Health Promotion overview

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  • - Malignant Melanoma is the most deadly type of cancer, If treated early: 100% cure rate If untreated: 100% mortality - 1935: Risk 1:1,500 - 2000: Risk 1:90 for Caucasians born in the yr 2000. It is probable that sunburn, rather than total sun exposure, is an etiological factor for malignant melanoma. Skin Cancer Prevention - Education Primary Prevention: Avoid exposure to UV Radiation (ACS Campaign: SLIP, SLAP, SLOP) Use Sunscreen > SPF 15 Wear Hats Wear protective clothing Avoid tanning salons Avoid the sun between 10 am-4 pm

Transcript

  • 1. Mike Chisick, LTC, DC, USA U.S. Army Center for Health Promotion and Preventive Dentistry Aberdeen Proving Ground, MD
  • 2. Pamila Richter U.S. Army Dental Command Fort Sam Houston, Texas
  • 3. Put More “Bite” Into Health Promotion
  • 4. “Bite”
    • A campaign to re-vitalize Health Promotion in the Army Dental Care System.
  • 5. “Bite”
    • A joint effort between USACHPPM and DENCOM
  • 6. ADCS Vision The Army’s dental care system of choice, focused on readiness, health promotion and exceeding our customer’s expectations.
  • 7. “ Put more dental into health promotion and more health promotion into the Army Dental Care System.” MG Patrick Sculley
  • 8. Partnerships
    • USADENCOM - USACHPPM
    • DENTAC - MEDDAC
    • DC - TMC
  • 9. “ Bite” puts more DENTAL into health promotion through patient-oriented initiatives for:
    • Sealants
    • Mouthguards
    • Lip and Oral Cancer
    • Nursing Bottle Caries
  • 10. “ Bite” puts more HEALTH PROMOTION in the dental care system through patient-oriented initiatives for:
    • Skin Cancer
    • Tobacco Cessation/Interdiction
    • Nutrition
    • Blood Pressure Screening & Referral
    • PPIP
  • 11. “ Bite” puts more HEALTH PROMOTION in the dental care system through provider-oriented initiatives for:
    • Ergonomics
    • Stress Management
  • 12. Guidelines Used in Developing “Bite”
    • Mindful of provider curative workload
    • Mindful of need for provider buy-in
    • Craft a well-focused, narrow, doable, acceptable agenda
    • Make initiatives evidence-based
  • 13. Rationale for “Bite” Initiatives
  • 14. Put More “Bite” Into Health Promotion Sealant Initiative
  • 15. Why Sealants?
    • High need in military population
    • Potential to greatly reduce future operative workload
  • 16. Why Oral Cancer?
    • 30,000 cases in U.S. annually
    • 8,000 deaths in U.S. annually
    • 90% occur in individuals > 45 y.o.
    • Risk factors
      • Tobacco
      • Sun Exposure
      • Alcohol
      • Diet
  • 17. Why Oral Cancer?
    • Tobacco & alcohol account for 75% of all oral cancers
    • Smokers 2-18x greater risk
    • Heavy drinkers who smoke > 1 pack cigarettes/day 24x greater risk
    • Military population has high exposure to oral cancer risk factors
  • 18. Why Skin Cancer
    • 800,000 new cases annually
    • Incidence of skin cancer has dramatically increased over past few decades
    • Everybody is susceptible
    • Military is high risk occupation for skin cancer
  • 19. Lifetime Risk of Malignant Melanoma Rigel, et al. J. Am. Acad. Derm. 17(6):1050-1053, 1987 0 4 8 12 16 1935 1950 1980 2000 Rate/100,000
  • 20. Why Tobacco Cessation/Interdiction?
  • 21. Tobacco Kills... over 400,000 people each year.
  • 22. Tobacco Kills... more people than heroin, cocaine, alcohol, AIDS, fires, homicides, suicides, and automobile accidents COMBINED.
  • 23. Why Tobacco Intervention?
    • Active duty compared to recruits
    • Limited to enlisted only with < 5 years service
    • Standardized for age, sex, and race
    • Cross-sectional design; no causation
    • (TSOHS)
  • 24. Cigarette Smoking 21 43 5 20 0 5 10 15 20 25 30 35 40 45 Whites Blacks Recruits Active Duty
  • 25. SLT Use 11 24 0 5 10 15 20 25 White Males Recruits Active Duty
  • 26. Put More ‘Bite’ Into Health Promotion
    • Tobacco cessation advisement by dentists to their patients
  • 27. The American Dental Association has recommended tobacco education for patients since 1964.
  • 28. Percent of Active Duty Military Seeing a Dentist within the Past Year 86% (‘94-’95 TSCOHS)
  • 29. Tobacco Cessation Advisement 57 62 68 68 72 0 15 30 45 60 75 Snuff Chewing Tobacco Cigarettes Cigars Pipes
  • 30. Law M, Tang JL (1995): An Analysis of the Effictiveness of Interventions Intended to Help People Stop Smoking. Arch Intern Med. 155:1933-41
  • 31.
    • Reviewed findings from 188 controlled clinical trials on smoking cessation.
    • Minimum 2 year duration.
    • Minimal intervention effective.
    • Despite low success rate, still cost effective.
  • 32. On- and Off-the-job Injury Prevention is one of the top priorities of LTG Blanck, the Army Surgeon General
  • 33. Why Mouthguards?
    • Military population is highly athletic
    • Am. Academy for Sports Dentistry recommends MGs for 40 sports
    • During any sports season, athletes have a 10% chance of sustaining an injury to the face or mouth
  • 34. Why Mouthguards?
    • High school football injuries to mouth and face
      • - 50% prior to 1962
      • - 1.4% today
    • Impact of official game rules mandating use of mouthguards
  • 35. Academy for Sports Dentistry endorses mouthguard use for the following sports:
    • acrobatics
    • baseball
    • basketball
    • boxing
    • cycling
    • discus
    • equestrian sports
    • field hockey
    • football
    • gymnastics
    • handball
    • ice hockey
    • judo
    • karate
    • lacrosse
    • motorcross
    • martial arts
    • parachuting
    • rugby
    • racquetball
    • skiing
    • soccer
    • Squash
    • surfing
    • skate boarding
    • shot putt
    • skydiving
    • trampoline
    • tennis
    • volleyball
    • wrestling
    • weight lifting
    • water polo
    (Johnsen & Winters, Dent Clinics N Amer 35:657-66, 1991)
  • 36. 13% - 39% of all dental injuries are sport-related (Hayrinen-Immonen et al., Endod Dent Traumatol 6:208, 1990) (San, Proc Finn Dent Soc 84:Supplement IV, 1988)
  • 37.
    • Ankle injuries and HEAD TRAUMA tie as the leading cause of MAJOR injuries in IDF paratroopers.
    • Overall injury rate 0.89% or 9/1000 plane jumps.
    • Earlier studies show injury rates of 0.3-1.4 % or 3.1-14/1000 plane jumps.
    • (Bar-Dyan, Bar-Dyan, & Shemer, Milit Med 163:1-2, 1998)
  • 38. Although the injury rate for parachuting may be low, the cost of a single major parachuting injury could be prohibitive in both lost productive time and medical costs. CHPPM ankle brace, now in mandatory use in airborne training, has cut the incidence of ankle injuries in half.
  • 39. Reducing injuries 10 % in the Army would save an estimated $35m. (COL Bruce Jones, MD, USACHPPM)
  • 40. Key Challenges to Changing Health-Related Behaviors
  • 41. “ Everybody loves to learn but nobody likes to be taught.” - Winston Churchill
  • 42. “ We don’t need no education. We don’t need no thought control” - Pink Floyd
  • 43. The most treasured of all American liberties is the right to be left alone . - Samuel Warren and Louis Brandeis The Right to Privacy. Harvard Law Review. 15 December 1890.
  • 44. Time Pressures
  • 45. Fragmented Audience
  • 46. General Principles to Follow When Counseling on Health Behaviors
  • 47. Teach Every Available Moment
  • 48. “TEAM” Approach
    • Clinic Waiting Room
      • Video Loops from ADA, ACS, TDA, etc
      • Posters
      • Pamphlets
      • Static Displays
  • 49. “TEAM” Approach
    • Clinical Staff
      • Patient Interviews
      • Reinforce Positive Lifestyles & Healthy Decisions
      • Reinforce Oral Message with Written Materials
      • Referrals
  • 50. Old Clinical Axiom: What is said is not what is heard.
  • 51. Deliver the Message Through Multiple Channels
    • Oral
    • Written
    • Visual
  • 52. Why educate people who can’t benefit from a service?
    • Raise awareness
    • Diffuse knowledge
    • May influence others as a parent, relative, or peer
  • 53. The only thing harder than getting an old idea out of the military mind is getting a new one in. - Liddell Hart
  • 54. ‘97 Dental Health Promotion Practices Survey
    • 606 full-time clinically assigned dentists
    • Queried on:
      • Frequency of delivering 20 dental health promotion/preventive services
      • Type and source of patient educational materials
  • 55. Dental Health Promotion/Preventive Services Delivered Frequently PSR Education 69% Tobacco Counseling 75% Blood Pressure Screening 79% Oral Cancer Screening 84% Individual Oral Hygiene Instruction 88%
  • 56. Dental Health Promotion/Preventive Services Delivered Infrequently Nursing Caries 8% Make Mouthguards 21% Mouthguard Education 24% Place Sealants 25% Sealant Education 28%
  • 57. Sources of Patient Education Materials Internet 2% Tobacco-Free 3% Steering Committee NOHICH 4% Other 7% Amer. Heart Association 12% Insurance Company 16% Amer. Cancer Society 23% Self-Designed 25% Army 38% ADA 49%
  • 58. Media used to deliver dental health promotion messages is almost exclusively oral counseling.
  • 59. “Bite” Interventions Include:
    • Screening and referral
      • - Skin, lip, & oral cancer
    • Clinical services
      • - Mouthguards
      • - Sealants
    • Patient Education
      • Sealants
      • Mouthguards
      • Skin, lip, & oral cancer
      • Tobacco cessation/interdiction
  • 60. You can resist an invading Army; you cannot resist an idea whose time has come. - Victor Hugo
  • 61. Points of Contact Pamila T. Richter, USADENCOM DSN 471-8241, COM (210)221-8241 MAJ Mark Piotrowski, USACHPPM DSN 584-7390, COM (410)436-7390