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

PRIMARYPrevention

SECONDARYPrevention

TERTIARYPrevention

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

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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 15

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

• 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

• 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

ApplyingPrimary 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%

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.

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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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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.

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 20130

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20.9 21.9 22.9 23.2 24.4 25.1 26.3 26.7 26.9 27.5 27.8 27.6

Adult ObesityTennessee and the US, 2001-2013

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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 25

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 26

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 27

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: 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 – Nutritionist – 615-253-8745

• Dare Bible: dare.bible@tn.gov– Project Diabetes– Public Health Educator– 615-253-0005

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