Connecting Health and Wellness to Career Development and Beyond: Center Life to Community Living

Medical Priorities in the Medical Priorities in the Health and Wellness ProgramHealth and Wellness Program

John Kulig, MD, MPHJohn Kulig, MD, MPHPrincipal Medical ConsultantPrincipal Medical Consultant

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Health & Wellness Program Goals

• Develop a model health and wellness Develop a model health and wellness program for Job Corpsprogram for Job Corps

• Require the setting of health and wellness Require the setting of health and wellness goals for goals for allall students enrolled in Job Corps students enrolled in Job Corps

• Implement case management for Job Corps Implement case management for Job Corps students with chronic illness and/or students with chronic illness and/or disabilitydisability

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Medical Program Goals

• Implement case management for all Job Implement case management for all Job Corps students with chronic illnessCorps students with chronic illness

• Launch a center-based asthma management Launch a center-based asthma management initiative in 2005initiative in 2005

• Strengthen the Job Corps Tobacco Use Strengthen the Job Corps Tobacco Use Prevention Program (TUPP)Prevention Program (TUPP)

• Strengthen the Job Corps Weight Strengthen the Job Corps Weight Improvement Program (WIP)Improvement Program (WIP)

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US Mortality: ages 15-19 years, 2002

DeathsDeaths %%• Accidents Accidents

(unintentional injuries)(unintentional injuries) 7,1377,137 52%52%• Assault Assault

(homicide)(homicide) 1,8921,892 14%14%• Intentional self-harm Intentional self-harm

(suicide)(suicide) 1,5131,513 11%11%______________________________________________________________________________________________

TotalTotal 10,542 10,54277%77%

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Years of Potential Life Lost (YPLL) Before Age 75, United States, 2002

YPLLYPLL %%• Accidents Accidents

(unintentional injuries)(unintentional injuries) 2,931,565 2,931,565 15%15%• Assault Assault

(homicide)(homicide) 940,781 940,781 5%5%• Intentional self-harm Intentional self-harm

(suicide)(suicide) 749,521 4% 749,521 4%__________________________________________________________________________________________________________________________________________________

TotalTotal 4,621,867 24% 4,621,867 24%

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Mortality in Job Corps

PY01 to PY04 (1PY01 to PY04 (1stst 45 weeks) – 82 deaths 45 weeks) – 82 deaths

• Unintentional injuryUnintentional injury 32/8232/82 39%39%• HomicideHomicide 18/8218/82 22%22%• MedicalMedical 15/8215/82 18%18%• SuicideSuicide 10/8210/82 12%12%• Drugs/alcoholDrugs/alcohol 4/82 4/82 5% 5%• UnknownUnknown 3/82 3/82 4% 4%

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Mortality in Job Corps

PY01 to PY04 (1PY01 to PY04 (1stst 45 weeks) – 82 deaths 45 weeks) – 82 deaths

• Unintentional injuryUnintentional injury 32/8232/82 39%39%• HomicideHomicide 18/8218/82 22%22%• MedicalMedical 15/8215/82 18%18%• SuicideSuicide 10/8210/82 12%12%• Drugs/alcoholDrugs/alcohol 4/82 4/82 5% 5%• UnknownUnknown 3/82 3/82 4% 4%

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Medical Mortality in Job Corps

PY01 to PY04 (1PY01 to PY04 (1stst 45 weeks) – 15 deaths 45 weeks) – 15 deaths• Cardiac diseaseCardiac disease 44• AsthmaAsthma 33• MeningitisMeningitis 22• Seizure disorderSeizure disorder 11• Sickle cell diseaseSickle cell disease 11• BronchopneumoniaBronchopneumonia 11• Blood disorderBlood disorder 11• Pulmonary embolismPulmonary embolism 11• Complication of surgeryComplication of surgery 11

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Mortality in Job Corps

PY01 to PY04 (1PY01 to PY04 (1stst 45 weeks) – 82 deaths 45 weeks) – 82 deaths

MaleMale** 61/8261/82 74%74%FemaleFemale 21/8221/82 26%26%

Off CenterOff Center 68/8268/82 83%83%On Center On Center 14/8214/82 17%17%

**Male deaths in PY04Male deaths in PY04 24/2724/27 89%89%

Actual causes of death: US population, total, 2000

RankRank CauseCause # deaths# deaths % total% total11stst tobacco tobacco 435,000 435,000 18.118.122ndnd diet/inactivity diet/inactivity 365,000 365,000 15.215.233rd rd alcohol consumption 85,000 alcohol consumption 85,000 3.5 3.566thth motor vehicles 43,000 motor vehicles 43,000 1.8 1.877thth firearms firearms 29,000 29,000 1.2 1.288thth sexual behavior sexual behavior 20,000 20,000 0.8 0.899thth illicit drug use 17,000 illicit drug use 17,000 0.7 0.7 Ref: Mokdad AH et al. JAMA 291:1238 Mar 10, 2004; rev Jan 19, 2005Ref: Mokdad AH et al. JAMA 291:1238 Mar 10, 2004; rev Jan 19, 2005

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Prevalence of cigarette smoking,US high schools, 2004

GradeGrade LifetimeLifetime 30 day30 day DailyDaily

88thth 28% 28% 9% 9% 4% 4%1010thth 41% 41% 16% 16% 8% 8%1212thth 53% 53% 25% 25% 16%16%

Ref: 2004 MTFRef: 2004 MTF

Smoking affects employability!

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Surgeon General’s Report: 2004

• bladder cancerbladder cancer• cervical cancercervical cancer• esophageal canceresophageal cancer• gastric cancer gastric cancer • laryngeal cancerlaryngeal cancer

• leukemia leukemia • lung cancerlung cancer• oral canceroral cancer• pancreatic cancerpancreatic cancer• renal cancerrenal cancer

“The evidence is sufficient to infer a causal relationship between smoking and . . .”

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Surgeon General’s Report: 2004

• aortic aneurysmaortic aneurysm• atherosclerosisatherosclerosis• strokestroke• coronary heart diseasecoronary heart disease• COPDCOPD• pneumoniapneumonia

• impaired lung growth in impaired lung growth in childhood and adolescencechildhood and adolescence

• early onset of declining lung early onset of declining lung function in late adolescencefunction in late adolescence

• respiratory symptoms in respiratory symptoms in childhood and adolescencechildhood and adolescence

“The evidence is sufficient to infer a causal relationship between smoking and . . .”

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Morbidity in Job Corps

Tobacco Use on Center and off CenterTobacco Use on Center and off Center

1991 1995

2002

Obesity Trends* Among U.S. AdultsBRFSS, 1991-2002

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

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Morbidity Associated with Obesity

• type 2 diabetes mellitustype 2 diabetes mellitus• hypertensionhypertension• hyperlipidemiahyperlipidemia• cardiovascular diseasecardiovascular disease• osteoarthritisosteoarthritis• gallbladder diseasegallbladder disease• sleep apneasleep apnea• breast and colon cancerbreast and colon cancer

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Morbidity in Job Corps

Overweight and Inactivity: Pilot Study ResultsOverweight and Inactivity: Pilot Study ResultsGrafton Job Corps Center – Winter 2004Grafton Job Corps Center – Winter 2004

OverweightOverweightBMI BMI >> 25 25

ObeseObeseBMI BMI >> 30 30

Morbidly obeseMorbidly obeseBMI BMI >> 40 40

All studentsAll students 45%45% 26%26% 7%7%

MaleMale 35%35% 20%20% 5%5%

FemaleFemale 54%54% 31%31% 8%8%

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Medical Program Goals

• Implement case management for all Job Implement case management for all Job Corps students with chronic illnessCorps students with chronic illness

• Launch a center-based asthma management Launch a center-based asthma management initiative in 2005initiative in 2005

• Strengthen the Job Corps Tobacco Use Strengthen the Job Corps Tobacco Use Prevention Program (TUPP)Prevention Program (TUPP)

• Strengthen the Job Corps Weight Strengthen the Job Corps Weight Improvement Program (WIP)Improvement Program (WIP)