Transcript Applying Primary Prevention Principles to Obesity Prevention

Primary Prevention Initiative:
Obesity Module
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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
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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
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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
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•
•
•
•
•
•
•
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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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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 Obesity Prevention
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2012 Adult Obesity Rates
• US = 27.6% obese
• Tennessee = 31.1% obese*
– 10th worst in the US (tied with Michigan)
• Best = Colorado 20.5% obese
• Worst = Louisiana 34.7% obese
* In 2013, the TN obesity rate was 33.7%
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Data Source: Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S. Department
of Health and Human Services, Centers for Disease Control and Prevention, 2012.
2013 Youth Obesity Rates
• US = 13.7 % obese
• Tennessee = 16.9 % obese
– 4th worst in the US (out of 42 states)
• Best = Utah 6.4% obese
• Worst = Kentucky 18.0% obese
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.
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Adult Obesity
Tennessee and the US, 2001-2013
50
40
Percent
35
30
25
20
23.4
20.9
24.5
21.9
25.0
22.9
27.2
23.2
27.4
24.4
28.8
25.1
30.7
31.2
26.3
26.7
32.9
26.9
31.7
27.5
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10
5
Tennessee
Major changes in survey methodology*
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33.7
29.2
27.8
31.1
27.6
U.S.
0
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
2011 2012 2013
Data Sources: 1) Centers for Disease Control and Prevention (CDC). Behavioral Risk Factor Surveillance System Survey Data. Atlanta, Georgia: U.S.
Department of Health and Human Services, Centers for Disease Control and Prevention, 2012. 2) Tennessee Department of Health; Division of Policy,23Planning
and Assessment; Behavioral Risk Factor Surveillance System. *BRFSS had substantial methodological changes starting in 2011; 2011-2013 data are not
Proven Primary Prevention
Strategies
• Example 1 — Obesity Prevention
• Objective: Early Childhood Obesity Prevention
• Activity: Increase the number of licensed child care facilities
that have healthy environments for nutrition, physical activity
and tobacco.
– Promote Gold Sneaker to local child are facilities, providing
technical assistance
– Promote the involvement of children in meal planning and meal
preparation
– Establish “turn off the TV weeks” at local facilities
– Provide expertise for parent education nights
– Educate providers on how to support breastfeeding moms and
babies
– Establish family gardens at child care facilities
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Proven Primary Prevention
Strategies
• Example 2 — Obesity Prevention
• Objective: Promote Breastfeeding
• Activities: Create a community supportive of
breastfeeding
– Encourage businesses to take the “Breastfeeding Welcome
Here” pledge
– http://breastfeeding.tn.gov/
– Promote existing laws that support breastfeeding
– Publicize and enforce employer compliance with existing law to
accommodate breastfeeding mothers at work
– Build breastfeeding support groups for prenatal and
breastfeeding mothers and their families
– Encourage hospitals to have a breastfeeding policy that supports
the 10 Steps to Successful Breastfeeding
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Proven Primary Prevention
Strategies
• Example 3 — Promoting Nutritious Choices
• Objective: Increase availability of nutritious food in the
community
• Activity: Ensure nutritious choices are available for
people away from home
– Adopt healthy meeting policies for worksites
– Enable local park and recreation facilities adopt healthier menus for
concessions
– Revamp vending choices to make healthier options available at local
worksites
– Ban the sale of sugar sweetened sodas in public places
– Work to establish local farmers markets and improved distribution of
local produce
– Establish community gardens
– Promote Food Service Guidelines in school cafeterias
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Proven Primary Prevention
Strategies
• Example 4 — Promoting Physical Activity
• Objective: Increase opportunities for residents to be
more active
• Activity: Ensure physical activity opportunities are
available
– Establish Joint Use Agreements with local schools
– Establish natural surface walking trails on public land
– Establish walking groups and walking clubs for community
participation
– Promote before and after school exercise, run and/or walk clubs
– Work with city council to adopt “complete streets”
– Create walking school bus routes to enable children to walk to
school
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– Promote daily physical activity within schools
Additional Resources
• Behavioral Risk Factor Surveillance System
– http://www.cdc.gov/brfss/
• State Plan for Nutrition, Physical Activity and Obesity
– http://www.eatwellplaymoretn.org/
• County Health Rankings
– http://www.countyhealthrankings.org/#app/
• American Public Health Association
– http://www.apha.org/programs/resources/obesity/
• Center for Disease Control and Prevention
– http://www.cdc.gov/obesity/resource/
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Technical Assistance Resources
• Beth Allen: [email protected]
– CDC 1305 Chronic Disease & School Health Grant
– Nutritionist
– 615-253-8729
• Joan Cook: [email protected]
– Project Diabetes & Gold Sneaker Initiative
– Nutritionist
– 615-253-8745
• Dare Bible: [email protected]
– Project Diabetes
– Public Health Educator
– 615-253-0005
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