1. Primary Prevention Initiative: Substance Use 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 Substance Use and Abuse

21. 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.http://nccd.cdc.gov/youthonline/ *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.

22. Tennessee Data: Alcohol Use in Youth 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.http://nccd.cdc.gov/youthonline/ *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.

23. 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

24. 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.

25. 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,V82.0- V82.1,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. 2011.

26. 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.

27. 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 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.

28. 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.

29. Additional Resources Youth Risk Behavior Survey –http://www.cdc.gov/HealthyYouth/yrbs/index.htmhttp://www.cdc.gov/HealthyYouth/yrbs/index.htm Tennessee Data Mart –http://eou.emt.org/_TN_Repository/http://eou.emt.org/_TN_Repository/ SAMHSA Center for Substance Abuse Prevention –http://www.samhsa.gov/prevention/http://www.samhsa.gov/prevention/

30. Technical Assistance Resources Angie McKinney Jones –Director of Prevention –615-532-7786 –Angela.mckinneyjones@tn.gov