caregivers

Underage drinking is a significant public health problem in the United States.

This webpage contains interactive activities to help parents, caregivers, and teachers introduce and reinforce key messages about peer pressure, resistance skills, and other important topics related to underage drinking.

These engaging activities are designed for middle schoolers ages 11 to 13. They can be used at home, in classrooms, or in after-school programs.

The content is based on a curriculum for grades 6–8 developed by the University of Michigan. The curriculum was created for the Alcohol Misuse Prevention Study (AMPS), a large-scale project supported by the National Institute on Alcohol Abuse and Alcoholism (NIAAA).

One goal of AMPS was to give students a clearer picture about alcohol use among their peers. Many middle schoolers tend to overestimate how much other students their age really drink. When they learn more accurate information, some of the pressure to drink can subside. Other goals of AMPS were to help students learn skills to resist pressure to drink and to give them reasons not to drink. This site incorporates AMPS goals in these and other features.

This website contains three sections focused on different aspects of alcohol, peer pressure, and resistance skills, followed by a resource list in section 4. The first three sections contain an overview, handouts, and role-playing exercises. The overviews provide background information to help you prepare to discuss alcohol and peer pressure with middle schoolers. The handouts are designed to be given to middle schoolers. The role-playing exercises are designed to be led by an adult and consist of two parts—a guide for the adult leader and a script for the middle schooler to read aloud.

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Abstract

Importance: Pneumonia affects more than 250 000 nursing home (NH) residents annually. A strategy to reduce pneumonia is to provide daily mouth care, especially to residents with dementia.

Objective: To evaluate the effectiveness of Mouth Care Without a Battle, a program that increases staff knowledge and attitudes regarding oral hygiene, changes mouth care, and improves oral hygiene, in reducing the incidence of pneumonia among NH residents.

Design, setting, and participants: This pragmatic cluster randomized trial observing 2152 NH residents for up to 2 years was conducted from September 2014 to May 2017. Data collectors were masked to study group. The study included 14 NHs from regions of North Carolina that evidenced proportionately high rehospitalization rates for pneumonia and long-term care residents. Nursing homes were pair matched and randomly assigned to intervention or control groups.

Intervention: Mouth Care Without a Battle is a standardized program that teaches that mouth care is health care, provides instruction on individualized techniques and products for mouth care, and trains caregivers to provide care to residents who are resistant and in special situations. The control condition was standard mouth care.

Main outcomes and measures: Pneumonia incidence (primary) and hospitalization and mortality (secondary), obtained from medical records.

Results: Overall, the study enrolled 2152 residents (mean [SD] age, 79.4 [12.4] years; 1281 [66.2%] women; 1180 [62.2%] white residents). Participants included 1219 residents (56.6%) in 7 intervention NHs and 933 residents (43.4%) in 7 control NHs. During the 2-year study period, the incidence rate of pneumonia per 1000 resident-days was 0.67 and 0.72 in the intervention and control NHs, respectively. Neither the primary (unadjusted) nor secondary (covariate-adjusted) analyses found a significant reduction in pneumonia due to Mouth Care Without a Battle during 2 years (unadjusted incidence rate ratio, 0.90; upper bound of 1-sided 95% CI, 1.24; P = .27; adjusted incidence rate ratio, 0.92; upper bound of 1-sided 95% CI, 1.27; P = .30). In the second year, the rate of pneumonia was nonsignificantly higher in intervention NHs. Adjusted post hoc analyses limited to the first year found a significant reduction in pneumonia incidence in intervention NHs (IRR, 0.69; upper bound of 1-sided 95% CI, 0.94; P = .03).

Conclusions and relevance: This matched-pairs cluster randomized trial of a mouth care program compared with standard care was not effective in reducing pneumonia incidence at 2 years, although reduction was found during the first year. The lack of significant results in the second year may be associated with sustainability. Improving mouth care in US NHs may require the presence and support of dedicated oral care aides.

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