Primary Prevention Initiative: Tobacco Module. Objectives Upon completion of this module, learner will be able to: –Define levels of prevention –Describe.

Primary Prevention Initiative:Tobacco 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

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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

– NACCHO Model Practice Database• http://naccho.org/topics/modelpractices/database/

– Promising Practice Network• http://www.promisingpractices.net/programs_topic.asp

– SAMSHA National Registry of Evidence-Based Practices and Programs

• http://nrepp.samhsa.gov/

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

Tobacco Use

Tennessee Data:Tobacco Use in Adults

• 24.9% of adults in Tennessee were current cigarette smokers in 2012

• Nationwide, 19.6% of adults smoked• Tennessee had the fourth highest adult

smoking prevalence in the nation

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.

Tennessee Data:Tobacco 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.

2003 2005 2007 2009 2011 20130

102030405060708090

100

61.8 61.754.6 50.7 48.2

43.6

High School Students Who Ever Tried Cigarette SmokingTennessee, 2003-2013

Perc

ent

Tennessee Data:Tobacco 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.

2003 2005 2007 2009 2011 201305

101520253035404550

16.4 16.712.9 14.5

17.313.6

High School Students Who Obtained Cigarettes by Buying Them in a Store or Gas StationTennessee, 2003-2013

Perc

ent

Proven Primary Prevention Strategies

• Example 1—Preventing Youth Access• Objective: Decrease the % of vendor violations selling

tobacco/nicotine to youth• Activity: Monitor effectiveness of laws restricting youth

access to tobacco/nicotine products utilizing SYNAR data (Tobacco Coordinators have tobacco enforcement summary by county) and use as point of discussion.

• Establish Youth Tobacco Prevention Committees • Feedback from Youth committee on best course of action • Distribute Tobacco Retailer Education Guide to public and

retailers• All vendors are monitored and reported to the Department of

Agriculture – contact: Sherrie Kemp -615-837-5545

Proven Primary Prevention Strategies

• Example 2—Preventing Youth Access• Objective: Increase # of tobacco/nicotine-free schools

and child care campuses• Activity: Youth Tobacco Prevention Committee – get

feedback– Schools implement tobacco/nicotine-free schools/campuses

– Engage schools, youth, parents – tobacco education– Tobacco Coordinator have Tobacco/Nicotine Free School

Policies

– Schools promote education preventing tobacco/nicotine use among youth

– Promote Gold Sneaker policies (includes tobacco free day care campuses)

Proven Primary Prevention Strategies

• Example 3—Eliminate exposure to secondhand smoke in public places

• Objective: Increase # of workplaces, restaurants, parks that are 100% smoke free – including patios and outdoor areas

• Activity: Educate public about dangers of secondhand smoke– Target key areas using community supporters– Encourage restaurants/ bars to be 100% smoke free including

outdoor areas (voluntarily)– Distribute print materials and display posters on tobacco use– Spotlight and advertise workplaces that agree to a voluntary

100% smoke-free policy

Additional Resources

• Behavioral Risk Factor Surveillance System– http://www.cdc.gov/brfss/

• CDC Best Practices User Guide– http://www.cdc.gov/tobacco/stateandcommunity/bp_user_guide/index.htm

• CDC Evaluation Toolkit for Smoke Free Policies – http://www.cdc.gov/tobacco/basic_information/secondhand_smoke/evaluation_to

olkit/index.htm

• CDC Tobacco Free Sports– http://www.cdc.gov/tobacco/youth/sports/index.htm

• County Health Rankings– http://www.countyhealthrankings.org/#app/

Technical Assistance Resources for Tobacco

• Lacanas Jordan– Tobacco Use Prevention and Control Program

Director– 615-253-2551

• Horace C. Pulse Jr.– Tobacco Use Prevention and Control Health Educator– 615-741-7577