1. Primary Prevention Initiative: Infant Mortality 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 2

3. The Levels of Prevention PRIMARY Prevention SECONDARY Prevention TERTIARY Prevention DefinitionAn 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 IntentReduce or eliminate causative risk factors (risk reduction) Early identification (through screening) and treatment Prevent sequelae (stop bad things from getting worse) ExampleEncourage 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.htmhttp://www.cdc.gov/mmwr/preview/mmwrhtml/00016403.htm 3

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 5

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 6

7. 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 7

8. 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 8

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

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 10

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 11

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 12

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 13

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 14

15. 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#interhttp://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.pdfhttp://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 15

16. PPI Proposal Once determined, submit PPI Proposal in PPI Proposal Survey Gizmo link: http://www.surveygizmo.com/s3/1537642/PPI-Proposal 16

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

18. 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 18

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 19

20. Applying Primary Prevention Principles to Infant Mortality Prevention

21. Tennessee Data: Infant Mortality 7.9 out of every 1,000 babies born in Tennessee die before reaching their first birthday (2010) Many infant deaths in Tennessee can be attributed to prematurity and low birth weight, which are largely related to the mother’s health before she ever becomes pregnant Other causes of infant death include: –Congenital malformations –Suffocation/strangulation (ex. Sleep-related deaths) –Infection Data Source: Tennessee Department of Health, Number of Infant Deaths per 1,000 Births. Available at: http://health.tn.gov/statistics/PdfFiles/VS_Rate_Sheets_2010/Infant2010.pdf http://health.tn.gov/statistics/PdfFiles/VS_Rate_Sheets_2010/Infant2010.pdf

22. National and State Data: Infant Mortality Trends Sources: Tennessee Department of Health, Division of Health Statistics; Centers for Disease Control and Prevention, National Center for Health Statistics.

23. Tennessee Regional Data: Infant Mortality Data Source: Tennessee Department of Health, Vital Statistics Resident Summary Data 2010. Available at: http://health.tn.gov/statistics/PdfFiles/VSSum10.pdf http://health.tn.gov/statistics/PdfFiles/VSSum10.pdf

24. Proven Primary Prevention Strategies Example 1—Promote Breastfeeding Objective: Increase the percentage of mothers who breastfeed their infants Activity: Support mothers’ efforts in initiating and continuing breastfeeding. –Encourage businesses to take the “Breastfeeding Welcome Here” pledge http://www.eatwellplaymoretn.org/resources-and-tools/breastfeeding- welcome-here.htmlhttp://www.eatwellplaymoretn.org/resources-and-tools/breastfeeding- welcome-here.html –Promote existing laws that support breastfeeding –Build breastfeeding support groups for prenatal and breastfeeding mothers and their families –Implement the “Give Me 5” campaign in local hospitals http://www.nashvitality.org/healthy/breastfeeding.aspx

25. Proven Primary Prevention Strategies Example 2—Promote Safe Sleep Objective: Increase safe sleep practices among Tennessee caregivers Activity: Promote “ABC’s of Safe Sleep” –Work with local child care centers to develop safe sleep policies that align with the latest recommendations from the American Academy of Pediatrics –Work with local hospitals to ensure that hospital nurseries adopt safe sleep policies –Share safe sleep information with new parents and other caregivers (grandparents and other relatives) –Create a safe crib display for use in public venues

26. Proven Primary Prevention Strategies Example 3—Prevent smoking among women of childbearing age Objective: Decrease the percentage of women of childbearing age who smoke Activity: Educate public about dangers of smoking for mother and baby and connect smoking women with cessation resources –Distribute print materials and display posters on tobacco use –Discuss the dangers of smoking at adolescent well visits and well-woman visits –Screen pregnant women for substance use (including tobacco)* –Promote use of the Tobacco QuitLine for everyone who smokes* *Note: Smoking cessation would normally not be considered primary prevention. However, in the case of infant mortality, smoking cessation among women of childbearing age can reduce the likelihood of premature birth or low birth weight, both of which contribute to infant mortality. While smoking cessation is tertiary prevention for the mother, it can be viewed as primary prevention of infant mortality when viewed from the infant’s perspective.

27. Additional Resources AMCHP Compendium: Forging a Comprehensive Initiative to Improve Birth Outcomes and Reduce Infant Mortality –http://www.amchp.org/programsandtopics/womens-health/infant- mortality/Pages/default.aspxhttp://www.amchp.org/programsandtopics/womens-health/infant- mortality/Pages/default.aspx Georgetown MCH Library: Infant Mortality and Pregnancy Loss Knowledge Path –http://mchlibrary.info/KnowledgePaths/kp_infmort.htmlhttp://mchlibrary.info/KnowledgePaths/kp_infmort.html National SUID/SIDS Resource Center –http://www.sidscenter.org/http://www.sidscenter.org/ TN Department of Health Safe Sleep Campaign –http://safesleep.tn.govhttp://safesleep.tn.gov

28. Technical Assistance Resources Rachel Heitmann –Director, Injury Prevention and Detection –615-741-0368 Kelly Luskin –Women’s Health Nurse Consultant –615-741-0370 Michael Warren –Director, Family Health and Wellness –615-741-0310