Using Evidence to Improve Public Health Decision Making on Comprehensive Cancer Control:

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• Using Evidence to Improve Public Health Decision
  Making on Comprehensive Cancer Control
• An update on findings from the Guide to Community
  Preventive Services on tobacco, physical
  activity, cancer and nutrition

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Community Guide Basics

• What is the Community Guide project?
• Systematic reviews of literature
• Evidence-Based recommendations
• DHHS initiative/CDC coordination
• Independent, non-federal oversight

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The Community Guide is Part of a Family of
Federal Initiatives
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Who Is the Audience?

• People who plan, fund, or implement services and
  policies for health care systems, communities,
  and states
• Public health departments
• Health care delivery systems
• Purchasers of health care
• Government and foundations
• Community organizations

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Two Primary Objectives for the Community Guide

• As a standard reference for effectiveness
  information on population based interventions
• what does the scientific evidence tells us what
  works?
• Supporting prevention research
• where there is insufficient evidence of
  effectiveness or when we want to develop
  localized version of generally effective
  interventions

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So What Makes the Community Guide An Ideal
Decision Tool?

• Looks at evidence of effectiveness in peer
  reviewed published literature
• Uses a 20 page abstraction form for each study
  reviewed
• Led by independent panel of experts and is
  supported by CDC
• Includes system level strategies to improve
  delivery of clinical services and population
  based efforts (e.g. mass media) for disease
  prevention and health promotion

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Methods for Systematic Reviews of Effectiveness
Evaluations

• Develop conceptual framework
• Search for and retrieve evidence
• Rate quality of evidence
• Summarize evidence
• Translate strength of evidence into finding
• Strongly recommended
• Recommended
• Insufficient evidence

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Two Outcomes of a Community Guide Review

• Summarize scientific evidence about What Works
• Identify areas of insufficient evidence
  supporting prevention practice

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There are two types of Insufficient Evidence

• Too few studies to reach a conclusion
• Sufficient number of studies, but results are
  inconsistent
• Neither of which means that the intervention does
  not work, just that more research is needed.

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Application of Community Guide Findings

• Aid in program planning
• Identify options
• Select appropriate options for context
• Assess effectiveness
• Consider local applicability
• Encourage use of effective interventions
• Encourage efficient use of resources
• Contribute to a research agenda

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What Will Be Reviewed in the Community Guide?
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Community Guide Scope of Reviews in
Comprehensive Cancer Control

• Tobacco prevention and control
• Improving physical activity
• Early detection and control of cancer
• Nutrition

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Addressing Tobacco Use At the Policy and Program
Level

• Reducing exposure to second hand (environmental
  tobacco smoke)
• Reducing initiation of tobacco use
• Promote cessation from use of tobacco products

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Content Reviewed in Recent Guidelines
CDC Best Practices
PHS Clinical Practice Guidelines
Tobacco User
Provider
Health Care System
Community
Community Guide
Clinical Guide
SGR Reducing Tobacco Use
NCI Population Based Smoking Cessation
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The Tobacco Chapter

• Recruited 20 experts
• Selected 10 intervention categories
• Screened 16,000 citations
• Reviewed 1300 papers
• Evaluated 350 studies
• Summarized evidence for 15 interventions

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Analytic Framework Smoking Bans
Reduced Morbidity and Mortality
Reduced Exposure to ETS
Smoking Bans
Fewer Tobacco Users
Change In Attitudes
Reduced Initiation
Change In Attitudes
Reduced Consumption
Increased Quit Attempts
Increased Cessation
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In Communities
Increase the price (tax)
Mass media campaigns
Telephone Quit lines
Smoking bans
Increase the price (tax)
Mass media campaigns
Smoking bans
When combined with other interventions
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In Communities
Smoking cessation contests
Broadcast smoking cessation series
Community-wide efforts to reduce ETS exposure in
the home
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Reviews in Progress
Youth access interventions
School-based interventions
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Early Detection and Control of Cancer

• Links to other cancer-related information
• Tobacco, Physical Activity, Sexual Behavior and
  other behaviors
• Oral Health, Vaccine Coverage, and other subject
  specific chapters

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Addressing Early Detection and Control of Cancer

• Prevent UV exposure/promote skin protection
• Promote informed decisions regarding cancer
  screening
• Increase early detection of breast/cervical/colore
  ctal cancer

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Setting Specific Interventions
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Setting Specific Interventions
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Target Specific Interventions
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Community Wide Interventions
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Informed Decisions About Cancer Screening
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Improving the Use of Breast, Cervical and
Colorectal Cancer Screening Community Oriented
Interventions
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Improving the Use of Breast, Cervical and
Colorectal Cancer Screening Community Oriented
Interventions
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Improving the Use of Breast, Cervical and
Colorectal Cancer Screening Health Care System
Oriented Interventions
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Improving the Use of Breast, Cervical and
Colorectal Cancer Screening Health Care System
Oriented Interventions
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Other Interventions to Improve Screening are
Under Review

• Community oriented
• - Reducing physical barriers
• - Multi-component approaches
• Provider oriented
• - Incentives
• - Reminders
• - Checklists
• - Assessment and feedback
• - Multi-component approaches

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Addressing Inadequate Physical Activity

• Informational approaches to increasing physical
  activity
• Behavioral and social approaches to increasing
  physical activity
• Environmental and policy approaches to increasing
  physical activity

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Informational approaches to increasing physical
activity
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Informational approaches to increasing physical
activity
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Behavioral and social approaches to increasing
physical activity
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Behavioral and social approaches to increasing
physical activity
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Environmental and policy approaches to increasing
physical activity
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Environmental and policy approaches to increasing
physical activity In progress
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Environmental and policy approaches to increasing
physical activity In progress
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Nutrition
Task Force is reviewing the effectiveness of
nutrition interventions to improve
knowledge/attitudes and consumption patterns and
environments to enhance healthy food choices
through ?school-based programs
?consumer literacy ?community
fruit vegetable promotion ?food nutrition
policy
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LOGIC FRAMEWORK ILLUSTRATING CONCEPTUAL APPROACH
TO NUTRITION COMMUNITY HEALTH
Interventions
Modifiable Determinants
Intermediate Outcomes
Community Health Outcomes
POPULATION FOOD INTAKE Food
Consumption Patterns (e.g.
fruits, vegetables) Intake of Nutrients and Food
Components Vitamins Minerals Fiber Fats Other
food constituents Dietary supplements Alcohol Ener
gy balance
Food Supply Factors -Agriculture
policy -Nutrition policy -Science and technology
-Food production, processing, storage and
distribution -Food fortification -Food safety
Physiologic Indicators Growth Adipose
tissue Musculoskeletal Gastrointestinal Metabolic
Cardiovascular Reproductive Immunological Neurolog
ical
Morbidity Mortality Measures of Health
Fitness Quality of Life
Environmental Factors
Availability Price -Neighborhoods -Schools -Work
sites -Homes -State and National -Food and
nutrition assistance programs
Life Stage Requirements Pregnancy Lactation
Childhood Adolescence Adulthood
Older Adulthood
Genetics, Co-morbidities
Consumer Demand -Household
resources -Nutrition knowledge -Cultural
practices -Psychosocial characteristics -Taste
and preferences -Advertising and marketing
Physical Activity Patterns
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How Do I Find It?

• Publications
• MMWR Reports Recommendations (RR) series
• American Journal of Preventive Medicine
• Website
• www.thecommunityguide.org

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Easy Steps You Can Take Now

• Bookmark www.thecommunityguide.org
• Include information in your next presentation
• Tell someone about it
• Use it as a reference for decision making
• Use the information to advocate for something you
  want to do

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For More Information

• Brad Myers Community Guide
• phone [phone]
• e-mail BMyers_at_cdc.gov
• Website www.thecommunityguide.org

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www.thecommunityguide.org