Do smoking cessation activities as part of oral health promotion vary between dental care providers relative to the NHS/private treatment mix offered? A study in West Yorkshire.

OBJECTIVE: To determine whether or not and to what extent health promotion and smoking cessation activities varied between dental practices relative to their National Health Service (NHS)/private treatment mix. METHODS: A piloted questionnaire was posted to all dental practitioners within West Yorkshire, with two follow-up mailings. RESULTS: The response rate was 50% (386/769) of dental practitioners within West Yorkshire. Respondents were dichotomised at the median according to the proportion of NHS/private patients seen (>89% NHS, described as 'NHS-orientated practices' [NHSOPs] and <90% NHS, referred to as 'more privately-orientated practices' [POPs]). Practice profiles: Compared with POPs, NHSOPs' respondents had a significantly higher proportion of adult patients exempt from NHS charges (34% vs 57%), together with a higher proportion of children. Health promotion activities: there was no significant difference between the two groups of practitioners regarding the proportion claiming to give smoking cessation advice (42% vs 37%), although a higher proportion of those from POPs offered guidance on diet and nutrition (67% vs 54%; P<0.05). However, a significantly higher proportion of POP respondents reported (a) recording smoking status in the clinical notes, (b) giving out smoking-related leaflets, and (c) referring to an NHS 'Stop Smoking Service'. NHSOP respondents were more likely to cite 'lack of time', 'no incentive' and 'lack of expertise' as potential barriers to providing health promotion advice. General: 7% of POP respondents thought that the new NHS contract arrangements would influence their smoking cessation activities versus 19% of NHSOP residents. CONCLUSIONS: Considerable variation between NHSOPs and POPs was found when comparing aspects of their health promotion/smoking cessation activities. The findings identified here suggest that the current situation, with regard to the NHS, will tend to increase health inequalities.

Inequalities in health and oral health in the UK.

UNLABELLED: New legislation is increasingly recognizing that addressing diversity is a crucial issue, in order that the health and social service needs of the whole population can be better met by equitable access, experience, and outcome. This paper aims to: describe the evolution of the UK inequalities agenda together with some of the governmental responses; consider aspects of oral and general health in this context; and reflect on the implications for general dental practice. CLINICAL RELEVANCE: Practitioners should be aware of the patient's background--social, physical and mental--as these can all impact on that person's oral and general health status, as well as his/her norms and values. This in turn can influence the capacity of that patient to accept specific care regimes and advice and hence has key implications for treatment and care.

Cultural aspects of tobacco use.

UNLABELLED: Tobacco is used worldwide, but culture shapes the specific methods and patterns of its use, with implications for uptake, continuation and cessation. The purpose of this paper is to highlight the range of tobacco use which occurs worldwide, in the context of cultural and social norms. Many of these practices are relevant to the U.K., some having been brought here by migrants, with consequences for general and oral health. CLINICAL RELEVANCE: It is important that dental professionals are aware of the range of tobacco-related practices prevalent in the variety of dental patients that they may encounter.

Obtaining informed consent for children receiving dental care: a pilot study.

AIM: To explore the outcome of the consent process with parents/carers of children of different ethnic minority backgrounds in a primary care salaried dental service setting. MATERIALS AND METHODS: One hundred parents of children were recruited to the study. The sample was balanced by ethnicity (White and Pakistani) and type of care (routine and general anaesthesia [GA]). Subjects were interviewed using a questionnaire enquiring about the various aspects of the consent process. RESULTS: For routine care, 53% of parents were unaware of the type of pain relief to be used. The majority (78%) knew of the benefits of treatment but few (7%) were aware of risks or alternative treatment options (5%). Significantly more White parents were able to recall the treatment their child was to receive compared with Pakistani parents (P <0.01). With respect to GA, there were no significant differences according to ethnicity. Most parents (95%) could recall risks of treatment and 72% of parents could report benefits; however, only 20% could recall discussion of alternative treatment options. CONCLUSION: For procedures involving GA, consent is more likely to be informed. For routine care, a more structured approach is required and Pakistani parents in particular need more support. A third of all parents (routine and GA group) felt that they had not been involved in the final treatment decision.

Profiling the interest of general dental practitioners in West Yorkshire in using teledentistry to obtain advice from orthodontic consultants.

OBJECTIVE: To seek opinions from general dental practitioners in Calderdale and Kirklees (West Yorkshire) regarding an online orthodontic referral service and to establish the profile of dentists working in primary care who would refer patients online for a consultant orthodontist's opinion. METHODOLOGY: All 91 general dental practices in Calderdale and Kirklees in West Yorkshire were sent a piloted questionnaire enquiring into their orthodontic treatment and referral patterns, and also into their attitudes to the use of the Internet and related technologies. Three mailings were performed, followed by telephone contact with non-responders. RESULTS: Usable responses were obtained from 119 general dental practitioners who worked in 71 practices (78%). Analysis of data showed that, when asked whether they would be interested in using teledentistry to obtain a consultant orthodontist's opinion online, 53/116 (46%) replied positively. The most frequently specified reason for this interest was that it would save time and would achieve a quicker opinion for a practitioner's treatment plan. These dentists were more likely to be familiar with the use of digital cameras, be using removable appliances, and currently be in the habit of referring orthodontic cases to consultants and specialists. CONCLUSIONS: Just under half of the dentists working in primary care in Calderdale and Kirklees who responded had a positive attitude towards the benefits of a teledentistry referral scheme. However, a substantial number remained undecided, possibly because they were unsure of their information technology (IT) skills. A further pilot study is planned. It will enquire into the feasibility of carrying out such an exercise across West Yorkshire.

A comparison of attitudes and practices of gutka users and non-users in Chitrakoot, India. A pilot.

AIMS AND OBJECTIVES: As part of a student elective, this pilot study aimed at investigating attitudes and practices concerning gutka use in a town in India. It was hoped that information gained would assist in formulating an appropriate health education programme to encourage gutka cessation locally and would provide more information about a habit which is also relevant to some UK South Asian populations. DESIGN AND SETTING: 124 consecutively attending subjects (103 males and 21 females) at a charity-run dental clinic in Chitrakoot, India, were interviewed using a semi-structured questionnaire. MAIN FINDINGS: 57 (46%) of the respondents, of whom there were more males than females (103 v. 21), reported current gutka use. There were no differences between users and non-users by age or educational attainment. Users found gutka 'helpful' in relieving tension, aiding con- centration, combating bad breath and as a leisure activity. They all cited other family members who were using gutka as compared to only 40% of the gutka non-users. Cancer was mentioned as a harmful outcome of gutka use more frequently by non-users. Of the 57 gutka chewers, 36 also chewed paan with tobacco and 20 smoked cigarettes. CONCLUSIONS: Gutka chewing involved almost half of the study population and proportionately more males than females. The habit was endemic within families. Many gutka chewers also smoked, chewed paan or drank alcohol, representing a high-risk behaviour for oral cancer. Proportionately more non-chewers were aware of the link with cancer. There are clear implications for health promotion in India. General dental practitioners in the UK should also be aware of the possibility that this habit is becoming more widely adopted in South Asian communities here, involving young children as well as adults. Research into gutka use is also required in the UK.

Developing explanatory models of health inequalities in childhood dental caries.

OBJECTIVE: Long-term aim is to determine optimum interventions to reduce dental caries in children in disadvantaged communities and minimise the effects of exclusion from health care systems, of ethnic diversity, and health inequalities. DESIGN: Generation of initial explanatory models, study protocol and development of two standardised measures. First, to investigate how parental attitudes may impact on their children's oral health-related behaviours and second, to assess how dentists' attitudes may impact on the provision of dental care. SUBJECTS: Core research team, lead methodologists, 44 consortium members from 18 countries. To complete the development of the questionnaire, the initial set of items was administered to parents (n = 23) with children in nursery schools in Dundee, Scotland and sent to the same parents one week later. A standardised measure examining barriers to providing dental care for children aged 3 to 6 years was developed. 20 dentists working in primary dental care in Scotland completed the measure on two different occasions separated by one week. RESULTS: Explanatory models were developed. Family questionnaire: test-retest reliability excellent (r = 0.93 p < or = 0.001) with very good internal reliability (alpha = 0.89). Dentists questionnaire: excellent test-re-test reliability r = 0.88, (alpha = 0.90). CONCLUSIONS: Interaction between consortium members enhanced the validity of the questionnaires and protocols for different cultural locations. There were challenges in developing and delivering this multi-centre study. Experience gained will support the development of substantive trials and longitudinal studies to address the considerable international health disparity of childhood dental caries.

Adolescent girls school achievement: nutrition, health and social factors

In many developing countries there is little information on the nutritional status of adolescents. In general, research in this area has been neglected and attention focused on younger children who are most vulnerable to malnutrition. However, adolescents is a period of rapid growth and nutritional deficiencies may occur. In particular with menarche, iron deficiency may be a problem among adolescent girls (Brabin & Brabin, 1992). Poor levels of school achievement are a major problem in developing countries. Many social factors may affect school achievement, including parental attitudes to education, and the educational and occupational levels of the parents (Wagner, et al 1985). School characteristics such as teacher's training and availability of textbooks are also important (Schiefelbein & Simmons, 1979; Fuller, 1987). There is increasing recognition, however, that health and nutrition may contribute to poor school performance, either through effects on attendance, or by affecting children's ability to learn through poor attention and cognitive function (Pollitt, 1990). Health and nutrition variables have been included in some studies of the determinants of school performance among primary-school children in developing countries. After controlling for socio-economic factors, height-for-age was associated with achievement in several studies (Moock & Leslie, 1986; Agarwal et al, 1987; Florencio, 1988; Clarke et al, 1991) and weight-for-height was associated with achievement in one study (Popkin & Lim-Ybanez, 1982). Anaemia and missing breakfast or feeling hungry, also, have been reported to affect school performance (Popkin & Lim-Ybanez, 1982; Florencio, 1988; Clarke et al, 1991). Most of the children in these studies were of primary-school age and there is relatively little information on the extent to which health and nutrition affect achievement in adolescents.(AU)

Adolescent girls school achievement: nutrition, health and social factors

In many developing countries there is little information on the nutritional status of adolescents. In general, research in this area has been neglected and attention focused on younger children who are most vulnerable to malnutrition. However, adolescents is a period of rapid growth and nutritional deficiencies may occur. In particular with menarche, iron deficiency may be a problem among adolescent girls (Brabin & Brabin, 1992). Poor levels of school achievement are a major problem in developing countries. Many social factors may affect school achievement, including parental attitudes to education, and the educational and occupational levels of the parents (Wagner, et al 1985). School characteristics such as teacher's training and availability of textbooks are also important (Schiefelbein & Simmons, 1979; Fuller, 1987). There is increasing recognition, however, that health and nutrition may contribute to poor school performance, either through effects on attendance, or by affecting children's ability to learn through poor attention and cognitive function (Pollitt, 1990). Health and nutrition variables have been included in some studies of the determinants of school performance among primary-school children in developing countries. After controlling for socio-economic factors, height-for-age was associated with achievement in several studies (Moock & Leslie, 1986; Agarwal et al, 1987; Florencio, 1988; Clarke et al, 1991) and weight-for-height was associated with achievement in one study (Popkin & Lim-Ybanez, 1982). Anaemia and missing breakfast or feeling hungry, also, have been reported to affect school performance (Popkin & Lim-Ybanez, 1982; Florencio, 1988; Clarke et al, 1991). Most of the children in these studies were of primary-school age and there is relatively little information on the extent to which health and nutrition affect achievement in adolescents.

A method to estimate prevalence of iron-deficiency and iron deficiency anemia in adolescent Jamaican girls

A method is presented to estimate a cutoff for hemoglobin concentration appropriate for estimating the prevalence of iron deficiency anemia in poor Jamaican girls 13-14 years of age. Iron deficiency was determined from a three-variable model of iron status (serum ferritin, erythrocyte protoporphyrin, and mean corpuscular volume). The most appropriate hemoglobin cutoff was considered the one that minimized misclassification of iron deficiency: that yielding the maximum kappa coefficient for correctly classifying iron deficiency between 100 and 120 g/L, at 1-g/L intervals. By using this method, a hemoglobin cutoff and the other indicators were used to estimate prevalences of iron deficiency and iron deficiency anemia in the Jamaican girls: 7.6 percent and 4.3 percent respectively. This approach should be appropriate for determining hemoglobin cutoffs for iron deficiency anemia in other populations.(AU)

Anthropometry in adolescent girls in Kingston, Jamaica

There is little information on the nutritional status of adolescents in developing countries. In particular there is a lack of data concerning black adolescents. We measured height, weight, and triceps and subscapular skinfolds in 452 13-14 year-old girls, randomly selected from those attending nine schools in Kingston, Jamaica. The girls' heights and body mass indices were appropriate for their age. This suggests that undernutrition was not a significant problem in this population. However, the girls' skinfolds were smaller than the US references, both those for the total population and those for blacks only. The fat pattern (triceps/subscapular ratio) was similar to that reported for adult black women in the United States. It is possible that the levels of fat in the references are not appropriate for this population. Data from other black population are needed for comparison. (AU)

Health, nutrition and socio-economic predictors of school achievement among 13- and 14-year-old Kingston girls - abstract

Poor school achievement is a major problem which seriously affects the future of many students in Jamaica. As part of a study on the health and nutrition of 13- and -14-year-old girls their nutritional status and health-related behaviours were investigated to determine whether they contribute to the poor levels of achievement. The sample was selected from all 9 All-Age and New Secondary Schools in the city of Kingston with over 40 girls enrolled in grade 8. Four hundred and fifty-two girls were selected by random sampling from the 1061 eligible girls. Each girl was given an indepth interview by 1 of 5 trained female interviewers, using a structured questionnaire to collect health-rlated behaviours and social background. The girls' heights and weights and skinfolds were measured and blood taken for the assessment of iron status. School achievement was measured, using the Wide Range Achievement Test and expressed ingrade level ratings. Mean achievement levels was poor (5.1ñ2.1). The girls' weights and heights were appropriate for their age. However, 16 per cent of them were anaemic (Haemoglobin<11.5gm/dl). Variables which made unique contributions to the variance in school achievement were identified, using stepwise multiple regression analyses. Lack of school materials, reading stimulation at home and community participation; anaemia, involvement in fights, early sexual intercourse and chores before school were associated with poor school achievement. Interventions to addresss these problems need evaluation (AU)

Sexual abuse in 13 and 14 year old school girls in Kingston - abstract

The prevalence and circumstances of rape were investigated as part of a study into the nutrition and health of 13 and 14 year old girls attending all-age and new secondary schools in Kingston. 475 girls were randomly selected from 1,116 in grade 8. Each girl was given an indepth, private interview by 1 of 5 female interviewers. 450 interwiews were completed. 18 (4 percent girls reported they had been raped, including 3 more than once. One girl reported that she was raped by a household member, and 16 girls were raped by persons they knew. 7 girls said that they had been raped when they were under 12 years of age. 10 girls had told their mother/guardians about the episode but in only 5 cases had the rape been reported to the police. Only 4 girls had been seen by a doctor. Sexual abuse of young girls is an important problem and most do not receive counselling or medical help. (AU)

Nutritional and Health determinants of school failure and dropout in adolescent girls in Kingston, Jamaica

Studies the nutritional status and health-related behaviours of adolescent Jamaican girls, examining the relationships between these factors and school achievement, attendance and dropout. Concludes that there is little information on the health and nutritional status or health behaviours of adolescent girls and that this adversely affects school achievement and contributes to dropout, as the available data suggest undernutrition is a problem. (AU)

Sexual abuse and experience of violence among 13- and 14-year-old Kingston girls - abstract

As part of a study on health and nutrition of grade 8 girls in Kingston schools, their experience of violence and sexual harassment was investigated. Nine all-age and new secondary schools serving poor socio-economic areas in Kingston were identified. Four hundred and fifty-two girls were randomly selected from the 1,064 in grade 8, in proportion to the number enrolled in each school. Each girl was given an in-depth private interview by 1 of 5 trained female interviewers using a structured questionnaire. Nineteen girls (4 per cent) had been raped, including 3 girls raped more than once, one of whom was a victim of incest. The offenders were usually casual acquaintances. Sixteen cases were reported to an adult, 6 were reported to the police and 6 seen by a doctor. No girl received counselling. In the past year, twenty-two per cent of the sample had seen violent acts involving the use of a weapon at home, 40 per cent saw these at school and 64 per cent saw them elsewhere. While in Grade 8, 8 per cent were involved in fights at school with a weapon, and 21 per cent without any. Twenty-one per cent were afraid to come to school because of the violence in the community. Thirty-eight per cent had been beaten by an adult at home, and 57 per cent had been beaten at school with an instrument. Sexual abuse is under-reported, and few girls receive medical care or counselling. Also, there is an urgent need for remedial action to reduce the level of violence (AU)

Questioning and answering techniques: part of the teaching act for gifted and talented students

Examines the concept of questioning and answering as a valuable aid in allowing students to be self-enquiring learners. Develops point by using a classroom situation with a specific science lesson. Demonstrates through examples of questions asked, i.e. the use of divergent and convergent questions. Analyses the two types of questions from responses elicited. Concludes that divergent questions encourage a variety of responses and can expand the students' awareness of their environment and their ability. (AU)