Box 7-1

Additional Sources of Information

Theory—the basis for generalizing from evidence by matching the source of the evidence to the circumstances in which it would be applied. Social and behavioral theory specifies the conditions under which stimulus A (an intervention) produces response B (a change in attitude, belief, behavior, or organizational or community conditions). It allows for consideration of whether such conditions are salient in generalizing the intervention effects found in previous studies to the circumstances in which the intervention would be applied in the particular population, setting, and time at hand.


Professional experience—pooling of the experience of those who have addressed the problem in populations or circumstances similar to those at hand. The result is sometimes referred as tacit knowledge and sometimes as anecdotal evidence. Systematic procedures can make such pooling more reliable (D’Onofrio, 2001).


Local wisdom—engagement in the planning of interventions of those who have lived with the problem.

Box 7-2

Blending Theory, Expert Opinion, and Local Wisdom: Tobacco Control Efforts

In the latter part of the 20th century, innovators in schools, worksites, restaurants, towns, cities, and states enacted clean air policies and conducted smoking prevention and cessation programs, with varying degrees of evidence supporting their actions (Eriksen, 2005; Mercer et al., 2005); similar patterns can be seen in other public health successes of the period, such as injury control (Martin et al., 2007). Those policies and programs that demonstrated effectiveness and sustainability were deemed worthy of note by other jurisdictions. The most notable state tobacco control programs, for example, were those of California and Massachusetts. Those two states, with the support of increased tobacco taxes, had mandates in the early 1990s to undertake and evaluate more comprehensive programs (IOM, 2007). They mobilized aggressively with mass media and programs in schools, worksites, and communities. Evaluation demonstrated first a doubling, then a tripling, of the annual rate of decline in tobacco consumption in California relative to the other 48 states (Siegel et al., 2000). Massachusetts started later than California but eventually achieved a quadrupling of those average 48-state rates of reduced smoking as its program hit its stride in the mid1990s with higher taxes and greater per capita program expenditures (CDC, 1996). The other states showed more interest in the experience and evaluation data from these two states than in the several thousand randomized controlled trials (RCTs) of smoking cessation and prevention in the scientific literature. This was the case because they perceived the greater relevance and representativeness of the two states’ experience relative to the highly controlled, often artificial circumstances and sampled populations of RCTs.



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