Linking Research and Public Health Practice

A Review of CDC's Program of Centers for Research and Demonstration of Health Promotion and Disease Prevention

Michael A. Stoto, Lawrence W. Green, and Linda A. Bailey, Editors

Committee to Review the CDC Centers for Research and Demonstration of Health Promotion and Disease Prevention

Board on Health Promotion and Disease Prevention

INSTITUTE OF MEDICINE

NATIONAL ACADEMY PRESS
Washington, D.C.
1997



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Linking Research and Public Health Practice: A Review of CDC's Program of Centers for Research and Demonstration of Health Promotion and Disease Prevention Linking Research and Public Health Practice A Review of CDC's Program of Centers for Research and Demonstration of Health Promotion and Disease Prevention Michael A. Stoto, Lawrence W. Green, and Linda A. Bailey, Editors Committee to Review the CDC Centers for Research and Demonstration of Health Promotion and Disease Prevention Board on Health Promotion and Disease Prevention INSTITUTE OF MEDICINE NATIONAL ACADEMY PRESS Washington, D.C. 1997

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Linking Research and Public Health Practice: A Review of CDC's Program of Centers for Research and Demonstration of Health Promotion and Disease Prevention NATIONAL ACADEMY PRESS 2101 Constitution Avenue, N.W. Washington, D.C. 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee consisting of members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. Funding for this project was provided by the Centers for Disease Control and Prevention, U.S. Department of Health and Human Services (contract no. 200-95-0964). The views presented in this report are those of the Committee to Review the CDC Centers for Research and Demonstration of Health Promotion and Disease Prevention and are not necessarily those of the funding organization. International Standard Book No. 0-309-05680-2. Additional copies of this report are available for sale from the National Academy Press , Box 285, 2101 Constitution Avenue, N.W., Washington DC 20055. Call (800) 624-6242 or (202) 334-3313 (in the Washington Metropolitan area), or visit the NAP's on-line bookstore at http://www.nap.edu/bookstore. Copyright 1997 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The image adopted as a logotype by the Institute of Medicine is based on a relief carving from ancient Greece, now held by the Staatlichemusseen in Berlin.

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Linking Research and Public Health Practice: A Review of CDC's Program of Centers for Research and Demonstration of Health Promotion and Disease Prevention COMMITTEE TO REVIEW THE CDC CENTERS FOR RESEARCH AND DEMONSTRATION OF HEALTH PROMOTION AND DISEASE PREVENTION LAWRENCE W. GREEN (Chair), Director, Institute for Health Promotion Research, and Professor of Health Care and Epidemiology, University of British Columbia, Vancouver, British Columbia, Canada NOREEN M. CLARK, Dean and Marshall H. Becker Professor of Public Health, University of Michigan, Ann Arbor, Michigan JOHN W. FARQUHAR, * Director, Stanford Center for Research in Disease Prevention, and Professor of Medicine, Health Research and Policy, Stanford University, Palo Alto, California MARY DESVIGNES-KENDRICK, Director, Houston Department of Health and Human Services, Houston, Texas IRA S. MOSCOVICE, Professor and Associate Director, Institute for Health Services Research, School of Public Health, University of Minnesota, Minneapolis, Minnesota JAMES O. PROCHASKA, Director, Cancer Prevention Research Center, and Professor of Psychology, University of Rhode Island, Kingston, Rhode Island RANDY H. SCHWARTZ, Director, Division of Community and Family Health, Maine Department of Human Services, Bureau of Health, Augusta, Maine LEE SECHREST, Professor, Department of Psychology, University of Arizona, Tucson, Arizona HAROLD C. SOX, JR., * Chair, Department of Medicine, and Joseph M. Huber Professor of Medicine, Dartmouth Medical School, Lebanon, New Hampshire KENNETH E. WARNER, * Richard D. Remington Collegiate Professor of Public Health, University of Michigan, Ann Arbor, Michigan IOM Staff Michael A. Stoto, Director, Division of Health Promotion and Disease Prevention Linda A. Bailey, Study Director (until September 1996) Donna Thompson, Administrative Assistant * Member, Institute of Medicine.

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Linking Research and Public Health Practice: A Review of CDC's Program of Centers for Research and Demonstration of Health Promotion and Disease Prevention Preface In 1986, Congress authorized the Centers for Disease Control and Prevention (CDC) to develop a program of university-based research centers to undertake research projects in health promotion and disease prevention and to demonstrate the use of new and innovative research in public health techniques to improve public health. A decade later, after the prevention research center program grew from 3 initial centers to 13, the director of the CDC Division of Adult and Community Health, which oversees the program, requested of the Institute of Medicine (IOM) an evaluation of the overall program. To execute this study, the IOM established the Committee to Review the CDC Centers for Research and Demonstration of Health Promotion and Disease Prevention, which has prepared this report. The broad mission of the prevention research centers program—to contribute to a fuller understanding of how the health of communities, and the nation, can be improved—can be achieved only through the sustained cooperation of a diverse array of professionals and nonprofessionals who have roles in influencing the health of communities, who have competing goals and priorities, and who have little history of engaging in long-term, cooperative efforts. Consistent with this understanding, the committee took a broad view of how prevention research can influence the health of communities, considering not only the proximal risk factors for disease prevention, but also the more distal conditions for health promotion and improved equity in the distribution of risk factors.

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Linking Research and Public Health Practice: A Review of CDC's Program of Centers for Research and Demonstration of Health Promotion and Disease Prevention On a practical level, the committee recognized the difficulty of conducting community-based prevention research. The committee examined how a prevention research center could foster collaboration among these different groups and overcome the barriers separating universities from their surrounding communities. It also considered the need for high-quality research that produces research findings relevant to other communities, states, and regions. The committee brought together expertise in prevention research, behavioral sciences, preventive medicine, clinical medicine, community health, health promotion and education, rural health, health services research, research administration, evaluation sciences, epidemiology, and public health practice at the state and local levels. Committee members met three times between March and July 1996. CDC staff and some of those who advocated for the program while it was being considered by the Congress joined the committee for its first meeting. In addition to its regular meetings, members of the committee and its staff conducted site visits to prevention research centers in New York, North Carolina, and New Mexico, and to the CDC offices in Atlanta responsible for the direction and funding of the program. The director of the prevention research center at the University of Washington met with the committee during its July meeting. Telephone interviews, following detailed review of documents and written responses, were conducted with senior staff of the remaining nine centers. Informal contacts were made with others, including public health officials in the states and localities in which the centers are located. The site visits, meetings, reports, and telephone interviews gave the committee the opportunity to discuss important issues with prevention research center researchers and their collaborators, such as the challenges of developing innovative research projects, conducting demonstration projects in underserved communities, improving public health practices, and disseminating research findings. The committee is grateful for the input it received from many individuals at its meetings, during site visits, in writing, and in other ways. The prevention research center directors and co-directors and the CDC staff who responded to the committee's surveys and participated in site visits are listed in Appendix C. Bo Barrow, Don Benken, Roger Bulger, Michael Eriksen, Patricia Evans, Michael Gemmell, D.A. Henderson, Martha Katz, Lloyd Kolbe, James Marks, David McQueen, Gil Omenn, and Jean Smith participated in the committee's meetings or provided information for the committee. Patricia Riley, the CDC program director, was especially generous of her time and energy. The committee also thanks the IOM staff responsible for the project, including Linda Bailey, who was responsible for organizing the committee's meeting, site visits, and interviews, and for background research and writing; Donna Thompson, for project assistance; Marnie Muscoplat and Kimberly Tremel, who provided

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Linking Research and Public Health Practice: A Review of CDC's Program of Centers for Research and Demonstration of Health Promotion and Disease Prevention research support; and Michael Stoto, the director of the IOM Division of Health Promotion and Disease Prevention, in which this project was housed. In this report the committee concludes that the CDC prevention research centers program has had substantial progress and its participants are to be commended for its contributions to health promotion and disease prevention. The report proposes a set of recommendations intended to strengthen the quality and management of the program as it begins its second decade of work. By strengthening the program, the prevention research centers can contribute even more to local, state, and national efforts to improve the health of Americans. Lawrence W. Green, Chair

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Linking Research and Public Health Practice: A Review of CDC's Program of Centers for Research and Demonstration of Health Promotion and Disease Prevention Contents     EXECUTIVE SUMMARY   1  1   INTRODUCTION   13      History of the Prevention Research Centers Program,   14      Growth of the PRC Program,   15      CDC's Request for a Review of the PRC Program,   16      Overall Impressions,   21      Additional Perspectives on the PRC Program,   21  2   A VISION FOR THE PREVENTION RESEARCH CENTERS PROGRAM   23      The Challenge Ahead,   23  3   THE RESEARCH AND DEMONSTRATION PROJECTS CONDUCTED BY THE PREVENTION RESEARCH CENTERS   33      Innovations,   34      Setting Priorities in the PRCs,   37      Dissemination and Implementation Activities,   43      Summary and Conclusions,   47  4   MANAGEMENT AND OVERSIGHT OF THE PREVENTION RESEARCH CENTERS PROGRAM   49      Vision and Goals,   49

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Linking Research and Public Health Practice: A Review of CDC's Program of Centers for Research and Demonstration of Health Promotion and Disease Prevention      Thematic Focus,   51      Networking, Communication, and Dissemination,   52      Criteria for Evaluating PRCs,   55      Funding for the PRC Program,   58      Summary and Conclusions,   63     REFERENCES   65     APPENDIXES    A   Committee Biographies,   69  B   Charge to the Committee,   75  C   Protocol for Site Visits and Telephone Interviews, June 1996,   77  D   The CDC Prevention Research Centers Program,   87  E   Prevention Research Centers: Investing in the Nations Health, 1986-1996,   101

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Linking Research and Public Health Practice: A Review of CDC's Program of Centers for Research and Demonstration of Health Promotion and Disease Prevention Linking Research and Public Health Practice A Review of CDC's Program of Centers for Research and Demonstration of Health Promotion and Disease Prevention

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