Deborah Mattheus

Smoking and diabetes have detrimental effects on tooth loss, though few studies have examined their interaction. Using five waves of cross-sectional data from the state of Hawai‘i in the United States, this study aimed to examine the interaction effects between smoking and diabetes on severe tooth loss ( ≥ 6 ) among adults, using a weighted logistic regression approach. In Hawai‘i, the overall prevalence of severe tooth loss was 9.7%. Among never smokers, diabetes was associated with a 10.3% higher prevalence of severe tooth loss compared with those without diabetes. The differences due to diabetes were nearly doubled among former smokers (19%) and current smokers (16.2%). After adjusting for sociodemographic factors, the differences were smaller but still statistically significant, indicating the aggravating effect of smoking on tooth loss among those with diabetes. Awareness of the interaction between smoking and diabetes is crucial for the development of policies aimed at improving health equity.

Oral health is a major health concern in the US and globally, particularly among communities of color and low-income/low-education groups. General health disparities have been reported among Native Hawaiians (NHs) and Other Pacific Islanders (OPIs), although less is known about the specific racial/ethnic and socioeconomic trends that are relevant to oral health disparities for NHOPIs. We examined delayed dental visits and severe tooth loss among older NHOPI adults in relation to sociodemographic factors and community level disparities using five waves of data from the Hawaiʻi Behavioral Risk Factor Surveillance System collected between 2012 and 2020. Weighted Poisson regression was used to estimate the unadjusted and adjusted prevalence ratio of delayed dental service utilization and severe tooth loss. Relative to other racial/ethnic groups, older NHs had higher rates of delayed dental service utilization and severe tooth loss after adjusting for sociodemographic factors, and disparities were also found in rural communities. Awareness of the unique challenges and inequities faced by older Indigenous and racially/ethnically marginalized populations is critical for policymakers to develop strategies to achieve health equity.

BACKGROUND: Youth may be reluctant to seek health care from school health providers due to feeling embarrassed or stigmatized in the health office environment or worried about their confidentiality. The purpose of this project was to create a set of youth‐centered health posters that promote youth engagement with nursing staff and to standardize health messaging across high schools in Hawaii school‐based clinics.METHODS: Two community advisory boards, 1 composed of 10 youth stakeholders (mean age 17 years) and the other of 7 adult stakeholders, informed poster development utilizing web‐based discussion groups. The discussions were transcribed, and additional data was collected using field notes and anonymous digital messages. Adult advisory board members also provided feedback on suggested poster text through an online survey.RESULTS: Youth and adult advisory board participants identified 4 key health concerns facing youth: confidentiality, sexual health, relationships, and mental health. Based on input from the 2 advisory boards, 4 posters were developed, each centered on 1 key health issue.IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY: School‐based posters can convey important messages to help youth understand their health care rights and responsibilities, as well as identify important issues open for discussion with nurses.CONCLUSION: Posters are an underutilized tool for school health providers to create welcoming, inclusive health care environments and facilitate health‐related conversations with youth. This paper describes participant feedback about the characteristics of a memorable poster and briefly outlines current knowledge and recommendations for school health providers regarding each of the 4 health issues.

BACKGROUND: School‐based dental sealant programs are noted to increase sealant uptake among children, especially those from low‐income families and those living in rural and underserved areas. However, nationally school‐based dental sealant programs are substantially underutilized. This paper describes a partnership approach to a school‐based dental sealant program for Title 1 public schools in Hawaii.METHODS: The Hawaii Keiki: Healthy and Ready to Learn program partnered with the Hawaii Dental Service to develop and implement an interprofessional, school‐based sealant program (SBSP). This article describes the development of key factors, such as partnerships, an interprofessional team, team roles, policies, and marketing tools to optimize program success.RESULTS: The SBSP has completed over 3 academic years of implementation in Hawaii public schools. In its initial year (school year [SY] 2019‐2020), which presented challenges due to the COVID‐19 pandemic, it served 6 schools (106 students screened) on 1 island. It expanded to 14 schools on 1 island (193 students screened) in its second year (SY 2020‐2021), 28 schools on 3 islands (653 students screened) in its third year (SY 2021‐2022), and during the Fall of the fourth year, the program reached 50 schools on 3 islands (1821 students screened) and is projected to reach over 70 schools by the end of SY 2022‐2023.CONCLUSION: Taking advantage of strategic partnerships and key interprofessional team members, a school‐based dental sealant program can help to improve the oral health of children in public schools by helping to decrease barriers to care.

School nurses have various degrees of experience responding to respiratory or cardiac emergencies, and most only receive Basic Life Support training every 2 years as required. The goal of the study was to assess school nurses' confidence and competence in emergency situations before and after engaging in emergency preparedness high-fidelity simulations. This mixed methods study used a pre-/postsimulation survey design for a group of school nurses (N = 40) in the State of Hawaii. The pre- and postsimulation survey assessed professional demographics and measured confidence. After the presimulation survey, nurses participated in a 1-day training that included two separate emergency simulations using high-fidelity equipment. In addition, education was provided on the program's standardized emergency supply bags with equipment and their use during an emergency. The postsimulation survey was distributed 5 days after the educational intervention. All confidence items significantly improved after the simulation session. Nurses noted the value of the training and hands-on simulation experience. Simulation is a useful tool for increasing school nurses' confidence in responding to emergencies occurring on school campuses. [J Contin Educ Nurs. 2023;54(2):71–77.]

The Kona WIC oral health pilot project was developed to assess the oral health beliefs and behaviors of parents of children and pregnant women at the Kona WIC site and to demonstrate the ease of providing oral health education to families in order to improve oral health behaviors. Data were collected from 50 families about the oral health behaviors and dental care of a total of 73 children, including 5 pregnant women, four of whom had a child enrolled in WIC and one pregnant woman without any previous children. Data revealed that 68% of children with teeth had been seen by a dentist within 6 to 12 months of the study visit. Mothers were seen less often, with 55% stating that they had not been seen for a dental visit for over one year. Parental knowledge about the effects of fluoride on teeth was limited; however, 90% of the parents would allow fluoride varnish applied to their child's teeth, 88% would give daily fluoride drops/tablets to their child, and 78% would support water fluoridation if it would help to improve their children's oral health. Additionally, for children old enough to receive fluoride supplementation, 60% were not given a prescription by their health care providers, and 58% had not received any fluoride varnish applications. By offering oral health education in a WIC clinic and assisting clients to seek out comprehensive care within a dental home, children and caregivers can be provided essential education and resources early in a child's life or women's pregnancies to reduce poor oral health outcomes.

Periodontal disease during pregnancy has the potential to increase the risk of adverse perinatal outcomes including preterm labor (PTL), prematurity, and low birth weight (LBW). Despite professional recommendations on the importance and safety of dental assessments and treatments, the rate of dental care utilization during pregnancy remains low. The purpose of this study was to document the utilization of dental services and explore the relationships among socio-demographic factors, dental problems, and PTL in pregnant women residing in Hawai'i. Hawai'i Pregnancy Risk Assessment Monitoring System (PRAMS) survey results were analyzed from 4,309 women who experienced live births between the years 2009-2011. Results revealed that 2 in 5 women in Hawai'i had their teeth cleaned during pregnancy, while 1 in 5 reported seeing a dentist for a dental problem. Women who reported having a dental problem during pregnancy were more likely to experience PTL (OR=1.46, 95% CI=1.10-1.94, P=.008) compared to women without a dental problem. In addition, Native Hawaiian and Part-Hawaiian women were more likely to experience PTL (OR=1.73, 95% CI=1.22-2.46, P=.002) compared to Caucasian women. These findings document the underutilization of dental services in pregnant women in Hawai'i and reveal an association between poor dental care and PTL. Identification of groups at risk for maternal complications may assist in the development of programs that are sensitive to the diverse cultures and variability of community resources that exist throughout Hawai'i.

Mattheus d.j. (2010) Vulnerability related to oral health in early childhood: concept analysis. Journal of Advanced Nursing 66(9), 2116–2125. Aim.  This article is a report of the analysis of the concept of vulnerability and its relationship to oral health in early childhood.Background.  Poor oral health is a continued problem for children worldwide. Vulnerability increases the probability of poor oral health outcomes. The lack of clarity of the concept of vulnerability creates difficulty in understanding this multi‐factoral condition.Data sources.  Data source included 34 articles covering the period 2000–2009 from a variety of disciplines, including nursing, dentistry, medicine and public health.Methods.  The concept analysis was conducted using Rodgers’ evolutionary method. The literature was analysed and a social ecology model was used to frame the discussion, recognizing family and community influences on children’s oral health.Results.  The context of oral health in early childhood contributes to the changes in the concept vulnerability. The attributes are closely related to family and community factors and identified as limited parental income, parental education, community‐based services and fluoride; and exposure to poor parental habits, parental neglect and harmful toxins. The primary antecedent is identified as a form of limited protection from exposure to various circumstances.Conclusion.  Children with limited protection have increased vulnerability and greater probability of poor health outcomes. Nurses who understand the concept of vulnerability related to oral health and can identify factors that create protection and are capable of decreasing vulnerability through parent education, community awareness and policy changes that support children and families.

Improving oral health outcomes in Hawai‘i for children and families remains a high priority. Children in the state are leading the nation with the highest caries rates, while women before, during, and after pregnancy are failing to receive regular and necessary dental care resulting in poor health outcomes. To answer for this need, an educational intervention was conducted among families enrolled in the Kapi‘olani Medical Center for Women and Children’s Women, Infant, and Children program (WIC) in O‘ahu. The project included the following activities: (1) identification the oral health beliefs and behaviors of families, (2) providing oral health education to families, and (3) reassessing beliefs and behaviors in 3–6 months to document the impact of theeducation session. Participants consisted of 81 families resulting in the data on 176 children and 4 pregnant women. Of the 81 families, 40 representing84 children completed the follow-up oral health questionnaire. Results of the assessment and education demonstrated a positive impact on the family’s oral health behaviors. Parents were 6.61 times as likely to report using fluoride toothpaste in the follow-up visit compared to their initial visit (95% confidence interval [CI] = 3.12–14.00). Additionally, statistically significant changes were noted in the frequency of children’s daily tooth brushing (odds ratio [OR] = 2.15, 95% CI = 1.33–3.46), as well as in the incidence of children receiving fluoride varnish application over time (OR = 2.66, 95% CI = 1.50–4.73). These results provide further evidence that initiating a simple educational intervention can have a positive impact on oral health behaviors in groups that are at highest risk for developing dental disease in Hawai‘i.