3

The Research and Demonstration Projects Conducted by the Prevention Research Centers

The value of the prevention research center (PRC) program is determined, to a large extent, by the content and the quality of the research and demonstration projects conducted by the individual PRCs. The committee assessed the contribution of the efforts of PRCs in terms of the criteria identified in Appendix B : innovation, methods for project selection, dissemination, incorporation into practice, and balance. The basis for this review, as described in Chapter 1 , is written documents from the centers as well as a series of questionnaires, telephone interviews, and site visits.

The committee has not assessed the research and demonstration projects of individual PRCs because the scope of the committee's charge is a review of the entire PRC program, not of the individual centers or their research projects. No comprehensive evaluation of the individual PRCs has ever been done. The committee has examined the range and distribution of performance among the 13 PRCs and the Centers for Disease Control and Prevention's (CDC) oversight of this performance. The PRCs have only recently prepared a unified list of the current projects in each center, so the Committee's review necessarily is qualitative rather than quantitative. A number of specific PRC activities are mentioned in this chapter to illustrate the committee's assessments of the entire PRC portfolio; reference to an activity is not intended to imply endorsements of the activity mentioned.

The committee's findings and recommendations regarding the PRCs themselves, as described in this chapter, indicate general directions for the PRCs, and they may not apply to all centers. Chapter 4 contains



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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 3 The Research and Demonstration Projects Conducted by the Prevention Research Centers The value of the prevention research center (PRC) program is determined, to a large extent, by the content and the quality of the research and demonstration projects conducted by the individual PRCs. The committee assessed the contribution of the efforts of PRCs in terms of the criteria identified in Appendix B : innovation, methods for project selection, dissemination, incorporation into practice, and balance. The basis for this review, as described in Chapter 1 , is written documents from the centers as well as a series of questionnaires, telephone interviews, and site visits. The committee has not assessed the research and demonstration projects of individual PRCs because the scope of the committee's charge is a review of the entire PRC program, not of the individual centers or their research projects. No comprehensive evaluation of the individual PRCs has ever been done. The committee has examined the range and distribution of performance among the 13 PRCs and the Centers for Disease Control and Prevention's (CDC) oversight of this performance. The PRCs have only recently prepared a unified list of the current projects in each center, so the Committee's review necessarily is qualitative rather than quantitative. A number of specific PRC activities are mentioned in this chapter to illustrate the committee's assessments of the entire PRC portfolio; reference to an activity is not intended to imply endorsements of the activity mentioned. The committee's findings and recommendations regarding the PRCs themselves, as described in this chapter, indicate general directions for the PRCs, and they may not apply to all centers. Chapter 4 contains

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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 recommendations for CDC management and oversight of the PRC program that address some of the issues raised in this chapter. INNOVATIONS The first question asked of the committee regards the level of innovation in the research conducted by the PRCs: To what extent are the university-initiated research and demonstration projects devoted to new and significant public health issues, new intervention strategies, or new methods to improve the practice of public health? In addressing this question, the committee found it necessary to expand the traditional criterion of innovativeness to encompass the populations and problems addressed. A research project might not be judged innovative as basic research, but may be innovative in the context of the purpose of the PRC program if it addressed an underserved or previously unreached population, or if it were to test previously tested methods on a different but important health problem. In these terms, the committee found that the research and demonstration projects conducted by the PRCs were indeed innovative. Nearly every PRC carries out research on underserved populations. These groups include African-Americans, Hispanics, Native Americans, residents of Harlem and Appalachia, adolescents, and elders. Some of the PRCs focus their efforts or individual projects on more specific populations such as rural African-American older adults (South Carolina), public safety personnel (North Carolina), and Korean-American women (Berkeley). The PRCs have addressed a wide variety of new and important public health problems. Topics that have been or are being addressed by the PRCs include: fortification of grains with folates to prevent neural tube defects (Washington); perinatal transmission of HIV (Berkeley); physical activity and nutrition in pregnancy (South Carolina); healthy transition to adolescence (Johns Hopkins); reproductive health in manufacturing industries (North Carolina); physical activity, estrogen metabolism, and breast cancer risk (South Carolina); asthma in African-American and Hispanic communities (Columbia); physical functioning and quality of life in older adults (Washington);

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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 effect of smoking cessation in older adults (Washington). The PRCs are also effective in applying existing methods to new and important public health problems. Some of the interventions that have been or are being studied at the PRCs include: efforts to reduce the risk of perinatal transmission of HIV by improving the quality of education, testing, and counseling services in county prenatal clinics (Berkeley); small-group interventions to foster decisionmaking and social skills among 6th grade students who attend school-based health clinics (Johns Hopkins); evaluating the impact of educational and enforcement strategies to increase compliance with a new law that prohibits the sales of cigarettes to minors (Columbia); school-based health promotion projects that include multicomponent interventions to address sexual risk behavior and violence-related behavior (Texas); school-based interventions to improve diet and increase physical activity in elementary school children (Texas); culturally specific and sensitive smoking prevention and cessation programs, as well as dietary and exercise programs, for Native American youth (Oklahoma); an adolescent pregnancy prevention education program using a computer program called “Babygame” (Columbia); counseling to promote consistent condom and spermicide use to reduce STD risk in high-risk women (Alabama); a smoking cessation intervention for low-income pregnant women (Texas); interventions to control asthma in African-American and Hispanic communities (Columbia); workplace health promotion interventions for blue collar women (North Carolina); a church-based, volunteer-led community health promotion program for cardiovascular risk factors (Columbia); computer-tailored health promotion materials to reduce cardiovascular risk factors in rural primary care settings (St. Louis); periodic screening and diabetes prevention programs for Native Americans (Oklahoma); program at a rural congregate meal site to improve strength and flexibility of older African-American adults (South Carolina); a low-cost, community-based exercise program for elders (Washington);

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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 a prevention education curriculum for physicians, including both lectures and print material, aimed at increasing physician knowledge of prevention guidelines and the delivery of preventive services to patients (Columbia). In addition, a number of the PRCs are addressing community interventions for the Women's Health Initiative, led by the National Institutes of Health (NIH), through the Special Interest Project (SIP) program. Some PRCs have addressed research methodology and the development of new interventions. Some of the best examples include programs to accomplish the following. Address problems in survey methods for underserved minority communities, such as inadequate sampling frames, low response rates, lack of telephones, and nonresponse bias (Columbia). Develop feasible methods for conducting the Behavioral Risk Factor Surveillance System (BRFSS) in Native American populations (New Mexico). Develop community-based measures of environmental and policy factors related to chronic disease risks, as well as intervening variables such as self-efficacy and normative beliefs (St. Louis). Create new instruments for the assessment of the health status of older adults (Washington). Develop a comprehensive student health survey (Texas). Improve statewide surveillance for HIV/AIDS (Berkeley). Develop statistical models for cross-validation of structural models for longitudinal studies and for ordinal outcomes for longitudinal clustered designs (Illinois). Develop an extensive database on methodology literature and instruments for health promotion research and evaluation in public health (Washington). Most of the PRCs, however, do not engage in this sort of methodological development. One way to enhance a PRC's ability to develop new research methods is to establish a methodology unit or otherwise identify a group of PRC personnel responsible for methodological development. The PRCs at the University of Illinois and the University of Alabama, Birmingham, for instance, have such units in place. Methodology units of this sort are also likely to increase the PRC's ability to raise research funding from sources other than CDC. Thus, the committee recommends that PRCs should include methodology units or assigned personnel in support of research methods development as a core activity.

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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 SETTING PRIORITIES IN THE PRCs Among the questions addressed by the committee were: What criteria and methods do—and should—CDC and the universities use to select health promotion and disease prevention research and demonstration projects and to judge their results? What is the appropriate balance between research supported by core funding, SIP funding, and other funding; between health promotion research and disease prevention research; and between basic research in health promotion and disease prevention and development of interventions? Criteria for Project Selection The establishment of a research center, as opposed to a group of uncoordinated researchers, should have implications for the selection of research topics and the evaluation of their results. One area where the “centerness” of a PRC should be evident is that of project selection, as addressed above. The “centerness” of a program will be reflected more accurately in its structure and the kinds of integrative activities it permits and fosters than in the more obvious ways in which titles and roles are made visible. PRCs will be more effective if they are able to call on the loyalties and participation of their key senior personnel on a frequent and regular basis. Provision for regular staff meetings that are well and willingly attended; frequent occasions for open, shared intellectual interchange; and interlocking collaborative efforts will be more indicative of the existence of a real PRC than any accounting of the sources of compensation or other resources. As a PRC matures, it is to be expected that its senior members will have increasing portions of their time committed to their own projects and to advisory roles in the work of their junior colleagues. As long as their decreasing dependence on center resources is not accompanied by a diminution of interest in the affairs and welfare of the PRC, the center can not only remain intact, but can prosper. Thus, one should expect mature PRCs to show evidence of ongoing programs of an integrative nature and structural arrangements that lead to shared intellectual enterprise and responsibilities. At the University of Washington, Healthy People (USDHEW, 1979) and later Healthy People 2000 (USDHHS, 1981) have provided guidance for PRC project selection. Columbia University has based its project selection on an analysis of excess mortality and morbidity in Harlem. Projects are chosen jointly with representatives of tribal groups at the University of Oklahoma. Beyond these kinds of examples, however, the committee found little evidence

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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 in its interviews, site visits, and record reviews of explicit criteria or systematic methods for selecting research projects in the individual PRCs. In general, the program of a research center is stronger if it is more than a collection of unrelated projects. With a coherent, coordinated program, for instance, projects can build upon one another's results, and staff gain methodological and substantive expertise that improves the quality of subsequent projects they undertake. The development of such a coherent research program requires careful attention to project selection. Thus, the committee recommends that PRCs should clearly state their criteria for project selection and evaluation. Criteria for project selection should be informed by objective data on the importance of health problems, community perceptions, gaps in scientific knowledge, and public health practice needs, as well as the interests and expertise of the PRC. These criteria should include: the magnitude of the problem, based on morbidity and mortality data and the number and kinds of people affected; the severity of the problem and the effectiveness of available or potential interventions; the funding level and degree of activity already present within the community; the level of expertise at the PRC; public health practice needs; the level of interest of local partners and stakeholders. Stakeholders should be identified and may appropriately include state and local health departments, which have a responsibility to assure that health promotion and disease prevention information and services are available in the community (IOM, 1988, 1996b). The PRC at the University of Illinois, Chicago, for example, has a portfolio of innovative projects bridging basic and applied research, methodologies, measures, and intervention modalities; multiple channels of communication; multiple behavioral risk factors; and high-risk but underserved populations. This center's framework can be a model for other centers to use in developing a comprehensive, integrated selection of projects (see Box 3-1 ).

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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 BOX 3.1 Health Promotion and Disease Prevention Research at the University of Illinois, Chicago. UIC's work bridges five phases of health promotion and disease prevention research (Flay, 1986). Phase I: Basic, epidemiological, and etiological research as well as theoretical development. UIC researchers have developed a “theory of triadic influence” (Flay and Petraitis, 1994) to unify biological, personality, social, and socioeconomic influences on behavior acquisition and change. Phase II: Methods development. UIC researchers have emphasized research design, sampling, intervention design, measurement, and statistical analysis. For example, in statistics, UIC researchers have developed new statistical methods and associated computer programs for multilevel analysis of categorical data needed for the analysis of community-level intervention. Phase III: Efficacy trials of promising interventions. UIC researchers have conducted studies of interventions in the areas of adolescent tobacco use and substance abuse, adult smoking cessation, youth AIDS, and violence. One such project is the Youth AIDS Prevention Program, which integrates school-based human sexuality, drug, STD/HIV/AIDS, and risk reduction education and prevention for junior high and middle-school students with parent and community involvement. This program, tested in 15 ethnically varied Chicago-area school districts in 1991–1993, has been shown to enhance perceived self-efficacy, behavioral intentions, knowledge, and communication skills, as well as attitudes regarding HIV/AIDS. Following eight articles about the program in scientific journals, the program was identified by the DHHS Office of Population Affairs as one of a small number of programs with demonstrated impact on fertility and STD/HIV/AIDS-related risk behaviors. Phase IV: Studies of the effectiveness of interventions under real-world circumstances. UIC researchers, for example, tested a self-help smoking cessation program incorporating television broadcasting and manuals, and found that it was successful in attracting smokers who were difficult to reach by other means: African-Americans, females, and those with annual incomes under $13,000. Phase V: Dissemination of interventions. One UIC study examined the dissemination of drug abuse prevention programs in Illinois. Surveys of school administrators, board members, teachers, and parents found that uptake was associated with perceptions about the seriousness of the problem, the acceptance of the program, program effectiveness, and satisfaction with the program.

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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 The community advisory committees that all PRCs are required to have can be helpful in project selection, but their consideration or approval of research projects cannot substitute for explicit criteria and systematic methods. The Johns Hopkins PRC, for instance, has three committees to consult with its constituencies; one with youth; another with community agencies; and a third with academic institutions, national agencies, and the private sector. The PRC advisory committee at the University of Illinois, Chicago, includes leaders in public health, voluntary health agencies, medicine, health media, private industry, and policymaking. The committee suggests that the PRCs ultimately, move toward a fuller collaboration with the community in research, as described in Chapter 2. Systematic procedures and methods for the use of these committees in the project selection and evaluation process are needed by most of the centers. Quality Control Given the broad range of research, demonstration, dissemination, and other activities that take place at the PRCs, it is difficult to specify objective measures of the quality of these efforts. The committee's subjective review of the PRC's research portfolios suggests that the quality of research and demonstration projects that are being conducted is highly variable. Some PRCs are conducting extremely high quality research and demonstration projects. In these institutions there tends to be a clear mechanism to eliminate low-quality projects that are unlikely to yield results that can be generalized to other populations, to different health outcomes, and so on. Most of the PRCs, however, do not seem to have a well-defined process for evaluating the results of their research projects. In general, PRCs describe their projects as relevant to their themes, addressing health problems of importance, or at least acceptable, to the community. The quality of research and demonstration projects may be enhanced by the existence of an internal quality control mechanism for reports, publications, research proposals, and other PRC products. Thus, the committee recommends that PRCs should have an internal quality control mechanism such as a review panel for reports, publications, research proposals, and other PRC products.

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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 Peer Review A few PRCs have progressed sufficiently to produce research that has been evaluated by the traditional academic standards of peer review. Peer-reviewed grant applications and publications an important means of reviewing the quality of projects, as well as an important channel for disseminating new knowledge in professional communities. The committee finds that as a group PRCs produce too few peer-reviewed research applications and publications relative to their resources and their maturity; they should be encouraged to pursue research funding through peer review channels other than CDC and to publish their findings in the peer-reviewed literature. Because funding for community-based research is relatively rare, the PRCs should be especially diligent about publishing articles that describe the process and the public health implications of their work in this area. The committee had no objective measure for the evaluation of the quality of non-peer-reviewed products. In this regard, the committee recommends that More of the findings of the PRCs should be published in the peer-reviewed scientific literature. Public Health Impact There are many examples of projects that have had a clear impact on the community's health, as well as policies and practices in public health agencies, health service delivery systems, and other community organizations concerned about public health. This can be seen most plainly through links between the PRCs and community institutions and organizations. The University of Washington PRC's link with the Center for Health Studies at Group Health Cooperative of Puget Sound, for instance, which provides a setting for prevention research as well as a dissemination channel. This PRC also works with local senior centers for dissemination of results on elder health. In New York, Columbia has partnered with the local Safe Kids/Healthy Neighborhoods Coalition. Johns Hopkins is working collaboratively with several local health departments to evaluate teen pregnancy prevention programs and school-based health clinics, and the PRC cooperates with Salisbury State University to improve connections to the rural Eastern Shore region of Maryland. The PRC at the University of North Carolina has worked with local county commissioners and municipal leaders to design strategies for reducing injury rates in their jurisdictions. The committee's impression, however, is that relatively few of the research efforts have produced impact beyond the immediate community. For instance,

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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 new methods for communicating with special target groups like minorities or adolescents developed in one PRC are generally not implemented in other similar groups in other communities. To clarify the impact of the PRC research, the committee recommends that PRCs should document the impact of their activities on public health research, practice, and policy, both locally and nationally. In this context and elsewhere in this report, it must be remembered that public health practice involves many public agencies and private community organizations as well as leaders and other individuals in the community (IOM 1988, 1996a, 1996b). Balance in Research Portfolios In addressing the question of balance among types of funding and research, the committee found as many different patterns as there were PRCs. Given this experience, it is not possible to make general statements regarding balance that would be appropriate for all centers. Rather, the committee recognizes the need for PRCs' to maintain a coherent program of research, and to be both opportunistic in relation to available funding sources and responsive to emerging community needs. The emphasis on a coherent research theme within a PRC is vital for maximizing the cross-fertilization of ideas and methods and for building on the strengths that the PRC develops over time in a defined area of research. Having a coherent theme is also likely to help a PRC raise research funding from sources other than CDC. Compared with other research programs in health promotion and disease prevention, the PRC program is unique in its focus on the community. Indeed, the added value of the PRC program is its potential for community-based research. This approach to health improvement is relatively new (Patrick and Wickizer, 1995; IOM, 1996b), and carries with it a philosophy and view of the scientific method that encourages the involvement of representatives of residents and practitioners in the communities to be studied, as discussed in Chapter 2. Community-based research of this sort is undertaken as a collaboration in which researchers and community partners participate from the earliest stages of a project, defining research objectives. The involvement of community representatives is evident in all phases of the research —setting goals, selecting and designing methods, and interpreting and disseminating data—and their participation plays a role in maintaining a research focus on issues that are relevant to the community. This approach is viewed by many public health practitioners and applied researchers as a way to facilitate the

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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 adoption of new health policies and practices among agencies, professionals, and the public (Green et al., 1995; Park et al., 1994; Schwartz and Capwell, 1995). Given the difficulties of conducting community-based research (Koepsell et al., 1992; Schwartz et al., 1993), there is a special need for CDC to nurture the approach and to discuss it both internally and externally. This approach to research is uncommon among funding agencies, and it is consistent with the organizational goals of CDC regarding a community orientation and commitment to the public health practice community. Integration of PRC activities with state and local health agencies is a critical as well as explicit component of PRC operations. Involvement of the public health practice community—including state and local public health agencies and community-based organizations, as well as the community or population under study—in the development of their health promotion and disease prevention research agenda should be an important consideration in that agenda-setting process. CDC has an opportunity to advance the science of community-based research through the PRC program. We use the term “community-based ” as defined in Chapter 2 as something more than research on the community, or research in the community. The committee's review of the individual PRCs, indicated that some are more oriented toward the participatory dimensions of this approach than others. Thus, the committee recommends that The PRCs should adopt a community-based approach to their research and demonstration efforts. Toward this end, PRCs could involve community representatives in all phases of research and demonstration activities, and study ways to make this involvement most effective; pursue research and demonstration projects in which community factors, and community interventions, are paramount; develop and improve statistical methods for the evaluation of community-based interventions. DISSEMINATION AND IMPLEMENTATION ACTIVITIES The committee was also asked to address the following two sets of questions:

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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 To what extent are the findings of the research and demonstration projects and related research disseminated? What methods are used to disseminate the results of the research and demonstration projects? Are they effective? To what extent are the findings of research and demonstration projects incorporated into prevention practice, particularly by state and local health departments? A major focus of the PRCs is the dissemination of their research findings and products to the public health practice community. Achieving changes in individual behavior and public health practices requires varying approaches. Some populations will, by reason of their special characteristics, require unusual efforts and considerable innovativeness. Improving dissemination and implementation practices calls for research that will inform health promotion professionals, educators, and policymakers about the most appropriate methods for disseminating health messages among different populations. The PRCs have employed a variety of methods for dissemination, including publishing in the scientific literature; providing workshop-mediated training methods; using advanced communications technologies, including interactive media; developing written and graphic materials for lay audiences; distributing training materials for professional and varied lay audiences; and attending meetings to present results to a wide variety of audiences (for example, local and state health departments, policymakers, public health professionals, lay audiences, education and social science professionals, and numerous organizations including schools, work sites, managed care organizations, and voluntary health organizations). These communications have involved materials to enhance awareness, information of a cognitive nature, and activities devised to improve performance skills. Some specific examples of PRC dissemination efforts are as follows: a summer institute for public health practitioners from HMOs, work sites, hospitals, and health departments (Washington); teleconferences to a rural collaborating center (Johns Hopkins); workshops for state and local health departments on best practices in adolescent health (Johns Hopkins); publication of “policy news briefs” that describe national policies and legislation related to children and adolescents, “issue briefs” that summarize major research findings, newsletters about the center's activities, and “Health of Maryland's Adolescents,” a fact book with health, education, and social indicators on adolescents (Johns Hopkins). electronic bulletin boards (South Carolina).

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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 The dissemination and implementation activities among the PRCs tend to have three elements: (1) conveying information to appropriate audiences; (2) developing methods for incorporating information into public health practice; and (3) evaluating the effectiveness of the attempts to influence public health practice and improve understanding of the entire dissemination process. The PRCs differ in both the effort they devote to dissemination and implementation and the nature of those efforts. Some PRCs do not appear to place a high priority on dissemination and implementation, some have ambitious plans that are not being carried out because of reductions in CDC funding levels, and some PRCs have experience and expertise in such activities. Some of the dissemination efforts of PRCs have been innovative and deserving of emulation and further testing. Examples of such efforts include bumper stickers devised by children from the local community, which are thought to be especially commanding of attention; activation of a lay group to bring political pressure to bear to maintain health promotion efforts for their group; and development of a game for adolescents devised to increase their understanding of critical issues related to their health. On the whole, however, the committee found that relatively little effort was expended in dissemination activities in the majority of PRCs. Indeed, the committee found that many PRCs are in an early stage of development. During this early phase, PRCs must devote a large proportion of their core funding to establishing a research program. PRCs can expend core funds justifiably to help initiate a cohesive program of research, but such research should then be continued through regular research funding channels so that an adequate proportion of core funds can be devoted increasingly to outreach and technical assistance activities. Research findings and products from the PRCs and CDC should be disseminated to all PRCs, their communities, and their regional populations; to the research and professional communities through scientific and professional literature; and to the public health practice community and the general public. Thus, the committee recommends that The PRC program, as a whole, should increase its focus on dissemination efforts. PRCs can employ a variety of methods for dissemination, as illustrated above, including publishing in the scientific literature; providing workshop-mediated training methods; using advanced communications technologies, including interactive media; developing written and graphic materials for lay audiences; and distributing training materials for professional and varied lay audiences. PRC personnel can also attend meetings to present results to a wide variety of audiences (for example, local and state health departments,

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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 policymakers, public health professionals, lay audiences, education and social science professionals, and numerous organizations including schools, work sites, managed care organizations, and voluntary health organizations). These communications should involve materials to enhance awareness, information of a cognitive nature and activities devised to improve performance skills. Prevention Networks The impact of the PRC program can be enhanced through cooperative dissemination activities among the PRCs, and between the network of PRCs and other health promotion organizations such as state and local health departments in the United States and elsewhere. Dissemination activities, especially those involving the academic and public health practice communities jointly, can accelerate the diffusion of new public health practices (Schwartz and Capwell, 1995). The PRCs can encourage these activities by taking the lead in creating a national network for dissemination. These efforts should involve the use of advanced communication technologies. Thus, the committee recommends that PRCs should seek to be part of regional and national networks for prevention that include CDC, the public health practice community, and other relevant parties. Dissemination Research It is important to distinguish between dissemination activities and research on dissemination. The goals of dissemination are to (1) convey information regarding effective prevention programs to public health officials, other health professionals, and community leaders and (2) inform the public about health-related matters. Dissemination research, on the other hand, seeks to identify better ways to communicate information to the public and to practitioners. The Texas PRC, for instance, has conducted dissemination research to demonstrate the effectiveness of interventions designed to influence schools to adopt effective tobacco prevention programs. In reviewing the activities of the PRCs, the committee found many instances of dissemination activities, but few projects focused on dissemination research. Since the university-based PRCs are attempting an array of dissemination approaches with a wide range of public and professional audiences, and because academic institutions have some research capacity, they are in a unique position to carry out dissemination research. Thus, the committee recommends that

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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 The PRCs should increase their dissemination research efforts. SUMMARY AND CONCLUSIONS By forging links with academia, CDC has created a gateway for access to a cadre of well-trained, university-based researchers who could serve to inform and collaborate with the agency and the public health community regarding health promotion and disease prevention. The PRC program also fosters the development of academic research in questions related to public health practice, community interventions, and the development of community links for translating research findings into practice. Overall, the committee finds that the PRC program has made substantial progress and is to be commended for its accomplishments in advancing the scientific infrastructure in support of disease prevention and health promotion policy, programs, and practices. By further strengthening the PRC program, the CDC can increase its capacity to contribute to local, state, and national efforts to improve the health of Americans. The committee's review of the efforts of the individual PRCs has indicated that each of the centers has made some contributions toward one or more of the goals of the program, and in the committee's judgment many of these activities would not have been undertaken in the absence of the PRC program. There are, however, substantial differences among the PRCs in the kinds of activities they have undertaken and their success, and only a few centers have made substantial progress on all fronts: research, dissemination, and developing connections with the community and public health practitioners. Given the breadth of the PRC program's goals, the limitations on core funding, and the relative newness of some of the PRCs, the program's successes have been genuine and important.

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