RCHC Community Project Abstracts

Back to subject search page or search by preceptor site Teen Pregnancy in Scappoose, Oregon and the Creation of an Educational Brochure Describing What to Expect and Available Resources for Pregnant Adolescents. Project Date: 12/29/2008 Although teen pregnancy rates have been declining in Columbia County since 1996, nearly 1 in 4 (23.5%) births are still to adolescent mothers aged 15-19 (1,2,3). Young woman in Columbia County face multiple challenges including higher rates of drug and alcohol use, lower economic status, earlier sexual debut, and most importantly lack of sexual education (4,5). During my clerkship in rural family medicine at OHSU’s Scappoose clinic, I saw many pregnant teenagers and was quite surprised by the questions they asked. The young woman that I saw had no idea what to expect, they did not know what resources were available to them, and some didn’t even understand their own anatomy. While researching this topic, I found that there is a great deal of effort being made in Scappoose (and Oregon as a whole) to convince parents that sexual education is important and to create curriculums that teach adolescents about safety and prevention. Prevention is always the best strategy when trying to combat health problems and I therefore understand why so much attention is being paid to prevention in the case of teen pregnancy, there is however less effort being focused on young woman who have already become pregnant. After identifying that education and resources for pregnant teenagers is an area of intense need in Scappoose, I set out to create a simple one to two page brochure that would answer common questions and concerns as well as list resources that would be helpful to young pregnant woman. Information to be included in the brochure was determined by talking with the young woman themselves and also through conversations with the physicians and nurses who take care of these woman at OHSU’s Scappoose family medicine clinic. This brochure will be handed out to pregnant teenagers who come to the Scappoose clinic for prenatal care, or those who attend the clinics prenatal classes. Enriching the Cancer Dialogue: The Development of a Patient Handout that addresses underlying roadblocks against parental acceptance of the HPV Vaccine Project Date: 12/29/2008 Cervical cancer remains the second leading cause of cancer-related deaths in women across the globe. In the United States alone, it claims the lives of 3,700 women each year. Infection by the human papillomavirus remains the leading cause of cervical cancer. Since the 2006 release of the first FDA approved HPV vaccine, marked controversy has emerged surrounding the administration of the vaccine to young adolescent girls in an attempt to target women prior to their first sexual encounter. This has led to diminished acceptance of the vaccine by parents as their daughters approach adolescence, a trend clearly observed in a rural Oregon community at a time when rural areas continue to mark the highest yearly incidence of HPV infection. Attempts to identify roadblocks to parental acceptance of the HPV vaccine were made through observation of patient encounters coupled with an examination of online parenting blogs and forums and augmented by a search of the medical literature. The final product of this project stemmed from the information gathered in the creation of a new patient handout that more directly addressed the most important underlying concerns expressed by parents who were reluctant to accept the HPV vaccine’s administration to their daughter. Childhood Obesity Knowledge in 9th Graders at Klamath Union High School Project Date: 10/13/2008 Since the 1960's, childhood obesity has increased in the United States foru fold from 4% to 16.3% in 2006. In Klamath County, the current rate is even higher at 24.4% in 2007 making childhood obesity a serious epidemic. This is also 5% higher rate than the rest of Oregon. The Klamath Basin United Way 'Trends and Solutions of Klamath County 2006' survey noted obesity as the #8 health concern among children. In addition, a panel of experts surveyed listed obesity/eating disorders as the #1 problem not addressed in the community. Even more surprising, obesity/eating disorder education was listed as the #1 service needing the most improvement. I sought out on my project to prove the United Way study was correct with the assessment that obesity education needs improvement. In order to do so, I taught three classes on obesity to 82 ninth graders at Klamath Union High School. I gave them a survey to fill out before and after the class about their knowledge on obesity. The results showed that less than fifty percent of the students had knowledge in many of the different complications of obesity. Of those, hypercholesterolemia and sleep apnea were two complications that they learned the most about. "Every 15 Minutes” Program Immediate and Short Term Outcomes Project Date: 4/28/2008 Underage drinking and driving remains a problem throughout the US, including Harney County. About 8.6% of eleventh graders in Harney County had drove under the influence in 2005-2006. Harney County high schools participated in the “Every 15 Minutes” program which focuses on making responsible decisions around driving and alcohol. High school students, sophomores, juniors and seniors, were surveyed approximately thirty days after involvement in the program. After the program students were more likely to be designated drivers and less likely to ride with someone who had been drinking. In general, the “Every 15 Minutes” program has had positive immediate and short-term outcomes. This data was compared with similar data from the 8th grade Oregon Healthy Teen Survey from 2005-2006 which these students participated in. Ongoing surveys would determine long-term effects of the program. An Assessment of the Teen Birth Rate in Florence, OR Project Date: 2/11/2008 Florence, OR is largely regarded as an elderly community where people go to age gracefully. In a population where nearly twenty percent of its citizens are over the age of sixty-five years old, a public heath problem continues to brew quietly among a younger generation. The teen birth rate in Florence and surrounding areas is 1.7 times higher than the State’s rate, a statistic that appears even more exaggerated within this elderly community. Yet even among health professionals there is disagreement as to whether or not there is a problem with teen pregnancy in Florence. This project is an assessment of those perceptions and an evaluation of the availability of specific resources for sexually active teens such as contraceptive methods, emergency contraception, abortion, and adoption services. While access to all of these resources was found to be limited, the most underutilized was emergency contraception. Suggestions are offered as to how a subsequent project may be able to provide help in improving access to key resources and/or improve cooperation between Siuslaw High School and the Center for Women’s Health in generating a school-based clinic or outreach program. Barriers to such changes and a look at the historical aspect of this dilemma are also offered. Implementation and Continuation of Sex Education in Harney County Project Date: 10/15/2007 Teen pregnancy and teen STD transmission are both issues that are of great impact on individuals, communities and society as a whole. In Harney County Oregon, where social support networks are scarce and difficult to access, this is also true. Although rates of both teen pregnancy and STD transmission are both less than state and national averages1,2, the individuals involved are still greatly affected by these life changing events. Teen pregnancy is well correlated to individuals living in poverty and that must later be supported by a Welfare program that spends 9 billion dollars a year on family support of these individuals4. Seeing that there are 700,000 new teen pregnancies a year4, there is still a lot to do in the department of prevention. My project was aimed at that exact goal, and sought to better educate the middle school students of Hines Middle School following comprehensive national guidelines. Assessment of the Gay Friendly Literature and Postings in the Waiting Areas of Local Eugene, Oregon Clinics Catering to Adolescent Populations Project Date: 8/6/2007 Adolescence is a time of great discovery, when important facets of our personalities are experimented with and solidified. It is also a time of great confusion and vulnerability. This vulnerability puts adolescents at increased physical and mental health risks. Gay youth, an often overlooked subpopulation of adolescents, are often at increased risk compared to their heterosexual peers for certain health problems. As medical providers, there are many things we can do to assist our young gay patients during this tumultuous time. Unfortunately, despite our best efforts to provide adequate care to this population of patients, studies show that gay youth are hesitant to disclose their identity to health care providers. Gay youth need to feel safe before disclosing their identity as this leaves them in an extremely vulnerable position. We can help increase their trust in us as providers, simply by encouraging gay friendly literature in our waiting rooms. A cursory assessment was made of local Eugene clinics. Ninety seven percent of clinics available for response did not display gay friendly literature in their waiting areas. The same percentage did not have any brochures on local gay resources to offer their patients. It was evident that if a gay adolescent was presenting at any of these clinics, they would have no obvious signs letting them know that they were in a safe place. It was also evident that a resource guide for gay youth was lacking in local Eugene clinics. A Closer Look at the Nutritional Habits of Scappoose High School Students Project Date: 4/30/2007 Obesity has become increasingly prevalent among school-aged children and adolescents in the United States. With obesity becoming increasingly more widespread in the U.S., especially amongst the rural population, it is probable that adolescents in their high school years will reflect this same trend. This study examines the attitudes towards nutrition of Scappoose High School students who do and do not participate in an athletic activity in Scappoose, Oregon. A survey was formulated which gathered information on their opinions on the cafeteria foods as well as on the impact of athletic or physical activity on nutritional choices. At the present, nutritional education for the general Scappoose high-school population is limited to a part of the Health class curriculum. At the clinic, nutritional habits are checked when adolescents come in for a sports physical exam. Otherwise, there was no established presentation of the nutritional values of the food offered by the school or the benefits of physical activity on their health. The results of this survey will be given to the athletic director and health class instructor to aid in their understanding of their students views on nutrition. Increasing High School Student Awareness of Health Careers in Union County Project Date: 3/19/2007 Although 20% of Americans live in rural areas, only 9% of the nation’s physicians practice there. Studies have shown that medical students raised in medically underserved areas tend to set up practice in such areas. Unfortunately, students from rural areas lack exposure to health care careers and practice opportunities. The purpose of this project was to develop and implement a rural outreach curriculum to help increase high school student awareness of health careers. The project goals were accomplished by visiting several high schools in Union County to give an interactive lecture designed to inspire students to enter the field of medicine. The project also included development of a student handout regarding age-specific OHSU and AHEC sponsored career exploration summer programs, available preceptorships, and available funding for high school students interested in a health career. The goal of the project is to reinforce the OHSU mission of attracting Oregonians to the School of Medicine and ultimately supplying all of Oregon with sufficient numbers of qualified health care professionals. Implementing the New HPV Vaccine: developing informational resources for patients and clinic tools for its use Project Date: 2/12/2007 A new vaccine is available that protects against the most common types of HPV that cause cervical cancer, but the patients of the High Desert Medical Center have limited information available to them about this vaccine, and the clinic itself has not begun using it. This project had two goals: first I attempted to help create informational resources about this new vaccine, and secondly, to help implement its use in the clinic. To achieve increased patient education, a brochure was developed to be distributed to patients at the clinic. An article about the vaccine and cervical cancer was also written that will run in the local newspaper. To help the clinic put the vaccine into use; I worked with IT staff to add reminders and schedule tracking of the new vaccine. I also acquired the cost information from the most commonly used insurance companies in the area. Risk reduction strategies for prevention of STDs and teen pregnancy in Madras, Oregon Project Date: 2/12/2007 Sexually transmitted diseases (STDs) and teen pregnancy remain major public health challenges for young people in the United States and rural Oregon is no exception. STDs in rural Oregon follow national trends: The top two STDs are HPC and Chlamydia, and about half of new infections diagnosed each year are young people 15 to 24 years of age. The service area of Madras Medical Group also has staggering teen birth rates (women age 15 to 19). 2004 estimates of teen births in the service area are 158 per 1,000 live births, almost four times the national average (CPU site information, CDC). The objective of this project was to find clinical evidence of effective risk-reduction interventions in preventing STDs and/or teen pregnancy. Literature search revealed risk-reduction counseling interventions that were effective in reducing STDs and increasing safe sex behavior, notably most effective in younger patients. Studied interventions were based on interactive counseling and the AIDS Risk Reduction Model which focuses on three stages of behavior change: labeling high risk behavior as problematic, making a commitment to change high risk behavior, and seeking and implementing solutions directed at reducing high risk activity. Similar counseling techniques were found to be effective in programs aimed at reducing teen pregnancy. From this data, a proposal for a brief, one-on-one, low cost intervention to reduce the risk of STDs and teen pregnancy was developed for Madras Medical Group. Though not yet fully implemented, the intervention has received positive feedback in informal interviews from both the target population and the clinicians. HPV Vaccination in the Illinois River Valley: A survey of attitudes and availability, with recommendations for increased vaccination Project Date: 2/12/2007 Gardasil, the vaccine against 4 strains of the Human Papilloma Virus, is currently a hot topic among women’s health providers and also the mainstream media. My project attempted to identify the best method for improving vaccination rates amongst young women in the Illinois River Valley. I found that no providers in the Illinois River Valley offered the vaccine, due to lack of demand, prohibitive costs and difficulty in purchasing. Young women who were interested in receiving the vaccine were referred to the County Health Department a 25-35 minute drive, which was prohibitive for some patients. Although, I would have liked to be able to recommend that providers in the IVR offer the vaccine to their patients, my research was not able to support that conclusion. Instead, I recommend provider education and a concerted effort to encourage vaccinations through the School Based Health Programs and continued referral to the County Health Department. Acceptance and Use of the HPV Vaccine in Lebanon, OR: Creation of an educational patient handout to increase awareness, acceptance, and use of HPV vaccines. Project Date: 1/1/2007 A vaccine against HPV and Cervical Cancer was recently FDA approved for use in the United States, representing a major public health advancement and effective method for decreasing the prevalence of an aggressive malignancy. This study attempted to assess the educational resources available for patients about the HPV vaccine as well as the use of the vaccine in a rural family practice clinic in Lebanon, Oregon. The design was to observe current methods of patient education for the HPV vaccine and the number of times the vaccination was given over a five week rotation. Informal interviews with physicians in the clinic, as well as patients, were conducted to access common questions and concerns about the new vaccine. The process of obtaining the vaccine as well as the rate of administration was assessed with the physician interviews, as well as talking with clinic staff. Due to the relatively short duration of vaccine availability and lack of informative yet concise materials, patients were uniformly unaware of the accurate details about the HPV vaccine and no vaccines had been given. Since the vaccine had a designated target population, those eligible were easy to identify and the barrier to patient education was seen to be the lack of an educational handout. Not only does the possible recipient need information, but the captive audience includes young females starting at age 9, which often includes parents in the educational equation. Therefore, the final product of this project was a concise yet appropriately informative patient handout to explain HPV; it’s relation to Cervical Cancer, and the HPV vaccine to adolescent females 9-15 years old and their parents to increase accurate awareness and subsequently utilization of the vaccine. Managing Medical Complications of Eating Disorders in the Outpatient Setting Project Date: 10/16/2006 "Eating disorder patients can be challenging for physicians to manage since there are many medical complications that arise in the setting of starvation or persistent purging. These medical complications put patients at risk and can add considerable cost to the health care system if not addressed properly. The purpose of this project was two-fold: 1) to identify the most important medical problems experienced by eating disorder patients that should be looked for and treated, and 2) to develop a screening tool for physicians to follow the symptoms of medical complications and guide treatment decisions. Visiting residents of an outpatient residential eating disorders treatment program outside of Eugene provided a unique opportunity to have good continuity with eating disorder patients and deal specifically with the medical (as opposed to psychiatric) aspects of their care. The population studied was a group of female patients diagnosed with either anorexia nervosa or bulimia nervosa that were currently undergoing medical, nutritional, and psychological intervention for their eating disorders. After reviewing the literature and conducting patient interviews, a worksheet of medical symptoms was created. The final product is designed to be filled-out by patients prior to seeing their doctor for medical appointments. The utility of such a tool is to focus the patient encounter towards relevant medical problems, to consolidate symptom information into one place, and to allow for the consistent tracking of the persistence or resolution of symptoms with treatment." Barriers to Utilization of the Human Papillomavirus (HPV) Vaccine at the Cottage Grove Hospital & Clinic; Development of Provider Education Materials Project Date: 9/11/2006 The Human Papillomavirus (HPV) is responsible for up to 99.7% of cervical cancer. A new HPV vaccine recently approved by the FDA has demonstrated significant efficacy in preventing persistent, high-risk HPV infections when administered prophylactically. Due to the novelty of this vaccine, however, many providers are unaware of the details of its availability and of their patients’ ability to procure the vaccine at affordable rates. In addition, vaccination is not yet widely accepted by patients or parents, for a variety of reasons. The goal of this project was to investigate the barriers to vaccination at the hospital and clinic in Cottage Grove, Oregon, a facility serving approximately 18,000 patients, 31.5% of whom are aged <25. A literature search was performed for information regarding HPV and the efficacy of the vaccine. Availability of the vaccine was confirmed by the hospital’s pharmacy. Several major insurance carriers were contacted regarding coverage for the vaccine. Availability and insurance coverage of the vaccine was found to be much greater than most providers had previously believed. A secondary goal of the project was to develop provider education materials aimed at minimizing barriers to immunization with this promising new vaccine. This was achieved by the production of a single-page, double-sided, tri-fold informational handout. Provider response was positive, and several providers who had not previously prescribed the vaccine offered it to their patients, some of whom began the 3-shot series immediately. Primary Prevention in Eugene Oregon: Recognizing Environmental Injuries during youth sporting events Project Date: 8/7/2006 Heat injuries have the potential to become a medical emergency if not detected and treated in a timely manner. Heat stroke, the most severe form of heat injury, carries a significant mortality rate, especially when therapy is delayed. Some studies cite mortality rates between 10-70% depending on several factors including duration of peak body temperature. Heat stroke is 100% preventable and with such a high morbidity and mortality rate primary prevention is paramount. Youth sports that start in the fall begin practice in August and there is a potential to develop heat injuries in this population. Coaches involved with these sports should be trained to recognize the signs, symptoms, and initial treatment of heat injuries to prevent the progression to heat exhaustion or heat stroke. In addition, it is important for coaches to recognize when the local emergency medical services should be activated in order to institute a higher level of care with regard to the injured individual. This project focused on educating youth coaches about the signs, symptoms, and treatment of heat injuries in the effort to prevent the morbidity and mortality associated with the more severe forms of heat injury, heat exhaustion and particularly heat stroke. A 5-year retrospective analysis of all-terrain vehicle (ATV) injuries in children presenting to the Emergency Room in Reedsport, OR Project Date: 8/7/2006 Reedsport, Oregon is located three miles from the Oregon Dunes National Recreational Area which attracts all-terrain vehicle (ATV) riders from all over the country. The frequency of ATV trauma is increasing nationally and this retrospective review of ATV-related injuries presenting to the local ER over the past 5-year period revealed that ATV trauma is a significant problem in Reedsport, OR. Children under 16 account for 16% of the overall morbidity and appeared to be more vulnerable to head/neck injuries when compared with adults, despite demonstrating good helmet usage upon subsequent analysis. However, children were less likely to be hospitalized or transferred to another hospital than adults, which may indicate that their injuries were not as severe. Tandem riding (i.e., riding as a passenger) was a risk factor for ATV-related injury in children, which is consistent with the literature on pediatric ATV-related injury, and therefore provides a potential target for legislative intervention. Improving Birth Outcomes Among Pregnant Adolescents in Klamath Falls, OR Project Date: 7/3/2006 U.S. adolescent pregnancy rates remain higher than any other industrialized nation. According to the Oregon Office of Rural Health, while Klamath Falls’ adolescent pregnancy rates are no higher than the Oregon average, the actual birth rate among pregnant teens is about 1.4 times higher than the Oregon average. Reasons for this have been investigated in prior community health projects, and include lack of access to or knowledge of abortion clinics, as well as the general attitude toward abortion in the community. The focus of this project was the health of those teenage mothers who do choose to give birth. Adolescent pregnancy is associated with various obstetric and birth problems such as premature labor and low-birth weight infants. Reasons for this are related to unique physical, psychological, and social factors present in adolescence. Several prior studies provide a strong argument for instituting specific programs that target this special population in order to improve pregnancy outcomes. Based on these findings, this project used two approaches to improve pregnancy outcomes – a community-based approach and a healthcare provider approach. A teenage pregnancy and parenting workshop course was developed and implemented in the community. Further, a brochure was developed for healthcare providers which provided important information to address in the care of pregnant adolescents. A talk was also given to the residents of Cascades East Family Practice regarding the issue. Teen Pregnancy In Coos County, Oregon Project Date: 5/1/2006 Although the rate of teenage pregnancy continues to decline in the United States, it continues to have a number of serious implications and to place a large burden on society. Not only does becoming pregnant as an adolescent decrease the likelihood of an adequate education and a successful future for the mother, the child often suffers from being raised by a parent who is ill-equipped for the challenge of parenting. While recent trends have shown a decreased teenage pregnancy rate in Coos County, Oregon, recent population studies suggest that this number is now on the rise. In an attempt to identify some of the factors contributing to this alarming trend, I interviewed teenage girls and some of the people who care for them. While several possible causes were identified, main factors included erratic use of contraception and a seeming lack of awareness of the risks of their sexual behavior. No concise educational material was available that discussed these concerns, so a handout was developed to address some of these issues in a matter that was appropriate for teenagers. Contraceptives: A Survey of Jefferson County Teenagers Project Date: 5/1/2006 Jefferson County has the highest rate of teen pregnancy in Oregon. Research shows that programs that combine emphasis on delayed initiation of sexual activity as well as sexual and contraceptive education helps reduce teen pregnancy rates. In order to reduce teen pregnancy in Jefferson County, sexual and contraceptive education will need to be taught in a comprehensive way. The goal of this project was to evaluate the knowledge regarding contraceptives of teenagers in Jefferson County, where they obtain their information, who they trust regarding contraceptive information, and what myths exist surrounding contraceptives among teens in this county. Surveys were administered to four health classes to a total of 79 high school students and discussions were held following the administration of the survey. Results showed teens get most of their information from school, friends, and health care professionals. They trust doctors, nurses, and parents to provide accurate information. There is good understanding that abstinence prevents pregnancy. Knowledge of comparative efficacy of specific contraceptive methods was not good. Knowledge of new contraceptive methods such as the NuvaRing and Mirena were low. Many students did not know the window of opportunity to take emergency contraception. Myths regarding side effects of contraceptives include breast cancer risk, infertility, birth defects and weight gain. Health care professionals are trusted by teens in this county generally feel safe speaking with their health care providers. Significant room for improvement exists in the education of teens in Jefferson County regarding contraceptive methods. Adolescent Injury in Reedsport, Oregon Project Date: 3/20/2006 Unintentional injury remains the leading cause of adolescent and young adult morbidity and mortality in the U.S. The leading causes of non-fatal injury for 13-24 year-olds are: being struck by or against an object, falls, motor vehicle accidents, overexertion and cuts or piercing. Reedsport, Oregon, a town of 7,900 located on the central coast has an aging population in which adolescents comprise 11% of its population. A recent unintentional motor-vehicle-related fatality of a teenager and injury of another in this small town has raised awareness on the lack of data for the incidence of adolescent injury in the community, including what types of injuries are occurring and what are the associated variables. A medical records search for Reedsport adolescents aged 13-24, who were seen and treated in the ER of the Lower Umpqua Hospital during calendar year 2005 for injuries or trauma was completed. A total of 100 charts were reviewed and descriptive statistics on injuries compiled. Reedsport adolescent injury patterns appear comparable to national statistics, although there is a lower incidence of motor-vehicle related accidents among Reedsport adolescents seen at this ER. The value of implementing a systematic adolescent preventive services program and a specific model for doing so are also discussed. Assessment of Baker High School Students' Perception of the Appropriateness of Antibiotic Use for Upper Respiratory Tract Infections Project Date: 3/20/2006 Antibiotic resistance is no less a public health problem in rural settings than it is in urban settings. One factor contributing to the development of antibiotic resistance is inappropriate prescription of these drugs for viral respiratory tract infections. In this study I developed a short presentation focusing on the differences between viruses and bacteria and the most frequent causes of respiratory tract infections. The presentation was given to high school sophomores in health classes at Baker City High School. A pre- and post-presentation questionnaire was employed to gauge the success of this presentation; post-test results indicate that students had a better understanding of the differences between viruses and bacteria after the presentation. School Based Health Center in Sweet Home, Oregon: Current self-reported health related issues and current acute-care facility usage. Project Date: 3/20/2006 There is an ongoing project by the Linn County Department of Health Services to start a school based health clinic in Sweet Home, Oregon. In an attempt to aid in the planning for this project, this report summarizes the Oregon Healthy Teens survey results for Sweet Home, and looks at emergency department and urgent care facility usage by high school aged children from this city. Findings include similar prevalence of self-reported alcohol use between Sweet Home and the state average (45.2% vs. 47.4%), as well as similar rates of use of other substances. Sweet Home students are more likely than the state average to report having had sexual intercourse, but are also more likely to report having used a condom and/or birth control. Self-reported asthma has a significantly higher prevalence in Sweet Home than across the state (16% vs. 10.8%), and is more likely to have caused students to miss school. The prevalence of self-reported depression is similar between Sweet Home and the state average (7.3% vs. 6.3%), but Sweet Home students are more likely to have considered suicide within the past year (18.1% vs. 12%). Also, at least 281 (39%) of ED/UC facility visits by this population were likely to have been issues that could have been handled appropriately in a primary care setting. Baker County Sexual Health Education: The Good, The Bad and The Ugly Project Date: 2/13/2006 Baker County has a several high-risk sexual health populations, including high school students, patients in inpatient alcohol and drug treatment facilities, and prisoners. Sexual health education for these groups has been limited in the past. A focus group of public health RNs identified a problem with poor resources for delivering STD education in these settings. They expressed a desire for an easy-to-give and easy-to-understand presentation that they could use to give educational talks to these high risk groups. They also described the lack of resources in the clinics for sexual education during family-planning or sexual health visits. They described a need for an easily accessible photographic flip-book for use with patients in the clinics. With their guidance, I developed a one hour Power Point presentation and a short color photo flip-book about STD risks, prevention and treatment in Baker County. Together we discussed a plan for putting these new resources to use in the community. Obesity Associated Type II Diabetes Mellitus In Scappoose, OR, Adolescents: Awareness May Lead Early Diagnosis and/or Prevention Project Date: 10/17/2005 As in adults, the numbers of overweight and obese children and adolescents have tripled over the past thirty years. As a result, the incidence of type-II diabetes, conventionally known as “adult onset diabetes”, in childhood has risen 10 fold. Obesity and its related co-morbidities represent a major proportion of family practice office visits. Indeed, during my time in the Scappoose clinic the majority of the adolescents seen were either overweight or obese. The aim of this study was to determine, using provider interviews and information available for the prevalence of obesity at Scappoose High School, OR, if adolescents are at high risk of developing type II diabetes (DMII), and if so, what are the rates of diagnosis and factors which may limit the process. Adolescents of Scappoose, OR, in accordance to national trends, were found to be at risk of developing DMII but have low rates of diagnosis, raising a concern for the awareness of overweight and obese adolescent patients and their parents. Finally, using the information learned from the study a new patient handout was made, aimed at increasing patient/parent awareness of obesity and DMII, to improve prevention, detection, and long-term outcomes. Emergency Contraception availability in Grant County: Assessing the attitudes and prescribing/dispensing practices of physicians and pharmacists Project Date: 9/12/2005 The 2005 Healthy Teens survey of 11th grade students in Grant County shows that 51% have had sexual intercourse. Of these sexually active teens, 57% rely on condoms as their main birth control, 12% use oral contraceptive pills, and 26% use no birth control method or withdrawal. Based on the results of this survey, emergency contraception (EC) could be very useful in preventing unintended pregnancies for this remote community. The purpose of this project was to survey family practice physicians as well as the pharmacists in Grant County about their attitudes towards EC and their current prescribing and dispensing practices. Sex Education in Philomath, Oregon: What is the message and is it getting across? Project Date: 9/12/2005 Teen pregnancy and sexually transmitted infection (STI) rates are important indicators of issues affecting the health and future prospects of our country's youth. This project attempted to look at the sexual education provided to students at Philomath High School to help them make the decisions affecting these rates, and compare this to programs used nationally. It researches the specific components of the high school curricula, then, by means of a questionnaire, evaluates how the Philomath specific education translates into the knowledge and attitudes of the students it serves. Finally, using available data, it looks at how Philomath compares at a national and state level regarding teen pregnancy rates and rates of sexual activity. Data collected on the Philomath School District sexual education was obtained by interviews with the school nurse, high school counselor and the high school health teacher. Skateboarding Safety: A project in Warms Springs, Oregon Project Date: 8/8/2005 Skateboarding has become a fast growing trend in the United States. It is projected that by the end of 2005 there will be 15 million participants in this sport7. Unfortunately, accompanying this increasing popularity is an increasing numbers of injuries. In 2002, a study done by the Consumer Product and Safety Commission demonstrated that skateboarding had the highest injury rate compared to other wheeled sports including bicycling, in-line skating and scooters7. According to American Academy of Orthopedic Surgeons, each year in the US skateboarding injuries cause about 50,000 visits to emergency departments. In addition, more than 1500 children need to be hospitalized for head injuries or disabilities that frequently result in loss of vision, hearing or speech, as well as changes in thinking and behavior. Furthermore, in most fatal cases the rider was not wearing a helmet3. The community of Warm Springs, located on the Warm Springs reservation in central Oregon, has a population of nearly 4000. Approximately one year ago, the community built a skate park for their youth; it is unknown exactly how many injuries have occurred at this park since its construction, but according to health care provider reports it is estimated to be significant. This study was designed to determine the underlying rationale of the children of the Warm Springs community for not wearing protective equipment, including helmets and pads, while skateboarding. A survey was developed to assess the motives of the children under the ages of 18 utilizing the skate park. In addition, an informative brochure was developed with educational activities as well as information for parents on the importance of wearing helmets while doing all wheeled sports. Twenty-one children were surveyed. The answers from the children paralleled responses from children across the nation. The most frequent response regarding not wearing a helmet was “I don’t get hurt and so I don’t need to”. Other popular answers included “I don’t know”, “It’s uncomfortable” and “I don’t like the way it looks”. Four children said they would wear them if it were required while others said they still would not. Eight children owned helmets. In addition, it was observed that many other wheeled vehicles were being used at the skate park including bicycles and scooters, again without helmets or other safety equipment. The information collected in this study will be used for further educational opportunities for the children as well as possible legislation. Educating pregnant teens about their options and the resources available to them in Klamath Falls, Oregon Project Date: 8/8/2005 Though teen pregnancy rates have been on the decline in the United States for many years, they remain higher than in any industrialized country. As a medical student found in 2002, while the teen pregnancy rate in Klamath County is no higher than that of Oregon as a whole, the teen birth rate is higher because more teens choose to raise their children than elsewhere in the state. This is potentially problematic because teen parents and their children are subject to a unique set of public health problems. One of the reasons discovered for why Klamath County teens chose to become parents is lack of access to pregnancy termination, a fact that was confirmed by discussions with Klamath Falls physicians and a health educator. Resources do exist for Klamath Falls teens seeking pregnancy termination, although these resources are limited. Realizing that Klamath Falls teens may not have information available to them about pregnancy termination, and also that termination is not the choice every pregnant teen will make, an informational brochure was created to be distributed to nurses at Klamath Falls high schools. This brochure listed resources for teens that choose to become parents, those who choose to place their baby for adoption, and those who choose to terminate their pregnancy. To address the issues of teen pregnancy prevention, a second informational brochure was created for the nurses, this one describing various birth control options and informing teens of local family planning resources. Emergency Contraception: School Counselor and Pharmacist Practices and Attitudes in Coos County, OR Project Date: 4/25/2005 The rate of teenage pregnancy has been declining in Oregon, yet it still remains unacceptably high. Nearly 26 per 1000 teenage girls ages 15-17 years old in Oregon will become pregnant this year, given current trends. Rural communities are plagued with even higher rates of teenage pregnancy, in large part due to the limited access to family planning and abortion care services. Emergency contraception (EC) provides a safe, easy to use, effective and relatively inexpensive method for preventing unintended pregnancy, yet it is extremely underutilized, particularly in rural communities. The reasons for this are not well understood, and are likely multi-facetted, with responsibility resting on physicians, pharmacists, patients, and educators. Physician attitudes and prescribing practices with EC have been fairly well documented, however little is known about pharmacist and school counselor attitudes and practices with respect to EC. The aim of this community project was to examine the attitudes and practices of Coos County middle and high school nurses and counselors regarding emergency contraception. Furthermore, the project also addressed pharmacist attitudes and dispensing practices for EC. The design was a written survey distributed to local school nurses and counselors, and community pharmacists. An informational pamphlet on EC was also developed and distributed to community clinics, schools and pharmacies. The overall response to the surveys suggest that school providers in the Coos Bay/North Bend area are open to the use of EC yet do not counsel students on it unless specifically requested by a student. It was also found that pharmacists dispense EC to all customers with a valid prescription, regardless of age, yet few pharmacies reported EC requests from teenagers. Lets Talk About Sex: A look into the Attitudes and Behaviors of Jefferson County Project Date: 4/25/2005 Teenage pregnancy is a problem throughout the United States. In Oregon, Jefferson County has the second highest teenage pregnancy rate when compared to other counties. This leads to increased health risks for teens and children, and an increasing amount of financial stress on Madras, OR, the heart of the medical and educational services in the county. This study connected the researcher with Jefferson County High School teens via one-hour focus groups in a effort to generate ideas that will be helpful in decreasing the teenage pregnancy rate in Jefferson County. The focus group design and the sample population were chosen because teenagers may have insight into solutions that adults are less able to provide. The information gathered from students was compared with literature recommendations for effective community strategies for decreasing teen pregnancy. The result is a list of recommendations or suggestions for the community of Madras in addressing the important problem of teenage pregnancy. Skateboarding Safety in the Community of Reedsport, Oregon Project Date: 3/21/2005 In 1996 it was estimated that approximately 5.8 million kids between the ages of five to eighteen years old participated in skateboarding. Of those 5.8 million, an estimated 750,000 skateboarded on a weekly basis (1). It is likely that this estimate will increase as the popularity of skateboarding surges. Paralleling the revival of skateboarding, there has been an increase in skateboard-related injuries. Most recently, the number of injured individuals younger than 20 years has increased from an estimated 24,000 in 1994 to approximately 51,000 in 1999 (1). Numerous studies have concluded that skateboarding-related injuries are more severe and have more serious consequences than those injured while roller skating or in-line skating (3). Reedsport has recently opened a skateboard park for its youth. The goal of my community project was threefold: 1. Assess how the skateboarding youth of Reedsport compare with national statistics regarding injury frequency and patterns. 2. Determine what methods to prevent injury were utilized among kids. 3. Promote helmet safety. Survey of Lower Umpqua Hospital’s emergency department records demonstrated that over 19 months a total of 345 encounters were recorded for trauma, ATV, and skateboarding accidents. Of the 345, 26 (8%) were related to skateboarding. The age range for skateboarding injuries was 8 – 29 years with an average of 16.6 years. 93% (23/26) were male. Skateboarding injuries were categorized by area injured including head, thorax, and extremities. 65% (17/26) of skateboard injuries were to extremities. Of extremity injuries 71% (12/17) were fractures. Alternatively stated, 46% of the 26 skateboarding injuries were fractures. Head injuries comprised 23% (6/26) of skateboard related injuries with one of these injuries also qualifying as a trauma secondary to a closed head injury. Injuries to the thorax comprised 12% (3.26) of the skateboard injuries. Multiple casual observations (> 10 occasions) of kids using the skate park revealed that most kids are not using a helmet when skateboarding, particularly older teenagers. In addition, on no occasion was a supervising adult present. To promote helmet safety and awareness I designed a locally based helmet safety pamphlet featuring many of the local skateboarders. The pamphlet was distributed to local skate shops (Pandemonium, Waxer’s), the elementary and junior/senior high schools, the local emergency department and the Dunes Family Health Care clinic. A summary of the pamphlet was also sent home to all the parents of children attending the junior/senior high school. I also collaborated with the outdoor editor of the local newspaper “The World” and wrote an article focusing on helmet safety and awareness. Lastly, I solicited sponsorship from five companies (The Tony Hawk foundation, Bell, Viking helmets, Wal-Mart, The Oprah Winfrey show) for 20 skateboard helmets. Waxer’s donated 3 helmets with elbow and knee pads. The rest of the sponsorship requests are pending at this time. If in the future more helmets are donated then I will return to Reedsport and work with the local fire department to distribute the helmets to kids in need on during the town’s annual “Skate Jam.” Physical Activity in Children and Adolescents in Ontario, OR Project Date: 1/3/2005 Obesity has become a major health concern in the United States over the past several decades. When attacking this overwhelming problem, two areas are often targeted in order to keep obesity at bay: nutrition and physical activity. Despite their equal importance in a healthy lifestyle, physical activity is often overlooked in favor of nutrition, hence the popularity of fad diets and the current anti-carbohydrate campaign. Unfortunately, these trends are often short-lived and allow for little long-term success. For significant and more permanent change, patient education is an absolute necessity. At the Treasure Valley Pediatric Clinic in Ontario, Oregon, the primary method of patient education came in the form of a handout, whether the health issue was constipation, acne, or nutrition. Glaringly absent from this selection of handouts was any information regarding physical activity and exercise. The aim of this project was to evaluate the level of physical activity in the community, particularly with children and adolescents, and then create a patient handout that would provide education regarding ways to improve current fitness levels. Ultimately, the level of physical activity was found to be inadequate among children and adolescents in Ontario, Oregon; therefore, a kid-friendly brochure was produced and distributed at the pediatric clinic with the hope that early education could lead to a lifetime of healthy habits. A Survey of Alcohol Use Amongst Seniors at Grant Union High School In John Day, Oregon Project Date: 10/18/2004 Underage drinking continues to be a problem among adolescents and has serious social, health, and economic consequences. The purpose of this study was to identify the prevalence of alcohol use among 12th grade students at Grant Union High School (John Day, OR) compared to that of high school students throughout the United States. It is hoped that the information gathered will be used by school district authorities to assess the success of currently instituted alcohol prevention programs, stimulate thought into further methods of prevention, and help promote student understanding and insight into the pitfalls of alcohol abuse. The study was conducted in a survey format, which was completed by individual students on a confidential and anonymous basis. The final results of this project show that alcohol use is common among students at Grant Union High School, with many of them being initially exposed to alcohol at an alarmingly young age. Fighting Childhood Obesity with Physical Education Project Date: 9/13/2004 Obesity is a growing problem in all age groups, but particularly alarming are the growing numbers of overweight children. The rural community of Burns, Oregon has not escaped this dilemma. Many attempts to address this problem have been made, but the community has yet to incorporate an important resource: physical education. Recent studies have shown that by enhancing physical education class, especially at the elementary level, dramatic differences can be made in a child’s weight. The purpose of this project is to evaluate the current PE and nutrition programs at Slater Elementary School in Burns, and make suggestions for increasing their effectiveness. This will be done by suggesting means to increase funding and support, and through making a parent handout on easy ways to keep their child’s diet healthy. You Are What You Eat! Project Date: 9/13/2004 My community project was aimed at educating teen athletes about eating healthy diets to maximize their success in sports and to maintain their health. I picked this topic because all teens that want to play school sports must get a sports physical before they can participate in the sports. This allows physicians a good opportunity to educate the athletes before they start to train. The second reason that I decided to educate teens about a healthy diet is because it may be confusing for teens. I was also hoping to educate the teens about eating disorders so that they may recognize the signs and seek help if needed. Lastly, I wanted to educate teens about nutrition because for them, this is the time to develop proper eating habits that will serve as a foundation for healthy eating as an adult. I decided that the best way to educate teen athletes was by making an informative flyer that could easily be handed out at their sports physical. In this flyer, I provide information about main things to consider with respect to diet as an athlete, helpful eating habit hints, pre and post game eating tips, and eating disorder signs. I hope that this information will contribute to the success of teen athletes in developing healthy eating habits for the present time and for later on in life. The Forty Assets: A Needs Assessment for Adolescent Well-Being in Burns Project Date: 8/9/2004 In response to a series of adolescent suicides in a single year, Burns developed the Positive Parenting Group to promote healthier adolescent development. They have modeled community interventions based on the Forty Assets program, as developed by the Search Institute. In this project, 124 students from Burns High School were surveyed to ascertain the extent to which adolescents in this community have developed positive assets. The strengths of adolescent development in Burns include family support, clear boundaries established by adults, high expectations by adults, and positive personal values. The community has fewer assets in the areas of adolescent empowerment, the constructive use of time by youth, and a sense of neighborhood support. This data can help community groups and future medical students develop interventions targeting teen involvement in service, community activities (social or religious), or school activities (including sports, arts, or other clubs). Service-related activities are encouraged to promote community interaction in a setting where resources are limited for the creation of new programs. Prevalence of Methamphetamine Use In Jefferson County, Oregon Project Date: 8/9/2004 Methamphetamines use has major health and societal impacts in rural communities across the United States. A previous community project in Madras, Oregon, sought to educate high school students regarding the ill effects of methamphetamine use. That investigator acknowledged the prevalence of methamphetamine use in the area, but did not attempt to quantify the prevalence. The aim of this project was to try and provide some numbers and demographics of methamphetamine use in Jefferson County, Oregon. Because there is no single source where such information is stored and tracked, a number of different sources were queried. Exploring Teenage Pregnancy Prevention in John Day, OR: Development of teen education material for birth control method selection Project Date: 7/5/2004 The purpose of this project is to investigate the teenage pregnancy rate and services available to adolescent women in John Day, Oregon. For the past few years, family physicians in John Day have noticed a trend in younger teens becoming pregnant in their small town. They have also reported that adolescent women in their rural community are often more likely to choose to keep their pregnancy and raise their children when compared to their urban counterparts. Teen pregnancies and adolescent childbearing is a important issue for rural towns due to the strain it causes on their limited financial and medical resources as well as the social and health consequences to these parents and their children. Since most programs to prevent pregnancy or adolescent motherhood have targeted young women who reside in metropolitan areas, it is important to evaluate whether similar resources should be directed at rural communities. This project intends to achieve two goals: first, examine the trend in the number of teenage pregnancies in rural counties in Eastern Oregon in comparison to urban counties along the I-5 corridor as well as assess whether or not current programs for teen pregnancy prevention are adequately thwarting the number of adolescent girls becoming pregnant in John Day, OR. Second, as part of the effort of teen pregnancy prevention, a patient education handout was created in order to better assist teens in selecting a birth control method. Television and Childhood Obesity: Spreading the Message in Harney County Project Date: 5/10/2004 Childhood obesity is a problem across the country with health implications for the present and future. Recent studies have shown that reduced time in front of the television for children and adolescents may help prevent obesity. While community groups and programs exist in Burns to promote youth fitness, no one has specifically outlined the role television viewing has on childhood obesity. The purpose of this project is to educate patients and the community about reducing time in front of the television and its potentially significant impact on childhood obesity prevention. This will be done through an article publication in the Burns Times-Herald and a public service announcement on local radio stations, KQHZ and KZZR, all in association with the physicians at High Desert Medical Center. In addition, a patient handout will be made available in clinic to help parents develop good television viewing habits with their children. Are the Diet and Exercise Habits of Middle & High School Students in Coos County Influenced by the School Environment? Project Date: 5/10/2004 The school environment has been shown to be a powerful determinant of child and adolescent diet and exercise habits. However, facets of school environment’s are believed to be unconducive to, as well as not fostering or promoting, healthy diet and exercise habits among students. In an effort to see whether the diet and exercise habits of students in Coos County School District are influenced by their school environment, 448 middle and high school students were surveyed. Specifically, their intake of fast food, candy and carbonated beverages, as well as their participation in school PE, or other physical activity was queried. They were also asked their responses to hypothetical situations where the school environment was modified, such as if vending machines were removed from campus, if they were not allowed to leave campus for lunch, or if PE were a required class. The results of the survey show that the school environment does indeed influence students’ diet and exercise habits. Furthermore, a majority of students indicated that they would relish changes to their school environment that would help foster healthier diet and exercise habits among them. Attitudes and Behaviors Regarding Nutrition and Exercise At Scappoose High School Project Date: 3/29/2004 The rates of obesity have been steadily increasing in rural and urban communities across the United States in recent years. Obesity rates among children and adolescents are growing even more rapidly than those seen for adults. There are many factors associated with the development of obesity; genetics, diet, physical activity and mental health to name a few. In an effort to address these issues, the USDA developed the Dietary Guidelines For Americans in 2002. By directing the implementation of the Dietary Guidelines For Americans towards the youth in America, we may be able to more effectively ensure the development and maintenance of healthy lifestyles. In order to better understand the health attitudes, beliefs and habits of adolescents in Scappoose, Oregon a survey was developed and conducted at Scappoose High School that addressed these issues. School Vending Machines and Obesity in Ontario, Oregon Project Date: 3/29/2004 Obesity is an epidemic among adolescents in America. Overweight children are at risk for many diseases as children and later as adults. There are myriad factors that have contributed to the current epidemic. These factors have been termed a “toxic environment.” I evaluated the food environment at Ontario High School to address what factors at school contribute to a toxic environment. My study found that 40.9% of students at Ontario High School were overweight or at risk to become overweight. This is well above the national rate of 30.4%. A survey assessed reasons for meal termination and the number of snacks purchased from school vending machines. Overweight adolescents were more likely to stop eating because of external cues than healthy weight adolescents. Overweight students drank nearly 2.5 times more soda pop than those of healthy weight. Using this data, a letter was sent to Ontario High School’s principal and school board members strongly encouraging the elimination of soft drink vending machines from school. Evaluation and Management of overweight children in Cave Junction, OR: development of a patient/student handout to outline behavior modification strategies for patients and students at the local schools. Project Date: 3/29/2004 Obesity is on the rise in the world, in the U.S. and in Oregon. Obesity and its complications and co-morbidities are poised to overtake tobacco as the leading “actual” cause of death in the U.S. And our children are right in the middle of the epidemic with the rate of overweight in Oregon’s teens tripling in the past 20 years. Objective: The aim of this study was to ascertain where the children in Cave Junction, OR fit in the larger picture of obesity. How many of the children in a rural Family Medicine practice are overweight and “at-risk” for overweight? Also, what interventions are available and what will be effective at helping these children maintain appropriate weights? Methods: The charts of the 208 children aged 2-20 years old that are seen at Cave Junction Family Medicine clinic were reviewed for heights, weights, gender and age of the children. Body Mass Indexes (BMIs) were then calculated using the CDC’s BMI-for-age and sex charts. Results: Of the 208 children found in the clinic’s database, only 113 of them had heights recorded. Two children (2%) were “underweight” (<5th percentile BMI for age and sex.) Seven children (7%) were “at risk for underweight” (5-10th percentiles). Fifty-eight children (51%) were “normal weight” (10-85th percentiles). Twenty-two children (19%) were “at risk for overweight” (85-95th percentiles.) And twenty-four children (21%) were “overweight” (<95th percentile.) The only BMIs in the charts were from transferred records. Conclusion: The children in Cave Junction are more overweight than the average child in the U.S. (21% in CJ vs. approx 15% in the U.S.) Also, BMIs are not currently being tracked in that clinic and there is good reason to do so. The Utility of Written Information for the Rural Family Practice Patient Project Date: 1/5/2004 As health technology becomes increasingly complicated and patient appointment times become shorter, written information for patients in the form of handouts and brochures has become more popular. This study sought to determine how many patients received this type of education, whether it was useful, what they liked or disliked about it, and how many used the Internet as a resource. A questionnaire was designed and distributed to all patients with appointments at the Scappoose Family Health Clinic for a three-week period. Compilation and analysis of the results revealed that approximately 80% of patients have received written information, all of which read at least some of it. Nearly all found the information at least somewhat useful, half kept the handout for future reference, and approximately 75% said they would like to receive written information in the future. Finally, approximately half of patients used the Internet as a resource for health information and would like to receive Internet sites from their health care providers. The results of this study are similar to those found in recent literature. Written handouts are helpful for patients, and most would like to receive information in this format in the future. Reasons centered around taking control of one’s own health, making informed decisions, and wanting to know accurate, updated information about their health. Adolescent development in the community of Harney County, what is the community concerned about, and how can a medical student contribute to their efforts. Project Date: 11/10/2003 Communitites across the US have always been concerned about how to encourage healthy- physically, socially, and mentally-development of youth. Countless programs and institutions have veen developed towards this effort, but at the same time people often feel overwhelmed with the problems facing adolescents. This project aimed to unveil the community's concerns about adolescents, establish their current efforts towards these concerns, and attempt to become effectively involved in this effort. It was identified that Harney County recently established a "Community Action Team" which is commited to creating a positive environment that will encourage and enagle the development of healthy, responsible, and caring adolescents. To become involved in their effort I met with the committee's memebers, attended their monthly meeting, and identified what role a medical student could play in working towards the goals of the committee. During this first meeting the "Community Action Team" identified and voted on the three most critical needs: underage alcohol and substance abuse, parental reponsibility, and truancy. Underage alcohol and substance abouse was the only problem voted on unanimously the the"Community Action Team", therefore, this became my project's focus. Through talking with community memebers it was decided that the greatest impact I could make was in working directly with teens. The majority of resources for teens with substance and alcohol problems and located at HBH. HBH coundsels youth who seekk counseling, but their major efforts involves a "Teen Alcohol and Drug Abuse" (A&D) group that is a court mandated group encounter for teens with criminal records involving substance use. This meeting was attended once for observation to identify educational needs of this group, and once to teach the group and ask questions to further understand how these adolescents believe they ended up in this court mandated group. During this obervation, teaching and interaction with the 6 teens in the A&D group I discovered that they too identify drugs and alcohol as the community's most critical need and saw the effects of parental influence, peer influence, and community acceptance leading them to where they currently sit. Therefore, it seems the "Community Action Team" goals coincide with those of adolescents most affected by substance use. Perhaps by working together their effort may contribute to healthier, more responsible youth. A study of Drug, Alcohol and Tobacco Use Among 7th Graders in Grant County Project Date: 11/10/2003 Drug, alcohol and tobacco use by adolescents are not only prevalent in urban cities but in rural areas as well. Several studies have shown the importance of parental communication on adolescent behavior, especially those who are in their early teens. A reduced rate of alcohol, tobacco and illegal drug use by teens is correlated with positive relationships with and clearly communicated expectations by parents. This study attempted to identify the rate of alcohol, tobacco and illegal drug use by 7th grade students in three rural middle schools in Grant County and compare that to the average in communication as well as to identify if parents were communicating clear expectations regarding alcohol, drug and tobacco use. Information obtained will be used by both school administrators and local physicans to determinine the need for screening, education and intervention in this age group. Furthermore, as the school district implements a similar survey for 8th grade students, they will use the information obtained to follow students throughout their middle school years and for grang writing purposes. Lastly, results obtained will be used to educate parents in Grant County about the importance of discussing alcohol, tobacco and drug use in this age group and the effect that communicationg clear expecations can have on their child's behavior. Improving preventative services in adolescents: developing a screening questionnaire and health education material. Project Date: 8/18/2003 Adolescence is a period of life associated with multiple risk-behaviors. Although some might consider these behaviors developmentally appropriate given the limited insight and immature cognition of adolescents, it is critical to realize that risk behaviors account for a significant majority of adolescent morbidity and mortality. Over 75% of adolescent deaths are, for example, attributed to behavioral causes. From drug use to depression, there is much that needs to be done to serve the needs of this unique population. Consequently, several physicians and national organizations have emphasized the need for a greater focus on preventative services in adolescents. Since adolescents visit physicians infrequently, rarely make health maintenance appointments, and often have limited continuity of care with their health care provider, there is definitely a challenge to offering preventative services in this population. Despite these obstacles, this project aimed to enhance adolescent preventative care in a busy pediatric clinic. A trigger questionnaire was developed to serve as a screening tool. The questionnaire was designed to be completed in the waiting room, and thus offers a means to enact preventative services even when the chief complaint is something other than a health maintenance visit. This questionnaire is intended to offer providers guidance as they counsel adolescents. Health education materials offer an effective means to follow up on issues identified by the screening questionnaire. Another component of this study involved conducting a survey of the clinic's health education materials on key adolescent health concerns to determine what materials were still needed in the clinic. In response to the identified needs, an adolescent-oriented informational handout about alcohol use was created. The adolescent years: A window of opportunity to influence lifelong bone health influence lifelong bone health Project Date: 12/30/2002 An estimated 25 million Americans suffer from osteoporosis and about 1.25 million skeletal fractures occur annually in the U.S. as a result of osteoporosis. Weight-bearing activity, avoidance of excessive use of alcohol and decreasing exposure to cigarette smoke are also important factors promoting bone health. Individuals living in northerly latitudes, who are dark-skinned, or who do not drink milk must be vigilant about getting adequate Vitamin D. The study’s results yield a somewhat mixed picture regarding bone health. Students’ calcium intake based on Calcium Score Survey indicates that the vast majority (>90%) are meeting at least the minimally recommended calcium requirements of 1300 mg and that only 12 % are meeting the National Institute’s of Health recommendation of 1500mg daily. However, the Bone Health Survey revealed that forty-five percent of students report not always getting their “4 a day” (approximately 1300 mg) requirement. The BHS also showed that half of students reported inadequate vitamin D levels. Students were two times more likely to report inadequacies in calcium and Vitamin D than in exercise and calorie consumption as factors adversely affecting bone health. Excessive use of alcohol use, on an intermittent or regular basis, and smoking were reported less frequently (10-20 percent of students). Moreover, according to the total scores on the BHS, 91 percent of students are no living adequately bone-healthy lifestyles to prevent future risk to their health. Quantification of risk is not possible because of the multi-factorial nature of osteoporosis and because the greater role of genetics in determining actual risk. Primary prevention of osteoporosis in adolescence is one of the very most potent ways to prevent this debilitating disease. Limiting intake of calcium in schools and milk-flavored vending machines have been successful endeavors in promoting calcium intake in several schools, including Sisters and Bend, and is also recommended for Madras High School. Furthermore, because of its northerly latitude and high number of dark-skinned, and presumably lactose-intolerant, students, a basic multivitamin is recommended to prevent osteoporosis secondary to a Vitamin-D deficiency. Prevalence of Methamphetamine Abuse in Ontario High School, Ontario, Oregon: A demonstration of the spread of methamphetamine abuse to rural communities Project Date: 11/4/2002 Methamphetamine is a drug of abuse which has been traditionally used in urban areas by mostly white, male, blue collar workers on the west coast. Attributes of this drug, such as its low cost, ease of production, and longer half-life, have led to its spread into more rural areas. This study surveyed 104 high school students in Ontario, Oregon, a town of about 10,500 people, in order to identify attitudes regarding and use of methamphetamine in this rural community. Students were administered a 22 question survey designed to measure exposure, use of, and attitudes towards methamphetamine and other common drugs of abuse. While students generally acknowledged the danger of methamphetamine, comparing it to drugs like cocaine and heroin, 7.7% (8/104) acknowledged use of the drug, a rate nearly twice the national average. Further, 1 in 3 acknowledged having been in the presence of others intoxicated by methamphetamine, 1 in 4 stated they had friends who had used the drug, and a majority (52.9%) knew people who had used the drug. Methamphetamine was also readily available. Half stated that they knew someone who could give or sell them methamphetamine, and more than 1 in 5 (21.2%) had been offered the drug at some point. While exposure is rampant, the attitude that methamphetamine is a dangerous drug is prevalent. This presents a unique window of opportunity for the community of Ontario to address this problem amongst a still receptive audience. Sex in the County, Coos County: Statistics, Sex Education, Social Change Project Date: 11/4/2002 With the United States currently leading the developed world in teen pregnancy and birth rates, teenage sexual activity is a major medical issue to be addressed. In an attempt to approach the problem from its roots of education this project focused on gathering data from surrounding school districts about their means of educating the students. The study was supported by the Coos County Prenatal Task Force and utilized a survey designed to glean information taught in the schools about contraceptives, prenatal care, STDs, and county resources. The survey was conducted with physical education/health teachers at 10 surrounding schools and the information was collated and then compared for uniformity in the county as well as contrasted with nationally researched sex education methods. Based on these comparisons recommendations for educational interventions were made and presented to the task force for activation. Mexican American attitudes and perspectives regarding Type II Diabetes and its modifiable risk factors. Project Date: 9/23/2002 CONTEXT: Mexican Americans have a genetic predisposition to Type II Diabetes Mellitus, whcih theoretically evolved from a "thrifty gene". In an increasingly obese and sedentary society, the frequency with which Mexican American youth and young adults are acquiring Type II DM is reaching epidemic proportions. OBJECTIVE: To explore cultural-specific attitudes and beliefs pertaining to Type II DM and its modifiable risk factors with the goal of providing valuable information about prevention strategies in a culturally-sensitive manner. DESIGN: A cross-sectional survey of 15 parents of school-aged patients at the Woodburn Pediatric Clinic appearing for routine clinic visits. Specific information about respondents included age, country of birth, and linguistic capabilities. Children's ages, weights (kg), and heights (meters) were recorded. BMI's were calculated using the equation kg/meters squared. Respondents answered 10 short-answer and 5 multiple-choice questions in their language of choice (Spanish and English), which addressed attitudes and beliefs surrounding four major themes: Diabetes, obesity, eating habits, and physical activity. Brief 5-10 minute follow-up interviews conducted by a skilled bilingual investigator provided clarifications of both questions and answers and explored additional commentaries on behalf of respondents. RESULTS: One-third of patients were considered obese (95th percentile or greater for weight) The majority of parents attributed diabetes and obesity to the excessive consumption of foods high in fat and carbohydrates. Only two believed diabetes was due to a "susto" (fright). Parents of obese children were concerned about their children's weight. Most parents felt that it was important to provide a variety of fruits and vegetables to their children and convince them that fruits and vegetables were necessary for good health. Half of the children engaged in sedentary activities (TV, video games, computer) for 3 or more hours per day. Seven of the children engaged in near daily physical activity, however the majority of these had a BMI at or above the 90th percentile. Parents who were active on a daily basis attributed activity to work-related activity (3) or walking 1/2 to 2 miles per day (3). The remaining nine were minimally active or sedentary. Parents encouraged their kids to engage in sports so they can be healthy, but only three were proactive about exercising for health and involving their kids in habitual exercise regimens. CONCLUSIONS: Mexican American parents are appropriately aware of the role of excessive fats and carbohydrates as a risk factor for diabetes. However, there is little awareness about the role of physical activity in diabetes prevention. In general parents do little to encourage their children to exercise, nor do they model physically active lifestyles to their children. Recommendations for cultural-specific approaches to diabetes prevention were provided based on these findin Assessing the needs of adolescence in a rural community with a high rate of teenage pregnancy. Project Date: 8/12/2002 This project aimed to assess the needs of adolescence in a rural community with a high rate of teenage pregnancy. Although the rate of teenage pregnancy and births has been declining across the U.S. and Oregon over the last decade, there are still many counties in Oregon that are disproportionately affected by this social burden. Linn county (as a rural community) has the highest rate of teenage pregnancy and births. This project tries to unravel the mystery of how we can best target teens with useful information that they want to hear and will further utilize. The project lead to numerous discussion groups with over 100 high school students. The results show that in the area of sex and pregnancy teens are concerned about their comfort level with the person discussing these issues and the relevance of these issues to their lives. Therefore, the most effective form of education for teens on pregnancy prevention would be one that incorporates a peer provider model into a comprehensive education program. Prevention of Smoking, Tobacco, and Illicit Drug Use by Native American School Children and Adolescents. Project Date: 7/1/2002 Smoking, alcohol, and illicit drug use cause significant health problems in society. These health problems not only affect the patient, but it affects the community as a whole. Often drugs of any kind are first tried when people are young. It has been found Native Americans on reservations have an increased rate of use of alcohol, tobacco, and illicit drugs. Additionally, many studies have found substance abuse by Native Americans whether they live on or off the reservation is increased compared to the general population. Adolescents who live on the reservation are most likely to use drugs followed by non-reservation Indian youth and finally non-Indian youth are least likely to use drugs in school. Reducing alcohol, tobacco, and illicit drug use could substantially increase the health status of Native American patients who live on or near the reservation. It has been found educating children about the effects of drugs on one's health and social relationships is an effective way to reduce substance abuse. However, it has also been noted starting the education program in high school is much too late. It is important to begin educating children while they are in elementary and middle school. This paper will outline the importance of an education program in the form of a lecture series that has medical, legal, and law enforcement contributions. A lecture was developed in conjunction with this research project to be used by my preceptor starting this fall for school aged children on the nearby Native American reservation. A basic survey was also constructed to help track the changes in substance use in the years following the initiation of this project. Prevention of Athletic Injuries in the 21st Century: Where do physicians fit in? A study of high school athletics in Klamath Falls. Project Date: 3/25/2002 It is estimated that 25 million scholastic and 20 million organized, community-based youth participate in sports annually in the United States. Injuries are the second leading cause of emergency room visits for youth and the second leading cause of injury in schools. Studies have shown that up to one half of all injuries sustained while playing organized sports by children and adolescents may be preventable. There are many reasons why sports injuries occur. Studies have identified the following frequent factors: lack of coaching education, inadequate preparticipation physical exams, hazardous playing fields, conditioning and training errors, inadequate safety equipment, poor fitness, poor nutrition, improper technique, inadequate supervision, lack of proper evaluation and body growth and development. Some of these "risk factors" are more modifiable than others. Specifically, the sports physical, lack of coaching education, training errors, lack of supervision, and lack of proper evaluation can be influenced directly with the help of physicians as health care providers and as respected community members. Other important aspects of injury prevention are the emergency response system and some means of surveillance to identify where to focus our resources. Back to subject search page or search by preceptor site