Example 1: MAP-IT in Action: A Local School Board Addresses Underage Drinking
Mrs. King, the head of the school board, has been answering phone calls nonstop for the past 2 days. Parents of high school students have been calling to ask what the school board is going to do about a number of underage drinking incidents at school events. The incidents were recently written up in the local paper. Mrs. King calls the other school board members, and they all agree to hold an emergency meeting.
Before the meeting, Mrs. King contacts school board members in surrounding towns to find out how they have addressed underage drinking in their schools.
After a long, sometimes heated discussion, the school board agrees to add a unit on alcohol abuse to the school’s curriculum. They decide that Mrs. King and Mr. Brown, another school board member, will lead the process of selecting, implementing, and evaluating a new unit on alcohol use.
Mrs. King and Mr. Brown decide that first they need to gather local, county, and State data to better understand the scope of the problem. They look at the Healthy People 2020 website and find the Substance Abuse topic area objective SA-13.1 Reduce the proportion of adolescents reporting use of alcohol or any illicit drugs during the past 30 days. The national measure for that objective comes from the National Household Survey on Drug Abuse (NHSDA). The national data stated that 18.3 percent of adolescents ages 12 to 17 reported use of alcohol or illicit drug in the past 30 days in 2008. The national goal is to reduce that number to 16.5 percent. Mrs. King and Mr. Brown are able to review the NHSDA data for their State and find that the State’s baseline is 15 percent.. It is clear to them that underage drinking is a public health priority.
Mrs. King and Mr. Brown also decide that the school board should hold meetings with students, parents, police, and local business owners to determine the causes of underage alcohol use, especially binge drinking. From these meetings, they find that peer pressure, easy access to alcohol, and perceived lack of consequences are reported by each group. After gathering this information, the school board requests curricula for review that address the causes of underage alcohol use. The school board makes a point to only request curricula that are evidence and science based.
Mrs. King and Mr. Brown present the school board with 3 curricula that address the causes of alcohol abuse in their community. The school board discusses the pros and cons of each and selects one that best meets their learning objectives as well as time and budget requirements. They pick 2 teachers who are well liked by the students and certified in health education to teach the course. Working with the teachers and administrators, the school board finds time in the school schedule for the course. Mrs. King and Mr. Brown work with another school board member with evaluation experience to create an evaluation plan. They decide that a pre- and post-test should be given to students. The evaluations will be collected and entered by a teacher’s aide familiar with data entry software. The same school board member who created the evaluation plan will analyze the data.
The school board sends the 2 teachers to training on the new curriculum, and they start teaching the course when the new semester begins. A volunteer student advisory group is formed to give the teachers additional feedback on the curriculum. The group meets periodically during the semester to discuss ways to make the course more relevant to their peers. The teachers give out a pre-test on the first day of class and a post-test on the last day of the curriculum.
Mrs. King and Mr. Brown collect attendance records for the course, review the student evaluation data, and monitor local police reports for alcohol-related incidents. The first group of students to complete the course reports binge drinking less often on their post-test.
They also collect informal data, such as teachers’ perceptions of students’ attitudes toward alcohol use and students’ requests for more alcohol-free school-sponsored events.
Mrs. King and Mr. Brown contact the director of the State Bureau of Substance Abuse to inform her of the community’s efforts. The State health official agrees to stay in touch and to alert them to possible funding opportunities in the future. They also brainstorm other potential funding sources, such as fundraising and partnering with local businesses.
The entire school board knows that it will be a challenge to keep momentum for this program going, especially if the issue is not in the news and budgets are cut. They hope that because students, parents, and other community members were involved in the assessment process, they will remain committed to offering alcohol abuse prevention education at the high school.
Example 2: MAP-IT in Action: Employees Organize to Improve Workplace Wellness
Linda recently had a mild heart attack and was out of work for 3 months. She returns to work and discusses her experience with a few coworkers. They are all surprised to learn that heart disease is the leading cause of death in both men and women. Linda shares information with them about the simple changes she’s making to help prevent another heart attack, such as going for walks during lunch and using less salt when she cooks.
Linda and her coworkers believe that other company employees need to know about their risk of heart disease and how to prevent it. They contact the company’s human resources (HR) department for a meeting to talk about ways to share health information with other employees. At the meeting, they all decide to form a workplace wellness committee, which will look into programs for improving employees’ well-being.
The workplace wellness committee first conducts an environmental scan to see what information exists and what, if any, wellness programs are available to employees. They find a few prepackaged programs from their health insurance company, but they require someone at their workplace to manage them. The group then meets and reviews data on sick days and short-term disability leave. They decide that they need more company-specific information on why employees are missing work and what types of wellness programs would help them.
They create an anonymous, brief online survey and send it out to the entire company. Out of 175 employees, they receive over 80 responses. Seventy-five percent of employees respond that they exercise sometimes or never. The main reason they stay home is because they (or their children) have a cold or flu. Nearly all of the employees selected “stress” as the top health issue they want the committee to address. With this and other information the committee receives from the survey, they are able to prioritize the top 3 issues for the program to address: exercise, cold and flu prevention, and stress.
Although Linda and her coworkers wanted to focus on heart disease, they come to the agreement that the committee should address the top issues from the survey results. The workplace wellness committee decides that they will try increasing employees’ physical activity during this quarter, which is directly linked with decreasing heart disease risk. Based on the success of that program, the workplace wellness committee will address a different priority topic each quarter.
Through their health insurance provider, they find a “small steps” program that they think would work in their company. The program encourages adults to get the recommended 30 minutes of daily physical activity by incorporating 10 minutes of movement 3 times throughout the day. They develop communication, implementation, and evaluation plans. Each plan has a specific timeline and person responsible for ensuring the completion of each activity.
To gain support from the company’s management, the committee puts together a report highlighting the Healthy People 2020 objectives related to workplace wellness. They find Physical Activity topic area developmental objective 12: Increase the proportion of employed adults who have access to and participate in employer-based exercise facilities and exercise programs. The committee also finds two relevant developmental objectives from Educational and Community-Based Programs: objective 8: Increase the proportion of worksites that offer an employee health promotion program to their employees, and objective 9: Increase the proportion of employees who participate in employer-sponsored health promotion activities. Although developmental objectives do not yet have national baseline data, they do have a confirmed, nationally representative data source that the committee could use to inform their own data collection.
Management is enthusiastic about the prospect of being “ahead of the curve” in the area of workplace wellness, and the marketing department is interested in using the potential positive public relations angle to attract clients and new employees.
The workplace wellness committee implements the “small steps” program, which encourages employees to take 10-minute breaks throughout the day to do physical activity. The program encourages simple, inexpensive activities like taking the stairs instead of the elevator and starting walking clubs during the lunch break. Linda posts flyers on the elevators to encourage coworkers to use the stairs and in the stairwells to congratulate employees on their small steps. The walking clubs are led by a different workplace wellness committee member each day, and employees are reminded about the walks on their time sheets and over the announcement system.
At the end of the quarter, the workplace wellness committee sends a follow-up survey to see if employees participated in lunchtime walks or report using the stairs more often. The survey also asks questions about the tone and style of the committee’s “small steps” messages in addition to the same questions about health from the first survey. This time they have more than 100 responses. All employees report knowing about the campaign, and most have a positive opinion about it. Fifty percent of employees report going on at least 1 lunchtime walk, and 35 percent report going on 5 or more lunchtime walks. There was not a significant change in the number of employees who reported they sometime or never exercise, but the committee hopes to ask the questions each quarter to see if they can track small improvements over time.
The workplace wellness committee knows that they will need to stay focused and active for the program to continue. Even with the support of management and HR, it will take leaders from the committee to continue to advocate for corporate support of wellness programs.
Example 3: MAP-IT in Action: A County Health Department Addresses Lead Poisoning
Rob works for the Springfield County Health Department and was recently put in charge of their Lead Poisoning Prevention Program (LPPP). After looking at trend data, Rob sees that rates have not decreased in Springfield County as quickly as the rest of the State. He also reviews national data in Healthy People 2020 and finds that the county’s rates are higher than the national baseline and target measures. Rob contacts his State’s Healthy People Coordinator to learn more about statewide efforts to meet the environmental health objectives in Healthy People 2020. Rob then does a brief environmental scan to see what the best practices are for lead poisoning prevention and what actions similar communities have taken to address the problem.
After his initial research, Rob decides that the LPPP needs to take a new approach and brings together key stakeholders in the county to help develop a plan. He invites county representatives from housing, environmental health, and education and local public health commissioners to form the Springfield County Lead Poisoning Prevention Task Force.
Rob and the task force hold a day-long strategic planning meeting. The first half of the day is dedicated to going through data. They review data sources identified in the Environmental Health Healthy People 2020 section. There they find objective 8: Eliminate elevated blood lead levels in children. After reviewing the data for their State, they find that their county has the highest rates of childhood lead poisoning in the State; out of all children under age 6 who are tested, 5.2 percent have elevated blood lead levels. The national average is 4.4 percent, while the State average is 2.1 percent, with some counties reporting no cases of elevated blood lead levels.
While doing their assessment, the task force also finds that the county’s childhood asthma rates are 4 percent higher than the State average. They think that the lead prevention plan they develop may be able to also address some environmental causes and triggers of asthma.
The new public health commissioner from Franklin identified his city as having the most cases of elevated blood lead levels in the county, most of which are concentrated in 1 area with a number of large public housing units. Best practices in lead poisoning prevention suggest that the county health department should focus on high-rate areas, particularly public housing units and economically disadvantaged neighborhoods with houses built before 1978 (the year lead was removed from paint).
During the afternoon of the strategic planning meeting, the task force agrees that they need to address elevated blood lead levels by improving the physical environment of the housing units. They also agree to include evidence-based interventions that will reduce rates of asthma.
Rob contacts a community-based organization (CBO) that has a long history of working with the public housing units and asks them to help develop a plan for the project. Rob works with other members of the county health department and Franklin city government to develop a proposal for the U.S. Department of Housing and Urban Development (HUD). The CBO signs a letter of support agreeing to collaborate on the project if funding is awarded.
They propose a pilot program that would remove lead paint and install air filters in the public housing units. The pilot program would also train some of the unemployed residents to assist in the renovations. They are able to link their proposal directly to national and State Healthy People 2020 objectives in both Respiratory Diseases and Environmental Health topic areas.
In addition to tracking blood lead levels, they decide to also monitor childhood asthma rates to see if they decline as a result of their focus on reducing dust and improving air quality.
HUD awards them funding for the project and notes their use of supporting data as a reason they were funded.
The CBO is excited about the project and is responsible for communicating with residents about the improvements, responding to any concerns they may have, and supervising the training and employment component of the project.
Rob is responsible for overseeing the entire project and works closely with contractors to ensure the work is completed correctly. Lead paint is removed, and air filters are installed throughout the public housing units over a 2-year period.
Rob carefully tracks the project’s progress and collects formal and informal data to measure the project’s impact. Elevated blood lead levels reported to the county health department are 0.75 percent lower after the project than before the improvements were made. Residents self-report feeling sick less often and having fewer asthma attacks. As a result of the project, residents also report high levels of satisfaction with the condition of their housing unit and the management of the public housing complex overall.
Rob hopes that by carefully tracking and evaluating the project, the county health department will receive funding to expand the project to all public housing units in the county. He expects that it may be difficult to continue funding the program through public grants, so he also contacts local and national businesses and private foundations that may be able to provide funding.
Rob works hard to keep the CBO and the local residents involved in the project, establishing “train-the-trainer” programs with residents in nearby public housing units and hosting ongoing community meetings and events.