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Heart Health Training Checklist: Does Your Team Have These Skills? [Checklist]

Heart disease is responsible for the most deaths of men, women, and people in most racial and ethnic groups around the US. People with heart conditions, such as hypertension or cardiovascular disease, have a higher risk of severe illness from COVID-19.

[Download Now: Heart Health Training Checklist]

Having a healthy heart is more important now than ever before. Luckily, people can protect themselves from heart disease and stroke in many ways. As a result, they can both reduce their risk and manage heart disease by making lifestyle changes like eating healthfully and staying physically active.

That’s why health promoters–such as community health workers, promotores (CHW/Ps), or similar job titles, are so important to healthcare agencies. They can use patient education and community outreach to improve health outcomes and avoid emergency rooms (ERs).

Heart Disease and Stroke Training for Community Health Teams

Training your team in heart health makes sense. CHW/Ps with the right skills can guide patients and clients toward preventing heart disease and stroke.

This means making sure your employees or volunteers are equipped to work directly with clients and patients to provide heart health education, find motivation for change, connect people with local resources and providers, and help to set, accomplish and maintain goals.

Some of these skills are covered in standard CHW core competencies training, but a more focused approach on cardiovascular health pays off.

Heart Health Checklist

 

Organizing Onboarding Programs

Every organization that serious about improving cardiovascular health in the community needs a training checklist to guide them when hiring new people. Making sure each hire has essential heart health training sets the tone their experience at your agency. Be organized about training at the beginning of the hiring process, or when educating an existing team to have community health skills. That way, your team perform better and make a bigger impact at work.

Some agencies train staff members by on-the-job training only. That process is certainly useful and should be part of a comprehensive training program. However, one-dimensional training leaves out a comprehensive foundation of knowledge.

Teams who learn the basics first can make better decisions and take smarter actions when they’re working with clients. They also stand to be better understood by a multidisciplinary team as part of a formal education plan.

Heart Health Training Checklist

 

Using a checklist makes the evaluation process simpler. So, we’ve created a Heart Health Training Checklist for you to download for free.

You can use this checklist to:

  1. Assess the skills of potential and new staff
  2. Evaluate the training needs of existing staff
  3. Help staff understand what they need to know in order to do their job
  4. Decide what training capacity you have internally vs. what you need to acquire from a vendor

When you use the checklist, add when the training was completed and also the date when training needs to be renewed—usually every year. Also include where the team member was trained and also an official sign-off, possibly by a director or HR manager. HR departments sometimes require a certificate of completion, so make sure your employee hands that over when they’re done.

Adapting Training to Various Teams

This checklist works for most teams that work in the role of a CHW. Here are some ideas for customizing it for different community-health oriented teams.

For Community Health Representative (CHR) Teams

  • Health disparities and social determinants of health
  • Basic anatomy/physiology
  • Community disease profiles
  • Emergency patient care

For Peer Support Specialists or Recovery Coaches

Add training in…

  • Behavioral health
  • Comorbidities and co-occurring conditions
  • Administering Naloxone

For Care Coordination Teams

Add training in…

  • Conducting community needs assessments
  • Documentation skills
  • Organizational skills
  • Service navigation
  • Telehealth

For Family Navigators

Add training in…

  • Conducting community needs assessments
  • Service navigation
  • Health disparities and social determinants of health

10 skills CHWs can learn right now—without leaving the couch

 

Why Teaching About Health Disparities Transforms Communities

By Kellie Woodson

As an instructional designer, I use my expertise in teaching and learning to create learning experiences on a wide variety of health topics. Whether I’m developing a course on breast cancer genetics or oral health , a significant part of the process is partnering with experts in the field to develop courses that are informative, engaging and effective.  Since many of these courses are written for frontline health workers such as community health workers or promotores (CHWs/Ps), they must also motivate participants to make positive changes in their communities.

[RELATED: Improve the mental wellness of your team]

Overcoming Barriers to Healthy Choices

A typical course not only provides information on health conditions; it also teaches strategies to effectively guide others in making healthier choices. To do this, it is important to acknowledge the barriers to healthy living that many people face.

For example, we know that regular health checks and healthy eating are important to overall health. But the truth is, getting to the doctor or grocery store can be very difficult for individuals who are disabled, elderly, or who live in rural areas.

The courses I write challenge participants to acknowledge and reflect on the realities of others that they might otherwise take for granted.

  • How does a person who struggles to get around their own home travel to regular doctor’s visits?
  • How can a person make healthier food choices if they only have access to neighborhood convenience stores? 
  • Does the disproportionate number of tobacco advertisements in low-income communities affect smoking rates in these areas?
  • How does one’s education level affect their ability to complete an application for financial healthcare assistance?

The truth is that for many individuals, factors such as age, disability, geographical location and education level pose significant barriers to staying healthy. These barriers in turn give rise to health disparities, or preventable differences in the rate of disease and access to health services among specific groups of people.  While health disparities can and do affect all people, they are more common among minorities and the socio-economically disadvantaged.

The coronavirus has been a wake-up for many as they see how the pandemic is affecting races differently in this country. Hospitalization and death rates from COVID-19 are highest among American Indian or Alaska Native and non-Hispanic blacks—five times higher than for whites, according to the CDC.

When writing a tobacco cessation course for the state of Washington’s Community Health Worker Training program, I learned that African Americans, Asian Americans, members of the LGBT community and American Indians use tobacco products in disproportionate numbers when compared to other groups in Washington.

Across the nation, individuals with lower income and education levels are also more likely to use tobacco.  These disparities then give rise to tobacco-related illness and disease. Due to the lack of quality health care, individuals living in rural areas, those who are living at or below the poverty line and those who have lower education levels are more likely to die as a result of tobacco-related disease.  

 

Health Disparities Reach Farther Than You Think

It’s important to understand that health disparities aren’t simply the result of groups of people making bad choices. Disparities are systemic, complex and cyclical in nature. For example, groups of people who migrated to the U.S. have been found to have high rates of mental disorder and trauma due to the hardships they experienced during migration.  Racism and oppression often result in trauma-related mental illness. To make matters worse, marginalized groups of people often avoid diagnosis and treatment which further perpetuates these disparities.

Consider these statistics:

  • Asian-American women over age 65 have the highest suicide rate of all similarly-aged women in the United States.
  • LGBT youth are about 2 1/2 times more likely to attempt suicide than their peers.
  • Only about ten percent of physicians practice in rural America.
  • People who live and work in low socioeconomic circumstances have an increased risk for mortality, unhealthy behaviors, reduced access to health care and low quality of care.
  • Due to trauma experienced before and after immigration to the United States, Southeast Asian refugees have an increased risk for posttraumatic stress disorder.
  • Native Hawaiians and Pacific Islanders are 30 percent more likely to be diagnosed with cancer than whites.
  • Close to a third of Hispanics get regular health care, including those with chronic health conditions.
  • African-American adults with cancer are significantly less likely to survive prostate cancer, breast cancer and lung cancer than their white counterparts.

These alarming statistics only represent a small fraction of the disparities that exist in our country. Remember that health disparities are found in every group in the U.S. and in every part of the body.

Frontline Health Workers and Communities

Being a frontline health worker is not just about giving guidance and advice– it’s a call to action and advocacy. These people and their employers their community members better than anyone else, and they understand the communities’ challenges, weaknesses and strengths.  As they educate and guide clients to achieving better health, they have the responsibility to acknowledge barriers to care and why they exist. This understanding will help them to better anticipate their client’s needs and respond appropriately and effectively.

Frontline health workers take different paths to solving problems. Many take it upon themselves to create much needed resources and programs in their communities. Others see themselves as organizers who unite members of the community to create solutions where none exist. Whatever the response, you are in the position to make a tremendous impact.

At the end of the day, the goal is to build communities where race, sex, sexual identity, age, disability or socioeconomic status never, ever affect one’s ability to be healthy.

Kellie Woodson is an expert in teaching, learning, and instructional design with content area specialization in health, science, and mathematics. She has extensive experience developing curriculum and learning programs for schools, organizations, and national and international publishers.

10 Signs You Need to Make a Behavioral Health Referral

Life is full of stressful situations. Frontline health workers, such as community health workers or promotores, are used to supporting clients as they juggle health issues along with stressors like child care and work. That’s on a good day.

Now think about how clients and patients deal with the outbreak of a crisis like the coronavirus disease 2019 (COVID-19) on top of day-to-day anxieties. This means more people are worried about paying the water bill, eviction, varying family obligations, changes to daily routines, and job instability.

[Download Now: Behavioral Health Resources]

Chronic stress can come from many sources such as poverty, long-term sickness, or domestic violence, in addition to a global pandemic. Stress has a serious effect on a person’s overall wellness. It can increase the risk of heart disease and strokes. It can increase depression, anxiety, and more serious mental illnesses—all associated with heart disease and a lower immune system. Stress can also lead people to unhealthy choices with food and substances.

“It’s now 455 days since my last sip of alcohol, and right now it feels harder than it has done, in over a year,” Yvette Mayer, a leadership coach, said on LinkedIn. “The idea of buffering with a bottle of red wine is appealing. I know I’m very unlikely to be alone in this ‘urge’.”

Supporting clients and patients in controlling stress is critical.

Managing Stress

10 Signs You Need to Make a Behavioral Health Referral

CHWs might feel helpless when they see clients have difficulty dealing with these anxieties, but they can still help. It’s always an important for CHWs to support clients’ behavioral health. They can do some things like be an active listener, give suggestions for telehealth, and coach healthy living. Here are two:

  1. Manage stress for health from the California Department of Public Health has some simple tips
  2. Free Online Sobriety Support During Covid-19 from the Sober Señorita is a great resource to share with clients with alcohol abuse issues

Supervisors of CHWs and program managers should look out for signs of stress and burnout among their staff. These resources are helpful with clients and also internally.

But there are some more serious signs that CHWs need to refer clients to a behavioral health provider who can give more support. Making a referral for a mental illness like depression or severe anxiety is an important step. Mental health disorders, like any chronic disease, can be managed or avoided with early intervention.

10 Signs Someone Needs a Behavioral Health Referral

  1. Suicidal thoughts
  2. Trouble concentrating
  3. Lack of interest
  4. Restlessness
  5. Constantly checking news outlets or social media
  6. Changed sleep patterns
  7. Fatigue
  8. Distant or withdrawn
  9. Mood swings
  10. Diet changes

These are 10 signs community health workers can look out for if you suspect someone in your community is struggling and needs help:

1. Suicidal thoughts

If someone talks about killing or harming themselves, make a referral right away. Call the 24-hour Suicide Prevention Lifeline at
1-800-273-8255 or text 838255. Not everyone who has suicidal thoughts shows them, but you can certainly notice subtle remarks that may point to trouble.

2. Trouble concentrating

When someone has difficulty concentrating on daily activities, are confused, forget things, has trouble getting anything done, this can be a sign of depression, anxiety, or substance use.

3. Lack of interest

Another warning sign is a lack of interest in things that used to cause joy, and even personal care. This can show up as the person not bathing or eating, stopping their hobbies, neglecting their job or responsibilities, and disengaging from their daily routine.

4. Restlessness

Someone might not be able to sit still. They might constantly shake their leg, shift between their feet when standing up, or fiddle with things in their hand.

5. Constantly checks news outlets or social media

Panic-scrolling is a sign of anxiety. This is the constant need to refresh social media channels, even knowing that nothing has changed since the last time they checked.

6. Changed sleep patterns

Someone might complain of sleeping more than usual or not sleeping at all. Significant changes in sleeping patterns can be a sign of a mental health issue—and can in some cases make it worse.

7. Fatigue

Feelings of fatigue might have nothing to do with sleep patterns. Even with normal sleeping, someone can feel constant fatigue. Even without realizing it, someone might feel this way because of irregular sleep, waking up in the middle of the night, or not being able to enter a deep state of sleep.

8. Distant or withdrawn

People who are clinically depressed often feel like withdrawing from social activities. Being isolated is not only a sign of mental illness but it can also be a cause of mental illness. This is especially challenging when so many people are required to self-isolate to stop spreading the virus.

9. Mood swings

Even though it’s fairly normal to go between moods in a week or even a day, someone who’s struggling with anxiety, depression, substance use, or other serious mental illnesses may experience wild changes in their mood quickly.

10. Diet changes

Whether someone is overeating or restricting food intake, any drastic changes to their daily food habits are often a red flag. This is another symptom that could be a cause. A healthy diet, such as the Mediterranean diet or DASH diet, can help with mental health as well as a variety of other conditions—including virus immunity.

Success

Does your team need training in behavioral health? Read about our Healthy Living learning track.

How I Started a Community Health Initiative and How It Can Make Your Clients Healthier

Finding fitness, friendship, and lifestyle change on the road to community health

By Eliana Ifill

One of the hardest parts of doing physical activity is finding the confidence and motivation to start. It’s intimidating to make a big life change, and it can be easier to push it to the side.

People like community health workers (CHWs) and promotoras know how limiting this is. They see how older people and those who stay home live in isolation unless they take an intentional approach to improving their social lives. Inactivity can lead to all sorts of health problems, according to the American Heart Association, including heart disease, high blood pressure, obesity, stroke, type 2 diabetes, depression, cancers—and more. Active living is a topic we cover in many of the elearning courses at CHWTraining.

Public spaces also take a hit when individuals stay home: parks and streets are empty, and smaller roads can be neglected by local authorities. This makes it even harder for community members to step outside and take charge of their health.

[Related Community Engagement the Right Way with Outreach Skills]

In my case, I live near an industrial area. It was bustling with activity during business hours. But come 5 p.m. the roads were empty, the lights didn’t work, and the police had long left the streets.

Collaborating for an Active Community

I had come home to Venezuela after living in the U.S. for a while and didn’t have a steady job or other activities where I could meet people. This, combined with some personal challenges, made me start thinking about forming a fitness group of some sort. After all, I’ve been involved in one sport or another since college. Integrating physical activity as part of my daily life has always been important to me. And the lack of activity mixed with all the life changes and all the time spent at home was really taking a toll on my mental health.

I ran into (pun intended) another neighbor with a similar idea: She and her husband had made drastic lifestyle changes, and along with a friend they decided to try and promote sports in our small community.

I found them on Twitter and we decided to try forming a community running group design a short route around our neighborhood. We started very small–just the four of us–and soon, a lot of neighbors started joining us to run three times a week.


Eliana’s running group after a run.

How success spread across the community

We found that the safety and comfort provided by group activities helps keep people accountable while they build a habit for themselves, especially in older communities. Running with others is a powerful motivator.

Group activity like ours helps neighbors connect over shared interests; bond in new, meaningful ways; and regain confidence, purpose, and happiness in their lives.

My running group reached close to 80 people running together on Tuesdays, Thursdays, and Sundays.

The demographics were wildly varied: there were a few of us in our early 20s, some in their mid-40s, and quite a few in their 60s and 70s. The younger ones often led the pack, going back and forth on our routes ensuring everyone was OK and no one was left behind.

And we had some experts: A trainer who led our warmups and HIIT classes on the weekends; a hiker who led our expeditions through the nearby mountains, and some yoga instructors. There was one man, Manuel, who worked in security for our community association and coordinated the team’s safety throughout the route, reminding everyone to bring reflective clothing, carrying radios and flashlights, and always counting heads before we left and after coming back.

We gathered local support and had police escorts on our routes, made T-shirts for the group, showed up in some radio interviews, and worked locally with churches and other initiatives.


Eliana’s running group in the orange T-shirts they had made.

Of course, the physical benefits were great. It was especially exciting to see those over 50 finishing their first races, shaving off minutes between 10ks, trying out yoga and hiking for the first time.

Many of the participants remain active to date (the group started in 2015 and Venezuela’s crisis made many of the original members move to other countries). Many of us remain close friends. We celebrated birthdays, went to theaters, had holiday parties, and supported each other through races and beyond.

More than simply exercising, we’d built a community based on friendship and common goals.

Skills to Motivate Lifestyle Change

CHWs and promotoras who work in neighborhoods that don’t lend themselves to physical activity can follow my lead and still make a difference. Training programs can provide the key skills they need to make meaningful change, especially among clients with chronic illnesses or high utilizers of emergency rooms.

[Related Build Skills in These 3 Areas To Stop Diabetes Killing People]

It helps to understand how healthy eating and active living (HEAL) programs fit into health conditions like HIV/AIDS, diabetes, heart disease, and others. But to build a program that can lead to community change, here are some of the most important skill-building courses any agency should provide to their staff:

Promoting Healthy Lifestyles

Practicing healthy behaviors has a huge effect on a person’s life. Knowing the concepts behind maintaining a well-balanced and healthy lifestyle is the place to begin to work with clients to make positive changes and mange their life. The knowledge of what a healthy lifestyle is, including nutrition, fitness, preventative healthcare, and behavioral health, helps learners instruct clients on how to make a change for the better.

Community Outreach and Engagement

Outreach is the most essential part of building and strengthening communities so the people who live in them can take advantage of everything available. By learning the basic concepts and skills in community outreach, as well as strategies such as community needs assessments, learners can promote and even create better health services.

Advocacy Skills

Advocacy Skills demonstrates ways to use advocacy to connect people to the most important resources in organizations, but also externally. They also learn how to involve the community at large in clients’ issues, educate community members, use media and social media, and organize change.

Motivational Interviewing: Peer Support for Behavior Change

Before anyone changes their health, they must want to. Training in Motivational Interviewing helps people find the lasting motivation to improve their health internally. These skills are especially useful for promoting healthy lifestyle changes, managing chronic diseases, and setting goals.

Behavioral Health Care

Physical activity has a close relationship with mental health. Understanding this relationship, as well as what the most common behavioral health conditions are, can help clients find resources and build external structures that help them improve.

Eliana Ifill is a content manager at CHWTraining.

Building a Healthy Habits Challenge: What Works and What Doesn’t

The team at CHWTraining might know all about developing and keeping healthy habits, but that doesn’t mean we always do it. Even for people in the health education business like us have habits we’d like to change: stopping smoking, drinking less alcohol, drinking more water, eating less meat, eating fewer sugary foods.

This January, our parent company Talance wanted to encourage this kind of change internally instead of just for our clients and course participants. Here’s what happened.

First, we researched several workplace wellness challenges to find a format we liked. This article on Health.gov, 7 Simple, Fun Wellness Challenges to Start At Work, had some ideas we liked.

Importantly, we wanted people to control how they participated. We teach many people about behavior change with techniques like Motivational Interviewing, and we all know that no one will change anything unless they’re inwardly motivated to do so. We wanted to tap into intrinsic motivation as well as extrinsic motivation. NBC’s Better explains it well in this article 3 types of motivation that can inspire you to do anything.

Setting Healthy Habits Goals

Armed with some ideas, we decided to create a challenge that affirmed any positive change that anyone wanted to make. However, because cutting back on smoking is the single best thing anyone can do for their health, we wanted to especially encourage any smokers to cut back or stop. The 31-Days-Free Challenge was born.

The 31-Days-Free Challenge was open to anyone who wanted to participate in one of two ways:

Title: Challenge description - Description: No Smoking Challenge: Stop smoking or cut back.Put Something Else in Your Mouth Challenge: Don't smoke? Pick something you DO or DO NOT want to do that will improve your health (drink water, quit drinking, cut out sugar).

From the start, everyone was very interested in curious about the challenge. But as time went by, fewer people decided to participate. We would have loved everyone to join, but creating new habits is tough. It has to happen on an individual basis—not just because there’s a challenge there or because it’s January 1. So we hope to catch more next time.

We were left with a core of four who signed up and stuck with it for the whole month. Here’s what our challenges looked like:

Anastasia

Title: goal - Description: My challenge: Smoke not more than 5 cigarettes per day for 5 days/ week. Don't smoke at all for 2 days/week.

Monique

Title: Goal - Description: “Reduce alcohol consumption in January from 5 units to 3 units by drinking only on weekends (Friday, Saturday, Sunday).”

Pamela

Title: Goal - Description: “I will reduce the sugar treats (cake, cookies, chocolate, ice cream, candies) + junk food (that's a long list including diet soda) from almost every day to *1 serving per week*.”

Peter

Title: goal - Description: “Eat vegetarian for 8 days in the month (about 2 days a week)”

We’re All Winners Here

There were no losers in this challenge–only winners. So we designed a system where every week participants would self-report how they did based on the achievement points (see the full list below), which were added to a scoreboard. During the week, we opened our internal chat channel (#31-days-free) to advice, reports, tips and encouragement.

This is what a typical week looked like on the scoreboard:

What Worked and What Didn’t

The result? It worked! Everyone who participated made improvement. Most people kept to their goals for the whole month, or at least got close. We all felt better physically and also had fun as a team in a different way that wasn’t related to a project.

As Anastasia said, “For me, it was important that we did it as a team, and that each week I had to say how I was [doing] and state specific achievement points.”

As planned, our chat channel was busy with reports, encouragement and recipes. It was empowering to see how everyone was working toward their goals and how they were navigating barriers. We were all in the spirit of helping each other succeed.

And as expected, there were some unforeseen holdups. For example, my challenge, which required me to cut out my dinnertime glass of wine most nights, didn’t take into account a mid-week birthday celebration that included champagne. So next time, I know to build in some flexibility.

This is a good lesson for anyone who doesn’t reach their goal, whether it’s someone with type 2 diabetes trying to cut down on sugary foods or someone who’s looking to control substance use. Failure can be valuable. It teaches you what your limits are and reveals obstacles that you can navigate next time.

Smokers know this too. Quitting is hard. Slip-ups are inevitable and can be discouraging. According to one study, “it may take 30 or more quit attempts before being successful.” But each slip-up is a learning experience. Note it, what caused it, and keep moving.

There were also some problems with the format. It felt too much like a competition to some. Anastasia said, “Competition didn’t work for me. I wanted to help and learn from the others so I couldn’t see it as a competition.”

There were also some logistical hiccoughs. About halfway through the month, we noticed that some people were making excellent progress but not earning any achievement points. We added a “fill-in-the-blank” point to use whenever you’re doing well but aren’t fitting the list of points.

Next time, we’ll probably forget any points and instead focus on supporting healthy habits only. Importantly, there will be a next time, and many of us are still sticking with our new healthy habits even past January. Hello, flexibility challenge!

Wellness Achievement Points

Here were the achievement points we awarded, which you can copy for motivating your group.

General Points

  1. Post your SMART goal to #31-days-free
  2. Put yourself on the scoreboard
  3. Help someone on  #31-days-free stay on goal
  4. Share a tip on #31-days-free for staying on challenge
  5. Stick to your challenge for 1 week for 1 bonus point
  6. Stick to your challenge for 2 weeks for 2 bonus points
  7. Stick to your challenge for 3 weeks for 3 bonus points
  8. Stick to your challenge for 4 weeks for  4 bonus points
  9. Recruit one person in your life to do your challenge with you
  10. Find a team partner
  11. Meet your challenge goal on both Saturday and Sunday
  12. Walk around the block instead of doing something you’re trying to stop
  13. Set your health goal for February
  14. Meditate
  15. Suggest an achievement point (if it gets enough thumbs-up, you
    get a point, and we’ll add it to the list)
  16. Distract yourself by doing a good deed for a few minutes

No-Smoking Points

  1. Go 1 day without smoking
  2. Try Nicotine Replacement Therapy (NRT), such as Nicorette gum, patch, lozenge
  3. Get a Chantix prescription
  4. Walk past the tobacconist
  5. Play with your phone rather than smoke
  6. Remove all ashtrays
  7. Look up number for local quitline
  8. Call quitline
  9. Set a quit day
  10. Download a quit app to your phone (QuitNow! for Android or QuitNow! for Apple)
  11. Read a quit smoking book
  12. Give money for a pack of cigarettes to a trusted friend or charity for safekeeping instead of buying one (count how much you have on Feb. 1)
  13. Attend a support group, such as https://stepbac.com/ or https://www.icoprevencio.cat/uct/en/quit-smoking/
  14. Try an alternative therapy, like acupuncture
  15. Take smoking cessation class
  16. Go to a smoke-free zone when you feel like smoking

Put-Something-Else-in-Your-Mouth Points

  1. Download a healthy eating app to your phone (food log, exercise log, no drinking log)
  2. Walk 1000 steps (or 1/4 mile or 1 km) instead of putting That Thing in your mouth
  3. Get a pedometer
  4. Cook a new healthy recipe (share it on #31-days-free)
  5. Skip meat at 1 meal
  6. Have a meatless Monday
  7. Eat 5 servings of produce in a day
  8. Drink a glass of water instead of a glass of wine
  9. Drink 8 glasses of water in a day
  10. Walk somewhere instead of driving/taking a taxi/metro
  11. Create a healthy grocery list
  12. Try one new healthy food you haven’t tried before
  13. Read a healthy eating/cooking book
  14. Take a cooking class that meets your challenge
  15. Plan a weekly menu (post it here!)
  16. Instead of putting That Thing in your mouth, chew a stick of gum