Overview
This lesson uses a role play technique in which students investigate
why “patients” are complaining of respiratory discomfort. They
investigate cause and effect relationships and try to diagnose the
problem, considering environmental factors common in urban areas.
Objectives
Students will:
•Readcloselyfordetailstoaccumulatecluesabouta“medical
mystery.”
•Makeconnectionsbetweentextualcluestopredictacauseand
effect relationship.
•Identifysomecommonairpollutants,sourcesandeffects.
Human Cities Lesson 1
Air Pollution
Medical
Mystery
By Rachelle McManus
SUBJECTS
Environmental Science
Health
Materials and Resources
Class Set of “Medical Mystery Air Pollution” handout
•1copyof“AirPollutionCaseStudies”patientspage,cutintostrips
(change as needed to make geographically relevant)
•5copiesof“AirPollutionCaseStudies”symptomspage,cutinto
strips. Each set of symptoms strips goes in an envelope marked
“Symptoms.”
•5copiesof“AirPollutionCaseStudies”exposurepage,cutinto
strips. Each set of exposure strips goes in an envelope marked
“Exposure.”
•1copyof“AirPollutionCaseStudies”treatment/curepage,cut
into strips.
The materials will provide enough for 5 groups of 4 students, but the
teacher can print doubles of as many “patients” as needed and student
groups can work on the same patient.
Air
Community
& Sustainability
Setting
Classroom
Time Needed
40 to 50 minutes
Glossary Terms:
Particle
Pollutant
Symptom Exposure
Ozone
Some of the definitions are on the
EPA website: http://www.epa.gov/
oar/particlepollution/ and use
fairly simple language and might
suggest alternate terms.
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Water
Background Information
At The Green School, this lesson takes place in the middle of a 6-week unit on water and air quality.
It is designed to introduce students to a number of common types of air pollution. While it is helpful
for students to be familiar with a variety of pollutants, it is not necessary for them to “memorize
trivia” (extensive information, not all of which in needed). For this reason, a “jigsaw” style activity -- in
which student groups each gain deeper familiarity with one pollutant, but will also hear about other
pollutants through student presentations at the end of the activity -- is helpful.
I have found that students with lower literacy are overwhelmed by physically long units of text, but
you can “trick” students into reading more if they see the text in shorter chunks. In addition, with a
clear and engaging goal – to find out what’s wrong with your patient before he or she becomes ill –
students are motivated to engage with the text in a deep and critical way.
engage with the text in a deep and critical way.
Urban Relevance
Air pollution is a serious human health issue that affects neighborhoods differently. City residents
who have respiratory illnesses are especially susceptible to air quality issues. For this reason, the
patient “stories” are set in the city to help make this relevant for students in urban schools.
Procedure
Preparation
• Students read “Air Pollution Case Studies” to familiarize themselves with the cases. The
paragraphs are not numbered or lettered, as this would ruin the “mystery” aspect, but they
are in order on each page before you cut them – that is, the first patient’s story goes with the
first symptoms paragraph, the first exposure paragraph, and the first treatment paragraph.
You will have to memorize or create your own teacher key to note which patient goes with
which pollutant.
• As mentioned above, cut “Air Pollution Case Studies” handouts into strips in advance and
place in envelopes as directed.
• Copy data table from “Medical Mystery Air Pollution” handout onto whiteboard for student
presentation part of the activity.
1. Introduce vocabulary through notes, lecture or other method: particle, pollutant, symptom,
exposure.
2. Conduct a whole-class brainstorm discussion for no more than 5 minutes asking students what
they already know about air pollution. Where can it come from? (Cars, factories, cigarette smoke,
fires, etc.) What types of particles are pollutants? (Soot, dust, etc.) How can they affect humans?
(Asthma, lung cancer, etc.) (5 minutes)
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3. Introduce the goal of the activity: Each group of 4 will get a “patient” who is sick because of air
pollution. Their goal is to figure out what is causing the person’s illness. Once the group correctly
determines what is wrong with the patient, it will be able to treat him or her. (5 minute transition
to activity)
4. Assign students to groups if they are not already in groups of 4. If the envelopes are not already on
desks, hand them out now. Hand out the “Medical Mystery Air Pollution” worksheet.
5. Ask a student volunteer to read aloud the procedure steps on the worksheet. Remind students
that their group will be working on only one case, but that each group will present their findings
at the end of class. Remind students that they will have 15 minutes to cure their patient. (5
minutes)
6. Ask student groups to assign the four group roles and write their classmates’ names in the
appropriate spaces on the worksheet. Let them know that they will get their patient as soon as
they have been assigned group roles. This should take no more than 2 minutes. You may need to
push along groups that are lagging. Hand out “patients” to groups as they finish assigning group
roles. (2 minutes)
7. Monitor groups as they independently search for clues through their envelopes. Correct any
misunderstandings about the procedure (for example, a doctor who has not opened the
symptoms envelope) but otherwise, allow students at least 5 minutes to get familiar with the
materials. (10-15 minutes total for group work until presentations)
8. As you begin asking students about their thoughts on their patient, call them “Dr.” and their last
name. It makes them feel official and also gives them a sense of what it would feel like to have
that title.
9. As student groups call you over to review their findings, ask critical questions like “What evidence
do you have that this patient has symptoms of carbon monoxide?” or “Where could this patient
have been exposed to smog?” Point out any mistakes in a questioning way, for example: “I see
here that sulfur dioxide is mainly created by burning coal. Does this patient live near a coal
power plant?” If students continue to struggle, point out clues that might direct them to the right
answer, for example: “It’s kind of interesting that she had worse headaches on the weekends,
when she probably spent more time in her apartment. Do you see any pollutants that have worse
exposure indoors?”
* You might also add the idea of “triage” or a decision tree where ER doctors use three questions to get them to the most likely answer.
10. If students have the correct answer, congratulate them and hand them a treatment slip for their
patient. Ask them to fill out the data table for their pollutant only. If students have an incorrect
answer, tell them they have not cured their patient yet and encourage them to look again at their
slips.
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11. After most groups are done and have had a few minutes to fill out their data tables, begin
student presentations. (All groups should diagnose their patients, but if one or two groups
cannot, you can begin the review portion anyway.) Remind students that they will have two
minutes to share their own cases and that they will be recording notes on each pollutant.
12. Ask each group to summarize their patient’s story and share what they filled in for their pollutant
in the data table. As they speak, record their answers in the data table on the whiteboard and
remind students to record in their own data tables. (15 minutes)
13. Complete the activity by giving students two more minutes to finish their data tables after all
groups have spoken. (2 minutes)
14. After all groups have spoken, close the lesson with a group discussion on an action plan to
reduce the risk of illness caused by air pollution in their neighborhoods. The discussion can result
in a letter-writing campaign or PSAs to address this issue.
Total Time 45-50 minutes
Extension Procedure (Optional)
None planned, but a teacher could certainly print a current events article about one of these
pollutants for students who need an extra challenge.
Assessment
• Teacher should monitor groups closely to assess any student mistakes in finding the main
idea of each slip, catching details or making connections among data.
• Teacher can assess the data table, but students can easily copy from each other. So this is not
a great way of assessing understanding.
© Kathleen Sullivan/The Nature Conservancy
• Teacher can assess knowledge of types of air pollutants later in a quiz, test or project.
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Case Studies
(Substitute a neighborhood in your city as needed)
Patients
Teacher: Cut page into strips, one patient per strip. Retain strips to give out to student groups.
I am a 25-year-old female who lives in Brooklyn. I just moved into a new apartment to be
closer to where I work at the Department of Motor Vehicles. Ever since I moved, I have been
getting headaches in the apartment. The headaches don’t come on right away – they take
a few hours to develop. Once when I woke up on a Sunday, I felt lightheaded and dizzy in
addition to my headache.
---------------------------------------------------------------------------------------------------------------------------I am a 15-year-old male who lives in Brooklyn. I have mild asthma. I have been having
especially bad asthma attacks for the past month. I think it’s because I am exercising more –
I started playing basketball every day right under the highway. I guess I’m playing too hard
because I have been having asthma attacks almost every time I play. But it’s weird, now it
sometimes hurts to breathe in. Before when I had attacks it was just hard to breathe. I’m
worried my asthma is getting worse.
---------------------------------------------------------------------------------------------------------------------------I am a 24-year-old female who lives in Binghamton, New York. I’m studying to become a dental
assistant. Since I’m a student I don’t have a lot of money, and the only apartment I could get
was far out of town by the coal power plant. I don’t really like it out there – it’s too far and
the smokestacks are always putting out smoke. I think it’s definitely made my asthma worse.
But now I’m more concerned with other things, since I just had a baby boy. He was born so
premature that he had to be in an incubator for two weeks before I could take him home.
-------------------------------------------------------------------------------------------------------------------------I am a 48-year-old male who lives in Queens. I paint houses for a living. I’ve been painting for
the past 30 years, ever since I got out of high school. But soon I’m going to be too sick to do
my job since I just found out I have a malignant lung tumor. I can’t believe it – I’ve smoked
maybe 10 cigarettes in my whole life, that’s all! And I always ate healthy. And nobody in my
family ever had lung cancer either. I feel so unlucky.
---------------------------------------------------------------------------------------------------------------------------I am a 63-year-old female who lives in The Bronx. I’ve lived there my whole life and I’ve
seen a lot. I’ve seen a new highway get built, I’ve seen factories come and go from my
neighborhood, I’ve seen the price of cigarettes go up from $2.50 to $9.00. That almost drove
me broke! But I guess I won’t see much more because I’m very sick. I just can’t breathe any
more – I don’t understand it. I never had asthma in my life. But lately I get short of breath
when I walk for more than a block. I have to sit down all the time. I spend most of my time at
home now since it’s so hard for me to get up and down the stairs.
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Symptoms
Teacher: Make 5 copies, cut page into strips, one patient per strip. Place each set of 5 different strips into
envelope marked “Symptoms.”
Symptoms of mild carbon monoxide (CO) poisoning include dizziness, lightheadedness and
headaches. Symptoms of severe CO poisoning include convulsions, unconsciousness, and
heart failure. Long-term exposure to CO can weaken the heart.
---------------------------------------------------------------------------------------------------------------------------Smog exposure is especially harmful for senior citizens, children, and people with heart
and lung conditions such as emphysema, bronchitis and asthma. It can inflame breathing
passages, decrease the lungs’ working capacity, and cause shortness of breath, pain when
inhaling deeply, wheezing and coughing. It can cause eye and nose irritation and it dries
out the protective membranes of the nose and throat and interferes with the body’s ability
to fight infection, increasing susceptibility to illness. Hospital admissions and respiratory
deaths often increase during periods when ozone levels are high.
---------------------------------------------------------------------------------------------------------------------------Inhaling sulfur dioxide (SO2) is associated with increased respiratory symptoms and disease,
difficulty in breathing and premature death. Mild exposure can increase symptoms from
other respiratory diseases like emphysema or asthma. A 2011 systematic review concluded
that exposure to SO2 is associated with preterm birth.
---------------------------------------------------------------------------------------------------------------------------Respiratory, allergic or immune effects in infants or children are associated with severe
exposure to manmade Volatile Organic Compounds (VOCs) and other indoor or outdoor air
pollutants. VOCs can cause eye, nose and throat irritation; headaches, loss of coordination,
nausea; and damage to liver, kidney and central nervous system. Some VOCs can cause
cancer in animals; some are suspected or known to cause cancer in humans.
---------------------------------------------------------------------------------------------------------------------------Emphysema is a disease of the lung tissue caused by swelling of alveoli, tiny sacs in the
lungs. People with this disease do not get enough oxygen and suffer a buildup of carbon
dioxide in their blood. At first, when emphysema is mild, this occurs only during physical
activity. Eventually, as the disease worsens, a buildup of carbon dioxide will occur after even
small amounts of physical exertion. Once the lungs are compromised badly enough, the
victim may feel short of breath all the time - even when at rest, relaxing.
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Exposure
Teacher: Make 5 copies, cut page into strips, one patient per strip. Place each set of 5 different strips into
envelope marked “Exposure.”
Carbon monoxide (CO) is a pollutant that occurs when substances are being burned where
there is limited oxygen (for example, inside a building). Sources of CO include cigarette
smoke, house fires, faulty furnaces, heaters, wood-burning stoves, internal combustion
vehicle exhaust, electrical generators, propane-fueled equipment such as portable stoves,
and gasoline-powered tools such as leaf blowers, lawn mowers, high-pressure washers,
concrete cutting saws, power trowels and welders. Exposure typically occurs when
equipment is used in buildings or semi-enclosed spaces.
---------------------------------------------------------------------------------------------------------------------------Smog is a word created by putting “smoke” and “fog” together. It refers to the combination
of pollutants, including ground-level ozone, sulfur dioxide, nitrogen dioxide and carbon
monoxide, that result from car exhaust and factory smoke. Smog is especially bad on humid
days, when the moisture in the air traps these particles and makes them heavy enough that
they float in the air near the ground. People in cities and near large highways and factories
get the most smog exposure.
*Conservation Connection: Scientists actually learned about animals adapting to their
environment because smog in London turned buildings black and birds could see white moths
and hunt them, but not black moths. So suddenly there were way more black moths. Nature’s
response was another sign that things were getting really bad for people and in fact led to the
Great Smog that killed 4,000 people over a weekend in 1952.
---------------------------------------------------------------------------------------------------------------------------Sulfur dioxide (SO2) is a poisonous gas that is released by volcanoes and in various industrial
processes. Since coal and petroleum often contain sulfur compounds, their combustion
generates SO2 unless the sulfur compounds are removed before burning the fuel.
--------------------------------------------------------------------------------------------------------------------------Volatile Organic Compounds (VOC’s) are harmful chemicals that have a low boiling point,
which means they turn from liquid to gas at room temperature. They are often used in paints,
industrial processes and metalworking. Liquids used in these processes contain a lot of VOCs
and those chemicals turn to gas as the liquid is being used, creating air pollution in the area.
---------------------------------------------------------------------------------------------------------------------------Cigarette smoke contains many harmful chemicals including formaldehyde, ammonia
and acetone. Cigarette smoke is the quickest way to get a huge amount of pollutants into
a person’s lungs because the smoke is inhaled directly out of the cigarette and is very
concentrated. The concentration of chemicals from inhaling cigarette smoke is similar to the
chemicals you would get from inhaling directly out of the exhaust pipe of a car.
* Conservation Connection: Tobacco for cigarettes is also a nutrient-intensive annual crop that requires
a lot of pesticides which can run off and harm plants, fish and other animals. The use of pesticides also
means you are breathing in pesticides when you smoke cigarettes.
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Treatment/Cure
Teacher: Cut page into strips, one patient per strip. Retain strips to give out to student groups when they
successfully solve the mystery.
For severe carbon monoxide (CO) poisoning, the person should immediately be placed in an
oxygen chamber. For mild CO poisoning, the person should be removed from the source of
the CO as soon as possible and the source of the CO in the space should be fixed.
---------------------------------------------------------------------------------------------------------------------------For smog exposure, the most important thing is to figure out where the smog is coming
from and remove the affected person from that area. Often people affected by smog may
need to increase the dose of their asthma medication.
---------------------------------------------------------------------------------------------------------------------------For sulfur dioxide (SO2) exposure, the most important thing is to remove the affected
person from the area. The damage done by SO2 is irreversible, but the person can avoid
further harm by leaving the area.
---------------------------------------------------------------------------------------------------------------------------For volatile organic compound (VOC) exposure, the most important thing is to remove the
affected person from the area. If this is not possible, some face masks can help filter out
VOCs. The damage done by VOCs is irreversible, but the person can avoid further harm by
leaving the area.
---------------------------------------------------------------------------------------------------------------------------For emphysema, the treatment is a combination of avoiding physical activity and getting
more access to oxygen. Often the patient is hooked up to a portable oxygen tank with
tubes running into his or her nose. The individual must carry this tank around everywhere.
However, emphysema is irreversible and eventually leads to death.
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Medical Mystery: Air Pollution
Procedure:
1. Assign group roles:
Patient ____________ Doctor ____________ Scientist ___________ Fact-Checker ____________
2. The patient reads his/her situation out loud.
3. The doctor and the scientist silently read their information sheets and make an independent
guess about what pollution is causing the patient’s problems.
4. The doctor and the scientist explain their choices to the group. The fact-checker gives advice if
he/she hears any mistakes.
5. All group members work together to agree on one choice.
6. Check your hypothesis with the teacher. If you are right, your patient will receive treatment!
7. Each group will present its findings and complete the Analysis table for all pollutants.
Analysis
POLLUTANT
SOURCE
EFFECT
Smog
Carbon Monoxide
(CO)
Tobacco Smoke
Volatile
Organic Compounds
(VOCs)
Sulfur Dioxide
(SO2)
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S U B M I T T E D
B Y
WILDERNESS ARTS AND LITERACY COLLABORATIVE
at Balboa High School
San Francisco, California
The Wilderness Arts and Literacy Collaborative (WALC)
is an academic program that uses environmental
education as the central, unifying theme to integrate
science, English, social studies, art, technology and
math. Field experiences such as hiking, camping,
habitat restoration and recycling are woven together
with classroom coursework and provide the
experiential foundation for a challenging academic
curriculum. Outdoor learning and classroom learning
complement and build upon one another to create
a more interconnected educational experience
for students. WALC is a teacher-initiated nonprofit
organization at Balboa and Downtown Continuation
High Schools, both in San Francisco.
www.walcsf.net
A
L E A F
P A R T N E R
S C H O O L