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”.

Have you had any similar cases in your clinical experience?

Discuss

S E P A

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

second hand smoke (SHS)?

• 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 :

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

exposure to mother’s smoking?

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 more informed about this issue?

Discuss, then click the light bulb

Action

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

Have you had any similar cases in your clinical experience?

Discuss similar cases

S E P A

What is the epidemiology of driving while distracted?

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?

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

You have finished applying the SEPA approach.

Please close this PowerPoint program to return to the remaining on-line materials.