COMMITTED TO EXCELLENCE IN TRIBAL PUBLIC HEALTH
T R I B A L
E P I D E M I O L O G Y
C E N T E R
NEWSLETTER OCTOBER/NOVEMBER/DECEMBER 2016
IS YOUR ORGANIZATION
Health Literate? We help you answer this question and share information to help you and your organization understand and become more aware of health literacy
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OCTOBER IS HEALTH LITERACY MONTH
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NOVEMBER IS AMERICAN DIABETES MONTH
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DECEMBER IS SAFE TOYS AND GIFTS MONTH
Contents
06 08 10 18
IS YOUR ORGANIZATION HEALTH LITERATE? To help you answer this question, we dive into ten attributes of a health literate organization. After reviewing it, we're confident you'll be able to answer this question and use the information to help your organization become more aware of health literacy.
SPOTLIGHT ON ORAL HEALTH LITERACY We highlight Julie Seward, SPTHB's Public Health Specialist, as she takes us on the journey of her childhood experiences of how the love-of-all-things dental came about in her life and how that ultimately influenced her to study dental hygiene.
HAVE YOU HAD YOUR MAMMOGRAM? The numbers don't lie. About one in eight women in the US will develop breast cancer in thier lifetime. Become familiar with the factors, warning signs, and information and learn why monthly self-exams and regular mammograms are the best plan of action.
LET ME TELL YOU A STORY: THE ROLE OF STORYTELLING IN NATIVE AMERICA The Indigenous tradition of storytelling is not only alive, but thriving. Mohawk educator and storyteller, Kay Olan, passionately shares the importance of storytelling and how we discover through telling our own story. We all have
more in common than we have differences.
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OCTOBER IS HEALTH LITERACY MONTH
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NOVEMBER IS AMERICAN DIABETES MONTH
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DECEMBER IS SAFE TOYS AND GIFTS MONTH
In this issue: Contents 2–3 National Health Observances
4–5
Is Your Organization Health Literate? 6–7 Spotlight On Oral Health Literacy Have You Had Your Mammogram? The Caring Van: Helping Make Your Community A Healthy Community
8–9 10–12
NOVEMBER IS AMERICAN DIABETES MONTH
13
The Citizen Potawatomi Nation Diabetes Program Presents the 2nd Annual Harvest Hustle 5K Run
14
Kansas Tribal Health Summit 2016
15
2016 National Indian Health Board Awards Gala Heroes in Native Health
16
Voices In Indian Country: Dear DAPL
17
Let Me Tell You A Story: The Role of Storytelling In Native America
18–19
Making Connections: Improving Mental Health and Well-being Among Boys
20–23
Pregnant? Important Zika Virus Facts
24–25
Oral Health During Pregnancy
26–27
OCTOBER/NOVEMBER/DECEMBER 2016 | 3
NATIONAL
HEALTH OBSERVANCES
SUBMITTED BY: PATRICIA YARHOLAR, OKTEC PUBLIC HEALTH COORDINATOR
October 2016 Breast Cancer Awareness Month Breast Cancer Awareness Month is an annual campaign to increase awareness of the disease. While most people are aware of breast cancer, many forget to take the steps to have a plan to detect the disease in its early stages and encourage others to do the same. We have made a lot of progress but still have a long way to go and need your help! You may visit the link for additional information and materials. For more information regarding
breast cancer awareness please visit: Source: https://www.cancer.org
National Bullying Prevention Month National Bullying Prevention Month is a nationwide campaign founded in 2006 by PACER’s National Bullying Prevention Center. The campaign is held during the month of October and unites communities around the world to educate and raise awareness of bullying prevention. Be a part of this exciting anniversary and spread the message: The End of Bullying Begins With Me! Visit the link for additional information and opportunities. For more information regarding bullying prevention, please visit: Source: https://www.pacer.org/bullying/nbpm
Sudden Infant Death Syndrome (SIDS), Awareness Month Sudden Infant Death Syndrome (SIDs) is not the cause of every infant death. Find out how to reduce baby’s risk of SIDS and other sleep-related causes of infant death. Information and materials are available for parents, grandparents, and health care providers. SID’s is the leading cause of death in infants between one month and one year of age. Most SIDs deaths happen when babies are between one month and four months of age. Each year, 4,000 infants die unexpectedly while sleeping, from SIDS, accidental suffocation or unknown causes. SIDS is not a risk for babies 1 year of age or older. Visit the link for additional information. For more information regarding sudden infant death syndrome awareness, please visit:
Source: http://www.webmd.com/parenting/baby/tc/suddeninfant-death-syndrome-sids-overview#1
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National Red Ribbon Week Red Ribbon Week is the oldest and largest drug prevention campaign in the country. Red Ribbon Week generally takes place the last full week in October. This year Red Ribbon Week will be celebrated October 23 - 31, 2016. Red Ribbon Week serves as a vehicle for communities and individuals to take a stand for the hopes and dreams of our children through a commitment to drug prevention, education, and a personal commitment to live drugfree lives with the ultimate goal being the creation of a drug-free America. For additional information, please visit the link below. For more information regarding national red ribbon week, please visit: Source: http://www.redribbon.org
November 2016 American Diabetes Month Observed every November, American Diabetes Month is an important event in the American Diabetes Association’s efforts to focus our nation's attention on the disease and the tens of millions of people affected by it. One in eleven Americans has diabetes, every 23 seconds someone in the United States is diagnosed with diabetes, eighty-six million Americans are at risk for diabetes, and diabetes causes more deaths than both AIDS and breast cancer combined. For more information, visit the links below. For more information regarding diabetes please visit:
Source: http://www.diabetes.org/in-my-community/americandiabetes-month.html
COPD Awareness Month Chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema, is a chronic lung disease that makes it hard to breathe. The disease is increasingly common, affecting millions of Americans, and is the third leading cause of death in the U.S. The good news is COPD is often preventable and treatable. Contact the American Lung Association to find information, resources and tools to help you understand COPD, manage treatment and lifestyle changes, find support and take action. Additional information is available on the following link. For more information regarding COPD, please visit:
Source: http://www.lung.org/lung-health-and diseases/lungdisease-lookup/copd
Lung Cancer Awareness Month
World AIDS Day
The American Lung Association is dedicated to providing those facing lung cancer with the most up-to-day and reader-friendly information, for people with lung cancer and their loved ones. Additional information is available on the following link.
World AIDS Day is held on the 1st of December each year and is an opportunity for people worldwide to unite in the fight against HIV, show their support for people living with HIV and to commemorate people who have died. World AIDS Day was the first ever global health day, held for the first time in 1988. Visit the links for additional information.
For more information regarding psoriasis, please visit: Source: http://www.lung.org
December 2016 Safe Toys and Gifts Month December is observed as "Safe Toys and Gifts Month" as a means for alerting us to the need to be careful when making our toy and gift choices, and to prompt us to keep in mind their safety and suitability. Knowing what to look out for can make a big difference in preventing possible injuries from well-intentioned gifts. Included is an overview of the things to bear in mind when shopping for those toys and gifts. Buy age-appropriate gifts, be aware of safety recalls on toys, read the warnings and safety precautions accompanying the toy, read the instructions accompanying any toys, avoid getting anything that has excess string or cords, such as slingshots, buy for durability, and avoid any toy or product that breaks into shards, splinters, sharp pieces, or releases anything toxic. For additional information visit the link below.
For more information regarding world aids day, please visit: Source: https://www.aids.gov/news-and-events/awarenessdays/world-aids-day/
National Influenza Vaccination Week The National Influenza Vaccination Week (NIVW) is a national awareness week focused on highlighting the importance of influenza vaccination. The flu is a contagious respiratory illness caused by influenza viruses that infect the nose, throat, and lungs. It can cause mild to severe illness, and at times can lead to death. The best way to prevent the flu is by getting a flu vaccine each year. Visit the Centers for Disease Control and Prevention link for additional information. For more information regarding recovery, please visit: Source: http://www.recoverymonth.org
For more information regarding safe toys and gifts, please visit:
Source: http://www.wikihow.com/observe-safe-toys-and-gifts-month
OCTOBER/NOVEMBER/DECEMBER 2016 | 5
Is your Organization Health Literate? WRITTEN BY: SUSAN GAY • OKTEC PUBLIC HEALTH COORDINATOR
Perhaps to answer this question, you need a check list. I will provide one. Perhaps you also need to be reminded of what health literacy means. So, let’s begin with a definition of health literacy. Like most concepts, there is more than one meaning. Here’s a simple one I like to use: “Health literacy is a person’s ability to read, communicate, find, understand, and act on health information.” However, in case you are wondering how this definition is related to organizations, here’s another one: “health literacy is a shared responsibility between patients and providers” (Helen Osborne, Health Literacy Consulting) Providers are health professionals, organizations, or agencies that give or communicate health information or services.
and empower patients to ask questions and share in decisions about their health. They provide information and services in ways that people can easily understand and use. In addition, they take steps to help patients prevent illness as opposed to just providing treatment. In brief, they are patient focused.
Health professionals, organizations, and agencies that are health literate make patients or those they serve feel welcome. They allow, encourage,
Before we go to the checklist, here are a few reminders that relate to health literacy: •
Many studies show that most health materials are written at a level that is difficult for most people to understand.
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Everyone needs health literacy skills since everyone needs health information or services at some time.
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Health literacy skills include speaking, reading, listening, writing, finding, mathematical ability, and decision making.
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•
Health literacy can be situational; this means even people who read well and are comfortable using numbers can sometimes face limited health literacy in some situations. Examples are when they are not familiar with medical language, they have health issues that require difficult self-care, or they are ill, afraid, or confused.
Now that you have some context, let’s turn to the big question, is your organization health literate? To help you answer the question, please view the table shown on the next page. It lists ten attributes or qualities of a health literate organization. Hopefully, after reviewing it, you will be better able to answer the question. Most important, I hope you will use the information to help your organization either become aware of health literacy or advance on their journey of becoming health literate.
Attributes of a Health Literate Organization* A Health Literate Organization:
Examples:
1. Has leadership that makes health literacy integral to its mission, structure, and operations
yy Develops and implements policies and standards yy Sets goals for health literacy improvement, establishes accountability and provides incentives yy Allocates fiscal and human resources yy Redesigns systems and physical space
2. Integrates health literacy into planning, evaluation measures, patient safety, and quality improvement
yy Conducts health literacy organizational assessments yy Assesses the impact of policies and programs on individuals with limited health literacy yy Factors health literacy into all patient safety plans
3. Prepares the workforce to be health literate and monitors progress
yy Hires diverse staff with expertise in health literacy yy Sets goals for training of staff at all levels
4. Includes populations served in the design, implementation, and evaluation of health information and services
yy Includes individuals who are adult learners or have limited health literacy yy Obtains feedback on health information and services from individuals who use them
5. Meets needs of populations with a range of health literacy skills while avoiding stigmatization
yy Adopts health literacy universal precautions, such as offering everyone help with health literacy tasks yy Allocates resources proportionate to the concentration of individuals with limited health literacy
6. Uses health literacy strategies in interpersonal communications and confirms understanding at all points of contact
yy Confirms understanding (e.g., using the Teach-Back, Show-Me, or Chunk-and-Check methods) yy Secures language assistance for speakers of languages other than English yy Limits to two to three messages at a time
7. Provides easy access to health information and services and navigation assistance
yy Makes electronic patient portals user-centered and provides training on how to use them yy Facilitates scheduling appointments with other services yy Uses easily understood symbols in way-finding signage
8. Designs and distributes print, audiovisual, and social media content that is easy to understand and act on
yy Involves diverse audiences, including those with limited health literacy, in development and rigorous user testing yy Uses a quality translation process to produce materials in languages other than English
9. Addresses health literacy in high-risk situations, including care transitions and communications about medicines
yy Prioritizes high-risk situations (e.g., informed consent for surgery and other invasive procedures) yy Emphasizes high-risk topics (e.g., conditions that require extensive self-management)
10. Communicates clearly what health plans cover and what individuals will have to pay for services
yy Provides easy-to-understand descriptions of health insurance policies yy Communicates the out-of-pocket costs for health care services before they are delivered
*Source: Attributes of a Health Literate Organization, Institute of Medicine of the National Academies, 2012
OCTOBER/NOVEMBER/DECEMBER 2016 | 7
Pictured from left: Dental Hygiene students, Shelley Collins and Julie Seward, Tulsa Community College, Fall 2007
Spotlight on Oral Health Literacy
I
STORY AND PHOTO BY: JULIE SEWARD, RDH, M. ED., PUBLIC HEALTH SPECIALIST
loved going to the dentist as a child. And I also love to tell people that I loved going to the dentist as a child just so I can see the look of shock and disgust staring back at me followed by, “Why in the world would anyone LOVE going to the dentist?!” I would be a very rich dental hygienist and retired at the age of 32 if I had a dollar for every time a patient told me, “I have dental anxiety,” or “I had a traumatic experience at the dentist as a child, so I hate going to the dentist!” I grew up one of five children in a rural community where we traveled an hour to get pediatric dental services. We were fortunate to have dental insurance and a means to travel that distance. However, I am sure my parents are STILL paying off loans for all the dental treatment I alone accrued over several years because of my intense excitement about going to the dentist. Here’s how the love of all things dental started. My parents worked full-time and couldn’t take an entire day off to take us to the dentist, so grandma took us. Most of
8 | OKLAHOMA AREA TRIBAL EPIDEMIOLOGY CENTER NEWSLETTER
the time, we were out of school for the entire day and grandma would take us to Luby’s for lunch (grandma usually got to pick the lunch spot but we learned to love it) followed by a trip to Wal-Mart or the mall for a toy.
maintenance, they did so in a manner that resonated with me and allowed my grandmother and me to understand the information.
The dental hygienist provided easy-to-follow diagrams illustrating the proper way to brush as well as diagrams After that initial trip with grandma, you can imagine of how cavities are formed. Dr. Wagoner explained, my reaction whenever I heard Dr. Wagoner say, “You in detail, the process of have three cavities young having a cavity filled to lady, I am going to need give me comfort that it was to see you back next I HEARD DR. WAGONER SAY, "YOU HAVE a routine procedure and month to get those filled.” THREE CAVATIES YOUNG LADY. I AM GOING there was no reason to I immediately screamed, be fearful (the thought of “YES!!” while making a fist TO NEED TO SEE YOU BACK NEXT MONTH another fun-filled day with pump in the air. The look TO GET THOSE FILLED." I IMMEDIATELY grandma helped too). on Dr. Wagoner and his hygienist’s face portrayed SCREAMED, "YES!!" October marks the start of deep concern and National Dental Hygiene confusion prompted by an Month as well as Health explanation of what a cavity Literacy Month. It is was and how it happened. important for dental professionals to understand oral At this point, you could almost see the bubble pop health literacy to communicate effectively with their up above my head with images of me and grandma patients. This can help to alleviate dental anxieties. skipping our way through the Luby’s line and visions of the Wal-Mart toy aisle. As in my experience, open and clear communication Aside from my and grandma’s fun activities, I think back to the message Dr. Wagoner and his hygienists were trying to get across to me and how it influenced my decision to take better care of my teeth and ultimately study dental hygiene. In trying to explain the importance of regular, preventative, at-home
allows patients to be at ease with dental practitioners and sets the stage for an environment where open dialogue and trust can occur. Of course, in my case it didn’t hurt for there to be some external, positive reinforcements.
OCTOBER/NOVEMBER/DECEMBER 2016 | 9
Have You Had Your Mammogram? OCTOBER IS BREAST CANCER AWARENESS MONTH AND ITS FOCUS IS TO INFORM PEOPLE OF THE IMPORTANCE OF EARLY AND REGULAR SCREENINGS AND RAISING FUNDS TO SUPPORT CANCER RESEARCH WRITTEN BY: YONAVEA HAWKINS • SPTHB PUBLIC HEALTH TRAINING COORDINATOR
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Did you know that breast cancer is the second leading cause of cancer death for U.S. women after lung cancer? For Native American women, it is the third leading cause of cancer death, with lung cancer being first and colorectal cancer being second. Statistics show that about one in eight women in the U.S. will develop breast cancer in her lifetime. Here’s another statistic: only 5% to 10% of breast cancers occur in women with a clearly defined genetic predisposition for the disease. The American Cancer Society had estimated in 2015, about 231,840 women will be diagnosed with invasive breast cancer and about 40,290 will die from the disease. The risk for developing breast cancer increases as a woman ages.
Factors that affect your risk of developing breast cancer: •
Not having children, or having your first child later in life
•
Starting your first menstrual period at an early age
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Beginning menopause at a late age
•
Having a personal history of breast cancer or certain benign breast diseases, such as atypical ductal hyperplasia
•
•
Having close family relatives (such as a mother, sister, father, or daughter) who have had breast cancer Having a genetic condition, such as certain mutations in your BRCA1 or BRCA2 genes
•
Having been treated with radiation therapy to the breast or chest
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Being overweight, particularly after menopause
•
Using hormone replacement therapy for a long time
•
Using oral contraceptives
•
Drinking alcohol
•
Being physically inactive
The recently changed guidelines from the American Cancer Society (ACS), urge women to start mammograms at age 45, rather than age 40. Check with your doctor as he/she will factor, your age, family, and other things that make you likely to need a mammogram sooner than age 45. One of the things you should be doing for yourself is a monthly exam; it helps you to be familiar with how your breasts look and feel so you are able to alert your doctor when there are changes. John Hopkins Medical center states: “Forty percent of diagnosed breast cancers are detected by women who feel a lump, so establishing a regular breast selfexam is very important.” Warning signs to be aware of when doing your monthly self-breast exam: •
A lump in the breast or armpit
•
Thickening of breast skin or tissue that lasts through your period
•
A change in the size, shape, or contour of the breast
•
Clear or bloody fluid coming from the nipple
•
A change in how the skin on your breast or nipple looks or feels. It may look dimpled, puckered, scaly, or inflamed.
•
Redness of your breast or nipple
•
An area on your breast that clearly looks different from any other
•
A hard, marble-like area under the skin
Many of the symptoms of breast cancer can also be symptoms of something else. Only your doctor can tell for sure. If you have any of these symptoms, make an appointment to see your doctor. Your doctor will do tests to find the cause. He or she can give you the "all clear" or help you start treatment if the tests show you have cancer. Most breast lumps are not cancer, but if your doctor believes it is, it’s best to start treatment right away. Breast cancer treatments have made great strides in recent years. A diagnosis of breast cancer is no longer a death sentence, and the treatment is no longer more painful than the disease. Breast cancer treatments are becoming more precise about the cells they target. Some treatments – standard chemotherapy and radiation-tend to attack all rapidly (Cont'd on Next Page)
OCTOBER/NOVEMBER/DECEMBER 2016 | 11
Information about breast cancer came from the following websites: I FINISHED SIX ROUNDS OF
http://www.cancer.org/research/ cancerfactsstatistics/breast-cancerfacts-figures
CHEMO WITH ALL THE SIDE EFFECTS OF EXTREME NAUSEA, UNENDING FATIGUE AND HAIR
http://www.cancer.org/cancer/ breastcancer/
LOSS, 25 DAYS OF RADIATION AND FIVE YEARS OF ANTI-
http://www.nationalbreastcancer.org/ breast-self-exam
ESTROGEN THERAPY. NOW, I AM A SURVIVOR.
http://www.webmd.com/breastcancer/tc/breast-cancer-armyourself-with-facts
- Yonavea Hawkins
https://www.cdc.gov/cancer/ nbccedp/pdf/toolkit/nbccedp_2011_ bcfacts_gen_508.pdf https://www.cdc.gov/cancer/breast/ statistics/
dividing cells throughout the body. That includes healthy cells lining the hair follicles and the intestines, as well as cancer cells. But researchers have learned that breast cancers, like people, are not identical and they've been using this knowledge to develop more effective, less toxic drugs. By discovering precisely how tumors differ from person to person, they've begun creating treatments that seek out and destroy specific types of cancer cells, and only those cancer cells-leaving healthy cells alone. With these facts and information on breast cancer, do your monthly self-exam and get your mammogram done regularly. Remember the one in eight women? Ask your family and friends if they have had their mammogram recently and if they do a monthly self-exam.
I discovered my own breast cancer by self-exam, the change in appearance was gradual. I wasn’t sure I was seeing a change until many months later, when I mentioned it to my doctor. My first mammogram and a follow-up mammogram confirmed cancer. A biopsy tells what kind of cancer and I had invasive ductal carcinoma, but a second biopsy confirmed I had Paget’s disease also. While fighting cancer I wanted life to be normal but it wasn’t and I wanted to win though I wasn’t sure I would. I finished six rounds of chemo with all the side effects of extreme nausea, unending fatigue and hair loss, 25 days of radiation, and five years of anti-estrogen therapy. Now, I am a survivor.
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More Information: www.cdc.gov/ cancer/breast/ • (800) CDC-INFO (800-232-4636) • TTY: (888) 2326348 https://www.cdc.gov/cancer/ nbccedp/ For more than 20 years, CDC’s National Breast and Cervical Cancer Early Detection Program (NBCCEDP) has provided low-income, uninsured, and underserved women access to timely breast and cervical cancer screening and diagnostic services. Can’t afford a mammogram? If you have a low income or do not have insurance and are between the ages of 40 and 64, you may qualify for a free or low-cost mammogram through CDC’s National Breast and Cervical Cancer Early Detection Program. To learn more, call (800) CDC-INFO
CARING
VAN EVENTS
Pictured: Bonnie Kraft, Dir of Public Health IHS and Morgan Ashcraft getting a headlice check
Caring Van Events for July, August, and September Waiting to get their HIV screening C&A Summer Fest
Helping Make Your Community a Healthy Community STORY AND PHOTOS BY: JANICE BLACK SPTHB PUBLIC HEALTH TRAINING COORDINATOR
The Southern Plains Tribal Health Board’s Caring Van Project continues to grow. We are offering additional health screenings as well as forming new partnerships with tribes and Indian communities across Oklahoma. For the months of July, August, and September we offered HIV, HEP C, Blood Pressure, Dental and Head Lice screenings. The Caring Van Staff are currently in preparation for the upcoming fall and winter events. We will continue to strengthen our tribal partnerships and get into the communities that we haven’t had the chance to visit. With the upcoming flu season, we are looking forward to visiting communities and offering the flu vaccine. Our goals are to contribute to the Indian communities, build relationships, and demonstrate what it means to be positive, and share our knowledge for a healthy lifestyle. To schedule the Caring Van for your next event, please contact the Caring Van staff. Janice Black – Public Health Training Coordinator, Ph. 405-652-9209, jblack@spthb.org Yonavea Hawkins – Public Health Training Coordinator, Ph. 405-652-9218, yhawkins@spthb.org
July 7, 2016 Sac and Fox Nation Health Fair • Stroud, OK 20 Dental screenings for all ages July 15, 2016 Absentee Shawnee Tribal Health Fair • Norman, OK 33 HIV screenings and 33 Hepatitis C screenings August 6, 2016 Cheyenne & Arapaho Oklahoma Indian Nations Powwow 75 HIV screenings and 72 Hepatitis C screenings August 13, 2016 Hanna Indian Community Back to School Event • Hanna, OK 18 Blood pressure checks and 11 head lice checks August 20, 2016 Cheyenne & Arapaho Block Party/Health Fair • Clinton, OK 5 head lice checks September 2, 2016 Riverside Indian School Health Fair • Anadarko, OK Over 500 School age children were in attendance for dental checks and BMI screenings. September 3, 2016 Colony Powwow • Colony, OK 35 Blood pressure screenings
Upcoming Caring Van Events October 4, 2016 Cherokee Nation Enrollment Fair • Tahlequah, OK November 3, 2016 Cheyenne & Arapaho Elders Conference Frisco Center • Clinton, OK November 4, 2016 Inter-Tribal VA Stand Down Health Fair at Cox Convention Center • Oklahoma City, OK
OCTOBER/NOVEMBER/DECEMBER 2016 | 13
THE CPN DIABETES PROGRAM PRESENTS THE 2ND ANNUAL
HARVEST
HUSTLE 5K RUN
NOVEMBER 5 8AM FOR DIABETES AWARENESS
REGISTER FOR FREE AT THE FIRELAKE WELLNESS CENTER BY OCTOBER 8TH LATE REGISTRATION WILL NOT RECEIVE A SHIRT FOR MORE INFORMATION CALL 405.395.9303 EXT 5106 ALL CHILDREN MUST BE ACCOMPANIED BY AN ADULT ACC
14 | OKLAHOMA AREA TRIBAL EPIDEMIOLOGY CENTER NEWSLETTER
Breakout Session during the Kansas Tribal Health Summit
Keynote speaker Theda Newbreast Pictured from left: Raphael Wahwassuck, Kelli Cheek, Carrie O’Toole, William Mitchell
Kansas Tribal Health Summit 2016 WRITEN BY: RHONDA LEVALDO FACULTY MEMBER AT HASKELL INDIAN NATIONS UNIVERSITY
The four tribes of Kansas hosted their Tribal Health Summit, August 22nd -23rd,at the Prairie Band Potawatomi reservation. The event gave attendees the opportunity to learn from local, regional, and national experts about health issues that impact Indian Country. In its fourth year, the Kansas Tribal Health summit has educated tribal citizens about health and what plans they can implement in their own communities. Summit organizer Dr. Dee Ann DeRoin said she sees a difference in tribal members being proactive in their well-being.
“It’s really wonderful to see. I can tell you that helping with the Kickapoo clinic in the past, there has been a real positive direction with people taking more responsibility for their health, eating better, exercising more. “ said-Dr. DeRoin. Julia Soap, Prairie Band Potawatomi tribal member, presented at the summit to help attendees understand why they want statistics about health from the tribes, hoping to break down any mistrust. “We had really good discussions on what is allowed to be shared and what isn't allowed to be shared. I
Dr. Dee Ann DeRoin and Julia Soap
think the tribes here in Kansas are trying to figure out what they are comfortable with sharing and that is an important issue to consider. As far as data sovereignty, you do want to have access to that data, you want that data shared. You want your tribal health director and tribal council members to have access to data. “ said-Julia Soap. Topics included mental health, elder issues, substance abuse to healthy lifestyles. Over one hundred participants registered for the event.
OCTOBER/NOVEMBER/DECEMBER 2016 | 15
Photo: Southern Plains Tribal Health Board Ambassadors
2016 National Indian Health Board
Awards Gala
SUBMITTED AND PHOTO BY: JENIFER LITTLESUN,
SPTHB EXECUTIVE DIRECTOR
Heroes In Native Health WEDNESDAY, SEPTEMBER 21, 2016 • SCOTTSDALE, AZ.
The National Indian Health Board (NIHB) hosted the 6th Annual Heroes in Native Health Awards Gala in conjunction with the 2016 National Tribal Health Conference (33rd Annual Consumer Conference) at the OdySea Aquarium in Scottsdale, AZ. The purpose of this Awards Gala was to honor and recognize outstanding individuals who have dedicated their time to advancing the delivery of the health care to tribal communities. On behalf of the Southern Plains Tribal Health Board, we would like to congratulate the following award recipients:
2016 LOCAL IMPACT AWARD
2016 AREA IMPACT AWARD
Each year the National Indian Health Board awards up to 24 recipients with this award. This award acknowledges an individual or organization whose work has affected change or impacted healthcare and public health services at
Each year the National Indian Health Board awards up to 12 recipients with this award. This award acknowledges individuals and organizations whose work has affected change or impacted healthcare and public health services for their entire Indian Health Services Area or region.
the local or tribal level.
MARTY WAFFORD, Chairperson, SPTHB, Chickasaw Nation Department of Health TORIE FULLER, Citizen Potawatomi Nation, Healthy Heart/Diabetes Program
LISA PIVEC, Treasurer, SPTHB, Cherokee Nation, Cherokee Nation Department of Health
2016 EXECUTIVE DIRECTOR'S AWARD MELANIE FOURKILLER, Cherokee, Senior Policy Analyst, Choctaw Nation of Oklahoma
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2016 NATIONAL IMPACT AWARD Each year the National Indian Health Board awards up to 6 recipients with this award. This award acknowledges individuals and organizations whose work has affected change or impacted healthcare and public health services in Indian Country.
MELISSA GOWER, SPTHB Alternate, Cherokee Nation, Chickasaw Nation Division of Health
VOICES IN
INDIAN
This letter was prepared and accomplished by Darryl Tonemah in his personal capacity. The opinions expressed in this article are the author's own and do not necessarily reflect the views of the Southern Plains Tribal Health Board, or the Tribal Nations we serve.
COUNTRY
Dear DAPL, I grew up in the Dakotas. I spent a big chunk of my youth on Standing Rock. It was great and it was challenging. I have many fond memories of biking around Golf Hill with my buddy Ron, and swimming and fishing in the Missouri River with Bucky and Harold. I still visit whenever I'm in the Dakotas. It was there I decided I wanted to be both a musician and a psychologist. It was also there that I learned the greatness of being Native, as well as the darkness of how trauma can affect an entire family and community. It either creeps in slowly and quietly like smoke and leaves its scent on everything it touches or knocks the door down violently and tries to claim power. It does anything necessary to survive-or thrive. Trauma occurs in the lack of options. It occurs in the inability to respond appropriately to a threat and rid ourselves of the charge given us to protect ourselves and our family. So that charge is stored in our bodies waiting for completion or satisfaction. It feels like overwhelm. It feels like hypervigilance. It feels like constriction. It feels like anger. Unfortunately, some have used external tools to mediate that overwhelm-drinking, drugs, etc. Those things do not define us as a people, but some less informed people incorrectly choose to define us in that way.
That being said, as I keep up with the Dakota Access Pipeline I feel compelled to write you a quick note. DAPL folks, you have possibly an unprecedented opportunity to do the right thing by a community that has been wronged so often. We have historically been abused, beaten and robbed. This has been labeled "Historical Trauma." It lives, it exists and it's passed on generationally through numerous modes of transmission. YET there also exists a fortitude in this community to stand up for another fight, to recognize that the DAPL cannot be another significant trauma passed to the next generation. This impressive group of people from all across the U.S. and Canada have gathered to claim its due justice and to ultimately have a voice. DAPL folks unlike many of your predecessors, you have the amazing opportunity to make the right choice and stand on the right side of history. You have the opportunity to help one group complete the cycle and get rid of the charge of trauma, as well as prevent it for future generations. Without prejudgment-in an honest way-look at the folks trying to protect their land. Have conversations with them, not about them. You may come to the conclusion that you would do the same if it were your land.
Darryl Tonemah a Kiowa, Comanche and Tuscarora holds a PhD, in Counseling Psychology and Cultural Studies, a Masters Degree in Community Counseling, as well as a double major and minor in Psychology, Sociology, and Gerontology. He was previously the psychologist for the southwest sites of the NIH Diabetes Prevention Program Study. He taught behavioral methods of change to health coaches and study participants. He was faculty at the University of Oklahoma Health Sciences Center
When we/you define each other by our best traits rather than our weakest moments we can create an understanding that is real and collaborative and build solutions together. Finally, not everything is a financial decision. I could go into the financial commitment that has been made, historically, to groups that have been traumatized. We could discuss that financially it is, in the long term, much more advantageous to stop the pipeline. But it's not a financial decision. The cost is much greater. It's the lives, livelihood and land of an entire cultural group. With so much at stake the benefit is also much greater. A victory of empowerment of native people isn't a loss for you. It is a win for all people. You have the chance to be involved in a great moment in history and out of conflict we can gain strength and understanding. In a world of social media all eyes are on the Standing Rock reservation. Do not make a financial choice, or a political choice.....make a choice that is right. Thank you Be Well Darryl Tonemah, PhD Kiowa/Comanche/Tuscarora #noDAPL
About Darryl
in Family Medicine, where he taught Health Behavior Change to Endocrinology Fellows. He was also the Administrative Director for the Oklahoma Diabetes Center, and Co-Director of the University of Oklahoma Health Sciences Center Special Populations Unit. He sits on numerous state and national boards addressing disparities in education, and health care among the Native communities. He currently travels to indigenous communities around the world teaching
behavioral methods of change, health and wellness. He is internationally viewed as an agent of change for his work. He has helped develop diabetes programs, youth initiatives, and community mobilization, cultural competency, and trained education and health professionals in working with students and patients. He and his wonderful wife and three kidlets live outside of Lewiston New York.
OCTOBER/NOVEMBER/DECEMBER 2016 | 17
Let Me Tell You A Story
THE ROLE OF STORYTELLING IN NATIVE AMERICA WRITTEN BY: KAY (IONATAIEWAS) OLAN, MOHAWK EDUCATOR AND STORYTELLER
Note to readers: I wanted to preface this story by stating that after some long thought about what to write regarding storytelling, there is no need to try and expand on Kays thoughts, she states it very well! I’m fortunate to be friends with Kay and wanted to
P
share what she wrote. Enjoy reading! Chris Tall Bear – Tobacco Program Coordinator, Southern Plains Tribal Health Board erhaps you’ve noticed that
painters, dancers, writers, poets,
CD’s, DVD’s, websites, newspapers and
storytelling is not only alive, but
quilters, beaders, jewelry makers or
more and more of these resources are
the indigenous tradition of
it is thriving. There is interest in
learning and remembering the stories that have been passed down through the oral tradition. It is recognized that
there is value in the storytelling tradition and that it isn’t just for children.
singers, sculptors, potters, weavers,
architects. The past, present and future are being portrayed in an increasing number of ways. There are so many
stories to tell. There are more every day
and there are many ways in which to tell them.
These days, it is more and more
When I first started teaching elementary
at Native festivals and powwows. Some
it was difficult to find mainstream
common to find at least one storyteller of those storytellers tell the traditional stories that have been passed down from generation to generation. But
some also tell contemporary stories
which underscores the fact that we are still here and that we know who we
are and from where we have come.
Contemporary stories bring the past
into the present and/or address current situations. Storytellers may be orators,
magazines. Even better news is that
being written and produced by native
peoples. We are telling our own stories in our own words and with our own
multi-media equipment. Our stories are being told the way we want them told. Our voices are being heard loud and clear, near and far.
school over four decades ago (yikes),
Why tell Native stories? It has
resources about Native Americans.
educational tool for the transmission
There were so few. Most of the
available materials at that time were
stereotypical, demeaning or inaccurate. There were even fewer that were
appropriate for use in an elementary classroom setting. The few that were
meaningful were hard to obtain. But, we’ve come a long way. Today, there
are so many worthwhile books, movies,
18 | OKLAHOMA AREA TRIBAL EPIDEMIOLOGY CENTER NEWSLETTER
always been and still is an important
of values and traditional knowledge. It is a way to open doors to thoughtprovoking discussion. It is a way
to dispel stereotypes and provide
accurate information. It is a way to
initiate bridge-building which can lead
to a greater mutual understanding and respect between peoples.
Some types of stories are told just for
hear because those words are a special
is and where the story is being told.
and laughter in our lives. Other stories
into another time or into another way
moment as do parents and educators
entertainment. We need to have fun are told so that we will always know about our history and our treaties.
Some stories describe how the universe came to be and what our relationship is to every part of the natural world.
Some legends explain why things are
the way they are, e.g. “Why does Rabbit have long ears?” Stories may remind
invitation to step into another reality, of thinking. Listening to a story may
result in my shedding a tear, bursting
into laughter or gasping in amazement. I may become more sensitized to
the feelings of others as I find myself
experiencing the world from another perspective. Hopefully, I will learn something new.
They take advantage of the teachable and tell the story that needs to be
told at that moment. The storyteller
is aware that there are certain stories that should be told only by certain people, at certain times and/or in
certain situations. Mentioning from
where the story comes and providing cultural context in order to give the
story dimension, validity, and respect is
us of how we should interact with one
Too often, it is assumed that storytelling
harmony. They help us transmit values
because stories can be meaningful
Storytelling is a living tradition. The
The shared experience offers the
includes stories that have been passed
another in order to maintain peace and and ideals from one generation to
another. The child who misbehaves may be told a story in which the character
exhibits the same behavior. In that way, the child learns about appropriateness and consequences, but without undue
embarrassment or damage to the spirit.
(Adults benefit from periodic reminders of those same lessons, as well.) Listening to stories can help us
emotionally and psychologically.
Listeners are transported to a place
where they can forget about their every day trials and tribulations, at least for
a little while. At the conclusion of the story, they return feeling refreshed
and reinvigorated because they gave
themselves a virtual vacation. That storytraveler might just return with a new
way of looking at life and possibly with some solutions to nagging questions. Sharing a story can also be a way to
is just for children. That’s too bad
for everyone and on many levels.
opportunity to bring friends, families and strangers together, which is especially relevant in this age of
running from one activity, job or
appointment to another. Listeners sit in close proximity with one another,
hear the same words, but apply their own thoughts and life experiences
to the stories they hear. Many stories
offer multiple levels of understanding and so listeners may process stories
differently. Therefore, it is important, whenever possible, to allow time for discussion and sharing so that each
listener can benefit from hearing other interpretations. Hearing stories more than once is valuable too, because it
is not uncommon to pick up on details we didn’t notice or remember from previous tellings.
important.
story bag is constantly growing fuller. It down from generation to generation. But, it also contains the stories that
come from our own family histories and from our personal experiences. We all have stories to tell. We need to make
the time to tell them so they won’t be
forgotten. We need to tell them in order to maintain our connections to one
another. We need to stay connected
so that we will remember that we are
all related. Why should we encourage storytelling? Because when we take the time to sit together and tell our
stories, we discover that we have more in common than we have differences. We find that we have similar hopes
and dreams for the future generations. We remember that we can accomplish
much more if we learn to communicate and work together.
reach out and initiate discussion on
Storytellers tell stories from their own
Kay (Ionataiewas) Olan, Mohawk
story.
way to tell a story. Storytellers tell
giving presentations about the
topics that are totally unrelated to the
“Let me tell you a story.” When I
hear those words, I relax and put aside whatever it was that I was
thinking about or doing. I prepare to
concentrate on that which I’m about to
perspective. There is more than one
stories in their own style and so may
differ in how they place emphasis on certain details or events, but they try to do so without changing the basic essence. Storytellers embellish or
educator and storyteller, has been Haudenosaunee for over twenty-
five years, is a former Director of the
Mohawk Community of Kanatsiohareke
and has released a Mohawk Stories CD.
simplify depending on who the listener
OCTOBER/NOVEMBER/DECEMBER 2016 | 19
Photo: Adina Vang
Photo: Adina Vang Photo: Adina Vang
Prevention Institute and the Movember Foundation Prevention Institute and the Movember Foundation are changing the paradigm for mental wellbeing for are changing the paradigm for mental wellbeing for Photo: Adina Vang men and boys. Together we are engaging 16 men and boys. Together we are engaging 16 communities across the U.S. in a major initiative to Prevention Institute and the Movember Foundation communities across the U.S. in a major initiative to develop and activate strategies to enhance are changing the paradigm for mental wellbeing for develop and activate strategies to enhance communities' sociocultural, physical/built, and men and boys. Together we are engaging 16 communities' sociocultural, physical/built, and economic environments in ways that can improve communities across the U.S. in a major initiative to economic environments in ways that can improve mental wellbeing for men and boys. We will share develop and activate strategies to enhance mental wellbeing for men and boys. We will share what we learn along the way. communities' sociocultural, physical/built, and what we learn along the way.
Photo: Choctaw Nation of Oklahoma Photo: Choctaw Nation of Oklahoma
The Initiative The Initiative Photo: Choctaw Nation of Oklahoma
economic environments in ways that can improve Making Connections for Mental Wellbeing employs mental wellbeing for men and boys. We will share Making Connections for Mental Wellbeing employs an innovative approach that creates a robust what we learn along the way. an innovative approach that creates a robust community of practice to help leverage the power community of practice to help leverage the power of communities and connection to create greater Making Connections for Mental Wellbeing employs of communities and connection to create greater opportunities for wellbeing and resilience. an innovative approach that creates a robust opportunities for wellbeing and resilience. community of practice to help leverage the power of communities and connection to create greater opportunities for wellbeing and resilience.
Multiyear initiative led by Prevention Institute and funded by the Movember Foundation with opportunity for co Multiyear initiative led by Prevention Institute and funded by the Movember Foundation with opportunity for co investment. investment. The Initiative Ambitious investment in a diverse range of communities that are developing and implementing communitydriven Ambitious investment in a diverse range of communities that are developing and implementing communitydriven strategies to address conditions in the social, economic, and built environment to improve mental wellbeing for men strategies to address conditions in the social, economic, and built environment to improve mental wellbeing for men Multiyear initiative led by Prevention Institute and funded by the Movember Foundation with opportunity for co and boys. and boys. investment. Focus on highneed populations, including men and boys of color, military members, veterans, and their families. Focus on highneed populations, including men and boys of color, military members, veterans, and their families. Ambitious investment in a diverse range of communities that are developing and implementing communitydriven Selected sites span the country in urban, rural, and suburban locations. Selected sites span the country in urban, rural, and suburban locations. strategies to address conditions in the social, economic, and built environment to improve mental wellbeing for men Partners include tribal, communitybased, public health, healthcare, and veterans' organizations. Partners include tribal, communitybased, public health, healthcare, and veterans' organizations. and boys. Communitydriven strategies that draw on indigenous knowledge and customs to develop the most effective and Communitydriven strategies that draw on indigenous knowledge and customs to develop the most effective and Focus on highneed populations, including men and boys of color, military members, veterans, and their families. culturallyrelevant approaches. culturallyrelevant approaches. Selected sites span the country in urban, rural, and suburban locations. Training and technical assistance by Prevention Institute to support communities in identifying the most effective Training and technical assistance by Prevention Institute to support communities in identifying the most effective Partners include tribal, communitybased, public health, healthcare, and veterans' organizations. processes, tools, and approaches to improve mental health outcomes. Knowledge is shared through convenings, processes, tools, and approaches to improve mental health outcomes. Knowledge is shared through convenings, Communitydriven strategies that draw on indigenous knowledge and customs to develop the most effective and site visits, oneonone consultations, and a peer learning network. site visits, oneonone consultations, and a peer learning network. culturallyrelevant approaches. Comprehensive, independent evaluation by the University of South Florida that includes theoryofchange Comprehensive, independent evaluation by the University of South Florida that includes theoryofchange Training and technical assistance by Prevention Institute to support communities in identifying the most effective development and assessment. development and assessment. processes, tools, and approaches to improve mental health outcomes. Knowledge is shared through convenings,
20 |
site visits, oneonone consultations, and a peer learning network. Comprehensive, independent evaluation by the University of South Florida that includes theoryofchange OKLAHOMA AREA TRIBAL EPIDEMIOLOGY CENTER NEWSLETTER development and assessment.
This initiative was launched following a groundbreaking Prevention Institute landscape analysis on the mental health of boys and men, Making Connections for Mental Health and Wellbeing Among Men and Boys in the U.S. Below are some of the key findings from the analysis.
Photo: Nebraska Association of Local Health Directors
Challenges The medical model has been the dominant approach for addressing mental health. Trauma affects both physical health and mental health. Some populations, including boys and men of color and veterans, may be at even higher risk of experiencing trauma due to factors such as greater exposure to violence and fewer economic opportunities. Many conditions in the U.S., including growing inequality and an unstable economy, contribute to stress, sadness, fear, and anxiety. Although equal numbers of men and women meet criteria for psychiatric disorders during their lifetimes, men are at greater risk for many disorders.
Photo: Fathers Uplift Photo: greenhouse, Boston.com
Solutions The Opportunity There is strong evidence that prevention and early intervention can help improve mental health. Changing limited definitions of masculinity and addressing stigmas can increase opportunities for men to seek care that can help prevent and address mental health problems. Mental health is not only an individual issue, but also a societal issue that can be addressed with broader communitybased and policylevel approaches. There are promising strategies to improve the underlying conditions in the social, economic and built environments that contribute to stress, sadness, fear, and anxiety in both communities and individuals. There is an opportunity to further develop and activate these strategies to enhance opportunities for mental wellness.
Stigma and socialization put males at risk for being mentally unhealthy and for not seeking care or treatment that could help prevent and address mental health problems.
Resilience is a critical protective factor for mental wellbeing. Resilience can be fostered in individuals, families, and communities.
The mental health system is fragmented and lacks the capacity to adequately address the mental health needs in the U.S.
Indigenous and laypeople approaches are emerging that support healing and mental wellbeing.
OCTOBER/NOVEMBER/DECEMBER 2016 | 21
Community Partners
Office of School and Adolescent Health (OSAH), New Mexico Department of Health, Albuquerque, New Mexico Populations of focus: Youth in Albuquerque’s International District, including AfricanAmerican, urban NativeAmerican, first generation American, native New Mexican Latino, and militaryinvolved youth. Local Initiatives Support Corporation Resilient Communities, Resilient Families (RC/RF) program, Boston, Massachusetts Populations of focus: Men of color in Roxbury, Dorchester, and Mattapan. Resilience Grows Here, Farmington Valley Health District, Canton, Connecticut Populations of focus: Active and retired veterans in East Granby and nine other towns within Farmington Valley. Sinai Health System, Chicago, Illinois Populations of focus: AfricanAmerican and Latino men and boys in the communities of North Lawndale, South Lawndale, and Chicago Lawn. Denver Men’s Health Connection (DMMHC) project, Denver Department of Human Services, Denver, Colorado Populations of focus: Adolescent and transitionage young men living in the five ZIP code areas in the City and County of Denver with the highest percentage of hotline calls for child abuse and neglect. HopeHealth Inc., Florence, South Carolina Populations of focus: Men and boys and veteran populations of Florence in the rural Coastal Plain region. Kokua Kalihi Valley, Honolulu, Hawai’i Populations of focus: Native Hawaiian, Asian, and Pacific Islander young men in the ahupua’a of Kalihi. Houston Health Department, Houston, Texas Populations of focus: Boys and young men of color in the Kashmere, Wheatley, and Scarborough high school neighborhoods of Houston. 22 | OKLAHOMA AREA TRIBAL EPIDEMIOLOGY CENTER NEWSLETTER
Kankakee Community College, Kankakee, Illinois Populations of focus: Student veterans and community veterans in the Kankakee area. Nebraska Association of Local Health Directors (NALHD), Lincoln, Nebraska Populations of focus: Veterans and their families in the 76 rural and frontier counties served by NALHD member local public health departments. Violence Prevention Coalition of Greater Los Angeles, Los Angeles, California Populations of focus: Boys and men of color in south Los Angeles (LA) and the surrounding LA County communities. New Orleans Health Department, New Orleans, Louisiana Populations of focus: AfricanAmerican men and boys ages 824 in the New Orleans neighborhood of St. Roch. Southern Plains Tribal Health Board, Oklahoma City, Oklahoma Populations of focus: American Indian boys and men in the Oklahoma City Indian Health Service Area. United Women of East Africa Support Team, San Diego, California Populations of focus: East African refugee young men in the City Heights area of San Diego. Lao Family Community Empowerment, Inc., Stockton, California Populations of focus: Hmong elders, adults and young men and boys in the Stockton area. Tacoma Pierce County Health Department, Tacoma, Washington Populations of focus: Men and boys of color and masculine, and otherly identified people in the Parkland, Hilltop, and East Side communities.
Photo: Kokua Kalihi Valley
Photo: Kokua Kalihi Valley
Making Connections Photo: Kokua Kalihi Valley Broadening understanding of how mental wellbeing is connected to communitylevel approaches.
Connecting men and boys in the places where they spend their time and through the activities Making Connections
they enjoy doing. Broadening understanding of how mental wellbeing is connected to communitylevel approaches. Reconnecting men and boys to cultural identity and expanded notions of masculinity. Connecting men and boys in the places where they spend their time and through the activities Supporting connection in coping with stressors – past, present and future. they enjoy doing. Connecting men and boys to each other, their families, and their communities. Reconnecting men and boys to cultural identity and expanded notions of masculinity. Connecting systems, institutions, and community organizations to mental health and wellbeing Supporting connection in coping with stressors – past, present and future. and to each other in stronger safety nets. Connecting men and boys to each other, their families, and their communities. Connecting systems, institutions, and community organizations to mental health and wellbeing and to each other in stronger safety nets.
About Prevention Institute
About the Movember Foundation
Prevention Institute is a nonprofit, About Prevention Institute national center dedicated to improving community health and wellbeing by Prevention Institute is a nonprofit, building momentum for effective national center dedicated to improving primary prevention. Primary prevention community health and wellbeing by means taking action to build resilience building momentum for effective and prevent problems before they primary prevention. Primary prevention occur. The Institute's work is means taking action to build resilience characterized by a strong commitment and prevent problems before they to community participation and occur. The Institute's work is promotion of equitable health outcomes characterized by a strong commitment among all social and economic groups. to community participation and promotion of equitable health outcomes among all social and economic groups.
The Movember Foundation is the only About the Movember Foundation global charity focused solely on men’s health. The Foundation raises funds to The Movember Foundation is the only deliver innovative, breakthrough global charity focused solely on men’s research and support programs that health. The Foundation raises funds to enable men to live happier, healthier, deliver innovative, breakthrough and longer lives. In the annual research and support programs that Movember campaign in November, men enable men to live happier, healthier, are challenged to grow a moustache or and longer lives. In the annual make a commitment to get active and Movember campaign in November, men MOVE. Millions have joined the are challenged to grow a moustache or movement, raising $710M and funding make a commitment to get active and over 1,000 programs. MOVE. Millions have joined the movement, raising $710M and funding OCTOBER/NOVEMBER/DECEMBER 2016 over 1,000 programs.
| 23
PREGNANT? IMPORTANT ZIKA VIRUS FACTS Southern Plains Tribal Health Board’s Response to ZIKA
Travel Notice: The Centers for Disease Control and Prevention (CDC) has issued a level 2 (Practice Enhanced Precautions) travel notice to people traveling to Zika affected areas.
Zika Symptoms
The four most common symptoms include:
The symptoms of Zika are often mild and can last a couple days to a week. In fact, many people will not even know they are infected with Zika.
▪ Fever ▪ Conjunctivitis (red eyes) ▪ Joint pain ▪ Rash
What you need to know: ▪ The primary way pregnant women get Zika is from a mosquito bite. ▪ The mosquito that spreads Zika is an aggressive daytime biter. ▪ Zika can be spread by a man to his sex partners. ▪ Zika can be spread from a pregnant woman to her fetus during pregnancy or at delivery. ▪ Zika infection during pregnancy can cause serious birth defects. ▪ Currently, there is no vaccine or treatment for Zika.
COMMITTED TO EX CE L L E NCE I N TRI BA L PU BLI C HEA LTH|SPTHB - OK A rea TEC
24 | OKLAHOMA AREA TRIBAL EPIDEMIOLOGY CENTER NEWSLETTER
Pregnant women and women trying to become pregnant should take special precautions to avoid mosquito bites. Are you pregnant? ▪ Avoid travel to Zika affected areas. ▪ You and your sex partner should always take precautions to avoid mosquito bites. ▪ If your sex partner travels to Zika affected areas, correctly use condoms every time you have sex, or do not have sex during pregnancy. ▪ If you develop symptoms of Zika, immediately go to your healthcare provider for testing.
Are you trying to become pregnant? ▪ You and your male partner should always take precautions to avoid mosquito bites. ▪ Speak with your healthcare provider about trying to become pregnant.
Protect Yourself: Clothing
▪ Wear long-sleeved shirts and long pants. ▪ Use permethrin on clothes and gear (follow the instructions carefully). ▪ Purchase permethrin treated clothes (check label for details about length of effectiveness). ▪ Do not use permethrin directly on skin.
Protect Yourself: Environment
▪ Stay in places with windows and door screens to keep mosquitos outside. ▪ Stay in places with air conditioning. ▪ Remove any standing water in and around your home.
▪ Sleep under mosquito netting if outside or if mosquitos can get inside your house.
Protect Yourself: Repellent
▪ Use an Environmental Protection Agency (EPA)-registered insect repellent. If EPA-registered repellents are used as directed, they are safe and effective for pregnant and breastfeeding women. ▪ Repellents with one of these five active ingredients should be used: DEET, picaridin, IR3535, oil of lemon eucalyptus or para-menthan-diol.
*Information used in the development of this fact sheet was obtained from www.CDC.gov/Zika
OCTOBER/NOVEMBER/DECEMBER 2016 | 25
VOLUME 7 ISSUE 3 September 2016
Oral Health During Pregnancy Research shows that good oral health protects a woman’s well-being and quality of life before and during pregnancy. Good oral health also has the potential to reduce the transmission of pathogenic bacteria from mothers to their children.1 In addition, studies have linked dental infection and inflammation to preterm birth.2 Yet barriers to dental care during pregnancy continue to exist.
Figure 1. Oral Health Care by Insurance Status 90 80 70
60.5
60
75% of mothers in Oklahoma reported having dental insurance during pregnancy
Half of the mothers reported receiving a dental cleaning during pregnancy
One in four of the mothers had a dental problem that needed to be seen by a dentist
71% of mothers with a dental problem sought care for the problem
Non-Hispanic Black mothers reported the:
59.1
t 50 n ec r e 40 P
Percent
OKLAHOMA FACTS
80.6
32.7 25.4
30 18.2
20 10 0
Teeth cleaning
Received care for a problem
Without Insuran ce
For this report, 2012-2013 Oklahoma Pregnancy Risk Assessment Monitoring System (PRAMS) data were used to gauge dental care access and practices of Oklahoma mothers during pregnancy.
Oral health counseling
With Insurance
compared to 32.7% that sought care with no insurance. Among racial and ethnic groups, NonHispanic (NH) Black mothers reported the highest rates of dental insurance (84.2%), teeth cleaning (56.5%), and dental problems (37.4%). Hispanic mothers reported the lowest rates in these same three indicators (46.4%, 35.7%, and 17.5% respectively; Figure 2).
Dental insurance coverage is an important predictor of dental care utilization. Overall during pregnancy, three-fourths (75%) of Oklahoma mothers reported having some form of dental insurance and half (50%) of mothers reported getting their teeth cleaned.
Overall, one fourth of mothers reported a dental problem, of which 71.4% visited a dentist to take care of the problem. There were no significant associations with accessing dental care related to age, race, Hispanic origin, or educational status of mothers with dental problems (data not shown).
Figure 1 reveals that a significantly higher percentage of mothers sought dental care when they had dental insurance. In fact, over 80% of mothers with dental problems sought care when they had dental insurance
Nearly 80% of mothers who received oral health counseling had a dental cleaning compared to 19% that did not receive oral health counseling
89% of mothers reported knowing the importance of oral health
Percent
Figure 2. Oral Health by Insurance Status and Maternal Race/Hispanic Origin
t n e cr e P
90 80 70 60 50 40 30 20 10 0
84.2
79.5
53.4
80.8
5 6.6 37.4
26.5
NH-White
NH-Black
Dental Insurance
69.5
46.2 27.4
NH-American Indian
Teeth Cleaned
26 | OKLAHOMA AREA TRIBAL EPIDEMIOLOGY CENTER NEWSLETTER
46.4
39.9
35.7
18.8
NH-Other
17.5
Hispanic
Dental Problem
highest rate of dental insurance (84%) highest rate of dental cleaning (57%) highest rate of dental problems (37%) highest rate of oral health counseling (71%)
There was a significant association (P<0.05) between oral health counseling and teeth cleaning. Mothers who reported oral health counseling had a higher rate of teeth cleaning compared to those who did not receive counseling (79.7% vs 19.1%). Overall, 51% of Oklahoma mothers reported receiving oral health counseling and, consistent to previous results, NH Black mothers reported the highest rate (data not shown).
Since over half of Oklahoma births are covered by Medicaid, the ability of women to access dental care through Medicaid is essential for maintaining good oral health of expectant mothers. Mothers on Medicaid reported significantly lower rates of visits for teeth cleaning compared to nonMedicaid mothers. Subsequently, Medicaid mothers also reported significantly higher rates of dental problems (Figure 3).
Table 1.Unadjusted and adjusted risk ratio for preterm births among mothers who had a dental cleaning during pregnancy Indicator Unadjusted Adjusted
Risk Ratio 0.09 0.82
95% Confidence Interval 0.07 - 0.11 0.62 - 1.08
Adjusted for maternal age, race, Hispanic origin, education, marital status, and income
A bivariate analysis indicated that there was a slightly higher risk for preterm births among Oklahoma mothers who did not seek preventive dental care (12.1% vs 9.1%), but the same association was not evident when the model was adjusted for maternal age, race, Hispanic origin, marital status and income (Table 1).
The Perinatal Dental Access Program administered by the State Medicaid agency was eliminated in July 2014 due to lack of funds and under utilization. As a result, some of the trends observed in this report may be different with more current data. Studies show that oral health care during pregnancy is safe and should be recommended.3 Increasing awareness about the importance of oral health during pregnancy and improving oral health care access and utilization are key to improving the overall health of women.
Figure 3. Oral Health Experiences by Mother's Medicaid Status Dental visit for a problem
13.9
Dental problem
16.3
25.3
Medicaid Non-Medicaid
31.5
71.0
Dental insurance 42.8
Teeth cleaned
60.2
86.3
Knowledge about oral health 0
20
40
Percent
60
80
- PRAMS mom
ACKNOWLEDGEMENTS Special assistance for this Brief was provided by Binitha Kunnel, MS; Jana Winfree, DDS, MPH; Ayesha Lampkins, MPH, CHES; Alicia Lincoln, MSW, MSPH; and Wanda Thomas. Funding for PRAMS is provided by the Centers for Disease Control and Prevention (CDC) and the Maternal and Child Health Bureau, Department of Health and Human Services, Maternal and Child Health Services (MCH) Title V Block Grant. PRAMS is a population-based surveillance system about maternal behaviors and experiences before, during, and after pregnancy. Approximately 250 mothers are selected to participate in Oklahoma each month. Mothers are sent as many as three mail questionnaires seeking their participation with follow-up phone interviews for non-respondents. Information included in the birth registry is used to develop analysis weights that adjust for probability of selection and non-response. Prevalence rates were calculated and the potential risk factors were identified using the Cochran-MantelHaenszel Chi-Square (χ2) Test. PRAMS had 3,735 respondents for 2012-2013 for a response rate of 64.1%. The Oklahoma State Department of Health (OSDH) is an Equal Opportunity Employer. This publication was issued by OSDH, as authorized by Terry Cline, PhD, Commissioner. This Brief is available for download at www.health.ok.gov.
81.7
48.5 53.7
Oral health counseling
“I did not realize that Sooner Care (Medicaid) covered dental.”
93.4
100
References 1. The Association between Maternal Oral Health Experiences and Risk of Preterm Birth in 10 States, Pregnancy Risk Assessment Monitoring System, 2004–2006. Matern Child Health J. 2012 Nov; 16(8): 1688–1695 2. Periodontitis: A risk for delivery of premature labor and low-birth-weight infants. J Nat Sci Biol Med. 2010 Jul-Dec; 1(1): 40–42. 3. Oral health during pregnancy and early childhood: evidence-based guidelines for health professionals. California Dental Association Foundation, American College of Obstetricians and Gynecologists District IX. J Calif Dent Assoc 2010;38:391–
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