public health and pediatrics module 1 choking, smoking, teen driving november, 2010 deborah moss, md...
Post on 27-Dec-2015
222 Views
Preview:
TRANSCRIPT
Public Health and PediatricsModule 1
Choking, Smoking, Teen Driving
November, 2010Deborah Moss, MD MPH
Dianna Ploof, EdD
Case 1: Case 2: Case 3:
Choking Case Smoking Case Teen Driving Case
S S S
E E E
P P P
A A A
You have completed Case 1. Now try applying the SEPA approach for Case 2 or Case 3 in this jeopardy-style format.
Click on the topic of your choice to get started.
Case 2: Smoking
You are seeing Justin Smith who is brought by his mother for his 2 month well child check. He was born full term without complications, has been generally healthy, and is Mrs. Smith’s 4th child.
S E P A
In reviewing the vital signs on the chart, you notice that the smoking status vital sign box is marked “yes”.
• 15.1% of women smoke during pregnancy (Allen et al, 2004); up to 30-40% in some low income populations
• 19.8% of adults in US report current smoking: 20.9% in PA (2007 MMWR)
• 59.6% of non-smoking children ages 3-11 had serum cotinine levels consistent with second hand smoke exposure (Pirkle, 2006)
S E P A
Epidemiology :
Exposure to maternal smoking is associated with:
• Prenatal risks: preterm delivery, low birth weight, pregnancy complications
• 2-3 times the risk of SIDS
• 4 times the rate of hospitalizations for exposed infants
• Increased rates of lower respiratory tract illnesses and of asthma exacerbations
Exposure to maternal smoking or SHS is associated with:
• Increased incidence (new cases) of asthma
• Increased rate of middle ear infections
• More respiratory symptoms
• Dental caries
• Increased risk of meningitis
• Greater risk for injury and death due to fires
Exposure to maternal smoking is associated with:
Increased health care costs. SHS exposure from parental smoking is responsible for*:
• 22,000 national annual excess hospitalizations for RSV/bronchiolitis
• 1.8 million national annual excess outpatient visits for asthma
• 8000-26,000 new asthma cases per year
• $4.6 billion excess annual health care costs
* Aligne: Arch Pediatr Adolesc Med, Volume 151(7). July 1997, 648-653
Additional long-term health risks related to parental smoking include:
• Increased risk of teen smoking initiation
• Impaired cardiovascular health
• Impaired lung function
• Adult periodontal disease
S E P A
What actions could you take to protect children from the harms of
second hand smoke?
Become informedActions in the clinic
Actions beyond the clinic
How can you become informed?• Google it!
• Learn about advocacy resources: e.g., the AAP Advocacy Guide (excellent resource!)
http://www.aap.org/moc/advocacyguide/chapter2-main.cfm (See “Resource Section”)
• Join a list-serve Bill Godshall: bg-announce@ smokescreen.org (See “Resource Section”)
• Read newspapers
• Other ideas?
Action
Actions in the clinic
What are actions in the clinic you might take to protect a patient(s) from second-hand smoke exposure?
(Discuss, then click the light bulb)
Action
Actions in the clinic?Adhere to evidence-based practice guidelines*:
a. Ask every parent if they smoke cigarettes
b. Advise every parent to protect their children: • advise smokers to quit (physicians’ advice doubles
quit rate)• advise non-smokers to keep home and child’s
environment smoke-free
c. Assist every parent (See “Resources Section” in module for information, sample Rx and links to brochures)
*US Department of Health and Human Services, Public Health Service. Treating Tobacco Use and Dependence: 2008 Update
Action
Actions beyond the clinic
What actions outside the clinic could you take to protect children from second-hand smoke exposure?
Action
Actions beyond the clinic?
•Join existing campaigns: e.g., campaign to regulate smoking in movies
http://smokefreemovies.ucsf.edu/ (See “Resources Section”)
• Support local efforts: e.g., our institution’s smoke-free campus policy
• Advocate for legislation that benefits child health: e.g., for more comprehensive smoking bans
locally and statewide. Call, write letters to legislators; testify at hearings on this issue.
Action
Actions beyond the clinic?• Identify your legislator :
http://www.congress.org/congressorg/dbq/officials/?&lvl=L)
• Meet with your legislator so you can be a resource: One call can make a difference. Example*:
…one pediatrician took 5 minutes between patient appoint-ments to call her state representative about a bill she cared about. Later that day, the representative spoke on the floor of the state house on behalf of the bill, and specifically stated:
"My pediatrician supports this bill, and if it's good enough for her, it's certainly good enough for the state”.
* extracted from the AAP advocacy website
End of Case 2
Action
Case 3: Teen Driving
You are seeing a 16 year old boy for a driver’s license physical. During the encounter you notice that he is easily distracted by his phone, checking it frequently and even sending a few texts while you are talking.
S E P A
Driver DistractionFor all ages, driver distraction is the leading contributor to
automobile accidents (80%) (NHTSA). • includes cell phone use and texting • Inexperienced drivers < 20 yo have the highest proportion of
distraction-related fatal crashes
87% of motor vehicle accident (MVA) deaths involving teens are related to distraction (Allstate Foundation study)
16-year-olds have almost 10 times the crash risk of older drivers (30-59 yo); and 3 times the risk compared with older teen drivers (David Hemenway, (2009) While we were sleeping, p. 12)
Driver DistractionThe AAA Foundation for Traffic Safety analyzed data on fatal motor
vehicle crashes from 1998 through 2007:
In 2008, nearly 6,000 people died in crashes involving a distracted driver and more than 500,000 people were injured. (CDC) S E P A
What are public health approaches to this issue?
• Policies and legislation that prevent accidents (requiring a the fence along the cliff). e.g.:
Graduated driver’s license programs – where enacted, these laws have reduced the crash risk by 30%
Bans on texting while driving
• Public education campaigns about not driving while distracted (placing a warning sign near the cliff)
S E P A
What are actions you can take to protect teens from the risks of driving
while distracted?
Become informedActions in the clinic
Actions beyond the clinic
How can you become more informed about this issue?
Where/How can you find out more about this topic ?
(Discuss, then click the light bulb)
Action
How can you become more informed about this issue?
• Google it
• Use trusted sources: AAP and CDC websites
• Read newspapers
• See if your state bans texting while driving http://www.nophonezone.com/subscribe.html
• Other ideas?
Action
Actions in the clinical encounter?
What are actions you might take in the clinic for injury prevention regarding teen driving and texting?
(Discuss, then click the light bulb)
Action
Actions in the clinic?
Address these issues with your patients/parents
•During the driver’s license physical examination, emphasize the risks of driver distraction.
•Advise the driver to be to turn the cell phone off and place it well out of reach before starting the car.
Action
Actions beyond the clinic?
What actions outside the clinic might you take to reduce injury related to teen driving and
texting?
(Discuss, then click the light bulb)
Action
Actions beyond the clinic?• Visit CHP’s Legislative Action Center at
http://capwiz.com/chp/issues/alert/?alertid=18925501&type=ST&show_alert=1 to let advocate for teen driving safety)
• Join a letter-writing campaign advocating for comprehensive texting bans in your state
See a Sample Letter in the “Resources Section” of the module.
• Other ideas?
End of case
Action
top related