health promotion overview
TRANSCRIPT
Mike Chisick, LTC, DC, USA
U.S. Army Center for Health Promotion and Preventive Dentistry
Aberdeen Proving Ground, MD
ADCS Vision
The Army’s dental care system of choice, focused on readiness, health promotion and
exceeding our customer’s expectations.
“Put more dental into health promotion and more health promotion into the Army
Dental Care System.”
MG Patrick Sculley
“Bite” puts more DENTAL into health promotion through patient-oriented initiatives for:
Sealants
Mouthguards
Lip and Oral Cancer
Nursing Bottle Caries
“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
“Bite” puts more HEALTH PROMOTION in the dental care system through provider-oriented initiatives for:
Ergonomics
Stress Management
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
Why Sealants?
High need in military population
Potential to greatly reduce future operative workload
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
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
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
Lifetime Risk of Malignant MelanomaRigel, et al. J. Am. Acad. Derm. 17(6):1050-1053, 1987
0
4
8
1 2
1 6
1 9 3 5 1 9 5 0 1 9 8 0 2 0 0 0
/10
0,0
00
Rate
Tobacco Kills...
more people than heroin, cocaine, alcohol, AIDS, fires, homicides, suicides, and automobile accidents COMBINED.
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)
Tobacco Cessation Advisement
5 76 2
6 8
6 8
7 2
0 15 30 45 60 75
Snuf f
Chewing Tobacco
Cigaret t es
Cigars
Pipes
Law M, Tang JL (1995): An Analysis of the Effictiveness of Interventions Intended to Help People Stop Smoking.
Arch Intern Med. 155:1933-41
Reviewed findings from 188 controlled clinical trials on smoking cessation.
Minimum 2 year duration.
Minimal intervention effective.
Despite low success rate, still cost effective.
On- and Off-the-jobOn- and Off-the-job
Injury PreventionInjury Preventionis one of the top priorities ofis one of the top priorities of
LTG Blanck, the Army Surgeon GeneralLTG Blanck, the Army Surgeon General
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
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
Squash surfing skate boarding shot putt skydiving trampoline tennis volleyball wrestling weight lifting water polo
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
(Johnsen & Winters, Dent Clinics N Amer 35:657-66, 1991)
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)
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)
Although the injury rate for parachuting may Although the injury rate for parachuting may be low, the cost of a single major parachuting be low, the cost of a single major parachuting injury could be prohibitive in both lost injury could be prohibitive in both lost productive time and medical costs.productive time and medical costs.
CHPPM ankle brace, now in mandatory use CHPPM ankle brace, now in mandatory use in airborne training, has cut the incidence of in airborne training, has cut the incidence of ankle injuries in half.ankle injuries in half.
Reducing injuries 10 % in the Army Reducing injuries 10 % in the Army
would save an estimated would save an estimated $35m.$35m.
(COL Bruce Jones, MD, USACHPPM)(COL Bruce Jones, MD, USACHPPM)
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.
“TEAM” Approach
Clinic Waiting Room
– Video Loops from ADA, ACS, TDA, etc
– Posters
– Pamphlets
– Static Displays
“TEAM” Approach
Clinical Staff
– Patient Interviews
– Reinforce Positive Lifestyles & Healthy Decisions
– Reinforce Oral Message with Written Materials
– Referrals
Why educate people who can’t benefit from a service?
Raise awareness
Diffuse knowledge
May influence others as a parent, relative, or peer
The only thing harder than getting an old idea out of the military mind is getting a new one in.
- Liddell Hart
‘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
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%
Dental Health Promotion/Preventive Services Delivered Infrequently
Nursing Caries 8%
Make Mouthguards 21%
Mouthguard Education 24%
Place Sealants 25%
Sealant Education 28%
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%
“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