APPENDIX B

Lessons from SBS Integration into the “Public Health Enterprise”

As part of the search for models from which the weather enterprise can gain useful insights, the Committee explored how social and behavioral sciences (SBS) research has been supported and applied, increasingly over time, within two federal agencies in the realm of public health—the Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA). We offer below some highlights of lessons learned.

CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC)

The CDC offers a mature model, with more than 30 years of experience, for strategic integration of SBS into agency-wide operations. The initial development of SBS within the agency was supported by strong active champions, informal coordination, and application of SBS to individual work areas. Participants during those early years refer to the integration of SBS as a “grassroots movement.” The spark for institutionalizing and expanding SBS was a mission-driven initiative with agency-level support by senior leadership. The institutional implementation was driven by several key developments, including:

• leadership identification of five mission areas;
• establishment of a dedicated coordinating position sponsored by the Office of the Chief Science Officer within the CDC Office of the Director;
• agency level tasking;
• congressional level interest and support; and
• development of an SBS coordination work group, the Behavioral and Social Sciences Work Group (BSSWG), to implement SBS integration policy objectives and a peer support program.

The HIV epidemic, as it grew through the 1980s and 1990s, was one of the primary factors that motivated recognition of the need for more SBS research within CDC. Epidemiological data could help explain how infections were spreading, but this

understanding did not help solve the challenge of mitigating the situations and behaviors that placed people at risk. The growing rate of diabetes during this time also led to a recognition of the critical importance of understanding the social and behavioral context of disease, including the need to augment purely medical model for addressing such diseases with behavioral models to support effective strategies to motivate and support behavioral changes.

As a result of these developments, the agency identified several key missions for strengthening SBS capability within CDC: (1) expanding understanding and use of SBS; (2) promoting excellence in SBS research; (3) expanding communication and collaboration among SBS within the agency and with external partners; (4) improving the recruitment and retention of SBS scientists; and (5) supporting professional development of SBS scientists within CDC (Herring, 1997).

Today the voluntary membership of the BSSWG provides the primary continuing support for SBS development and integration within the agency. The group has formal by-laws, elected officers, regular meetings, and a regular annual report to leadership. All SBS staff across the agency are invited to participate in the BSSWG. Annual activities have included developing and maintaining a database of member contacts, skills and interests, and current positions and managing a listserv for BSSWG members, which includes updates on related work and job announcements. The BSSWG has organized workshops and training on topics of interest, an annual speaker series, an annual awards program specifically for SBS work, support for BSSWG member attendance at relevant professional conferences (both for professional development and recruitment), and direct SBS employee recruitment.

The establishment of the SBS initiative and the BSSWG has resulted in significant increases in representation by scientists from multiple SBS disciplines in the CDC workforce, including at the primary CDC Centers across the country. Currently there are approximately 700 SBS professionals in the BSSWG, an increase from about 300 in 2006.

Some of the critical contributions of SBS staff to the agency’s operations include applied public health through development, testing, and evaluation of behaviorally based interventions (Holtzman et al., 2006). Research has included study of the effects of attitudes and behaviors on the public’s health; understanding critical social factors (such as class, family structure, and community integration) that affect public health; and better identifying, understanding, and reducing health disparities. In addition to the HIV and diabetes examples noted earlier, some other specific health issues that have benefited from substantial SBS research at CDC include injury and violence prevention, occupational safety and health, reproductive health, development disabilities, and environmental health concerns (Holtzman et al., 2006). Recently SBS professionals

have played critical roles in CDC’s emergency response to the Ebola and Zika public health threats, and BSSWG is helping bring greater visibility to these contributions being made to CDC’s emergency response efforts. SBS participation has been critical for developing priorities for grants and for developing a new agency framework for program evaluation in public health (Koplan et al., 1999).

The CDC model suggests that some key elements for expanding and integrating SBS with a federal agency may include having grassroots champions and professional support, including peer-level support mechanisms, and having funding support for coordination, recruitment, professional development, and recognition of the contributions of SBS to the mission. At the institutional level, key elements of success include agency-level recognition of the critical role of SBS in mission success and leadership support through policy direction, goal-setting, and expanded use of SBS resources for addressing mission areas.

FOOD AND DRUG ADMINISTRATION (FDA)

SBS research has long been important for the FDA in communicating information and assessing product designs, given that consumers, patients, and health care professionals all need understandable information about products’ risks as well as benefits. The FDA began hiring in-house social scientists in the early 1960s following multiple agency reviews that recommended improvement in consumer education practices under the guidance of scientific experts. Development of several consumer health and safety education programs created more demand for expert social scientists to shape the agency’s health literacy efforts. Legislative requirements for full disclosure of side effects on drug product labels compounded the need for behavioral science expertise in assessing labeling design, and congressional investigations into the health concerns of the elderly created a new impetus for the agency to recruit social scientists. All these efforts lead to a wide range of important studies. For example, in the 1960s and 1970s, the FDA recruited social scientists to study drug abuse, contracted a national survey on consumers’ understanding of food and drug labeling and poison prevention practices, and began drawing on social scientific studies to influence policy that affected many agency-regulated commodities. Numerous FDA program areas employ SBS expertise, including:

• The Center for Drug Evaluation and Research has a dedicated social science research program in their Office of Prescription Drug Promotion to address needs stemming from direct-to-consumer advertising of prescription drugs.

• The Center’s Office of Communications focuses on risk communication research to enhance its efforts at providing evidence-based communications.

• The Center for Food Safety and Applied Nutrition’s Consumer Studies Branch is composed of social scientists with expertise in psychology, sociology, agricultural economics, public health, and public policy, who advise policy makers on consumer behavior related to food and nutrition.
• The Center for Tobacco Products’ Office of Health Communication and Education has social scientists that conduct research and evaluation to support its public health education campaigns.
• The Center for Devices and Radiological Health leverages social science research to assure that the public has access to clear medical device labeling and consumer-friendly materials that help make informed health decisions.
• The Office of the Commissioner’s Office of Planning has a Director for Risk Communication and a Risk Communication Advisory Committee. The Risk Communication Staff also established an Internal Message Testing Network to connect message designers in various FDA Centers and Offices with employees who are willing to provide feedback on draft messages, web content, graphics, and proposed label changes.

FDA designs SBS research projects to meet particular program needs or broader mission goals. Most of this research is carried out by contractors, but with significant direction and oversight by FDA social scientists, including research for designing studies and developing protocols; reviewing the relevant scientific literature; crafting study-related materials such as screening documents, interview and moderators guides for focus groups and individual interviews, and survey questionnaires; reviewing work plans, project reports, and presentations; and leading data analysis and drafting of articles for peer-reviewed journals. On an informal basis, FDA social and behavioral scientists also regularly advise FDA employees from other disciplinary backgrounds about how to apply SBS insights, typically within their own centers and offices, through seminars, meetings, and individual consultations.

Social scientists at FDA present research results in peer-reviewed publications and at numerous conferences and invited presentations; and these research findings are all available to the public. FDA strives to incorporate SBS research results and insights into operations through a variety of cross-agency internal information exchanges, including a Social Science Forum (a cross-agency interest group for information exchange), and an SBS Subcommittee (a cross-agency small working group providing social science input).

FDA’s Risk Communication Advisory Committee holds periodic state-of-the-science meetings, which are open to the public; and they recently produced a collected volume titled Communicating Risks and Benefits: An Evidence-Based User’s Guide (FDA, 2011). FDA also organizes public events, like the biennial FDA Science Forum presentations and posters showcasing FDA scientists and their work, including sessions on social and behavioral research.

A recent publication by a psychologist who worked with the FDA for many years (Fischhoff, 2017) highlights the opportunities and obstacles for successful social science collaborations within the agency. Three key conditions are identified as necessary for incorporating SBS into agency operations:

• An external catalyst that recognizes the relevance and salience of SBS to the agency’s mission;
• The presence of a core of in-house resident behavioral scientists that were able to identify the relevant science and apply it, at the opportune time; and
• Engaged and committed social scientists with a good understanding of the agency, its mission and the environment it operates in who were ready to deploy their expertise when called upon.

Other current FDA staff have similarly noted that crucial elements of success are broad buy-in about the importance of SBS research to the mission of the center, office, or agency as a whole by senior leaders, along with dedicated funding and staff needed to undertake the work.

As discussed in Box 6.3, these and other examples from the “public health enterprise” offer some important lessons for the weather enterprise, regarding the critical factors that drive successful integration of the social and behavioral sciences.

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