The role of health literacy in achieving oral health for elders

A mismatch between the literacy skills of individuals and the demands of oral health services may erect an unnecessary barrier to preventive care and treatment. Findings from the 1992 survey of adult literacy in the United States indicate that more than two-thirds of adults over the age of sixty were limited in their ability to use written health materials in prose format, had problems finding and processing quantitative information, and were very limited in their ability to use documents such as forms, lists, charts, and graphs. Thus, many older adults face barriers to oral care, to needed information, to full participation in decision making and informed consent, and for follow-up activities. The pathways between literacy and health outcomes are being examined, and the body of literature linking literacy to health continues to grow. However, similar studies examining literacy and oral health outcomes have not yet been undertaken. Research in this area might well begin with consideration of the skills needed to perform important oral health tasks. Rigorous studies of the impact of improved communication strategies on elders' access to care, participation in services, and action steps would lend insight into needed change.

Assessing oral cancer knowledge among dental students in South Carolina

BACKGROUND

Because South Carolina has the fourth highest mortality rate for oral cancer among the 50 states, dental students in the state must be knowledgeable about prevention and early detection of the disease.

METHODS

In 2002, the authors surveyed 163 students using a written questionnaire (response rate, 79.1 percent). The questionnaire included questions about oral cancer risk and nonrisk factors as well as oral cancer diagnostic signs, symptoms and examination procedures. The authors performed univariate and bivariate analyses (alpha < or = .025).

RESULTS

At least 93 percent of the students replied that tobacco, alcohol and previous oral cancer lesions were risk factors. One hundred six students (65 percent) knew that the most likely site for oral cancer is the ventrolateral border of the tongue. Students differed in their overall knowledge of risk factors (P = .002), nonrisk factors (P < .001) and diagnostic procedures (P < .001).

CONCLUSION

Although students' level of knowledge increased with academic year, educators and policy-makers need to place greater emphasis on oral cancer education and training in dental schools.

PRACTICE IMPLICATIONS

Morbidity and mortality are likely to be reduced if dentists know how to prevent and detect oral cancer.

Oral cancer information in health education textbooks

BACKGROUND

Previous studies have reported a lack of knowledge and misinformation about oral cancer, its risk factors, and preventive methods among the general public. This study evaluated the quality, completeness, and accuracy of oral cancer information in 26 health education (elementary to high school) textbooks.

METHODS

Twenty-six health education textbooks were purchased and evaluated.

RESULTS

A deficiency in the amount, accuracy, and quality of oral cancer information in grade school and high school textbooks was evident.

CONCLUSION

Current health texts do not provide adequate information to educate future adults about oral cancer prevention and early detection.

Coverage and quality of oral cancer information in selected popular press: May 1998 to July 2003

OBJECTIVES

A 1998 study demonstrated a lack of coverage about oral cancer in the popular press between April 1987 and April 1997. Since that study, several oral cancer-related activities took place, many of which could have increased the media's attention to oral cancer. Therefore, this study analyzed coverage and quality of oral cancer information in selected popular press between May 1998 and July 2003.

METHODS

Articles from magazines and newspapers were retrieved from three databases and were analyzed by specific topics and subtopics for adequacy of content and accuracy of information. Articles were categorized as either "primarily oral cancer-related" or "primarily tobacco-related."

RESULTS

Sixty articles were identified, 39 of which were included in the analysis (14 magazines; 25 newspapers). Seventeen articles were "primarily oral cancer-related," and 22 were "primarily tobacco-related." Seventy-two percent of the articles mentioned at least one risk factor for oral cancer, the most common being tobacco use (69%). Far fewer articles noted alcohol (10%) or the combined use of tobacco and alcohol (5%) as risk factors. Only 8 percent of the articles recommended an oral cancer examination.

CONCLUSION

Despite local and limited national efforts and activities aimed at increasing public awareness of oral cancer, the popular press coverage of those activities was minimal or nonexistent.

Early childhood caries: prevalence and risk factors in Seoul, Korea

OBJECTIVE

The purpose of this study was to determine the prevalence of early childhood caries (ECC), including noncavitated lesions (d1), in children 6-59 months of age in relation to socioeconomic factors, feeding practices, and oral health behaviors in Seoul, Korea.

METHODS

The children attended child care facilities and were selected from 32 primary sampling units. Two dentists examined 470 children. Parents of 383 of the subjects were interviewed by phone regarding caries risk factors.

RESULTS

For children 6-59 months of age, the prevalence of ECC and severe ECC were 56.5 percent and 47.0 percent respectively. In bivariate analysis, the children whose nursing bottle contained sweetened solution had higher severe ECC prevalence (P=.035), and children whose parents reported a lower frequency of between-meal snacks showed lower ECC prevalence (P=.046). By logistic regression analysis, age and frequency of between-meal snacks were associated with the prevalence of ECC (P<.05).

CONCLUSION

This study demonstrates that the prevalence of ECC was high among children in Seoul. Early educational intervention programs for pregnant women and mothers of young children should be developed based on the risk factors identified in this study.

Use of skin and oral cancer examinations in the United States, 1998

BACKGROUND

Findings from previous surveys suggest low utilization of oral cancer examinations, even though this examination is noninvasive. The purpose of this analysis is to compare the use of an oral cancer examination (OCE) and a skin cancer examination (SCE) in the past 12 months within the United States. Both exams are noninvasive and include a visual component.

METHODS

Weighted data from the Adult Prevention Supplement of the 1998 National Health Interview Survey (NHIS) for adults 40 years of age or older were analyzed using SAS and SUDAAN. A ratio compared the percentage reporting an OCE (%OCE) with the percentage reporting a SCE (%SCE).

RESULTS

The percentage having an OCE in the past year (13.8%) was very similar to the percentage having a SCE (13.5%) during that same period. With increasing age group, the %OCE/%SCE ratio varied inversely from 1.60 (C.I. 1.42-1.78) among persons 40-49 years to 0.62 (C.I. 0.55-0.69) among persons 70+ years. The ratio was similar in whites and blacks, males and females, and Hispanics and non-Hispanics. There was a positive gradient in the ratio by education and family income.

CONCLUSIONS

Overall, less than 15% of the population is receiving either of these examinations, although the American Cancer Society recommends both of them on an annual basis for individuals 40 years of age and older. To increase detection of these cancers at early stages, extensive educational and media campaigns for the public and providers identifying risk factors and the availability of and the need for these examinations are required.

Oral cancer examinations among U.S. Hispanics in 1998

BACKGROUND

An oral cancer examination (OCE) is crucial for early detection of oral and pharyngeal cancers. The objectives of this study were: 1) to estimate the percentages of Hispanics and Hispanic subgroups who reported having an OCE in the past 12 months; 2) to compare these groups with various Non-Hispanics; and 3) to evaluate the extents to which having an OCE might be explained by age, gender, education, family income, a recent visit to a dentist, and edentulism.

METHODS

Descriptive and logistic regression analyses using data from the 1998 National Health Interview Survey.

RESULTS

6.4% of Hispanics and 14.5% of non-Hispanics had had an OCE in the past 12 months. After adjusting for age, gender, education, income, a dental visit, and edentulism, Hispanics were 1.7 times less likely than non-Hispanics to have had an OCE in the past 12 months.

CONCLUSIONS

Fewer Hispanics are receiving OCEs relative to Non-Hispanics.

Attitudes of pediatric dentists towards tobacco intervention for children and adolescents: a pilot survey

PURPOSE

The purpose of this study was to obtain pilot information concerning the attitudes of pediatric dentists regarding their role in tobacco intervention for children and adolescent patients.

METHODS

A 1-page survey, which was adapted and pretested from a previous, comprehensive survey, was distributed to all registrants at the 2001 American Academy of Pediatric Dentistry Annual Meeting in Atlanta, Ga. Descriptive and exploratory multivariable techniques were used to analyze the data.

RESULTS

Of the 173 respondents, only 18% had ever received training in tobacco cessation counseling. Although most dentists agreed that they should play a role in tobacco intervention with their young patients, the majority was not comfortable with this task. Pediatric dentists with tobacco counseling training were more likely to accept their role in tobacco prevention and cessation efforts and were more confident in their ability to do so than were their counterparts. Pediatric dentists consider tobacco cessation an important role in their practices, but do not consider themselves well prepared to act on this responsibility.

CONCLUSIONS

The results of this pilot survey strongly suggest that a similar, national, comprehensive study should be conducted among pediatric dentists.

Maryland adults' perspectives on oral cancer prevention and early detection

OVERVIEW

In any given 12-month period, Maryland ranks 27th among all states and the District of Columbia in estimated new cases of oral cancer. The state also has the seventh highest overall mortality rate for oral cancer. Because of earlier research indicating that Maryland adults had little knowledge and many misconceptions about oral cancer, the authors undertook a study to obtain in-depth information from Maryland adults 40 years of age or older on oral cancer, oral cancer examinations and factors associated with having an oral cancer examination.

METHODS

The authors conducted a qualitative descriptive study using information gathered from three focus groups consisting of nine, 10 and seven adults respectively, and which met at two locations. The authors hired a private focus group research firm, which randomly selected participants from a telephone list of local residents. A professionally trained moderator conducted all focus groups using a semistructured interview guide.

RESULTS

Participants were struck by the fact that they rarely hear about this type of cancer. Many said that they never had had an oral cancer examination and did not know there was such a thing. Many participants also reported that they likely would be more comfortable discussing oral cancer with their physicians than with their dentists.

CONCLUSIONS

These findings provide additional in-depth insights to earlier work about Maryland adults' oral cancer knowledge, opinions and practices. The state plans to use this information to develop educational materials and interventions for the public to promote oral cancer prevention and early detection in Maryland.

CLINICAL IMPLICATIONS

Extensive public education about oral and pharyngeal cancers should be provided in dental offices and clinics, as well as in mass media of all types. More clinicians should include comprehensive oral cancer screenings in their oral examinations, and they should explain to patients what they are doing when they provide these screenings.

Oral and pharyngeal cancer: practices and opinions of dentists in British Columbia and Nova Scotia

Oral and pharyngeal cancers are associated with high mortality rates, a situation usually attributed to late-stage diagnosis. Dentists in British Columbia and Nova Scotia were surveyed regarding their practices and opinions related to oral and pharyngeal cancer. In February 1998 a pretested, 41-item survey was mailed to a random sample of dentists in British Columbia (n = 817) and the population of dentists in Nova Scotia (N = 423). A reminder postcard and one additional mailing were sent to nonrespondents. Of the 670 dentists supplying usable responses (response rate 55.2%), only 56.7% agreed that their knowledge of the subject was current. Of 8 health history items, dentists assessed 5 on average, with most (88.0%) asking about the patients' current use of tobacco. A total of 72.7% of the responding dentists performed an oral cancer examination for all edentulous patients at every appointment, but 10.9% never did so. Similarly, 70.7% of the dentists always provided an oral cancer examination at the initial appointment for patients 40 years of age and older, but 9.8% never did so. Undergraduate training related to oral cancer examination was reported as good by only 52.2% of the dentists. About three-quarters of all dentists (77.0%) were interested in taking continuing education courses on this subject. Differences between the 2 provinces were not statistically significant (p > 0.01). Dentists in British Columbia and Nova Scotia could benefit from undergraduate and continuing education courses to increase their knowledge of health history assessment, examination for oral and pharyngeal cancers, and risk reduction strategies, such as counselling about tobacco cessation.

Reviews of evidence on interventions to prevent dental caries, oral and pharyngeal cancers, and sports-related craniofacial injuries

This report presents the results of systematic reviews of effectiveness, applicability, other positive and negative effects, economic evaluations, and barriers to use of selected population-based interventions intended to prevent or control dental caries, oral and pharyngeal cancers, and sports-related craniofacial injuries. The related systematic reviews are linked by a common conceptual approach. These reviews form the basis of recommendations by the Task Force on Community Preventive Services (the Task Force) about the use of these selected interventions. The Task Force recommendations are presented in this supplement.

Maryland family physicians' knowledge, opinions and practices about oral cancer

The objective of this study was to assess family physicians' knowledge, opinions and practices regarding oral cancers in the state of Maryland, USA. A 40-item, self-administered questionnaire was mailed to all members of the Maryland Academy of Family Physicians. Unweighted data (n=240) were analyzed using SAS and SUDAAN software; results were evaluated using an alpha < or =0.05. Family physicians (FPs) were aware of the major risk factors for oral cancers, but misinformation existed about the non-risk factors. Approximately 77% asked their patients the eight questions related to risk factors for oral cancer when taking a medical history but less than 24% provided an oral cancer examination to patients 40 years of age and over. Nearly 64% were interested in a continuing education course about oral cancer. This survey identified gaps in knowledge and practices among FPs but it is encouraging that they expressed interest in continuing education courses on this topic.

Oral and pharyngeal cancer: knowledge and opinions of dentists in British Columbia and Nova Scotia

Oral and pharyngeal cancers are largely preventable and can be successfully treated when diagnosed at an early stage. Dentists in British Columbia and Nova Scotia were surveyed regarding their knowledge and opinions about oral and pharyngeal cancer. In February 1998 a pretested 41-item survey was mailed to a random sample of dentists in British Columbia and the population of dentists in Nova Scotia. A reminder postcard and one additional mailing were sent to nonrespondents. Of the 670 dentists supplying usable responses (response rate 55.2%) only 56.7% agreed that their knowledge of the subject was current. Most dentists correctly identified tobacco use (99.4%) and alcohol use (90.4%) as risk factors, but fewer correctly identified factors such as the use of spicy foods (57.0%) and poor oral hygiene (46.3%) as not being risk factors. Only 42.5% identified both erythroplakia and leukoplakia, in that order, as the conditions most likely associated with oral cancer. Indices of risk and diagnostic knowledge were constructed by summing the number of correct responses to items in each domain. On 16 risk factors the mean correct score was 9.2, and on 14 diagnostic procedures the mean correct score was 10.0. Only 38.5% of dentists had consistent levels of knowledge on both indices. Differences between the provinces were statistically significant (p < 0.01) for only 2 knowledge items. About three-quarters of all dentists (77.0%) were interested in taking continuing education courses. Dentists in British Columbia and Nova Scotia could benefit from undergraduate and continuing education courses to increase their knowledge of risk and diagnostic factors for oral cancer.

Views of oral cancer prevention and early detection: Maryland physicians

The purpose of this study was to obtain in-depth information on Maryland physicians' knowledge, opinions and practices about oral cancer examinations. The qualitative descriptive study used one focus group conducted in a conference facility and nine one-on-one interviews at private medical offices. A criterion-purposeful sampling was used for selection of participants. Generally, we found low awareness of, and surprise about, Maryland's high oral cancer mortality rates. Physicians were not surprised that they detect more lesions than dentists, although most physicians did not provide oral cancer examinations on a routine basis. Physicians were interested in attending continuing medical education (CME) courses on oral cancer prevention and early detection but only if worked into other CME programs on cancer. They were very interested in having hands-on training on performing an oral cancer examination. These findings will be used to implement educational interventions for Maryland physicians to help increase early detection of oral cancers.

Dental hygienists' knowledge, opinions, and practices related to oral and pharyngeal cancer risk assessment

METHODS

A pre-tested, validated 62-item survey was mailed to a 1% national random sample of licensed dental hygienists, (n = 960). Four complete mailings of the instrument resulted in a 74.4% percent return rate of which 65% percent were usable (n = 464). Respondents provided information on their knowledge of oral cancer risk assessment factors, their use of health history questions to assess patients' oral cancer risks, how they conduct oral cancer examinations, and their beliefs about their oral cancer training. Data were analyzed using descriptive and inferential statistics and evaluated at a significance level of p < or = 0.05.

RESULTS

Based on responses to 14 questions, the average score on knowledge of oral cancer risk factors was 7.92, with a significant difference found among age groups and year of graduation, (p = 0.006). On average, dental hygienists assessed five of eight risk assessment items with "use of alcohol" receiving the least attention. Although nearly 100% percent agreed that oral cancer examinations for adults 40 years of age or older should be provided annually, only 66% percent reported doing so for patients on their initial appointment. Seventy-four percent believed they were adequately trained to provide oral cancer examinations, while only 27 percent agreed that they were prepared to provide tobacco cessation counseling. There was no significant correlation between knowledge of oral cancer risk factors and probing these risk factors when conducting a health history.

CONCLUSIONS

Results from this study indicate that interventions are needed to increase dental hygienists' knowledge of oral cancer risk factors, correct misinformation, and close the gap between their knowledge and its application in providing prevention and early detection services. The majority believed that they are not as knowledgeable as they could be and are interested in attending an oral cancer continuing education (CE) course.

Oral cancer knowledge and opinions among Maryland nurse practitioners

OBJECTIVES

As part of a Maryland statewide oral cancer needs assessment, a census of adult and family practice nurse practitioners was conducted to determine their knowledge of oral cancer risk factors, diagnostic procedures and related opinions.

METHODS

Information was obtained through a pretested, 40-item, self-administered mail questionnaire of 389 nurse practitioners. A second complete mailing was sent three weeks after the initial mailing; two postal card reminders were mailed at 10 and 17 days after the second mailing, which yielded a response rate of 56 percent.

RESULTS

Most nurse practitioners identified the use of tobacco, alcohol, and prior oral cancer lesions as real risk factors. But only 35 percent identified exposure to the sun as a risk for lip cancer. Respondents were not overly knowledgeable about the early signs of oral cancer, most common forms, or sites for oral cancer. Only 19 percent believed their knowledge of oral cancer was current. Nurse practitioners who reported having a continuing education course on oral cancer within the past two to five years were 3.1 times more likely to have a high score on knowledge of risk factors and 2.9 times more likely to have a high score on knowledge of both risk factors and of diagnostic procedures than were those who had never had a continuing education course.

CONCLUSIONS

The reported knowledge of oral cancer, in conjunction with opinions about level of knowledge and training, point to a need for systematic educational updates in oral cancer prevention and early detection.