Transcript Primary Prevention Initiative: Tobacco Module

Primary Prevention Initiative:
Substance Use Module
Objectives
• Upon completion of this module, learner
will be able to:
– Define levels of prevention
– Describe how to select relevant topic, locate
data, and identify an appropriate intervention
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The Levels of Prevention
PRIMARY
Prevention
SECONDARY
Prevention
TERTIARY
Prevention
Definition An intervention
implemented before
there is evidence of a
disease or injury
An intervention
implemented after a
disease has begun,
but before it is
symptomatic.
An intervention
implemented after a
disease or injury is
established
Intent
Reduce or eliminate
causative risk factors
(risk reduction)
Early identification
(through screening)
and treatment
Prevent sequelae
(stop bad things from
getting worse)
Example
Encourage exercise
and healthy eating to
prevent individuals
from becoming
overweight.
Check body mass
index (BMI) at every
well checkup to
identify individuals
who are overweight
or obese.
Help obese
individuals lose
weight to prevent
progression to more
severe
consequences.
Adapted from: Centers for Disease Control and Prevention. A Framework for Assessing the Effectiveness of Disease and Injury Prevention. MMWR. 1992; 41(RR-3);3 001.
Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/00016403.htm
Primary Prevention Initiative (PPI)
• Established by Dr. Dreyzehner in 2012
• Goal is to focus the Department’s energy
on primary prevention—eliminating risk
factors for later problems
• Intent is for all TDH employees to engage
in primary prevention efforts in their
community
• Statewide Roll- out January, 2013
PPI Process
– All counties participating in Primary
Prevention Initiatives
– County forms PPI Team
– PPI Team meets to determine focus areas
– Counties may utilize Community Health
Assessments to determine priority topics
– PPI Team submits PPI Proposal
– PPI Team submits reports on each Activity
– Process continues
5
Team Work
• Your county may have multiple teams working
on different community activities
• Teams will spend 5% of their time working on
PPI
– Approximately ½ day every other week
6
PPI Teams
• Team members will be:
– Catalysts
– Encouragers
– Resource providers
– Data keepers/providers
• Team members are not sole workers
– Teams will engage community partners to
accomplish activities
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PPI Teams
• Team size will vary
– Teams of 3, 5, or 7 depending on health
department size
• Team composition:
– Include community members
– Teams should be multidisciplinary (clerical,
nursing, clinical, administrative)
– Include Regional office staff
• i.e. Health Promotion Coordinator and/or
Community Health Council Coordinator, county
staff such as Health Educator, Health Care
Provider, and administrative staff
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Topics for PPI Activities
– Tobacco
– Obesity
– Teen Pregnancy
– Infant Mortality
– Substance Use and Abuse
– Immunizations
– Suicide Prevention
– Occupational Safety
– Healthcare Associated Infections
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Selecting a Topic
• There are so many things you could
choose to work on—but time and
resources are limited!
• You will need to prioritize your efforts
based on the specific need(s) in your
community
• Needs (and therefore, projects) will likely
vary across the State
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Selecting a Topic
• What can you use to help you prioritize?
– Community Health Assessment Tools
– County Health Council Priorities
– Needs Assessments
– Strategic Plans
– Ranking/Report Card findings
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Locating Data
• Once you’ve selected the topic on which
you plan to focus, you will need to locate
data that is relevant to the topic
• Data can help you:
– Confirm “suspicions” or “hunches”
– Sharpen your focus on a particular aspect of
the topic
– Identify baseline for measuring improvement
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Locating Data
• Some Potential Data Sources:
– Birth/death certificates
– Hospital Discharge data
– Health Information Tennessee (HIT) website
– Behavioral Risk Factor Surveillance System
(BRFSS)
– Youth Risk Behavior Survey (YRBS)
– Pregnancy Risk Assessment Monitoring
Survey (PRAMS)
– Data from community health assessments
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Identifying An Intervention
• Once you’ve selected your topic and
gathered appropriate data, it’s time to
decide what you’re actually going to do
• There is no need to “re-invent the wheel”
• Explore what others have done, what has
been tested, and what has been shown to
work
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Identifying An Intervention
• Some Sources for Identifying an Intervention:
– Guide to Community Preventive Service
• http://www.thecommunityguide.org/index.html
– Healthy People 2020, Community Interventions
• http://www.healthypeople.gov/2020/topicsobjectives2020/ebr.
aspx?topicid=33#inter
– Institute of Medicine
• http://www.iom.edu/~/media/Files/Report%20Files/2012/APO
P/APOP_insert.pdf
– Tennessee State Plan on Nutrition, Physical Activity
and Obesity
• http://www.eatwellplaymoretn.org/assets/files/plan.pdf
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PPI Proposal
• Once determined, submit PPI Proposal in
PPI Proposal Survey Gizmo link:
http://www.surveygizmo.com/s3/1537642/PPI-Proposal
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PPI Proposal contains
•
•
•
•
•
•
•
•
•
County
Topic
Objective
Activities
Team members
Primary contact
Community partners
Estimated Start Date
Estimated Completion Date
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PPI Activity Reporting
• As the PPI Team completes each activity, report
in PPI Activity Reporting Survey Gizmo link:
• http://www.surveygizmo.com/s3/1458250/PPI-V3-0
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PPI Activity Reporting Contains
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•
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•
•
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•
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County name
Division/Office
Topic
Objective
Activity description
Key Partners/Contributions
Start date of activity
Facilitating factors of success
Barriers encountered
Plans to overcome barriers
Unanticipated outcomes
Impact measures- numbers served
Stage of Change
Success Stories
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Applying
Primary Prevention Principles
to Substance Use and Abuse
Tennessee Data:
Alcohol Use in Youth
• 28.4% of TN high school students were
current drinkers in 2013*
• 16.1% reported binge drinking†
Data Source: Centers for Disease Control and Prevention (CDC). 1991-2013 High School Youth Risk Behavior Survey Data.
Available at http://nccd.cdc.gov/youthonline/. Accessed on 8/11/2014.
*Current drinking defined as at least one drink of alcohol on at least 1 day during the 30 days before the survey.
†Binge drinking defined as five or more drinks of alcohol in a row within a couple of hours on at least 1 day during the 30 days before the survey.
Tennessee Data:
Alcohol Use in Youth
50
45
41.1
41.8
40
36.7
33.5
Percent
35
30
33.3
28.4
25.5
25
24.9
21.7
20
15
19.1
18.6
16.1
Current Drinkers*
10
Binge Drinkers†
5
0
2003
2005
2007
2009
2011
2013
Data Source: Centers for Disease Control and Prevention (CDC). 1991-2013 High School Youth Risk Behavior Survey Data.
Available at http://nccd.cdc.gov/youthonline/. Accessed on 8/11/2014.
*Current drinking defined as at least one drink of alcohol on at least 1 day during the 30 days before the survey.
†Binge drinking defined as five or more drinks of alcohol in a row within a couple of hours on at least 1 day during the 30 days before the survey.
Drug Overdose Deaths Are Increasing
• The number of drug overdose deaths in
Tennessee increased from 753 in 2001 to
1,166 in 2013.
• The number of drug overdose deaths in 2013
represents an increase of 150% over the 10
year time period
Data source: Tennessee Department of Health; Division of Policy, Planning and Assessment; Death Statistical System. Overdose deaths were defined as having underlying
cause of death ICD-10 codes X40-X44, X60-X64, X85, and Y10-Y14.
Drug Overdose Deaths Are Increasing
Deaths Due to Drug Overdose
Tennessee, 1999-2013
1,400
1,166
1,200
Number of Deaths
1,059 1,062
963
1,000
868
800
972
924
1,094
929
753
660
600
400
484
342
391
422
200
0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Data source: Tennessee Department of Health; Division of Policy, Planning and Assessment; Death Statistical System. Overdose deaths were defined as having underlying
cause of death ICD-10 codes X40-X44, X60-X64, X85, and Y10-Y14.
Drug Overdose and Motor Vehicle Traffic Accident Deaths
Tennessee and the US, 1999-2013
Age-Adjusted Deaths per 100,000 Population
30
TN MVA
US MVA
25
TN OD
US OD
20
15
10
5
0
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
Data sources: 1) Tennessee Department of Health; Division of Policy, Planning and Assessment; Death Statistical System. Deaths defined as having underlying cause of death
ICD-10 codes X40-X44, X60-X64, X85, and Y10-Y14 (overdose) or V02-V04,V09.0,V09.2,V12-V14,V19.0-V19.2,V19.4-V19.6,V20-V79,V80.3-V80.5,V81.0-V81.1,V82.0V82.1,V83-V86,V87.0-V87.8,V88.0-V88.8,V89.0,V89.2 (motor vehicle accident). 2) Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying
Cause of Death 1999-2011 on CDC WONDER Online Database, released 2014. Accessed at http://wonder.cdc.gov/ucd-icd10.html on Aug 12, 2014. 3) Warner M, Chen LH,
Makuc DM, Anderson RN, Miniño AM. Drug poisoning deaths in the United States, 1980–2008. NCHS data brief, no 81. Hyattsville, MD: National Center for Health Statistics.
Proven Primary Prevention
Strategies
• Example 1—Preventing Youth Access
Alcohol
• Objective: Decrease the % of vendor violations for selling alcohol to
youth
• Activity: Monitor effectiveness of laws restricting youth access to
alcohol products utilizing local enforcement check data (Counties
that have community prevention coalitions should check with their
local coalitions for compliance information, counties that do not have
coalitions should check with local law enforcement, who have the
authority to do alcohol checks).
•
Do you know who your Beer Board is? Beer Boards are governed at the
local level and set their own policies. Become aware of those policies and
practices as you may need to set new policies that increase fines for
persons who sell to minors or begin to implement Responsible Beverage
Service training to those who are out of compliance or as a condition of
becoming an alcohol retailer.
Proven Primary Prevention
Strategies
• Example 2—Preventing Access to
Prescription Drugs
• Objective: Decrease the prescription drugs available on
the street.
• Activity: Plan a take back event in corporation with the
DEA!
– Register with the DEA to host a take back event* at
http://www.deadiversion.usdoj.gov/Registration.html
– Partner with local agencies and the media to spread the word
about the upcoming event and raise awareness of TN’s
prescription drug problem.
– Participate in the take back event and publicize the results.
* Take back event s = are organized in partnership with law enforcement to allow individuals to drop off unused medications for proper
destruction. The purpose of these events are removal of substances from communities, raise awareness of proper drug disposal
methods, and to demonstrate the need for permanent prescription disposal sites.
Proven Primary Prevention
Strategies
• Example 3—Prevent promotion of substance
use to youth and adults.
•
•
Objective: Decrease the # of vendors selling paraphernalia and other items (clothing,
trinkets, rolling papers, pipes…) that tend to support the use and normalization of
illegal drug use.
Activity: Community supporters conduct a quarterly community scan to observe and
document outlets that sale paraphernalia and other items (Counties that have
community prevention coalitions should check with their local coalitions for
compliance information).
Develop a community scan* check sheet that identifies item placement,
visibility to youth, identification checks prior to sale, required signage, and
other community considerations.
Provide a copy of the completed community scan checklist to outlet owner with
recommended corrective action(s).
Assist community supports develop to a plan to address sales sites with
repeated poor sales practices.
*Community scan = an organized and consistent method for observing the day to day operation of an organization
without exposing the identity of those involved in the process. The community scan documents the observed practices
for a specific date, time and location with recommendations for corrective action.
Additional Resources
• Youth Risk Behavior Survey
– http://www.cdc.gov/HealthyYouth/yrbs/index.htm
• Tennessee Data Mart
– http://eou.emt.org/_TN_Repository/
• SAMHSA Center for Substance Abuse Prevention
– http://www.samhsa.gov/prevention/
Technical Assistance Resources
• Angie McKinney Jones
– Director of Prevention
– 615-532-7786
– [email protected]