Appendix D

The CDC Prevention Research Centers Program: A Decade of Achievement, 1986–1996, and an Agenda for the Decade Ahead

This appendix reproduces a report prepared in 1996 by the CDC Prevention Research Center directors, under the leadership of Darwin Labarthe.



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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 Appendix D The CDC Prevention Research Centers Program: A Decade of Achievement, 1986–1996, and an Agenda for the Decade Ahead This appendix reproduces a report prepared in 1996 by the CDC Prevention Research Center directors, under the leadership of Darwin Labarthe.

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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 CDC PREVENTION RESEARCH CENTERS PROGRAM: A DECADE OF ACHIEVEMENT, 1986-1996 and AN AGENDA FOR THE DECADE AHEAD A landmark event for health research in the United States was the establishment of the Centers for Research and Demonstration of Health Promotion and Disease Prevention, through Public Law 98-551, enacted on October 30, 1984, and implemented by the Centers for Disease Control and Prevention (CDC) in 1986. This report illustrates the Program 's achievements in its first 10 years, 1986-1996, and proposes an agenda for its further development over the next 10 years. EXECUTIVE SUMMARY The CDC Prevention Research Centers Program is unique in the nation 's health research enterprise: This Program applies current knowledge about health promotion and disease prevention directly to the benefit of the public's health. And it forges essential new linkages for health between participating academic health centers and numerous federal, state, and local agencies — public and private — and with the communities they serve. Its mission is to provide a rigorous scientific underpinning for health promotion and disease prevention policies and practices and to transalate this science into the practical demonstration and evaluation of cost-effective strategies. The Program's success is a consequence of the joint efforts of CDC, state and local health departments, and their natural partners — the schools of public health and other academic health centers. Collectively, this collaborative program of research, demonstration, and implementation of health promotion and disease prevention in local communities is having a significant impact on the nation's health. The Critical Need for “Prevention Research” Prevention research involves the direct and immediate application of effective strategies to benefit the public's health. Further, it aims to avert the onset of disease or disability, to reverse subclinical or inapparent disease, and to delay progression from established asymptomatic The ultimate benefit of prevention research is to prolong health, well-being and self-sufficiency and thereby to enhance productivity and quality of life. These fundamental aspects of prevention research contrast sharply with research in the laboratory and with individual patients. In fact, it is prevention research which identifies and

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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 demonstrates those products of laboratory and patient-oriented research which can be translated into direct improvements in the nation's health. Without prevention research, those other research accomplishments may remain on the shelf and thus confer no health benefit to the nation. Achievements of the Program: 1986-1996 As of 1996 the Prevention Research Centers Program comprises 13 academic centers located as shown (see map), reflecting growth from the 3 initial Centers. 1 2 For the purposes of this report, the most significant achievements of the Program as a whole are illustrated by several brief examples: HIV/AIDS research in nine counties based at the Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, has provided new information on knowledge and attitudes of religious leaders, instructional materials for care-givers, educational materials for schools, and a community resource guide, all of which serve as models for use by other agencies. Studies of disability prevention among older Americans by the Northwest Prevention Effectiveness Center. University of Washington, have demonstrated that low-cost group exercise programs in community-based senior centers can produce meaningful and measurable improvements in endurance, flexibility, lower body strength, self-reported health status, and fewer injurious falls; these findings have great potential for prolonging self-sufficiency and independent living, thereby adding to quality of life and reducing health care costs. Studies of the health of children, in order to prevent obesity, diabetes, heart attack, stroke, and other adult diseases, conducted by the Southwest Center for Prevention Research in the University of Texas-Houston Health Science Center have shown that at age 10. Mexican-American children already show a greater tendency toward risk of obesity, diabetes, heart attack, and stroke than their non-Hispanic classmates; this finding adds to information on the high risk of Mexican-American adults and underscores the need for prevention in the school years for all children if the major burdens of adult cardiovascular diseases — personal, social and economic — are to be reduced. The special role of the Prevention Research Centers in training of public health professionals has been recognized by the Association of Schools of Public Health, which has utilized the Centers for selection and placement of its graduate public health interns; this approach capitalizes on the strengthened linkages of these Centers with the health departments where interns are placed. The Special Interest Projects (SIP) mechanism initiated by CDC matches research priorities of Centers within CDC with the capabilities of the Prevention Research Centers; multiple partnerships have now become established as a result, and for FY 1995-96 the investment of CDC in these projects reached $9.5 million; examples include the Tobacco Control Network, Support to Historically Black Colleges and Universities, and Physical Activity in Minority Women. New linkages between academic health centers and communities are illustrated by Columbia University's Harlem Center for Health Promotion and Disease Prevention. uniquely based in a community hospital (Harlem Hospital) and providing direct access to high-risk populations of New York City, in a close interaction between the University and the community developed directly through this Program. The Prevention Research Centers have multiplied the investment in research projects by being resourceful and highly effective in utilizing core funds to develop proposals for independent prevention research support; the number of prevention research projects being undertaken as a result is well above that possible with the limited core funding available to date. 3 These achievements and many others indicate the present capacity of the Prevention Research Centers Program to fulfill its mission of research and demonstration of health promotion, and disease prevention.

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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 It is important to note that core support for this Program has remained at approximately $0.5 million per year per Center (total cost, including institutional indirect cost) since its inception. The original authorization of $1 million per Center (in 1984 dollars) has never been realized, as priority has consistently been placed on inclusion of new Centers whenever the appropriation was increased. This strategy has increased the number of Centers, which enhances the Program's impact; however, it conduct the full-scale demonstration and evaluation projects originally contemplated. Meanwhile, support of background studies, pilot projects, analysis of existing data and preparation of formal research proposals has been a critical investment of the core funds awarded to each Prevention Research Center and remains a unique and indispensable feature of the Program. No alternative mechanism is available to support these preparatory research activities, which are essential for innovation in prevention research. The Agenda for a Second Decade of Success As of 1996, the Prevention Research Centers are demonstrably effective in generating new knowledge and applications for the benefit of the public's health. It is important to capitalize on the progress to date and to enhance the linkages that tie together CDC, state health and education agencies. Program objectives presented in the table below have therefore been adopted for the decade from 1996-2006. The Prevention Research Centers can help insure that expenditures for health care are contained whenever possible by prevention of costly illness and disability, and that expenditures for prevention are based on cost-effective evaluations of the interventions. In short, the need for prevention research is now more critical than ever before. Expanded support will allow the Prevention Research Centers to: add continuously to knowledge of effective health promotion and disease prevention strategies for the health benefit of the public, helping to achieve the measurable objectives of the nation's blueprint for action. Healthy People 2000; expand the professional capacity to conduct prevention research and apply its results in communities throughout the nation: broaden and strengthen the linkages among fedral, state and local health agencies and academic health centers to improve the identification, evaluation, and application of measures for health promotion and disease prevention: and insure that prevention research serves its critical role complementary to laboratory and patient-oriented investigations, as part of the full spectrum of biomedical and community health research.

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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 CDC PREVENTION RESEARCH CENTERS PROGRAM: A DECADE OF ACHIEVEMENT, 1986-1996 and AN AGENDA FOR THE DECADE AHEAD A landmark event for health research in the United States was the establishment of the Centers for Research and Demonstration of Health Promotion and Disease Prevention, through Public Law 98-551, enacted on October 30, 1984, and implemented by the Centers for Disease Control and Prevention (CDC) in 1986. This report illustrates the Program 's achievements in its first 10 years, 1986-1996, and proposes an agenda for its further development over the next 10 years. FULL REPORT

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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 Summary The Prevention Research Centers Program is unique in the nation's health research enterprise: Its mission is to provide a rigorous scientific underpinning for health promotion and disease prevention policies and practices and to translate this science into the practical demonstration and evaluation of cost-effective strategies. Collectively, this collaborative program of research, demonstration, and implementation of health promotion and disease prevention in local communities is having a significant impact on the nation's health. Examples of significant progress through this Program include studies of HIV/AIDS, disability prevention among older Americans, and the prevention of obesity, diabetes, heart attack and stroke beginning in childhood. Additional successes include expanded training capacity for public health professionals: broadened partnerships among components of CDC, the Prevention Research Centers, state and local health departments, and communities: and multiplication of the investment in prevention research by effective use of Program core funds. These achievements and many others indicate the present capacity of the Prevention Research Centers Program to fulfill its mission of research and demonstration of health promotion and disease prevention. Support of background studies, pilot projects, analysis of existing data, and preparation of formal research proposals has been a critical investment of the core funds awarded to each Prevention Research Center — a unique and indispensable feature of the Program. No alternative mechanism is available to support these preparatory research activities, which are essential for innovation in prevention research. Four Program objectives for the period 1996-2006 are proposed: Expand the level of core support per Center and the number of Centers. Broaden and strengthen the networks and interactions already developing. Establish a forum for systematic evaluation of current issues in prevention research, using Prevention Priority Panels. Reassess progress in midcourse: Reassessment, 2001 — the 15-year mark. The collaborators in the Prevention Research Centers Program are pleased to acknowledge the interest and participation of many individuals, organizations, agencies, and communities in the conduct of our work and anticipate expanded cooperation toward improving the public's health in the decade ahead. Introduction The CDC Prevention Research Centers Program is unique in the nation 's health research enterprise: This Program applies current knowledge about health promotion and disease prevention directly to the benefit of the public's health. And it forges essential new linkages for health between participating academic health centers and numerous federal, state, and local agencies — public and private — and with the communities they serve. Its mission is to provide a rigorous scientific underpinning for health promotion and disease prevention policies and practices and to translate this science into the practical demonstration and evaluation of cost-effective strategies. The Program's success is a consequence of the joint efforts of CDC, state and local health departments, and their natural partners — the schools of public health and other academic health centers. Collectively, this collaborative program of research, demonstration, and implementation of health promotion and disease prevention in local communities is having a significant impact on the nation's health.

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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 Background of Program Authorization and implementation In July, 1981, D. A. Henderson (Dean of the Johns Hopkins School of Public Health) proposed in Congressional testimony “a national network of academic centers for health promotion and disease prevention . . . charged with education of [public health] program leaders and staff, participation in operative programs with relevant public and private agencies, and research to assess programs, to identify and measure risks and to devise new means to prevent disease.” The ensuing efforts of William F. Bridger, Robert W. Day, and Michael Gemmell, on behalf of the Association of Schools of Public Health, and the support of key members of Congress, led to the authorization of this Program in 1984 and the first appropriation for its implementation in 1986, with CDC as the implementing agency 1 . The Critical Need for “Prevention Research” Prevention research involves the direct and immediate application of effective strategies to benefit the public's health. Further, it aims to avert the onset of disease or disability, to reverse subclinical or inapparent disease, and to delay progression from established asymptomatic conditions to overt clinical disease and disability. The ultimate benefit of prevention research is to prolong health, well-being and self-sufficiency and thereby to enhance productivity and quality of life. These fundamental aspects of prevention research contrast sharply with research in the laboratory and with individual patients. In fact, it is prevention research which identifies and demonstrates those products of laboratory and patient-oriented research which can be translated into direct improvements in the nation's health. Without prevention research, those other research accomplishments may remain on the shelf and thus confer no health benefit to the nation. The health research spectrum must extend from laboratory and patient-oriented investigation through prevention research in order to impact the health of the community — a concept not adequately conveyed by the term “biomedical research.” Congress recognized the critical place of prevention research in this spectrum when it established this Program. It is timely for the health research spectrum to embrace “biomedical and community health research.” In addition to undertaking prevention research as described above, each Prevention Research Center is charged with bridging the health and behavioral sciences with the economic and business sectors through new “multidisciplinary interactions”: conducting “developmental prevention research” on newly-emerging issues; and providing “shared expertise” to health and education agencies engaged in planning and evaluation of health interventions. With these tasks in view, CDC solicited competing applications from qualifying academic health centers throughout the United States in April, 1986. Achievements of the Program: 1986-1996 As of 1996 the Prevention Research Centers Program comprises 13 academic centers (Table 1) located as shown (see map, Figure 1), reflecting growth from the three initial Centers. 2 , 3 For the purposes of this report, the most significant achievements of the Program as a whole are described, from the perspective of all 13 Centers, in five key areas: conducting prevention research in areas identified in the National Health Promotion and Disease Prevention Objectives: expanding education and training resources in prevention research: broadening collaborations between the Prevention Research Centers and CDC; forging new linkages for prevention research at local, regional and national levels 4 ; and leveraging core support to increase research capacity.

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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 Several brief examples illustrate these achievements: HIV/AIDS research in nine counties based at the Center for Health Promotion and Disease Prevention, University of North Carolina, Chapel Hill, has provided new information on knowledge and attitudes of religious leaders, instructional materials for care-givers, educational materials for schools, and a community resource guide, all of which serve as models for use by other agencies. Studies of disability prevention among older Americans by the Northwest Prevention Effectiveness Center, University of Washington, have demonstrated that low-cost group exercise programs in community-based senior centers can produce meaningful and measurable improvements in endurance, flexibility, lower body strength, self-reported health status, and fewer injurious falls; these findings have great potential for prolonging self-sufficiency and independent living, thereby adding to quality of life and reducing health care costs. Studies of the health of children, in order to prevent obesity, diabetes, heart attack, stroke, and other adult diseases, conducted by the SouthWest Center for Prevention Research in the University of Texas-Houston Health Science Center have shown that at age 10, Mexican-American children already show a greater tendency toward risk of obesity, diabetes, heart attack, and stroke than their non-Hispanic classmates; this finding adds to information on the high risk of Mexican-American adults and underscores the need for prevention in the school years for all children if the major burdens of adult cardiovascular diseases — personal, social and economic — are to be reduced. The special role of the Prevention Research Centers in training of public health professionals has been recognized by the Association of Schools of Public Health, which has utilized the Centers for selection and placement of its graduate public health interns; this approach capitalizes on the strengthened linkages of these Centers with the health departments where interns are placed. The Special Interest Projects (SIP) mechanism initiated by CDC matches research priorities of Centers within CDC with the capabilities of the Prevention Research Centers; multiple partnerships have now become established as a result, and for FY 1995-96 the investment of CDC in these projects reached $9.5 million: examples include the Tobacco Control Network, Support to Historically Black Colleges and Universities, and Physical Activity in Minority Women (see. for example, Figure 2). New linkages between academic health centers and communities are illustrated by Columbia University's Harlem Center for Health Promotion and Disease Prevention, uniquely based in a community hospital (Harlem Hospital) and providing direct access to high-risk populations of New York City, in a close interaction between the University and the community developed directly through this Program. The Prevention Research Centers have multiplied the investment in research projects by being resourceful and highly effective in utilizing core funds to develop proposals for independent prevention research support; the number of prevention research projects being undertaken as a result is well above that possible with the limited core funding available to date. 5 These achievements and many others indicate the present capacity of the Prevention Research Centers Program to fulfill its mission of research and demonstration of health promotion and disease prevention. It is important to note that core support for this Program has remained at approximately $0.5 million per year per Center (total cost, including institutional indirect cost) since its inception (see Figure 2. “core”). The original authorization of $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 million per Center (in 1984 dollars) has never been realized, as priority has consistently been placed on inclusion of new Centers whenever the appropriation was increased. This strategy has increased the number of Centers, which enhances the Program's impact; however, it has also limited the individual Centers' ability to conduct the full-scale demonstration and evaluation projects originally contemplated. This level of research project — such as comprehensive community-based evaluations of the effectiveness and cost-benefit of new interventions — must await increased funding in the future. Meanwhile, support of background studies, pilot projects, analysis of existing data, and preparation of formal research proposals has been a critical investment of the core funds awarded to each Prevention Research Center and remains a unique and indispensable feature of the Program. No alternative mechanism is available to support these preparatory research activities, which are essential for innovation in prevention research. To assure the continued success of the Program, core funding must be continued and, insofar as possible, increased to strengthen the existing Centers and to maintain the momentum of growth experienced in the first 10 years. The Agenda for a Second Decade of Success As of 1996, the Prevention Research Centers are demonstrably effective in generating new knowledge and applications for the benefit of the public's health. It is important to capitalize on the progress to date and to enhance the linkages that tie together CDC, state health and education agencies, and the participating academic health centers. The Prevention Research Centers can help insure that expenditures for health care are contained wherever possible by prevention of costly illness and disability, and that expenditures for prevention are based on cost-effective evaluations of the interventions. In short, the need for prevention research is now more critical than ever before. Expanded support will allow the Prevention Research Centers to: add continuously to knowledge of effective health promotion and disease prevention strategies for the health benefit of the public, helping to achieve the measurable objectives of the Public Health Service blueprint. Healthy People 2000: expand the professional capacity to conduct prevention research and apply its results in communities throughout the nation: broaden and strengthen the linkages among federal, state and local health agencies and academic health centers needed to improve the identification, evaluation, and application of measures for health promotion and disease prevention; and insure that prevention research serves its critical role complementary to laboratory and patient-oriented investigations, as part of the full spectrum of biomedical and community health research. Program Objectives, 1996-2006 The agenda for the second decade of the CDC Prevention Research Centers Program includes four specific objectives (each objective is addressed briefly below): Expand the level of core support per Center and the number of Centers. Broaden and strengthen the networks and interactions which are already developing. Establish a forum for systematic evaluation of current issues in prevention research, using Prevention Priority Panels. Reassess progress in midcourse: Reassessment, 2001 – the 15-year mark.

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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 Expand the level of core support per Center and the number of Centers. Increasing the level of core support per Center to at least the level of $1 million authorized in 1984 will greatly enhance the contributions of the Program: The research, demonstration and evaluation projects on the scale contemplated in the original legislation will become feasible: training opportunities for health professional can be diversified and expanded; and the impact of the CDC, state and local health departments, and their academic and medical care partners toward achievement of the Healthy People 2000 goals and objectives will be accelerated. Increasing the number of Centers to include at least 20 states will broaden involvement of schools of public health and other qualified academic health centers and their community-based constituencies. Broaden and strengthen the networks and interactions which are already developing. The Prevention Centers Program should continue to lead CDC beyond its traditional focus on state health departments and to bring academic health centers outside their institutional bounds to interact jointly with communities, at work sites, and in other settings. Continuation of these developments will help to: link all components of CDC with their academic partners through the Prevention Research Centers Program: build partnerships with a wider array of health, education, housing, and managed care organizations in communities throughout the country; and provide leadership for the professional organizations in medicine and public health to enhance healthful behavior and empower all Americans to take charge of their personal health and their communities' health. Establish a forum for systematic evaluation of current issues in prevention research, using Prevention Priority Panels. Prevention Priority Panels should be appointed by CDC and the network of Prevention Research Centers on a biennial basis to review science and policy on specific questions of national importance in health promotion and disease prevention, including gaps in current policies, needs for legislative initiatives, or priorities for further research. Reassess progress in midcourse: Reassessment, 2001, the 15-year mark. The next formal internal Program reassessment should address progress toward achievement of the foregoing Program objectives, using the following criteria for success: the impacts of the Prevention Research Centers on community health measures, as presented in Healthy People 2000; the adequacy of the number of Centers and their level of core support: the strength and breadth of Program linkages with multiple component s of CDC and with professional organizations dedicated to prevention; the contribution of the initial Prevention Priority Panels to resolution of issues in prevention research and prevention practice: and the quality of the Program's contributions in the areas of new knowledge, new applications, new training programs and opportunities, and new partnerships for effective health promotion and disease prevention.

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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 Acknowledgments The collaborators in the Prevention Research Centers Program are pleased to acknowledge the interest and participation of many individuals, organizations, agencies, and communities in the conduct of our work and anticipate expanded cooperation toward improving the public' s health in the decade ahead. The Prevention Research Center Directors, in presenting this report, wish especially to acknowledge those whose efforts brought about the establishment of this program: First, Dr. D.A. Henderson, formerly Dean of the Johns Hopkins University School of Public Health, for proposing the concept before a hearing chaired by Sen. Orrin Hatch in 1981 and Dr. Robert Day, then President of the Association of Schools of Public Health; next, Dr. William F. Bridgers, formerly Dean of the University of Alabama at Birmingham School of Public Health, for devoting countless hours on Capitol Hill in pursuit of a vision that eventually became the Prevention Centers Program — the Centers would have remained no more than proposal if not for Dr. Bridgers' relentless determination, intellectual vigor and just plain hard work; and not least, our friends and supporters on Capitol Hill — Senator Hatch and his principal health advisor, Dr. David Sundwall; Senator Kennedy and his staffer, JoAnne Glisson, to whom we owe special thanks for her keen advice and counsel; then Representative and now Senator Shelby; Representative Waxman and his staffers Dr. Brian Biles and Ruth Katz, who counseled ASPH throughout the campaign and first identified its early champions (then Representative and now Senator Mikulski and Representative Scheur); Tony McCann, then Senate Budget Committee staffer, for his assistance and counsel; and Dr. William Roper, then Special Advisor for Health to President Reagan, who signed S.771 into law, thanks to him. Footnotes 1   See Appendix 1 : Public Law 98-551 – Oct. 30, 1984. 2   In a detailed appendix to this report, the 13 currently funded Prevention Research Centers are characterized individually. This information includes for each Center its institutional base; its research theme; its collaborative arrangements and organizational interactions established to date; and a profile of its current prevention research projects. 3   Three other Centers were discontinued on the basis of extensive scientific peer review. 4   See, for example, Table 2. 5   See National Center for Chronic Disease Prevention and Health Promotion. Prevention Centers: Making Prevention a Practical Reality. Annual Report 1996. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, January, 1996.

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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 CDC PREVENTION RESEARCH CENTERS PROGRAM: A DECADE OF ACHIEVEMENT, 1986-1996 and AN AGENDA FOR THE DECADE AHEAD FACT SHEET In a landmark event for health research in the United States, the Prevention Research Centers Program 1 was established through PL 98-551 (October 30, 1984). This Program was implemented by the Centers for Disease Control and Prevention (CDC) in 1986. A new report illustrates the Program's achievements in its first 10 years, 1986-1996, and proposes an agenda for its further development over the next 10 years, 1996-2006. The Prevention Research Centers Program is unique in the nation's health research enterprise: It applies current knowledge about health promotion and disease prevention directly to the benefit of the public's health, and it forges essential new linkages for health between participating academic health centers and numerous federal, state, and local agencies — public and private — and with the communities they serve. The Program mission is to provide a rigorous scientific underpinning for health promotion and disease prevention policies and practices and to translate this science into the practical demonstration and evaluation of cost-effective strategies. The ultimate benefit of prevention research is to test the application of promising products of laboratory and patient-oriented research in communities to determine their real impact on the public's health. Collectively, this collaborative program of research, demonstration, and implementation of health promotion and disease prevention in local communities is having a significant impact on the nation's health. Examples of significant progress through this Program include studies of HIV/AIDS, disability prevention among older Americans, and the prevention of obesity, diabetes, heart attack and stroke beginning in childhood. Additional successes include expanded training capacity for public health professionals; broadened partnerships among components of CDC, the Prevention Research Centers, state and local health departments, and communities; and multiplication of the investment in prevention research by effective use of core funds awarded through the Program. These achievements and many others indicate the present capacity of the Prevention Research Centers Program to fulfill its mission of research and demonstration of health promotion and disease prevention. Support of background studies, pilot projects, analysis of existing data, and preparation of formal research proposals has been a critical investment of the core funds awarded to each Prevention Research Center — a unique and indispensable feature of the Program. No alternative mechanism is available to support these preparatory research activities, which are essential for innovation in prevention research.

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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 PROGRAM OBJECTIVES: 1996-2006 Expand the level of core support per Center and the number of Centers. Increasing the level of core support per Center to at least the level of $1 million authorized in 1984 will greatly enhance the contributions of the Program. Increasing the number of Centers to include at least 20 states will broaden involvement of schools of public health and other qualified academic health centers and their community-based constituencies. Broaden and strengthen the networks and interactions which are already developing. The Prevention Centers Program should continue to lead CDC beyond its traditional focus on state health departments and to bring academic health centers outside their institutional bounds to interact jointly with communities, at work sites, and in other settings. Establish a forum for systematic evaluation of current issues in prevention research, using Prevention Priority Panels. Prevention Priority Panels should be appointed by CDC and the network of Prevention Research Centers on a biennial basis to review science and policy on specific questions of national importance in health promotion and disease prevention, including gaps in current policies, needs for legislative initiatives, or priorities for further research. Reassess progress in midcourse: Reassessment 2001, the 15-year mark. The next formal internal Program reassessment should address progress toward achievement of the foregoing Program objectives. 1   Formally, the Centers for Research and Demonstration of Health Promotion and Disease Prevention

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