Effectiveness evaluation of Contra Caries Oral Health Education Program for improving Spanish-speaking parents' preventive oral health knowledge and behaviors for their young children

OBJECTIVES

To determine the effectiveness of the Contra Caries Oral Health Education Program (CCOHEP) for improving low-income, Spanish-speaking parents' oral health knowledge and behaviors for their young children. Mexican American children in the United States suffer disproportionately high prevalence and severity of early childhood caries, yet few evaluated, theory-based behavioral interventions exist for this population. CCOHEP is a theory-based curriculum consisting of four 2-h interactive classes designed for and by Spanish speakers and led by designated community health educators (promotoras). Topics included children's oral hygiene, caries etiology, dental procedures, nutrition, child behavior management, and parent skill-building activities.

METHODS

Low-income Spanish-speaking parents/caregivers of children aged 0-5 years were recruited through community services in an agricultural city in California. Survey questions from the Oral Health Basic Research Facts Questionnaire measuring oral health-related behaviors and knowledge were verbally administered before, immediately after, and 3 months after attendance at CCOHEP. Five questions measured aspects of parental toothbrushing for their children (frequency, using fluoridated toothpaste, brushing before bed, not drinking or eating after nighttime brushing, adult assistance), three questions measured other oral health behaviors, and 16 questions measured oral health-related knowledge. Analyses of within-person changes between pre- and post-tests and again between post-test and 3-month follow-up consisted of McNemar's test for binary outcomes and sign tests for ordinal outcomes.

RESULTS

Overall, 105 caregivers participated in CCOHEP (n = 105 pretest, n = 95 post-test, n = 79 second post-test). At baseline, all parents self-reported doing at least one aspect of toothbrushing correctly, but only 13% reported performing all five aspects according to professional guidelines. At post-test, 44% of parents reported completing all aspects of toothbrushing according to professional guidelines (P < .001). Statistically significant improvements were seen in 4 aspects of toothbrushing (P ≤ .008) between pretest and post-test (all but adult assistance). The second post-test showed 3 of these improvements were maintained, while adult assistance and the other reported behaviors improved (P ≤ .008). Between pretest and post-test, checking child's teeth monthly and frequency of sweet drinks consumption improved (P ≤ .008), while frequency of eating sweet foods did not change. Knowledge was high at baseline (mean 12.8 of 16), but 6 knowledge items improved significantly between pretest and post-test. Improvements were maintained at second post-test.

CONCLUSIONS

Contra Caries Oral Health Education Program improved low-income Spanish-speaking parents' oral hygiene knowledge and self-reported behaviors for their young children, and change was sustained 3 months after the end of the intervention. Future, more rigorous evaluation of the intervention is recommended.

Rural Mexican immigrant parents' interpretation of children's dental symptoms and decisions to seek treatment

OBJECTIVE

Mexican-origin children have higher rates of decay and lower dental utilization rates than children from all other racial/ethnic groups. Different cultural groups' interpretations of dental symptoms illuminate their different decision-making process about seeking care. Through ethnography in a small rural U.S. city, we examined low-income Mexican immigrant caregivers' interpretations of their children's dental symptoms and evaluations of the need for treatment.

BASIC RESEARCH DESIGN

We conducted 49 in-depth interviews with 26 Mexican immigrant caregivers about their perceptions of their children's dental symptoms, and observations of five such caregivers' help-seeking episodes and 30 other caregivers' presentation of their children's symptoms at dental clinics. All interviews and fieldnotes were analyzed qualitatively through a series of readings and codings.

RESULTS

A conceptual model of caregivers' decision-making processes was developed. Most caregivers deduced the health of teeth from visible appearance, and thus children's complaints of pain alone were often ineffective in triggering a dental visit. Caregivers often delayed treatment because they viewed their children's oral disease as mere "stains" requiring cleaning rather than as bacterial infections requiring restorative treatment. Parents appeared to confuse carious "stains" with fluorosis stains common in rural Mexico.

CONCLUSIONS

Even when Mexican immigrant caregivers recognize a dental problem, they often misinterpret it as a "stain." Caregivers' interpretations of decay were shaped by their lack of experience with children's decay in rural Mexico. Oral health education programs should help rural immigrant caregivers distinguish between "stains" and "cavities," and understand the heightened oral hygiene requirements of the cariogenic diet in industrialized countries.

Socio-cultural anthropology and alcohol and drug research: towards a unified theory

The arrival of the millennium has understandably created a growing tendency for social commentators to evaluate the current state of the world, assess prior developments and suggest new and enlightened ways forward. In this time of re-appraisals, we assess the current state of the anthropology of alcohol and drug research, consider its early history, examine the range and theoretical underpinnings of work done today, and propose the elements of a possible future model. In formulating the model, we have borrowed from a number of different theoretical approaches and insights not only from anthropological discussions of alcohol and drug issues but also from anthropological research outside these arenas. In examining these issues, and as a way of attempting to answer the question--where has the field come from and where is it heading--we situate anthropological contributions to this area not merely within the wider context of anthropological thought and research, but more importantly within a wider social and political context that takes account of the organizational, funding and conceptual influences, constraints and pressures that operate on anthropologists who wish to conduct research on alcohol and drug issues.

Smoking policy in long-term care: a survey of administrators in San Francisco

Despite the fact that smoking is a ubiquitous yet potentially hazardous behavior in long-term care settings, little previous investigation has been made into the construction or implementation of policy to manage smoking by elderly residents. This survey of administrators in long-term care facilities in San Francisco city and county reveals that fire and safety issues were the prime forces motivating smoking policy, which operated through control of behavior rather than by other available means, such as the use of fire retardant aprons. Although all facilities permitted smoking, a hierarchy of limit setting strategies was adopted, strategies which successively and evermore intrusively overrode the resident's autonomy and turned smoking policy from beneficent philosophy into a coercive moral statement. Arranged in order of frequency of occurrence and increasing degree of restriction, these strategies were: (a) designating appropriate locations; (b) controlling smoking opportunities and materials; (c) requiring staff supervision or help; (d) limiting the availability of staff help; and (e) writing Doctor's orders. By acknowledging the tensions between ambivalent goals inherent in smoking in long-term care, administrators could devise policies and procedures that are both supportive of collective rights and less corrosive of individual ones.

A demographic survey of Iu-Mien in West Coast states of the U.S., 1993

Beginning in 1975, Mien refugees migrated to the United States from the highlands of Southeast Asia, primarily but not exclusively from Laos. Reported here are 1993 data on the basic size and composition of the Iu-Mien population in the West Coast states (Washington, Oregon, and California), the most popular settlement destination for this group. Three-fourths of Mien in this region live in California. Surveys reveal a young population, half being under age 15 years but with a surprisingly large (6.8%) proportion of people aged 60 or older. Approximately half of all Mien households, which typically contain 5-7 members, are two-generation nuclear families, i.e., parents and their school-age or younger children. Through the addition of grandparents, other kin, or unrelated individuals, the remaining households comprise three- or four-generation domestic units. Most (around 90%) Mien households are headed by middle-aged males, although some households in all locations are headed by females. Employment rates for Mien households vary by state and by location in an urban or rural area. State welfare policies as well as differential availability of work for unskilled or poorly educated individuals seem to be major factors accounting for differences in employment.

Drug treatment in contemporary anthropology and sociology

The relatively slim social science literature on drug treatment is reviewed. Attention is paid to the institutionalization of treatment at the meso (local community or clinic) level and the micro (client) level rather than to the more commonly examined macro (societal or national) level. The inter-penetration across these levels of ideologies and practices around drugs is revealed through discussion of the targeting of certain populations for treatment, methods of client control in treatment settings, and the client's view of treatment. In the literature, drug users are often presented as passive individuals, subject to various forms of restrictive social control in therapeutic settings. Their perspective on the processes or efficacy of treatment is rarely sought. The concept of drug treatment as necessarily beneficial to clients is questioned in this paper.

Are African American women worried about getting AIDS? A qualitative analysis

The aims of this study were to explore and describe AIDS-related worry among African American women and determine whether AIDS risk behaviors were associated with women's AIDS-related worry status. Of 142 women interviewed, 36% (n = 51) expressed some worry about getting AIDS, compared to 64% (n = 91) who did not express worry. In general, both worried and nonworried women were equally likely to report risk behaviors such as no condom use or having risky sexual partners and no significant relationships were found between worry status and self-reported HIV/AIDS risk behaviors. Women gave several reasons for why they did or did not feel worried about getting AIDS. For example, 23% of worried women responded that they were worried about getting AIDS because of the uncertainty of their sex partners' risk behaviors. This contrasted strongly with the nonworried women, 10% of whom reported trusting their partners and 64% of whom reported engaging in some type of protective behavior. Results indicate that regardless of worry status, women were not protecting themselves by using condoms or using careful partner selection. Therefore we recommend that future HIV/AIDS educational intervention programs appeal to and encourage participation for all women whether or not they express concern about contracting the disease. In addition, programs must carefully address the issue of denial, and provide skills for assessing and modifying risky behaviors.

Management and utilization of poultry wastes

Waste by-products such as excreta or bedding material that are generated by the worldwide annual production of more than 40 million metric tons (t) of poultry meat and 600 billion eggs are generally land applied as the final step of a producer's waste management strategy. Under proper land application conditions, the nutrients and organisms in poultry wastes pose little environmental threat. Environmental contamination occurs when land application of poultry wastes is in excess of crop utilization potential, or is done under poor management conditions causing nutrient loss from environmental factors such as soil erosion or surface runoff during rainfall. Environmental parameters of concern are N, P, and certain metals (Cu and Zn in particular), as well as pathogenic microorganisms that may be contained in poultry waste. The biochemical cycle of N is very dynamic, and N contained in poultry waste may either be removed by crop harvest, leave the animal production facility, waste treatment lagoon, or application field as a gas (NH3, NO, NO2, N2O, or N2), or, due to its mobility in soil, be transported in organic or inorganic N forms in the liquid state via surface runoff or leaching into groundwater. Elevated concentrations of NO3-N in groundwater used for human consumption is a health risk to infants that are susceptible to methemoglobinemia. An environmental impact resulting from elevated NO3-N is eutrophication of surface waters. Ammonia loss from poultry waste is an environmental concern because of volatilized wet and dry deposits of NH3 into nitrogen-sensitive ecosystems. Phosphorus in poultry wastes may contribute to environmental degradation by accelerating the process of eutrophication. Unlike N, P is very immobile in soil and must first be transported to a surface water environment to have an environmental impact. It is generally accepted, however, that this nutrient affects receiving waters via transport in eroding soil as sediment-bound P or in surface runoff as soluble inorganic or organic P. Numerous studies have reported that excess P contained in land-applied manures may contribute to eutrophication. Soils containing P concentrations that greatly exceed the agronomic potential of crops may require years or even decades to return to levels that are crop limiting for this nutrient. Environmental concerns include the capacity of such soils to adsorb new P and the amount of P loss from these soils from erosion, runoff, drainage, or leaching to groundwater. Although much information is available regarding the loss of P from agricultural fields from erosion and runoff, less information is available regarding P losses from fields receiving poultry wastes. However, studies have shown that there are many challenges to controlling P losses from fields receiving manures. In addition, subsurface transport of P resulting from repeated application of poultry manure onto soils that are artificially drained is an environmental concern where drainage waters enter or interact with water bodies sensitive to eutrophication. Trace elements such as As, Co, Cu, Fe, Mn, Se, and Zn are often added in excess to poultry feed to increase the animal's rate of weight gain, feed efficiency, and egg production and to prevent diseases. Because most of the excess trace elements are not absorbed by the bird, the concentration of elements excreted in the manure will reflect dietary overformulation. Because trace elements are generally required in very small quantities for crop growth and, like P, are immobile in most soil types, their concentrations will increase with repeated land application of poultry wastes. Of particular concern are accumulations of Cu and Zn in certain soil types utilized for certain crops. Copper and Zn toxicity for some crops have been documented in some areas receiving repeated land-applied poultry wastes. A potential environmental concern relative to poultry litter and trace elements in receiving soils involves the transpor

Older home health care patients and their physicians: assessment of functional ability

Assessment of a person's level of functional impairment is a key aspect of geriatric clinical practice. This study examines the agreement between functional assessments reported by 54 physician-patient dyads. Physicians were typical of those providing services to elderly patients in an urban area. Patients, all aged 65 or more years and community-living, had been referred by these physicians for in-home health care services. Generally, physicians reported less impairment than did their patients, functional assessments by both doctors and patients matching completely in only 15 of 54 (28%) dyads. Underestimation of patient impairment occurred most commonly with respect to stair climbing, control of the urinary bladder, and bathing, but was also substantial for dressing, walking, and toileting. Few patient or doctor characteristics predicted congruence or lack thereof in assessment of functional impairments. Some implications of these findings for clinical practice and medical education are examined.

A household survey of older Iu-Mien refugees in rural California

There is a very sparse literature on the distinct named cultural groups that migrated from Southeast Asia to the USA in recent years, especially on the elderly. People aged 60 or more years from one specific group, Iu-Mien refugees primarily from the highlands of Laos, are discussed here, through: (a) a review of available information about the traditional roles of older people and adjustment to life in the USA, and (b) a household survey of one community of Iu-Mien in Merced, California. Older people comprise a larger than expected proportion (7%) of the Iu-Mien community. The large households remain traditional in composition with many older men acting as patriarchs to several generations of lineal kin. Women, who are usually widows, tend to live with the families of sons or sons-in-law. Intergenerational disaffection has been reported in the literature, in part due to the status losses by older people and role reversals so common among refugees.

Application of nitrogen from swine lagoon effluent to bermudagrass pastures: seasonal changes in forage nitrogenous constituents and effects of energy and escape protein supplementation on beef cattle performance

A 2-yr study was conducted to evaluate 1) the effects of nitrogen level from swine lagoon effluent on forage composition and animal performance and 2) the effects of supplemental escape protein (EP) on performance by steers grazing pastures fertilized with swine lagoon effluent. Bermudagrass (Cynodon dactylon) pastures were fertilized via sprinkler irrigation with either 448 or 896 kg/ha of N from swine lagoon effluent (two pasture replications/treatment). Within each pasture, four supplement treatments were evaluated using electronic Calan gates (8 steers.pasture-1.yr-1). The treatments were 1) negative control (pasture only); 2) energy control, which supplied 79.9 g of EP.hd-1.d-1; 3) 159 g of EP.hd-1.d-1, and 4) 239 g of EP.hd-1.d-1. Gains were increased (P < .05) an average of .15 kg/d by supplementation, with no differences in gain among supplements. Forage samples representative of that grazed by steers (CONSUM) and representative of all available forage (AVAIL) were obtained at 14-d intervals. Total CP content of CONSUM and AVAIL samples were slightly higher (P < .20 and P < .15, respectively) from pastures fertilized with 896 compared with 448 kg/ha of N (20.8 vs 20.0% for CONSUM and 15.2 vs 14.2% for AVAIL). Concentrations of nonprotein N and soluble true protein (% of CP) in both AVAIL and CONSUM samples were higher (P < .06) from pastures fertilized with the higher N level. Total N uptake by the plant, based on CP content and animal grazing days/ha, was essentially the same for both N treatments.

Alcohol consumption among older urban American Indians

OBJECTIVE

To describe the pattern of alcohol consumption by older urban American Indians in Los Angeles, California, in 1987-89.

METHOD

Data come from a cross-sectional community health survey with a convenience sample of 282 nonhomeless American Indians, both male and female. The sample matched the age and sex distribution reported by the U.S. Census. During the face-to-face structured interview self-reports of alcohol consumption were gathered for American Indians recognized by their community as elders (mean [+/-SD] age 61.1 +/- 11.1 years).

RESULTS

Most elders (73%) did not drink alcohol. More women than men, and more individuals aged 60+ than people under 60 years, abstained. Elders in single generation households tended to consume more alcohol than those in multigeneration households. Among the 76 people we reported drinking, significantly more people under age 60 than over age 60 consumed four or more drinks per sitting (p < .01), and those who lived alone were more likely than drinkers living with others to consume alcohol at least once a week (p < .04).

CONCLUSIONS

Age seemed to be a salient marker with respect to alcohol consumption, with fewer people 60+ years of age drinking as much or as often as people under this age. Abstainers are not necessarily lifetime teetotalers, but may be former drinkers who have quit, and may still on occasion go on short-term binges. Results of this survey replicate findings from surveys of the general elderly population, suggesting that older urban American Indians are not different from other older people with respect to consumption of alcohol.

Stigmatizing a "normal" condition: urinary incontinence in late life

The geriatric medical literature presents a perspective on urinary incontinence in the elderly that is sharply divergent from the realities of medical and lay responses to incontinence. This contrast raises questions about the cultural significance of urinary incontinence. The geriatric literature reveals a consensus that urinary incontinence, a major health problem among the elderly, is treatable and frequently reversible. The elderly and their health care providers, however, not only see incontinence as an inevitable, irreversible, and normal part of growing old but also consider it a sign of incompetence. This linkage of incontinence with incompetence forces elderly people to adopt several strategies for managing their incontinence so as not to compromise their competence in the eyes of others. Incontinence is a cultural symbol for the increasing dependencies of old age, dependencies that are much feared and resented in U.S. society, where tremendous emphasis is placed on independence even into advanced old age.

Accessing an understudied population in behavioral HIV/AIDS research: low income African American women

Most HIV/AIDS behavior research involving African American women has focused on traditional high risk populations, such as those in drug treatment centers, STD clinics, and hospitals. Few studies have examined the health needs and behaviors of African American women in the general population (i.e., working mothers and homemakers). The Parent Health Project examined beliefs and concepts of illness, including AIDS, of low income African American mothers of young children. We used a variety of methods of community outreach and recruitment strategies to gain access and trust from these African American women, including (1) recruitment of women who had children in a related research project, (2) subject reimbursement, and (3) culturally sensitive community based outreach. Of approximately 200 women contacted, 147 (74%) agreed to participate in a two-hour face-to-face interview about concepts of health and illness. Through our efforts, we were able to gain access to a population generally not studies in HIV/AIDS research. We were also exposed to a number of issues, concerns and behaviors faced by women not classified as high risk, yet who are at risk as a result of their own and/or their sexual partner's(s) risk behaviors.

Hemoglobin switching in Rana/Xenopus erythroid heterokaryons: factors mediating the metamorphic hemoglobin switch are conserved

Hemoglobin switching, which occurs in all classes of vertebrates as well as in certain invertebrates, is due to developmental regulation of different globin genes which are typically arranged in clustered families. By fusing erythroid cells of different developmental programs, trans-acting factors that regulate this switch in gene expression have been detected [Ramseyer et al. (1989): Dev Biol 133:262-271]. Adult erythroid cells of one anuran species, Xenopus laevis, were fused with tadpole erythroid cells of another frog, Rana catesbeiana, creating developmental erythroid heterokaryons that synthesize adult Rana globin mRNA and hemoglobins. The results show that factors from adult Xenopus erythroid cells are capable of inducing adult Rana globin gene expression in the Rana tadpole erythroid cell nucleus. We have used the cross-induction of adult Rana hemoglobin synthesis in these adult Xenopus/Rana tadpole erythroid heterokaryons to address two practical questions, answers to which may be helpful in isolating developmental stage-specific globin gene regulatory proteins: 1) Are erythroblasts which are actively expressing globin mRNAs and hemoglobins richer in specific globin-inducing activities than other stages of erythroid cellular differentiation? 2) Do mature, circulating erythrocytes still have the activities necessary to mediate the cross-induction of Hb synthesis? The results reported here show that the answers to both questions are affirmative and show that quiescent, fully differentiated adult erythroid cells are still capable of expressing the trans-activator(s). These findings show that factors which mediate the metamorphic hemoglobin switch are conserved between these two genera of frogs.

Constipation in the daily lives of frail elderly people

OBJECTIVE

To examine the meaning and context of constipation in frail elders.

DESIGN

Interview study with monthly follow-up for a 6-month period.

SETTING

Respondents' homes.

PARTICIPANTS

Two hundred eleven randomly selected community-living, frail elders receiving in-home health care.

RESULTS

Constipation was spontaneously mentioned by 94 patients (45%); it was considered a major health problem by 11% of these frail elders. Of this 11%, over half rated it as one of their top three health concerns. Of elders who talked about management strategies, most (43 [61%] of 70 patients) used medication alone. Only eight people did not use pharmacologic agents. Few (16 [17%] of 94 patients) mentioned a health-care professional in the context of constipation, and only five of these people expressed satisfaction with advice or treatment.

CONCLUSIONS

Constipation was a health problem for many of these elderly patients receiving home health care. Although the stated goal in the treatment of constipation is to avoid laxatives, both lay and medical management focused primarily on the use of medications. The results of this study underscore the importance of addressing quality of life as well as physiological issues for optimal treatment of constipation and similar disorders.

Rehabilitation services for the Pacific

The Pacific Basin Rehabilitation Research and Training Center was created to help meet the challenges of rehabilitating people in rural remote communities in the United States-associated Pacific. We describe the center, the special region it serves, some of its many programs, and some of the ways it is helping communities in this region provide services that are appropriate and sensitive to the culture, the environment, and the disability.

Personalization of formal social relationships by the elderly

This article examines the role of formal support services in the lives of elderly residents of HUD-subsidized buildings. Tenants identified a variety of formal roles as important in their lives. The three most central roles were physician (79%), apartment manager (58%), and social worker (51%). Formal roles were an important source of both instrumental and affective support in a wide variety of circumstances. Many individuals in formal roles were considered friends and the highly personalized nature of these relationships was a surprising finding.

Admission of geriatric patients to hospital on Niue Island 1977-1982

This report analyses the admission to hospital of people aged 65 years or more on Niue Island in the years 1977-1982. Geriatric admissions, of which 59% were female, comprised 8% of all admissions, equalling the proportion of old people in the community. There were no significant differences by age and or sex for admission rates, reasons for admission, length of stay or disposition. Acute illnesses, particularly respiratory problems, accounted for the majority of geriatric admissions although chronic degenerative disorders, usually cardio-vascular in nature, also played a role. The median hospital stay was 10.5 days, with 81% of all geriatric patients being discharged within one month. The majority (79%) of patients are discharged back into the community. Longest hospital stays resulted from potentially preventable accidents and injury, which constitute a leading cause of death for elderly men, from infectious/parasitic diseases, and from nonspecific nursing care admissions.

Paediatric admissions to hospital on Niue Island, 1977-1982

For the period 1977-1982, hospital records on Niue Island, western Polynesia, reveal that a total of 929 children aged 0 to 15 years were admitted. Just over half (57%) of these children were male. The majority (62%) were under six years of age; one-quarter (25%) were infants. Leading reasons for admission were respiratory problems (45%) and gastrointestinal disorders (16%). Under five year old males were particularly affected by wheezing bronchitis which accounted for nearly half of all respiratory hospitalisations. The majority of admissions for digestive disorders were of preschoolage children. As age increased, so reason for admission changed from being primarily for respiratory and digestive disorders to being more for accidents, musculoskeletal problems, and conditions of the skin and subcutaneous tissues. Accidents were the third leading cause of admission for males but not for females. Little variation in length of hospital stay was found by age, sex or village of origin. The median stay for paediatric patients was five days. Longest stays come from accidents, parasitic infections, and, for boys, skin and subcutaneous tissue problems.

A double blind comparative trial of pericyazine and thioridazine in chronic schizophrenia

Pericyazine (“Neulactil”), introduced in 1961, is a phenothiazine with tranquillizing and stimulating properties.

A controlled trial of mebanazine ('Actomol') in depression

Mebanazine (‘Actomol’) introduced in 1960 for the treatment of depression is a monoamine-oxidase inhibitor hydrazine derivative having the following structural formula: