public health and pediatrics module 1 choking, smoking, teen driving

Public Health and PediatricsModule 1

Choking, Smoking, Teen Driving

Case 1: Case 2: Case 3:

Choking Smoking Teen Driving

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 1: Choking

• On a July afternoon in 2006, while watching TV together, Patrick Hale’s 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

Have you had any similar cases in your clinical experience?

Discuss

S E P A

What is the epidemiology of choking in the pediatric population?

Fatal Choking Rates

Non-Fatal Choking Rates

Contributors to increased risk in younger children

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 <3 year olds.

• Leading causes of choking:1. Latex balloons – 29% of all choking deaths2. 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.

Non-Fatal Choking Rates

• Non-fatal choking rates by age: (CDC report):Infants: 140.4 per 100 000 population< 14 years: 29.9 per 100 000 population (NOTE: same as SIDS rate)

• Of 17, 537 children <14 year treated for non- fatal choking:77.1% occurred among children aged 3 years or younger59.5% of those treated for choking were food-related31% of those treated were due to a non-food item—13% of these were from coins, 19% by candy or gum

Determinants of HealthContributors to increased risk in

younger children• Put things in their mouths• Molars for grinding food don’t 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

What are public health/preventive health approaches to this issue?

Primary PreventionSecondary PreventionTertiary Prevention

S E P A

What are opportunities for you to take action to reduce

children’mobidity and mortality?

How to become informed?Actions in the clinic?

Actions beyond the clinic?

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

http://www.cpsc.gov/cpscpub/pubs/282.html

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)

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

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)

How can you become informed?

Websites: US Consumer Product Safety Commission; Centers for Disease Control;

Colleagues: Associations: Other:

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)

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?



choking in advocacy activities outside of the clinic setting?


• 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

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.

• In reviewing the vital signs on the chart, you notice that the smoking status vital sign box is marked “yes”.

S E P A


Discuss

S E P A

What is the epidemiology of maternal smoking? of child exposure to

second hand smoke?

• 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

Epidemiology :

What are the public health implications related to this infant’s exposure to mother’s 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

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


• 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


• 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

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

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 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: [email protected] )• Read newspapers • Other ideas?

http://www.aap.org/moc/advocacyguide/chapter2-main.cfm

http://www.aap.org/moc/advocacyguide/chapter2-main.cfm

mailto:[email protected]


What are actions you might take for injury prevention / health promotion regarding second-hand smoke exposure when seeing patients?


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; (Physician’s advice doubles quit rate)

• advise non-smokers to keep home and child’s environment smoke-free

c. Assist every parent (links to brochures, quitline fax, NRT prescription HERE)


Assist every parent * (links to brochures, quitline fax, NRT prescription HERE)



childhood smoke-exposure in advocacy activities outside of the clinic setting?

Actions beyond the clinic?•Join existing campaigns: eg the campaign to regulate smoking in movies - http://smokefreemovies.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.

http://smokefreemovies.ucsf.edu/

Actions beyond the clinic?• Identify your legislator :

http://www.pasen.gov/cfdocs/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.”

.

http://www.pasen.gov/cfdocs/legis/home/find.cfm

Case 3: Teen Driving

• You are seeing a 16 year old boy for a driver’s license physical. You notice during the encounter that he checks his phone frequently and even sends a few texts while you’re talking.

S E P A


Discuss

What is the epidemiology of driving while distracted?

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 < 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)

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)

What are public health approaches to this issue?

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 driver’s license programs – where enacted, these laws have reduced the crash risk by 30% (shope 2007??)

• Bans on texting while driving

Public education campaigns

What are opportunities for you to take action to motor vehicle

accidents (MVA) in young drivers?





choking when seeing patients?



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 placing it well out of reach before starting the car.


What are actions you might take for injury prevention / health promotion regarding safe driving advocacy activities outside of the clinic

setting?


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


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

public health and pediatrics module 1 choking, smoking, teen driving

Documents