Connecting Health and Wellness to Career Development and Beyond: Center Life to Community Living Medical Priorities in the Health and Wellness Program John Kulig, MD, MPH Principal Medical Consultant

2 Health & Wellness Program Goals Develop a model health and wellness program for Job CorpsDevelop a model health and wellness program for Job Corps Require the setting of health and wellness goals for all students enrolled in Job CorpsRequire the setting of health and wellness goals for all students enrolled in Job Corps Implement case management for Job Corps students with chronic illness and/or disabilityImplement case management for Job Corps students with chronic illness and/or disability

3 Medical Program Goals Implement case management for all Job Corps students with chronic illnessImplement case management for all Job Corps students with chronic illness Launch a center-based asthma management initiative in 2005Launch a center-based asthma management initiative in 2005 Strengthen the Job Corps Tobacco Use Prevention Program (TUPP)Strengthen the Job Corps Tobacco Use Prevention Program (TUPP) Strengthen the Job Corps Weight Improvement Program (WIP)Strengthen the Job Corps Weight Improvement Program (WIP)

5 US Mortality: ages years, 2002 Deaths % Deaths % AccidentsAccidents (unintentional injuries)7,13752% AssaultAssault (homicide)1,89214% Intentional self-harmIntentional self-harm (suicide)1,51311% _______________________________________________ Total 10,54277%

6 Years of Potential Life Lost (YPLL) Before Age 75, United States, 2002 YPLL % YPLL % AccidentsAccidents (unintentional injuries) 2,931,565 15% AssaultAssault (homicide) 940,781 5% Intentional self-harmIntentional self-harm (suicide) 749,521 4% _________________________________________________________________________ Total 4,621,867 24%

7 Mortality in Job Corps PY01 to PY04 (1 st 45 weeks) – 82 deaths Unintentional injury32/8239%Unintentional injury32/8239% Homicide18/8222%Homicide18/8222% Medical15/8218%Medical15/8218% Suicide10/8212%Suicide10/8212% Drugs/alcohol 4/82 5%Drugs/alcohol 4/82 5% Unknown 3/82 4%Unknown 3/82 4%

9 Mortality in Job Corps PY01 to PY04 (1 st 45 weeks) – 82 deaths Unintentional injury32/8239%Unintentional injury32/8239% Homicide18/8222%Homicide18/8222% Medical15/8218%Medical15/8218% Suicide10/8212%Suicide10/8212% Drugs/alcohol 4/82 5%Drugs/alcohol 4/82 5% Unknown 3/82 4%Unknown 3/82 4%

10 Medical Mortality in Job Corps PY01 to PY04 (1 st 45 weeks) – 15 deaths Cardiac disease4Cardiac disease4 Asthma3Asthma3 Meningitis2Meningitis2 Seizure disorder1Seizure disorder1 Sickle cell disease1Sickle cell disease1 Bronchopneumonia1Bronchopneumonia1 Blood disorder1Blood disorder1 Pulmonary embolism1Pulmonary embolism1 Complication of surgery1Complication of surgery1

11 Mortality in Job Corps PY01 to PY04 (1 st 45 weeks) – 82 deaths Male * 61/8274% Female21/8226% Off Center68/8283% On Center 14/8217% * Male deaths in PY04 24/2789%

Actual causes of death: US population, total, 2000 Rank Cause # deaths % total 1 st tobacco 435, nd diet/inactivity 365, rd alcohol consumption 85, th motor vehicles 43, th firearms 29, th sexual behavior 20, th illicit drug use 17, Ref: Mokdad AH et al. JAMA 291:1238 Mar 10, 2004; rev Jan 19, 2005 Ref: Mokdad AH et al. JAMA 291:1238 Mar 10, 2004; rev Jan 19, 2005

13 Prevalence of cigarette smoking, US high schools, 2004 Grade Lifetime30 dayDaily 8 th 28% 9% 4% 8 th 28% 9% 4% 10 th 41% 16% 8% 12 th 53% 25%16% Ref: 2004 MTF

Smoking affects employability!

15 Surgeon General’s Report: 2004 bladder cancerbladder cancer cervical cancercervical cancer esophageal canceresophageal cancer gastric cancergastric cancer laryngeal cancerlaryngeal cancer leukemia lung cancer oral cancer pancreatic cancer renal cancer “The evidence is sufficient to infer a causal relationship between smoking and...”

17 Surgeon General’s Report: 2004 aortic aneurysmaortic aneurysm atherosclerosisatherosclerosis strokestroke coronary heart diseasecoronary heart disease COPDCOPD pneumoniapneumonia impaired lung growth in childhood and adolescence early onset of declining lung function in late adolescence respiratory symptoms in childhood and adolescence “The evidence is sufficient to infer a causal relationship between smoking and...”

18 Morbidity in Job Corps Tobacco Use on Center and off Center

Obesity Trends* Among U.S. Adults BRFSS, No Data <10% 10%–14% 15%–19% 20%–24% ≥25% (*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” woman)

21 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

23 Morbidity in Job Corps Overweight and Inactivity: Pilot Study Results Grafton Job Corps Center – Winter 2004 Overweight BMI > 25 Obese BMI > 30 Morbidly obese BMI > 40 All students 45% 45% 26% 26% 7% 7% Male 35% 35% 20% 20% 5% 5% Female 54% 54% 31% 31% 8% 8%

24 Medical Program Goals Implement case management for all Job Corps students with chronic illnessImplement case management for all Job Corps students with chronic illness Launch a center-based asthma management initiative in 2005Launch a center-based asthma management initiative in 2005 Strengthen the Job Corps Tobacco Use Prevention Program (TUPP)Strengthen the Job Corps Tobacco Use Prevention Program (TUPP) Strengthen the Job Corps Weight Improvement Program (WIP)Strengthen the Job Corps Weight Improvement Program (WIP)