Primary Prevention Initiative: Obesity 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

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); 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

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

PPI Teams Team members will be: Team members are not sole workers Catalysts Encouragers Resource providers Data keepers/providers Team members are not sole workers Teams will engage community partners to accomplish activities

PPI Teams Team size will vary Team composition: 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

Topics for PPI Activities Tobacco Obesity Teen Pregnancy Infant Mortality Substance Use and Abuse Immunizations Suicide Prevention Occupational Safety Healthcare Associated Infections

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

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

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

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

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

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/APOP/APOP_insert.pdf Tennessee State Plan on Nutrition, Physical Activity and Obesity http://www.eatwellplaymoretn.org/assets/files/plan.pdf

PPI Proposal Once determined, submit PPI Proposal in PPI Proposal Survey Gizmo link: http://www.surveygizmo.com/s3/1537642/PPI-Proposal

PPI Proposal contains County Topic Objective Activities Team members Primary contact Community partners Estimated Start Date Estimated Completion Date

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

PPI Activity Reporting Contains 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

Applying Primary Prevention Principles to Obesity Prevention

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% 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.

Major changes in survey methodology* 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, Planning and Assessment; Behavioral Risk Factor Surveillance System. *BRFSS had substantial methodological changes starting in 2011; 2011-2013 data are not comparable to earlier years.

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

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

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

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 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/

Technical Assistance Resources Beth Allen: elizabeth.allen@tn.gov CDC 1305 Chronic Disease & School Health Grant Nutritionist 615-253-8729 Joan Cook: joan.cook@tn.gov Project Diabetes & Gold Sneaker Initiative 615-253-8745 Dare Bible: dare.bible@tn.gov Project Diabetes Public Health Educator 615-253-0005