1. Primary Prevention Initiative: Obesity Module

2. 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

3. 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 ; 41(RR-3); Available at:

4. 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

5. 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

6. 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

7. 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

8. 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

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

10. 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

11. 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

12. 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

13. 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

14. 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

15. Identifying An Intervention
Some Sources for Identifying an Intervention:
Guide to Community Preventive Service
Healthy People 2020, Community Interventions
Institute of Medicine
Tennessee State Plan on Nutrition, Physical Activity and Obesity

16. PPI Proposal
Once determined, submit PPI Proposal in PPI Proposal Survey Gizmo link:

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

18. PPI Activity Reporting
As the PPI Team completes each activity, report in PPI Activity Reporting Survey Gizmo link:

19. 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

20. Applying Primary Prevention Principles to Obesity Prevention

21. 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.

22. 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).  High School Youth Risk Behavior Survey Data.  Available at  Accessed on 8/11/2014.

23. 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, ) Tennessee Department of Health; Division of Policy, Planning and Assessment; Behavioral Risk Factor Surveillance System. *BRFSS had substantial methodological changes starting in 2011; data are not comparable to earlier years.

24. 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

25. 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
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

26. 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

27. 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

28. Additional Resources Behavioral Risk Factor Surveillance System
State Plan for Nutrition, Physical Activity and Obesity
County Health Rankings
American Public Health Association
Center for Disease Control and Prevention

29. Technical Assistance Resources
Beth Allen:
CDC 1305 Chronic Disease & School Health Grant
Nutritionist
Joan Cook:
Project Diabetes & Gold Sneaker Initiative
Dare Bible:
Project Diabetes
Public Health Educator