Priority Health Topic: Injury Prevention


Background & History

Among causes of death in Alaska, unintentional injury has the largest toll in terms of years of potential life lost, followed by cancer and suicide, respectively. One of the most striking differences between Alaska and US death rates is  seen with unintentional injury, with the Alaska age-adjusted rate of death from unintentional injuries at 63.0 per 100,000 compared to 52.2 per 100,000 in the US overall.

The HA2030 team chose to keep the HA2020 LHI on unintentional injury the same for the HA2030 plan to keep prevention efforts focused on this health priority. The HA2030 team discussed adding another objective focused on the unintentional morbidity rate as well to address the effects of non-fatal trauma, however when limiting the plan to 30 objectives ultimately decided to focus on addressing this through strategies and actions. The strategies and action steps were created to focus on the main unintentional injuries seen across the state: injury and death from falls, substance misuse, and transportation.

Objective 12: Reduce the unintentional injury mortality rate per 100,000 population

Target: 56.5%

Strategy 1: Bring partners together and use multiple approaches to reduce all injuries and deaths from falls by older Alaskans

Many fall prevention programs recommend a multi-faceted approach to elder fall prevention, including examining and correcting household risks, determining the elder’s health risks for falls, especially their vision, medications and balance, and promoting strength and balance exercises. The CDC’s STEADI program recommends the involvement of multiple experts in a patient’s fall prevention program. The CDC also includes a number of multifaceted interventions, requiring partners with different expertise, in their Compendium of Effective Fall Interventions.

Sources:

Action Step 1

ActionIncrease training and provision of strength and balance activities for elders at the community level.
Participating community level organizations may include but not limited to the following:
• Senior Center Activity Programs
• Assisted living facilities around the state• Tribal Injury Prevention programs
• YMCA
• Tribal Injury Prevention Cooperative Agreement Program (TIPCAP) recipients
• State of Alaska, Division of Public Health, Section of Chronic Disease Prevention and Health Promotion
• Statewide Independent Living Council
• AARP
MeasureAnnual program/grant and activity and/or training records.
Timeframe2020-2030
Key Partners• Alaska Native Tribal Health Consortium, Health Promotion/Disease Prevention Program
• Alaska Native Tribal Health Consortium, Injury Prevention Program
• State of Alaska Division of Senior and Disabilities Services

Action Step 2

ActionIncrease access to fall prevention training for target audiences which may include but are not limited to the following:
• Medical Staff
• Community Health Aides and Practitioners
• Caregivers (Elders in Facilities)
• Community Caregivers (Elders or Families)
• Direct Providers
Measure• Center for Human Development training records
• Alaska Native Tribal Health Consortium training records
Timeframe2020-2030
Key Partners• Alaska Native Tribal Health Consortium
• State of Alaska, Division of Senior and Disabilities Services
• UAA-Center for Human Development

Strategy 2: Promote environmental strategies that change community conditions to reduce all injuries and deaths that involve problematic alcohol and other substance/drug use

The CDC and World Health Organization both have documented the association of alcohol and other substance use with injuries. Alcohol and drugs have been linked to injuries both as an indirect cause (when under the influence) and as a direct cause (as a poison). Studies have shown that efforts to reduce problem drinking result in decreased injury risks and that reducing access to drugs, such as opiates, reduces poisoning injuries.

Sources:

Action Step 1

ActionAlaska’s Prescription Drug Monitoring Program (PDMP) began in 2008 and is housed with the Board of Pharmacy under the Department of Commerce, Community, and Economic Development (DCCED) – Corporations, Business, and Professional Licensing (CBPL) section. Mandatory registration, reviewing, and reporting requirements went into effect in July 2017. The PDMP is established in the Board of Pharmacy under AS 17.30.200 to contain data on each prescription of a schedule II, III, or IV controlled substance dispensed in the state. Funding for the PDMP comes from several sources, including the Office of Substance Misuse and Addiction Prevention in the Department of Health and Social Services, Division of Public Health through a federal grant for the purposes of PDMP education and providing strategies to increase provider adherence.

Environmentally control the drug supply in the community through the Prescription Drug Monitoring Program (PDMP) by:
• providing prescribers and pharmacists with a detailed and current controlled substance dispensing history of their patients;
• assisting practitioners in prescribing clinically appropriate controlled substance medications;
• assisting with investigative efforts to identify and reduce drug diversion; and
• reduce the prescribing of inappropriate controlled substance medications

Additional partners may include but are not limited to:
• Boards for pharmacy, dentistry, medicine, nursing, optometry, veterinary
Measure• Bi-annual reporting to the Bureau of Justice Assistance
• Reporting to the CDC for the Overdose Data to Action grant thru 2023
Timeframe2020-2030
Key Partners• State of Alaska, Division of Public Health, Office of Substance Misuse and Addiction Prevention
• State of Alaska, Department of Commerce, Community, and Economic Development
• Office of Substance Misuse and Addiction Prevention (OSMAP)
• 4A’s

Action Step 2

ActionReduce access to prescription medication through distribution of safe disposal materials and locking medication safes. Distribution occurring through ANTHC IknowMine website: https://www.iknowmine.org/provider-materials/safe-medicine
MeasureAnnual report on the number of disposal containers and medication safes distributed
Timeframe2020-2030
Key Partners• Alaska Native Tribal Health Consortium, Substance Misuse Prevention Program
• OSMAP and 4A’s

Action Step 3

ActionReduce poisoning deaths from opioid overdoses by increasing access to and distribution of Naloxone kits and training on their use to communities throughout Alaska. Kits are currently available through State of Alaska’s Project Hope (http://dhss.alaska.gov/dph/Director/Pages/opioids/narcan.aspx) and at medical facilities around the state, along with instruction on use. Increasing access to Fentanyl test strips so users can check for Fentanyl content in their drugs and reduce the risk of overdose.
MeasureAnnual reports from key partners on the number of disposal containers and medication safes distributed
Timeframe2020-2030
Key Partners• State of Alaska, Division of Public Health, Office of Substance Misuse and Addiction Prevention, Project Hope
• Alaska Native Tribal Health Consortium, Substance Misuse Prevention Initiative
• OSMAP and 4A’s

Strategy 3: Promote best practices for reducing unintentional injuries and injury related deaths by improving coordinated data collection, analysis and dissemination

As described in the Mission of the International Collaborative Effort (ICE) on Injury Statistics, “…data needed to better assess the causes and consequences of injury, differences in injury occurrence over time and place, and the most effective means of prevention and control.”

Sources:

Action Step 1

ActionEstablish a data work group to prioritize injury topic focus

In addition to key partners, the following is a list of recommended work group members:
• State of Alaska, Division of Public Health (ATR and HAVRS)
• State of Alaska, Division of Behavioral Health
• University of Alaska Anchorage
• Center for Safe Alaskans
• Tribal Health Organization IP programs
• CDC (WISQARS)
MeasureWork group report to Healthy Alaskans core team annually.
Timeframe2020-2030
Key Partners• Alaska Native Tribal Health Consortium, Injury Prevention Program
• Alaska Statewide Violence and Injury Prevention Plan (ASVIPP)
• State of Alaska, Division of Public Health, Section of Chronic Disease Prevention and Health Promotion

Action Step 2

ActionData work group will create a centralized location to access links and contacts for all available injury data.
MeasureWork group report to HA core team annually.
Timeframe2020-2030
Key Partners• Alaska Native Tribal Health Consortium, Injury Prevention Program
• Alaska Statewide Violence and Injury Prevention Plan (ASVIPP)
• State of Alaska, Division of Public Health, Section of Chronic Disease and Health Promotion

Strategy 4: Promote best practices for reducing transportation related injuries and deaths by improving coordinated data collection, analysis and dissemination

Transportation related injuries are one of the leading causes of death for most age groups in Alaska. The first action step listed below is designed to increase important knowledge about motor vehicle related crashes to improve intervention design (see citation below). The next action step will increase protective factors that are associated with multiple health conditions, including safe driving, riding, boating etc. And action step 3 is intended to increase collaboration between Alaska State Public Health and Department of Transportation’s Alaska Highway Safety Office, along with relevant partners.

Sources:

Action Step 1

ActionExpand linkage of Alaska Trauma Registry and Department of Transportation Crash reports beyond Anchorage, and to include Health Facilities Data Reporting (HFDR) program data.
• Organizations utilize data for resource prioritization, intervention design, implementation and evaluation.
MeasureAnnual measurement will include count of years of data and sources of data that are linked, then tracking success of programs utilizing the linked data.
Timeframe2020-2030
Key Partners• Center for Safe Alaskans
• Alaska Traffic Records Coordinating Committee
• RKDS Consulting
• University of Alaska Fairbanks

Action Step 2

ActionPromote and practice utilization of a shared risk and protective factor approach to reducing transportation related injuries based on Strategies to Address Shared Risk and Protective Factors for Driver Safety (Safe States Alliance. (2019).

Resource Document: Strategies to Address Shared Risk and Protective Factors for Driver Safety. Atlanta, GA: Safe States Alliance).

The factors listed below are also included:
• Utilize mindfulness training to reduce aggressive driving and speeding (Safe States Alliance, p. 24 and 32). Mindfulness encourages emotion-regulation and involves acceptance of, but not reaction to situations. This is also a protective factor for multiple other objectives and health conditions.
• Design and implement campaigns focusing on changing group norms around distracted driving, seatbelt use and impaired driving. (Safe States Alliance, p 34, 36 and 62). In addition to the norms of safe behavior, these protective factors include promoting speaking up in unsafe situations and caring for and connection to others, which are protective factors for multiple other Healthy Alaskans’ objectives and health conditions.
Measure• Tracking changes in the self-regulation YRBS question. (2019 was the first year it was asked)
• Alternative measure: Use and tracking of results of the self-regulation question in programmatic evaluations.
• Include social norms questions in the annual statewide Alaska Driver Survey conducted by Center for Safe Alaskans on behalf of the Alaska Highway Safety Office.
Timeframe2020-2030
Key Partners• Center for Safe Alaskans
• Alaska State Violence and Injury Prevention Partners
• State of Alaska, Division of Public Health, Section of Chronic Disease Prevention and Health Promotion (CDPDP), Injury Prevention Program

Action Step 3

ActionPromote collaborative implementation of the strategies in the existing 2018-2022 Alaska Highway Safety Strategic Plan (SHSP). http://dot.alaska.gov/stwdplng/shsp/shsp_plan.shtml
Participate in planning and implementation of future SHSPs.
MeasureUse same measures in the Safe Highway Strategic Plan, which are updated annually.
Timeframe2020-2022
Key Partners• Alaska Highway Safety Office
• Center for Safe Alaskans
• State of Alaska, Division of Public Health, Section of Chronic Disease Prevention and Health Promotion, Injury Prevention Program

Action Step 4

ActionPromote public practice of safe boating behaviors and increase preparedness per the USCG and National Boating Safety Advisory Council. Focus areas of the National Recreational Boating Safety Program 2017-2021 Strategic Plan include:
• Improve and expand recreational boating education, training, and outreach (e.g. Kids Don’t Float and Cold Water Survival)
• Update, leverage, and enforce policies, regulations, and standards; and
• Improve upon and expand recreational boating data collection.
MeasureBoating Accident Reporting Database (BARD); Trauma Registry; Vital Stats for Drowning Fatalities; Alaska Drowning Database
Timeframe2020-2022
Key Partners• U.S. Coast Guard
• State of Alaska, Department of Natural Resources, Division of Parks and Outdoor Recreation, Office of Boating Safety
• State of Alaska, Division of Public Health, Section of Chronic Disease Prevention and Health Promotion, Injury Prevention Program AMSEA
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