According to Nigro ( 2011 ), engaging in accountable talk, group discussion, paraphrasing, and summarizing helps students develop their critical thinking skills. These discussions help students reframe their thinking and increase their understanding through constructive exchanges as a group; this interaction can further students’ understanding of subject matter, especially through facilitated discussion, which increases the potential for improved written and artistic responses ( Nigro, 2011 ). These findings corroborate the university students’ responses to the book club practice.

Listening, speaking, reading, and writing are reciprocally reinforced through book club group work; in fact, book clubs connect all aspects of literacy for students with varied interests and levels of reading achievement ( Anderson & Corbett, 2008 ). Benefits of book clubs that have been identified include stronger connections between texts and personal experiences, improved classroom climates, enhanced degrees of gender equity and understanding, and a learning environment more conducive to the needs and abilities of English language learners ( Chase & Pheifer, n.d. ). Stringer and Reilly ( 2004 ) write that collaborative reading experiences, such as book clubs, reinforce cooperation and empathy among the students and cultivate further interest in reading.

The outcomes of this study support many of these findings. Students reported that the experience provided greater realism to each health issue being investigated, offering a personal connection to the characters. Students noted that these personal connections increased their feelings of empathy in far greater ways than would the reading of descriptions and statistical reports of health issues. Students also reported appreciation for the collaborative, engaging, and dynamic methodology, which contributed to a positive and productive learning environment. In efforts to improve effectiveness, content area teachers must become aware of instructional approaches and strategies that can be used within their existing curricula to help improve the literacy levels of their struggling readers ( National Institute for Literacy, 2007 ). In order to encourage students to think critically, they need to be provided with opportunities for cognitive and affective responses to literature; book clubs provide one instructional method for accomplishing this goal ( Chase and Pheifer, n.d. ). As part of balanced literacy instruction, book clubs have the potential to rejuvenate excitement about teaching and invoke enthusiasm for reading and discussing among students ( Certo, Moxley, Reffitt, & Miller, 2010 ) across all disciplines.

The health education majors involved in this assignment discovered many reasons to implement this methodology in their future classrooms, both as student teachers and as professional teachers:

• The advantages of implementing book clubs in the classroom (increasing student engagement and motivation, collaboration, peer support, and development of social skills).
• The benefits of using young adult literature (to study and add personal dimension to issues, to supplement the textbook, to provide differentiation of reading levels, and to raise interest and awareness about health issues).
• The potential for increased reading comprehension skills among readers through the use of journaling and text reformulation (post-reading class presentations) ( Roessing, 2009 ).
• An understanding of how to conduct supplementary research that is purposeful for an audience.

Students may be guided toward greater autonomy in and accountability for their own education if educators provide them with valuable, engaging, and relevant assignments to accomplish through collaboration with peers. Additionally, this collaboration between faculty members has led to the co-teaching of Health Education Curriculum and Methods, where traditional delivery of course content will be blended with the further use of YA book clubs as an introduction to reading and writing across the curriculum.

Lynn Hunt Long is currently an assistant professor in the School of Health and Applied Human Sciences at UNC, Wilmington, with a primary instructional focus on health education. She is a former public school health educator.

Lesley Roessing taught middle-grade language arts for over 20 years in Ridley Park, Pennsylvania. She currently serves as director of the Coastal Savannah Writing Project and senior lecturer in the College of Education of Armstrong State University in Savannah, Georgia, where she works with teachers in all grade levels and content areas. Lesley is the author of The Write to Read: Response Journals That Increase Comprehension (Corwin Press, 2009); No More “Us” and “Them”: Classroom Lessons & Activities to Promote Peer Respect (Rowman & Littlefield, 2012); Comma Quest: The Rules They Followed—The Sentences They Saved (Discover Writing, 2013); and Bridging the Gap: Reading Critically and Writing Meaningfully to Get to the Core (Rowman & Littlefield, 2014). Ms. Roessing serves as Editor of Connections, the journal of the Georgia Council of Teachers of English.

References

Anderson, P., & Corbett, L. (2008). Literature circles for students with learning disabilities. Intervention in School and Clinic, 44 , 25–33.

Bowman, C. A. (2000). Using literature to help troubled teenagers cope with health issues . Westport, CT: Greenwood Press.

Certo, J., Moxley, K., Reffitt, K., & Miller, J. A. (2010). I learned how to talk about a book: Children’s perceptions of literature circle across grade and ability levels. Literacy Research and Instruction, 49, 243–263.

Chase, P., & Pheifer, D. (n.d.). Summary of literature circles research . Retrieved from http://kcguidedreading.pbworks.com/f/LitCrcResearch.pdf .

Daniels, H. (1994). Literature circles: Voice and choice in the student-centered classroom . York, ME: Stenhouse.

Daniels, H. (2002). Literature circles: Voice and choice in book clubs and reading groups . Portland, ME: Stenhouse.

Ebert, E. S. II, & Culyer, R. C. III. (2011). School: An introduction to education . Belmont, CA: Wadsworth.

Hill, C. (2009). Birthing dialogue: Using the first part last in a health class. The Alan Review, Fall , 29–34.

Lloyd, R. M. (2006). Talking books: Gender and the responses of adolescents in literature circles. English Teaching: Practice and Critique, 5 (3), 30–58.

National Governors Association Center for Best Practices & Council of Chief State School Officers. (2010). Common core state standards for English language arts and literacy in history/ social studies, science, and technical subjects. Washington, DC: Author. Retrieved from http://www.corestandards.org/ela-literacy .

National Institute for Literacy. (2007). What content-area teachers should know about adolescent literacy . Jessup, MD: National Institute for Literacy.

Nigro, N. (2011, January 20). Using literature circles to engage students . Retrieved from United Federation of Teachers via http://www.uft.org .

Parkay, F. W., Hass, G., & Anctil, E. J. (2010). Curriculum leadership: Reading for developing quality educational programs (9th ed.). Boston, MA: Allyn & Bacon.

Roessing, L. (2009). The write to read: Response journals that increase comprehension . Thousand Oaks, CA: Corwin Press.

Roessing, L. (2012). No more “us” and “them”: Classroom lessons & activities to promote peer respect . Lanham, MD: Rowman & Littlefield Education.

Stringer, S., & Reilly, E. (2004). Literature circles in the physical education classroom. Strategies: A Journal for Physical and Sport Educators , 17 (4), 35–37.

Vanderbilt University Center for Teaching. (2014). Team/collaborative teaching . Retrieved from http://cft.vanderbilt.edu/guides-sub-pages/teamcollaborative-teaching .

Appendix A: YA Fiction and Memoir Related to Health Education

[ * Denotes titles chosen for the book club project in the health issues course. The two Trueman books were read by one club.]

Topic: Body Image; Eating Disorder

Anderson, L. H.	Wintergirls (2010, Speak)
Apostolides, M.	Inner Hunger: A Young Woman’s Struggle through Anorexia and Bulimia (1998, Norton)
Blume, J.	Blubber (2014, Atheneum Books for Young Readers)
Brande, R.	Fat Cat (2011, Ember)
Crutcher, C.	Staying Fat for Sarah Byrnes (2003, Greenwillow)
* Friend, N.	Perfect: A Novel (2004, Milkweed)
* Gotlieb, L.	Stick Figure: A Diary of My Former Self (2001, Berkley)
Hautzig, D.	Second Star to the Right (1999, Puffin)
Krasnow, M.	My Life as a Male Anorexic (1996, Routledge)
* Wheatley, S.	‘Till the Fat Girl Sings: From an Overweight Nobody to a Broadway Somebody—A Memoir (2006, Adams Media)

Topic: Disability; Illness

Arrick, F.	What You Don’t Know Can Kill You [HIV/AIDS] (1994, Laurel-Leaf)
Blume, J.	Deenie [birth defects] (2010, Delacourt)
Ferris, J.	Invincible Summer [cancer] (1994, Farrar, Straus & Giroux)
Foley, J.	Falling in Love Is No Snap [attention deficit hyperactivity disorder] (1986, Delacorte Books for Young Readers)
Green, J.	The Fault in Our Stars [cancer] (2014, Speak)
Hurwin, D.	A Time for Dancing: A Novel [cancer] (2009, Little, Brown Books for Young Readers)
Kingley, J., & Levitz, M.	Count Us In: Growing Up with Down Syndrome (2007, Mariner)
Klein, N.	Going Backwards [Alzheimer’s] (1987, Scholastic)
McDaniel, L.	All the Days of Her Life [diabetes] (1994, Laurel-Leaf)
Philbrick, R.	Freak the Mighty [disability] (2001, Scholastic)
* Sonnenblick, J.	Drums, Girls, and Dangerous Pie [family illness] (2006, Scholastic)
* Trueman, T.	Cruise Control [mental illness] (2005, Harper Teen)
* Trueman, T.	Stuck in Neutral [cerebral palsy] (2000, Harper Teen)
Voigt, C.	Izzy, Willy-Nilly [disability] (2005, Simon Pulse)

Topic: Sports Concussion

* Korman, G.

Pop (2009, Balzer+Bray)

Topic: Steroid Use

* Deuker, C.	Gym Candy (2007, Gym Candy)
* Mackel, K.	Boost (2008, Dial)
McKissack Jr., F.	Shooting Star (2010, Atheneum Books for Young Readers)

Topic: Substance Use; Addiction

* Anonymous	Go Ask Alice [substance abuse] (2005, Simon Pulse)
Anonymous	Jay’s Journal [substance abuse] (2010, Simon Pulse)
Anonymous	Lucy in the Sky [substance abuse] (2012, Simon Pulse)
Cadnum, M.	Calling Home [alcoholism] (1991, Viking Juvenile)
Cheripko, J.	Imitate the Tiger [alcoholism] (1998, Boyds Mills Press)
Gelb, A.	Real Life: My Best Friend Died [alcoholism] (1995, Simon Pulse)
Hopkins, E.	Crank [substance abuse] (2013, Margaret K. McElderry Books)
Hopkins, E.	Glass [substance abuse] (2013, Margaret K. McElderry Books)
Woodson, J.	Beneath a Meth Moon [substance abuse] (2013, Speak)

Topic: Teen Pregnancy

Efaw, A.	After (2010, Speak)
Johnson, A.	The First Part Last (2010, Simon & Schuster Books for Young Readers)
* Sparks, B.	Annie’s Baby: The Diary of Anonymous, a Pregnant Teenager (1998, Avon)

Appendix B: Sample Project Point-Distribution Rubric

__ / 40 points: Novel Overview: author, title, character(s), setting, plot elements</span>
__ / 40 points: Research Overview:

• health issue description, symptoms/effects, impact on self/family/friends
• recommendations for prevention and treatment
• current statistics
• considerations for teachers of students experiencing this issue
• annotated bibliography of references (one book, three peer-reviewed journal articles, two Web sources) typed in APA format

__ / 10 points: Public Speaking Skills: volume, clarity, eye contact, pacing, natural gestures</span>
__ / 10 points: Creative Appropriate Format: i.e., documentary, mocumentary, public service announcement