North Carolina s Injury & Violence Prevention Program

North Carolina s Injury & Violence Prevention Program NEHA AEC 2012 San Diego, CA NC Injury & Violence Prevention Branch Home NC Division of Public Health, Chronic Disease and Injury Section Organization 18 Permanent & Temp staff (26 FTE s with interns last year) Leadership, Epidemiology, Programs Units Extensive Partnerships Funding $3.65M from 13 grants & Funds (CDC, HRSA, SAMHSA, FEMA, John Rex Endowment) $6,500 from State Budget NEHA 2012 AEC June 2012 1

Base Integration Component (BIC) Key Features Partnership & Funding with the Forensic Test for Alcohol (FTA) Branch to work on DWI & Motor Vehicle Injury Child Maltreatment Surveillance System Project Lazarus Prescription Drug Death Prevention New Positions with BIC Epidemiologist Marketing/Policy Surveillance Quality Improvement Examine Injury ICD9 E-code Generation, Collection, and Reporting Identify how to Improve Completeness, Accuracy and Specificity of E- coding. Create the Business Case for High Quality E-coding Partnership with NC DETECT & UNC IPRC Support from NC Hospital Association Regional Network Leader Leader of a 13 State Region, SxSW Injury Prevention Network Partner with UNC Injury Prevention Research Center Monthly Training and Coordination Conference Calls Annual Network Meeting Assist, Mentor, Support the Development of the IVP Network in the Region NEHA 2012 AEC June 2012 2

What is Injury? ICD9 N &/or E-code 800-999.9 Connection with EH? Biological Chemical Physical The Public Health Approach applies to Injury like communicable diseases. Injuries & Violence are NOT: random acts of nature accidental destiny chance bad luck unavoidable Injuries & Violence ARE: Predictable Preventable Have known risk factors Opportunities for prevention NEHA 2012 AEC June 2012 3

Leading Causes of Chronic Disease and Injury Death and Years of Life Lost: N.C., 2009 Cause of Death 6,275 Total Deaths Average Years of Total Years Life Lost * of Life Lost * Cancer Deaths 17,476 3.46 60,420 Heart Disease 17,133 2.70 46,269 Injury 6,074 19.29 117,143 Stroke 869,6144,391 1.96 8,602 ED Visits Chronic Lower Respiratory 4,324 1.31 5,646 Diseases (Asthma, COPD)???,??? Outpatient Visits disease 2,645 Alzheimer's 0.04 112 Diabetes Mellitus 2,107 3.40 7,165 Hypertension?,???,??? Medically Unattended 796 Injury2.40 1,912 Atherosclerosis (home, work, school) 215 0.78 168 Total Deaths (all causes) 76,948 5.06 389,358 Chronic Disease Deaths 51,846 2.73 141,294 * Based on deaths that occurred prior to age 65 Source: N.C. State Center for Health Statistics, 2009 NEHA 2012 AEC June 2012 4

Deaths from Injury and Violence are Only the Tip of the Iceberg 10 th most populous state, 10M+ Pop 6,074* Deaths 159,645* Hospitalizations 860,103* ED Visits???,??? EMS???,??? Outpatient Visits Injury & Violence Leading Cause of Death for 86% of NC s Population (1-66 years)?,???,??? Medically Unattended Injury (home, work, school) INJURY ICEBERG * 2009 death file, 2008 for hospitalization discharge and 2009 for NC DETECT (Emergency Department visits) Leading Causes of Injury Deaths (by Number of Deaths, All Ages, North Carolina Residents: 2009) Motor Vehicle Crashes 1,342 Suicides 1,161 Unintentional Poisoning 1,036 Unintentional Falls Homicides 837 826 562 Unintentional, Other & Unspecified * 202 Unintentional Suffocation 108 Unintentional Fire/Burn Total Deaths = 6,074 * Unintentional Other and Unintentional Unspecified are two separate categories. Other comprises several smaller defined causes of death, while Unspecified refers to unintentional deaths that were not categorized due to coding challenges. Source: NC State Center for Health Statistics, Death file 2009; Analysis by Injury Epidemiology and Surveillance Unit North Carolina Strategic Plan for Prevention Injury and Violence NEHA 2012 AEC June 2012 5

More than 60 agencies and individuals worked over the course of a year to develop. Focuses efforts on leading causes of death and morbidity. Statewide Objectives Unintentional Motor Vehicle Unintentional Poisoning Unintentional Falls Homicide Suicide North Carolina Injury & Violence Prevention State Advisory Council Goal Team Leads 1. Data & Surveillance Phillip Graham Scott Proescholdbell 2. Research & Evaluation Sharon Schiro 3. Policy, Messaging, & Elizabeth Hudgins Environmental Change 4a. Motor Vehicle Alan Dellapenna 4b. Falls Sharon Rhyne 4c. Unintentional Poisoning Marsha Ford 4d Suicide Jane Miller 4e Violence Leah Perkinson 5. Coordination & Constituency Kimberly Bailey Kelly Ransdell 6. Workforce Development Stephania Sidberry Mariana Garretson NEHA 2012 AEC June 2012 6

Unintentional Poisoning Percent Change in Rates Between 1999 and 2009 Leading Causes of Injury Deaths: N.C. 1999 to 2009* Injury Mech/Intent Firearm Assault, 25.3% Firearm Self Inflicted, +1.7% Unintentional Falls, +68.1% Unintentional Poisoning, +212.7% Motor Vehicle, 28.8% 50 0 50 100 150 200 250 Percent Difference *Provisional data. Source: N.C. State Center for Health Statistics, Vital Statistics Deaths, 1999 2009 Analysis by Injury Epidemiology and Surveillance Unit Unintentional Poisoning Deaths by County: N.C., 1999 2009 Source: N.C. State Center for Health Statistics, Vital Statistics Deaths, 1999 2009 Analysis by Injury Epidemiology and Surveillance Unit NEHA 2012 AEC June 2012 7

Leading Causes of Injury Death Rates per 100,000, NC 1999-2010 25 20 19.93 Unt. Motor Vehicle/Transportation (MVT) 15 10 5 7.04 5.77 5.29 3.53 4.67 5.43 6.69 8.23 8.53 10.04 10.2 Unt. Poisoning 13.6 11 11 9.9 9.9 Unt. Falls Firearm-Homicide 9 7.4 Firearm-Suicide 3.9 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 NC State Center for Health Statistics Death file 2006-2007; NC Injury Epidemiology & Surveillance Unit Poisoning Deaths: N.C., 1999 2009 Number of Deaths 1,500 1,200 900 600 300 In 1999, the number of unintentional poisoning deaths was 279 In 2009, the number of deaths was 1,036 1,308 1,036 205 Unintentional Suicide Homicide Undetermined All Poisonings 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 67 0 Year Source: N.C. State Center for Health Statistics, Vital Statistics Deaths, 1999 2009 Analysis by Injury Epidemiology and Surveillance Unit Unintentional Overdose Deaths Involving Opioid Analgesics, Cocaine and Heroin United States, 1999 2007 Opioid analgesic Cocaine Heroin Year National Vital Statistics System, http://wonder.cdc.gov, multiple cause dataset Source: Len Paulozzi, CDC Nov. 2011 24 NEHA 2012 AEC June 2012 8

July 2002 North Carolina requests 1 st CDC Epidemic Intelligence Service (EIS) Poisoning Investigation 3 EIS Officers investigate fatal drug overdoses with NC-DPH Injury Branch. 1,096 accidental poisonings death records abstracted & analyzed with NC Offoce of Chief Medical Examiner. Report to NC-DHHS Secretary prompted a task force on unintentional drug-related death prevention. A letter to the JAMA editor (2003) highlights the enhanced lethality of methadone when prescribed as a pain reliever. DHHS Secretary Task Force Report 2004 43 recommendations Leadership, Surveillance, Law Enforcement, Legislative, Education, Clinical Interventions Controlled Substance Reporting System (CSRS) - NC Prescription Monitoring Program Established by State law. A prescription reporting system that allows registered dispensers and practitioners to review a patient s controlled substances prescription history on the web. Intended to assist practitioners in monitoring patients by identifying and referring patients for specialized substance abuse treatment or specialized pain management. NEHA 2012 AEC June 2012 9

Partners Safe Kids North Carolina State Bureau of Investigation Waterkeepers Carolina Costal Coalition for Substance Abuse Prevention North Carolina Operation Medicine Drop Results March, 2012 236 events held in NC 7.7 MILLION doses of medications were safely collected and destroyed Keeping drugs out of the wrong hands and out of our waterways. In 3 years, over 20 million doses collected 30% estimated to be narcotics Operation Medicine Drop moving from Annual Campaign to Permanent Drop Boxes NEHA 2012 AEC June 2012 10

Project Lazarus Innovative community intervention Lead by Wilkes County with efforts across NC, the Cherokee Reservation, & Fort Bragg Focused on avoiding & responding to opioid overdose Includes provision of naloxone (opioid overdose antidote) Training for Medical Providers Patients, Family, Peers including a free overdose rescue kit Project Lazarus in Wilkes County Wilkes Co NC US Source: Wilkes Co. Health Department; NC SCHS; CDC Wonder Partners in the NC Response to the Poisoning Epidemic Narcotics Task Force (Medicaid) Controlled Substance Reporting System State Bureau of Investigation NC State Center for Health Statistics Office of Chief Medical Examiner s Office Governor s Institute on Alcohol & Substance Abuse Carolina s Poison Center NC Division of Mental Health & Substance Abuse Services Project Lazarus SafeKids NC Waterkeepers Carolina Local Law Enforcement Coastal Coalition for Substance Abuse Prevention CCNC Local Health Departments NC Medical Society Statewide Strategic Plan- Injury/Violence Prevention Poisoning is a top priority NC IOM Healthy NC plan NEHA 2012 AEC June 2012 11

North Carolina Violent Death Reporting System (NC VDRS) Percent of Deaths Due to Violence by Manner/Intent: North Carolina Violent Death Reporting System, 2004-2009* Legal Intervention: 1% Undetermined Intent: 3% Unintentional Firearm: 1% Homicide: 35% Suicide: 61% * 2008 and 2009 data are provisional Percent of Deaths by Method of Fatal Injury: North Carolina Violent Death Reporting System, 2004-2008* 5% 4% 0% 6% 14% 3% Homicide 68% 19% 17% 0% 1% 3% 0% Suicide 60% Firearm Sharp Inst Blunt Poison Hanging Unarmed Other * 2008 data are provisional NEHA 2012 AEC June 2012 12

Unintentional Falls The Perfect Storm NEHA 2012 AEC June 2012 13

Rate of Deaths due to Unintentional Falls Since 2000: All Ages N.C., 2000 2009 10 65% increase in 9 years 8.1 8.9 Rate per 100,000 N.C. Residents 8 6 4 2 5.4 5.2 5.6 5.9 7.1 7.2 6.1 6.9 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Year Source: N.C. State Center for Health Statistics, Vital Statistics Deaths, 2000 2009 Analysis by Injury Epidemiology and Surveillance Unit Percent of Population Age 65+ in North Carolina, 2000 12% or less 12.1% to 13.0% 13.1% to 14.4% 14.5% to 15.9% The average for for NC is NC 12.0%. is 12.0%. The is from 6.3% to 23.6% The range is from 6.3% to 23.6% More than 16% Percent of Population Age 65+ in North Carolina, 2030* 12% or less 12.1% to 13.0% 13.1% to 14.4% 14.5% to 15.9% More than 16% The average for for NC is NC 12.0%. is 17.7%. The range is from 6.3% to 23.6% The range is from 10.5% to 35.2% *Based on July 2006 population projections NEHA 2012 AEC June 2012 14

North Carolina Falls Prevention Coalition Great partnership between aging and public health Over 70 member organizations, and growing = Source: N.C. State Center for Health Statistics, Vital Statistics Deaths, 1999 2009 Analysis by Injury Epidemiology and Surveillance Unit NC Local and Falls Regional Prevention Falls Initiatives Prevention Coalitions Winston-Salem Greensboro Raleigh Asheville Swain Graham Cherokee Macon Clay Alleghany Northampton Gates Ashe Surry Stokes Warren Rockingham Caswell Person Hertford Watauga Wilkes Halifax Yadkin Forsyth Guilford Franklin Bertie Avery Caldwell Davie Nash Madison Iredell Martin Davidson Wake Chatham Burke Randolph McDowell Wilson Buncombe Catawba Rowan Pitt Beaufort Johnston Rutherford Lincoln Lee Greene Cabarrus Harnett Wayne Polk Gaston Stanly Moore Lenoir Craven Hoke Jones Union Anson Sampson Falls Prevention Duplin Scot Coalitions land Onslow Carteret Alamance Orange Durham Tyrrell Hyde Dare Region A Health Promotion Charlotte Robeson Bladen Pender Western NC FP Regional Columbus Piedmont Area Brunswick Metrolina Guilford County Chapter of the NC FP Coalition Eastern NC Preventing Falls & Fall related injuries among older adults in Western North Carolina Infrastructure development and maintenance Community awareness and education Provider education Risk assessment Multifactorial interventions (lower body weakness, poor vision, medication interactions, environmental hazards) Surveillance and evaluation Advocacy for supportive policies & environments NEHA 2012 AEC June 2012 15

Unt. Motor Vehicle Traffic (MVT) Related Injuries Reportable Crashes: N.C., 2008 Number of Crashes/Vehicles/People 600,000 500,000 400,000 300,000 200,000 100,000 0 539,760 376,209 214,358 Crashes Vehicles People Non Fatal Injury, 71,773, 33% Fatal Injury, 1,340, 1% Property Damage Only, 141,245, 66% N = 214,358 Reportable Crashes Source: UNC Highway Safety Research Center, N.C. Crash Data, 2008 Analysis by Injury Epidemiology and Surveillance Unit Alcohol Involvement in Reportable Crashes: N.C., 2008 (N = 214,358 Crashes) 100% 94% No alcohol involved Alcohol involved 75% 70% Percent of crashes 50% 202, 376 Crashes 938 Crashes 30% 25% 0% 6% 11, 982 Crashes All reportable crashes Fatal crashes 402 Crashes Source: UNC Highway Safety Research Center, N.C. Crash Data, 2008 Analysis by Injury Epidemiology and Surveillance Unit NEHA 2012 AEC June 2012 16

Partnerships to Reduce Motor Vehicle Injury and Death Forensic Test for Alcohol BAT Mobile Graduated Driver s License Motorcycle Helmet Law, most effective in US Click it or Ticket You Drink You Drive You Lose NEHA 2012 AEC June 2012 17

North Carolina Injury and Violence Prevention Programs Injury & Violence Prevention Programs Get Alarmed! NC Youth Suicide Prevention RPE (Rape Prevention Education) EMPOWER (Enhancing & Making Programs & Outcomes Work to End Rape) NEHA 2012 AEC June 2012 18

Get Alarmed! NC Reduce Fire Deaths and Injuries in NC CDC funded, Community-based Program 11 years FEMA Funding 2012 Provide Fire Safety Education Install Smoke Alarms in the homes at greatest risk of fire injury. Over the program s 11 years Worked with 136 Fire Departments across NC Installed over 15,000 smoke alarms Documented over 100 lives saved Youth Suicide Prevention Addressing the public health problem of suicide among 10-24 year olds SAMHSA s Garrett Lee Smith Memorial Grant Program Provides: ASIST (Applied Suicide Intervention Skills Training) to adults who are in gatekeeper roles with youth ASIST training is provided across NC at the 57 School Based-School Linked Health Centers (SBSLHC) All 100 Child and Family Support Teams (CFST) in NC Current Focus Military Families, LGBTQ NEHA 2012 AEC June 2012 19

http://itsok2ask.com RPE (Rape Prevention and Education) Reduce the incidence of Rape & Sexual Assault in NC CDC funded, Community-based Program Employs multiple, comprehensive primary prevention approaches such as Policy development A broad array of Training & Educational Services 13 local agencies & a state-wide group funded Develop Policies Provide Prevention and Educational Services NEHA 2012 AEC June 2012 20

North Carolina Resources for Injury and Violence NEHA 2012 AEC June 2012 21