Prevention for the Health of North Carolina:

Prevention for the Health of North Carolina:

Prevention Action Plan

October 2009

North Carolina Institute of Medicine

In collaboration with the North Carolina Division of Public Health Supported by the Blue Cross and Blue Shield of North Carolina Foundation, The Duke Endowment, the Kate B. Reynolds Charitable Trust, and the North Carolina Health and Wellness Trust Fund

The North Carolina Institute of Medicine (NCIOM) is a nonpolitical source of analysis and advice on important health issues facing the state. The NCIOM convenes stakeholders and other interested people from across the state to study these complex issues and develop workable solutions to improve health, health care access, and quality of health care in North Carolina.

The full text of this report is available online at

North Carolina Institute of Medicine Keystone Office Park 630 Davis Drive, Suite 100 Morrisville, NC 27560 919.401.6599

Suggested citation North Carolina Institute of Medicine Task Force on Prevention. Prevention for the Health of North Carolina: Prevention Action Plan. Morrisville, NC: North Carolina Institute of Medicine; 2009.

Supported by the Blue Cross and Blue Shield of North Carolina Foundation, The Duke Endowment, the Kate B. Reynolds Charitable Trust, and the North Carolina Health and Wellness Trust Fund.

Any opinion, finding, conclusion or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view and policies of the North Carolina Health and Wellness Trust Fund Commission, the Blue Cross and Blue Shield of North Carolina Foundation, The Duke Endowment, or the Kate B. Reynolds Charitable Trust.

Credits Report design and layout Angie Dickinson Design, angiedesign@

Prevention for the Health of North Carolina:

Prevention Action Plan

October 2009

North Carolina Institute of Medicine

In collaboration with the North Carolina Division of Public Health Supported by the Blue Cross and Blue Shield of North Carolina Foundation, The Duke Endowment, the Kate B. Reynolds Charitable Trust, and the North Carolina Health and Wellness Trust Fund

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North Carolina Institute of Medicine

Table of Contents

Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Task Force Members . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Chapter 1: Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Chapter 2: Why Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Chapter 3: Tobacco Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Chapter 4: Obesity, Nutrition, and Physical Activity. . . . . . . . . . . . . . . . . 93 Chapter 5: STDs, HIV, and Unintended Pregnancy . . . . . . . . . . . . . . . . . 129 Chapter 6: Substance Abuse and Mental Health . . . . . . . . . . . . . . . . . . . 155 Chapter 7: Environmental Risks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 Chapter 8: Injury. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195 Chapter 9: Vaccine Preventable Disease and Foodborne Illness . . . . . . . 213 Chapter 10: Racial and Ethnic Disparities . . . . . . . . . . . . . . . . . . . . . . . . 229 Chapter 11: Socioeconomic Determinants of Health . . . . . . . . . . . . . . . . 243 Chapter 12: Cross-Cutting Strategies in Schools, Worksites,

and Clinical Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273 Chapter 13: Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293 Chapter 14: Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301 Appendix A: Full Recommendations of the NCIOM Task Force

on Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317 Appendix B: Compilation of Evidence-Based Prevention

Interventions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 347 Appendix C: Sources Used to Identify the Preventable Risk Factors that

Contribute to the Top Ten Causes of Preventable Death and Disability in North Carolina . . . . . . . . . . . . . . . . . . . . . . 353

Prevention for the Health of North Carolina: Prevention Action Plan

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