A community participatory oral health promotion program in an inner-city Latino community.

OBJECTIVES: This paper reports the planning, implementation, process evaluation, and refinement of an oral health community participatory project in Mount Pleasant, an inner-city Latino neighborhood of Washington, DC. The main goal was to explore the feasibility of implementing such a project. METHODS: The PRECEDE-PROCEED model was used to guide the planning and process evaluation of this project, in conjunction with community organizational methods. A steering committee, which met periodically, was formed to assist in program planning, implementation, and evaluation. The needs assessment of the community identified extensive dental health problems among children and deficiencies in their parents' oral health knowledge, opinions, and practices. In response, culturally appropriate health education and promotion activities were planned and implemented in collaboration with local community organizations, volunteers, and local practitioners. Process evaluation was used to provide feedback into the refinement of the community approach, which included record keeping and an inventory approach to activities completed and resources used. The overall impact and usefulness of this program were assessed informally using an anonymous open-ended questionnaire directed to members of the steering committee, and an outreach survey using a convenience sample at a local Latino health fair. RESULTS: The implementation of such a community participatory approach was feasible and useful for building upon existing local resources and addressing oral health concerns in a community not reached by traditional dental care and health promotion initiatives. Individuals in this community showed a substantial interest in oral health matters and participated in a variety of oral health prevention activities. The community approach adhered to community-based research principles.

Geographic variation in breast cancer mortality for white and black women: 1986-1995.

Breast cancer mortality rates have decreased during the last 20 years in the United States overall. However, declines in breast cancer mortality rates differ among individual states. This analysis ranked states from the highest to the lowest percentage change in mortality between 1986 to 1990 and 1991 to 1995. Data on white and black females were analyzed separately. Among white women, the 10 states showing the greatest percentage change in mortality during those two periods had the greatest baseline mortality in the 1986-to-1990 period. Similarly, the 10 states with the lowest percentage change in mortality had the lowest mortality rate in 1986 to 1990. In contrast, among black women, the top 10 states ranked by percentage change in mortality included either a decline or an increase. The disparities in mortality rates by state likely depend on the stage of disease at diagnoses, socioeconomic status, access to care, and adequacy of medical care.

Practices of Maryland dentists: oral cancer prevention and early detection--baseline data from 1995.

OBJECTIVES: To investigate practices and opinions of general dentists in Maryland, USA, related to oral and pharyngeal cancer prevention and early detection. DESIGN AND METHODS: A pre-tested, 34-item questionnaire, cover letter and addressed, stamped envelope were mailed in the summer, 1995, to a simple random sample of 800 members and non-members of the American Dental Association practicing in Maryland. A reminder postcard was sent 3 weeks after initial mailing; a second complete mailing to all non-respondents 6 weeks after first mailing. RESULTS: Over 90% of dentists asked about patient's current use of tobacco but only 77% assessed patient's history of tobacco use and types and amounts used. Fewer (66%) asked about present use of alcohol. Ninety percent reported providing an oral cancer examination at the initial appointment for patients 40 years of age or older; only 6% provided the examination for edentulous patients and only 40% reported palpating lymph nodes of patients 80% or more of the time. CONCLUSIONS: Dentists' reporting on providing oral cancer examinations and taking appropriate health histories are disappointing. These results call for comprehensive educational interventions in terms of changes in dental curricula and as continuing education courses especially since most dentists were interested in continuing education courses on oral cancer prevention and early detection.

Annual cancer incidence rates for Hispanics in the United States: surveillance, epidemiology, and end results, 1992-1996.

BACKGROUND: The expansion of the Surveillance, Epidemiology, and End Results (SEER) program and the determination of annual population estimates by county level for different racial/ethnic groups since 1990 allow the calculation of annual cancer incidence rates for Hispanics. METHODS: Incidence rates were calculated for 11 SEER areas representing 25% of the Hispanic population. Standard regression analyses of log-transformed rates were used to determine the trends of the rates. RESULTS: An important measure of the cancer burden among Hispanics is the rank order of their cancers. For Hispanic males, the five major cancers (in declining order) are prostate, lung and bronchus, colon/rectum, non-Hodgkin lymphoma, and stomach cancers. For Hispanic females, the top five cancers are breast, colon/rectum, lung and bronchus, cervix, and endometrial cancers. Another measure of cancer burden is their rates relative to white non-Hispanics. Hispanic males have rates greater than white non-Hispanic males for stomach (1.6 times greater) and liver and IBD cancers (2.2), whereas Hispanic females have greater rates for cervix (2.2 times greater), liver and IBD (2.0), stomach (2.1), and gallbladder cancers (3.3). Other measures of cancer burden include the trends in Hispanic rates. Hispanic males have significant declining trends for all sites, prostate cancer, and urinary bladder cancer, and an increasing trend for liver and IBD cancers. Hispanic females have significant declining trends for cervix and urinary bladder cancers. CONCLUSIONS: The SEER cancer incidence rates and trends provide a general overview of the cancer burden among Hispanics residing in the SEER sites. This type of information is critical for determining interventions to reduce the cancer burden among Hispanics in the United States.

Oral cancer educational materials for the general public: 1998.

OBJECTIVES: Previous studies have shown that US adults are not well informed about oral cancers and only 15 percent ever have had an oral cancer examination. This study sought to determine the quantity and adequacy of educational materials designed to inform or educate US adults about risks for, and signs and symptoms of, oral cancer and the need for an oral cancer examination. METHODS: Letters requesting copies of oral cancer educational materials produced by the organization or agency--leaflets, fact sheets, pamphlets, videos, posters--were sent to 172 national and state organizations or agencies. To determine the adequacy of the items, a previously developed, tested, and used form based on current science was adapted for this study. In addition, the SMOG index was used to determine readability for printed items. RESULTS: Seventy-seven percent or 132 of the selected organizations responded to queries. A total of 59 items were received that focused on or included the topic of oral cancer. Twenty of these 59 items focused specifically on oral cancer; the balance, on other topics, but mentioned oral cancer. The readability ranged from sixth to 13th grade. CONCLUSIONS: This study demonstrates a dearth of educational materials about oral and pharyngeal cancers; most are written at too high a grade level for the general public. These findings may help to explain why the public is so uninformed about these neoplasms.

Caries conditions among 2-5-year-old immigrant Latino children related to parents' oral health knowledge, opinions and practices.

OBJECTIVES: To collect baseline data prior to initiating a community-based, oral health promotion program in an inner city Latino community in Washington DC, populated by Central American immigrants. METHODS: In 1995, an oral survey of a convenience sample of children 2-5 years of age (n = 142) and a survey of the knowledge, opinions and practices (KOP) of their parents (n = 121) were completed. Clinical data of children were matched with parent respondents of the KOP survey. Data were analyzed for statistical associations using univariate odds ratios, Fisher's exact tests, and multiple logistic regression. RESULTS: Only 53% of the children were caries free. Eighteen percent of all children were in need of immediate dental care and 26% were in need of early or non-urgent dental care. Only 7% of the parents knew the purpose of sealants and 52% knew the purpose of fluorides. Further, only 9% thought that brushing with toothpaste can prevent tooth decay The strongest predictors of dental caries in this population, after adjusting for child's age and mother's education, were recency of mother's residence in the United States and report of an uncooperative child when attempting toothbrushing. CONCLUSIONS: Regimens of caries prevention have been successful in reducing dental decay for a large segment of the US population, yet this disease remains prevalent especially among low socioeconomic groups. The oral health status of the children and the oral health KOP of the parents in this community are disturbingly deficient.

Oral health knowledge, practices, and status among outpatient veterans at the VA Maryland Health Care System.

Poor oral health can have a significant impact on overall health and quality of life. Yet few studies have established the oral health needs of outpatient veterans. The purpose of this study was to assess the oral health knowledge and practices, the dental status, and the periodontal treatment needs of outpatient veterans seeking primary care services at a statewide healthcare system. Veterans were interviewed and received an oral examination by a trained examiner using NIDCR criteria for dental caries detection and the Community Periodontal Index of Treatment Needs (CPITN). The mean age of the study participants' (n = 135) was 57.7 (SD = 14.1) years. Ninety-five percent of the sample was male and 44% African-American. Untreated coronal and root caries was present in 57% and 36% of veterans, respectively. Sixty-nine participants received the periodontal examination, with 29% of them in Category III. An interpretation of these findings shows a high need for preventive and restorative oral health care among outpatient veterans receiving primary services in an integrated and comprehensive VA health care system.

Knowledge, opinions and practices of general dentists regarding oral cancer: a pilot survey.

The authors mailed a pilot survey to 500 randomly selected general dentists. Although most dentists reported their knowledge of oral cancer to be current, their actual knowledge of oral cancer risk factors and signs and symptoms was inconsistent. Conflicting data were also found between their level of knowledge and their provision of oral cancer examinations. Most respondents agreed that patients should undergo an oral cancer examination annually, yet many do not provide this service.

Maryland veterans' knowledge of risk factors for and signs of oral cancers and their use of dental services.

OBJECTIVES: The purpose of this study was to evaluate outpatient veteran'í knowledge about risk factors for and signs of oral cancers, and their utilization of dental services. DESIGN: Patients receiving primary health care services were surveyed during August 1997. SETTING: Primary health care services at three medical centres within the VA Maryland Health Care System (VAMHCS). SUBJECTS: A total of 135 outpatient veterans were interviewed. INTERVENTION: Questionnaire administered by trained interviewers. MAIN OUTCOME MEASURES: Fifteen percent of the sample were eligible for dental care at the VA, while over 40% of those veterans participating in the study were unaware of their VA eligibility for dental services. Fifty six percent of the total sample received dental services from a private dentist, while 13% reported they had no provider of dental care. Of those not eligible for dental care at the VA (n = 115), the majority (67%) received dental care from a private dentist. Current use of tobacco and alcohol was reported by 27% of the sample. Nonsmokers were more likely to visit the dentist in the previous year than smokers (OR = 2.39, 95% C.I. 1.11,5.12). Although 84% correctly identified tobacco use as a risk factor, only 39% correctly identified regular alcohol use as a risk factor. CONCLUSIONS: Veterans at higher risk for oral cancers were less likely to have visited the dentist in the previous year, and, overall, were ill informed and misinformed about these cancers.

Coverage and quality of oral cancer information in the popular press: 1987-98.

OBJECTIVES: National data show a lack of knowledge and misinformation about oral cancer and its early detection among the general public. A major source of health information is the popular press. For that reason this study reviewed coverage and quality of news items on the topic of oral cancer in the popular press. In addition, the number and types of tobacco advertisements in women and men's magazines were recorded for a one-year period. METHODS: Articles from magazines and newspapers were retrieved from the Magazine Index (1987 to April 1998), Newspaper Abstract (1989 to April 1998) and the Health & Wellness (1987 to April 1998) databases. The articles were analyzed both for adequacy of content and information. RESULTS: A total of 50 articles and news items including oral cancer were identified and analyzed, 18 from newspapers and 32 from magazines. Ninety-four percent of the articles mentioned at least one risk factor for oral cancer. More than half of the articles (56%) identified spit tobacco (chewing tobacco or snuff) as the major risk factor for oral cancer, while far fewer mentioned either cigarettes (32%) or cigars (12%). Over 50 percent of the articles did not mention warning signs for oral cancers. Fourteen percent suggested clinical oral cancer examinations by a health professional; only 8 percent advised the use of self-examination. A total of 417 tobacco advertisements (482 pages) were found among 22 magazines for the one-year period. They included 410 cigarette ads, seven cigar ads, and no spit tobacco ads. CONCLUSIONS: This study demonstrates the lack of coverage about oral cancer in the popular press in the past decade and provides a partial explanation of the public's lack of knowledge and misinformation about oral cancers.