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Public Health and Pediatrics Module 1

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Public Health and Pediatrics Module 1 Choking, Smoking, Teen Driving Actions in the clinic? Assist every parent * (links to brochures, quitline fax, NRT prescription ... – PowerPoint PPT presentation

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Title: Public Health and Pediatrics Module 1


1
Public Health and Pediatrics Module 1
  • Choking, Smoking,
  • Teen Driving

2
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 1 Case 2 Case 3
Choking Smoking Teen Driving
S S S
E E E
P P P
A A A
3
Case 1 Choking
  • On a July afternoon in 2006, while watching TV
    together, Patrick Hales 23-month-old daughter,
    Allison, turned purple and was unable to breathe.
  • An autopsy found that she had inhaled pieces of
    popcorn into her vocal cords, her bronchial tubes
    and a lung

S E P A
4
Have you had any similar cases in your clinical
experience?
  • Discuss

S E P A
5
What is the epidemiology of choking in the
pediatric population?
  • Fatal Choking Rates
  • Non-Fatal Choking Rates
  • Contributors to increased risk in younger children

6
Fatal Choking Rates
  • 449 deaths from aspirated non-food foreign bodies
    (coins and toys) among children aged 14 years or
    younger (1972-1992, US Consumer Product Safety
    Commission) 65 of these in lt3 year olds.
  • Leading causes of choking
  • 1. Latex balloons 29 of all choking deaths
  • 2. Round toys, small balls and marbles
  • 3. Food e.g. hot dogs, popcorn, peanuts, hard
    candy
  • 17 of food related choking events are due to
    hot dogs.

7
Non-Fatal Choking Rates
  • Non-fatal choking rates by age (CDC report)
  • Infants 140.4 per 100 000 population
  • lt 14 years 29.9 per 100 000 population (NOTE
    same as SIDS rate)
  • Of 17, 537 children lt14 year treated for non-
    fatal choking
  • 77.1 occurred among children aged 3 years or
    younger
  • 59.5 of those treated for choking were
    food-related
  • 31 of those treated were due to a non-food
    item13 of these were from coins, 19 by candy
    or gum

8
Determinants of Health Contributors to increased
risk in younger children
  • Put things in their mouths
  • Molars for grinding food dont erupt until after
    1.5 years
  • Smaller airway diameter
  • Airway mucous and secretions can form a seal
    around the foreign body, making it difficult to
    dislodge even with the Heimlich
  • Weak, non-forceful cough in infant/young child

9
What are public health/preventive health
approaches to this issue?
  • Primary Prevention
  • Secondary Prevention
  • Tertiary Prevention

S E P A
10
What are opportunities for you to take
action to reduce childrenmobidity and mortality?
  • How to become informed?
  • Actions in the clinic?
  • Actions beyond the clinic?

11
Primary prevention prevent the choking from
happening (Keep people from falling off the
cliff)
  • Identifying characteristics of choking hazards
    (size and shape) leads to product safety
    screening product labels or product re-design
    (hot dog cutter)
  • see consumer product safety fact sheet -
    http//www.cpsc.gov/cpscpub/pubs/282.html
  • Identifying the population at risk use
    epidemiology to inform public health campaigns,
    community and individual education

Small parts test fixture cylinder with a
diameter of 1.25 inches and depth between 1 and
2.25 inches
12
Secondary prevention early detection of choking
hazard
  •  
  • Surveillance of choking events leads to product
    recall by the U.S. Consumer Product safety
    commission (started 1972)

13
Tertiary prevention reducing the impact of the
choking event (ambulance in the valley)
  • Develop treatment/response approaches to choking
    victims
  • Community CPR training, for example
  •  

S E P A
14
How can you become more informed about this issue?
  • Where/How can you find out more about this
    topic/issue ? (Discuss, then click the light
    bulb)

15
How can you become informed?
  • Websites US Consumer Product Safety
    Commission Centers for Disease Control
  • Colleagues
  • Associations
  • Other

16
Actions in the clinical encounter?
  • What are actions you might take for injury
    prevention / health promotion regarding choking
    when seeing patients?
  • (Discuss, then click the light bulb)

17
Actions in the clinic?
  • Adhere to best practices
  • Talk to your patients about choking hazards
    (anticipatory guidance is clinical advocacy)
  • Give the choking hand-out with first aid
    instructions (12 month age-specific packet)
  • Other ideas?

18
Actions beyond the clinic?
  • What are actions you might take for injury
    prevention / health promotion regarding choking
    in advocacy activities outside of the clinic
    setting?

19
Actions beyond the clinic?
  • Promote CPR training for parents, caregivers and
    others
  • Work with your AAP chapter or a specific
    committee
  • e.g., join the AAP committee on injury, violence
    and poison prevention - participate in the
    advocacy effort calling for the FDA to require
    warning labels on foods proven to be choking
    hazards.

End of Case 1
20
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. Smiths 4th
    child.
  • In reviewing the vital signs on the chart, you
    notice that the smoking status vital sign box is
    marked yes.

S E P A
21
Have you had any similar cases in your clinical
experience?
  • Discuss

S E P A
22
What is the epidemiology of maternal smoking? of
child exposure to second hand smoke?
23
Epidemiology
  • 15.1 of women smoke during pregnancy (Allen et
    al, 2004) up to 40 in low income women
  • 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
24
What are the public health implications related
to this infants exposure to mothers smoking and
important to his care and children with similar
presentations? (Deb can you shorten this
question? It seems to be asking a lot.. but I am
a lay person)
S E P A
25
Exposure to maternal smoking is
associated with
  • Prenatal risks preterm delivery, low birth
    weight, pregnancy complications
  • 2-3 times the risk of SIDS compared with kids not
    exposed to smoke
  • Four times the rate of hospitalizations for
    exposed infants
  • Increased rates of lower respiratory tract
    illnesses and of asthma exacerbations

26
Exposure to maternal smoking is associated
with
  • Increased incidence (new cases) of asthma
  • Increased rate of middle ear infections
  • More respiratory symptoms
  • Dental decay
  • Increased risk of meningitis
  • Greater risk for injury and death due to fires

27
Exposure to maternal smoking is associated
with
  • Increased health care costs. Second hand smoke
    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

28
Additional long-term health risks related
to parental smoking include
  • Increased likelihood that teens see the behavior
    as normative
  • Increased risk of teen smoking initiation
  • Impaired cardiovascular health
  • Adult periodontal disease and increased risks for
    lung and cardiovascular disease

S E P A
29
What are actions you might take to help
reduce smoking rates? How can pediatricians
advocate to protect children from the harms of
second hand smoke?
  • How to become informed?
  • Actions in the clinic?
  • Actions beyond the clinic?

30
How can you become more informed about this issue?
  • Where/How can you find out more about this
    topic/issue ? (Discuss, then click the light
    bulb)

31
How can you become informed?
  • Google it!
  • Learn about advocacy resources eg the AAP
    Advocacy Guide (excellent resource!)
  • http//www.aap.org/moc/advocacyguide/chapter2-main
    .cfm
  • Join a list serve (Bill Godshall
  • bg-announce_at_smokescreen.org )
  • Read newspapers
  • Other ideas?

32
Actions in the clinical encounter?
  • What are actions you might take for injury
    prevention / health promotion regarding
    second-hand smoke exposure when seeing patients?
  • (Discuss, then click the light bulb)

33
Actions in the clinic?
  • Adhere to evidence-based practice guidelines
    (Fiore MC et al. 2000)
  • 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 childs
    environment smoke-free
  • c. Assist every parent (links to brochures,
    quitline fax,
  • NRT prescription HERE)

34
Actions in the clinic?
  • Assist every parent (links to brochures,
    quitline fax, NRT prescription HERE)

35
Actions beyond the clinic?
  • What are actions you might take for injury
    prevention / health promotion regarding childhood
    smoke-exposure in advocacy activities outside of
    the clinic setting?

36
Actions beyond the clinic?
  • Join existing campaigns eg the campaign to
    regulate smoking in movies - http//smokefreemovie
    s.ucsf.edu/
  •  
  • Support local efforts eg our CHP/UPMC smoke-free
    campus policy
  •  
  • Advocate for legislation to benefit child health
    eg advocate for stronger/more comprehensive
    smoking bans locally and statewide. Call, write
    letters to legislators . Testify at hearings on
    this issue.

37
Actions beyond the clinic?
  • Identify your legislator http//www.pasen.gov/cf
    docs/legis/home/find.cfm
  • Meet with your legislator so you can be a
    resource One call can make a difference. (Example
    below extracted from the AAP advocacy website)  
  • 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.
  • .

38
Case 3 Teen Driving
  • You are seeing a 16 year old boy for a drivers
    license physical. You notice during the encounter
    that he checks his phone frequently and even
    sends a few texts while youre talking.

S E P A
39
Have you had any similar cases in your clinical
experience?
  • Discuss

40
What is the epidemiology of driving while
distracted?
41
Driver Distraction
  • For all ages, driver distraction is the leading
    contributor to automobile accidents (80) and
    near-accidents (65) (NHTSA). This includes cell
    phone use and texting.
  • Inexperienced drivers lt 20 yo have the highest
    proportion of distraction-related fatal crashes.
  • 87 of 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 While we were sleeping p. 12)

42
Driver Distraction
  • The 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)

43
What are public health approaches to this issue?
44
What are public health approaches to this issue?
  • Policies and legislation that prevent the
    accidents (like putting the fence at the cliff).
    E.g.
  • Graduated drivers license programs where
    enacted, these laws have reduced the crash risk
    by 30 (shope 2007??)
  • Bans on texting while driving
  • Public education campaigns

45
What are opportunities for you to take action
to motor vehicle accidents (MVA) in young
drivers?
  • How to become informed?
  • Actions in the clinic?
  • Actions beyond the clinic?

46
How can you become more informed about this issue?
  • Where/How can you find out more about this
    topic/issue ? (Discuss, then click the light
    bulb)

47
How can you become more informed about this issue?
48
Actions in the clinical encounter?
  • What are actions you might take for injury
    prevention / health promotion regarding choking
    when seeing patients?
  • (Discuss, then click the light bulb)

49
Actions in the clinic?
  • Address these issues with your patients/ parents
  • During the drivers license physical examination,
    emphasize the risks of driver distraction.
  • Advise the driver to be to turn the cell phone
    off and placing it well out of reach before
    starting the car.

50
Actions beyond the clinic?
  • What are actions you might take for injury
    prevention / health promotion regarding safe
    driving advocacy activities outside of the clinic
    setting?

51
Actions beyond the clinic?
  • Join the CHP letter-writing campaign advocating
    for comprehensive texting bans in PA (link here
    to get to link, go to www.chp.edu and click on
    protect teen drivers at top right-hand corner.
  • Sample letter

52
Actions beyond the clinic?
  • Join the CHP letter-writing campaign advocating
    for comprehensive texting bans in PA (link here
    to get to link, go to www.chp.edu and click on
    protect teen drivers at top right-hand corner.
  • Sample letter HERE

End of case
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