Community-based participatory research: necessary next steps.

Community-based participatory research (CBPR) is gaining increasing credence among public health researchers and practitioners. However, there is no standardization in assessing the quality of research methods, the effectiveness of the interventions, and the reporting requirements in the literature. The absence of standardization precludes meaningful comparisons of CBPR studies. Several authors have proposed a broad set of competencies required for CBPR research for both individuals and organizations, but the discussion remains fragmented. The Prevention Research Centers (PRC) Program recently began a qualitative assessment of its national efforts, including an evaluation of how PRCs implement CBPR studies. Topics of interest include types of community partnerships; community capacity for research, evaluation, and training; and factors that help and hinder partner relationships. The assessment will likely contribute to the development of a standard set of competencies and resources required for effective CBPR.

School-based programs: lessons learned from CATCH, Planet Health, and Not-On-Tobacco.

Establishing healthy habits in youth can help prevent many chronic health problems later in life that are attributable to unhealthy eating, sedentary lifestyle, and overweight. For this reason, many public health professionals are interested in working with school systems to reach children in school settings. However, a lack of familiarity with how schools operate can be a substantial impediment to developing effective partnerships with schools. We describe lessons learned from three successful school health promotion programs that were developed and disseminated through collaborations between public health professionals, academic institutions, and school personnel. The programs include two focused on physical activity and good nutrition for elementary and middle school children--Coordinated Approach to Child Health (CATCH) and Planet Health--and one focused on smoking cessation among adolescents--Not-On-Tobacco (N-O-T). Important features of these school health programs include 1) identification of staff and resources required for program implementation and dissemination; 2) involvement of stakeholders (e.g., teachers, students, other school personnel, parents, nonprofit organizations, professional organizations) during all phases of program development and dissemination; 3) planning for dissemination of programs early in the development and testing process; and 4) rigorous evaluation of interventions to determine their effectiveness. The authors provide advice based on lessons learned from these programs to those who wish to work with young people in schools.

Assessing prevention research impact: a bibliometric analysis.

BACKGROUND: This study was undertaken to explore a bibliometric approach to assessing the impact of selected prevention research center (PRC) peer-reviewed publications. METHODS: The 25 eligible PRCs were asked to submit 15 papers that they considered the most important to be published in the decade 1994-2004. Journal articles (n=227) were verified in 2004 and categorized: 73% were research reports, 10% discussion articles, 9% dissemination articles, and 7% review articles. RESULTS: Only 189 articles (83%) were searchable via the Institute of Scientific Information (ISI) Web of Science databases for citation tracking in 2004. These 189 articles were published in 76 distinct journals and subsequently cited 4628 times (range 0 to 1523) in 1013 journals. Articles published before 2001 were cited a median of 14 times each. Publishing journals had a median ISI impact factor of 2.6, and ISI half-life of 7.2. No suitable benchmarks were available for comparison. The PRC influence factor (number of PRCs that considered a journal highly influential) was only weakly correlated with the ISI impact factor and was not correlated with half-life. CONCLUSIONS: Conventional bibliometric analysis to assess the scientific impact of public health prevention research is feasible, but of limited utility because of omissions from ISI's databases, and because citation benchmarks for prevention research have not been established: these problems can and should be addressed. Assessment of impact on public health practice, policy, or on the health of populations, will require more than a bibliometric approach.

Prevention Research Centers: contributions to updating the public health workforce through training.

Because public health is a continually evolving field, it is essential to provide ample training opportunities for public health professionals. As a natural outgrowth of the Centers for Disease Control and Prevention's Prevention Research Centers Program, training courses of many types have been developed for public health practitioners working in the field. This article describes three of the Prevention Research Center training program offerings: Evidence-Based Public Health, Physical Activity and Public Health for Practitioners, and Social Marketing. These courses illustrate the commitment of the Prevention Research Centers Program to helping create a better trained public health workforce, thereby enhancing the likelihood of improving public health.

Does health insurance coverage of office visits influence colorectal cancer testing?

OBJECTIVE: To assess the effect of differing health insurance coverage of physician office visits on the use of colorectal cancer (CRC) tests among an employed and insured population. METHOD: Cohort study of persons ages 50 to 64 years enrolled in fee-for-service (FFS) or preferred provider organization (PPO) health plans, where FFS plan enrollees bear disproportionate share of office visit coverage, for the period 1995 through 1999. RESULTS: Compared with FFS plans, enrollees in PPO plans were significantly more likely to obtain CRC tests [adjusted relative risk (RR(a)), 1.27; 95% confidence intervals (CI), 1.21-1.24]. The association was more pronounced among hourly individuals (RR(a), 1.43; 95% CI, 1.41-1.45) than among salaried individuals (RR(a), 1.09; 95% CI, 1.05-1.10), consistent with a greater differential in office visit coverage among the hourly group. CONCLUSIONS: Disproportionate cost-sharing seems to have a negative effect on the use of CRC tests most likely by discouraging nonacute care physician office visits.

Effect of the frequency of delivery of reminders and an influenza tool kit on increasing influenza vaccination rates among adults with high-risk conditions.

OBJECTIVE: To evaluate the incremental effect of a second client reminder postcard or an influenza tool kit targeted toward employers on increasing influenza vaccination rates among adults age < 65 years at high risk for complications from influenza illness. METHODS: In this demonstration study, enrollees of 3 managed care organizations (n = 8881) were randomized at the employer level into 4 arms: 1 postcard, 2 postcards, 1 postcard + tool kit, and 2 postcards + tool kit. The postcards and tool kits were mailed during the fall of 2001, and their effect on influenza vaccination rates was assessed through a survey. RESULTS: Compared with a single postcard, 2 postcards increased vaccination rates by 4 percentage points (adjusted relative risk = 1.05; P < .05) among persons aged 50 to 64 years but did not have any effect among younger adults. Older adults had a greater burden of disease and reported more favorable knowledge and attitudes toward the influenza vaccine. The influenza tool kit did not appear to have any incremental effect on vaccination rates. CONCLUSIONS: Our findings underscore the necessity of evaluating the effectiveness of interventions in different population subgroups and of identifying factors that modify the effectiveness of interventions. Rigorous assessment of intervention effectiveness in managed care settings will enable decision makers to optimize use of scarce healthcare dollars for improving the health and well-being of enrollees.

Chlamydia screening in a metropolitan Atlanta primary care clinic.

BACKGROUND: Chlamydia is the most commonly reported infectious disease in the United States, yet many women at risk for chlamydia infection are not being tested. METHODS: We conducted a chlamydia screening study (Phase I) and retrospective medical chart review (Phase II) of 199 women from 16 to 40 years of age attending a primary care clinic in metropolitan Atlanta. RESULTS: Two (1%) of the 199 study participants tested positive for chlamydia during Phase I. Phase II medical chart reviews indicated that only 35% of study participants had been tested for chlamydia at least once in the previous 15 months. Three of these individuals tested positive, yielding a prevalence of 5.6%. All infections occurred in women 30 years of age or younger. CONCLUSION: The results suggest that chlamydia screening is low and that recommended guidelines are not being followed. Strategies are needed to increase the rates of screening and adherence to these guidelines to ensure that chlamydia is detected before complications occur.

HFE genotype and transferrin saturation in the United States.

PURPOSE: Examine the penetrance (defined by high transferrin saturation [TS]) of C282Y and H63D in the U.S. population. METHODS: 5171 participants from the Third National Health and Nutrition Examination Survey, 1992 to 1994. RESULTS: 77.1% (95% confidence interval [CI], 2.3, 95.1) of men and 51.9% (95% CI, 0, 84.2) of women with C282Y homozygosity had high TS. The associations of H63D homozygosity with high TS were stronger in people aged 50 years or older than in younger persons. Among Mexican-Americans, simple H63D heterozygosity was associated with high TS. CONCLUSIONS: The associations between HFE genotype and high TS may vary by sex, age, and ethnic group.

Association between health insurance coverage of office visit and cancer screening among women.

BACKGROUND: Little is known regarding the nuances of insurance benefit design that may affect the receipt of clinical preventive services. OBJECTIVE: To evaluate whether differences in insurance coverage of physician office visits influences the receipt of cancer screening in women who have full coverage for the screening services. DESIGN: Cohort study of women enrolled in fee-for-service (FFS) or Preferred Provider Organization (PPO) health plans, where FFS plans have less generous office visit coverage, for the period 1995 to 1997. SETTINGS AND PARTICIPANTS: General Motors Corporation's employees and their dependents. MAIN OUTCOME MEASURES: Papanicolaou and mammography rates in women aged 21 to 64 years (n = 139,294) and 52 to 64 years (n = 56,554), respectively. RESULTS: Compared with FFS plans, enrollees in PPO plans were significantly more likely to obtain a Papanicolaou smear and mammogram (adjusted relative risk [RRa] = 1.22; 95% CI, 1.21-1.24; and RRa, 1.17; 95% CI, 1.15-1.18, respectively). The association was more pronounced among hourly individuals (RRa, 1.27; 95% CI, 1.26-1.29 for Papanicolaou smears; RRa, 1.17; 95% CI, 1.16-1.19 for mammograms) than among salaried individuals (RRa, 1.10; 95% CI, 1.08-1.12 for Papanicolaou smears and RRa, 1.10; 95% CI, 1.06-1.12 for mammograms), corresponding to a greater differential in office visit coverage among the hourly group. CONCLUSIONS: Benefit structure appears to have an important effect on receipt of cancer screening in women. The findings highlight the need to ensure that future reforms of the health care system do not adversely affect the use of preventive services.

Hospitalizations during pregnancy among managed care enrollees.

OBJECTIVE: To describe the prevalence of hospitalizations during pregnancy, the reason for hospitalization, the length of stay, and the associated costs. METHODS: We analyzed data from a national managed care organization and determined the occurrence of hospitalizations for 46,179 women who had a live birth or a pregnancy loss in 1997. RESULTS: Overall, 8.7% of women were hospitalized during their pregnancy. Of these, 5.7% were hospitalized and discharged while pregnant, 0.8% experienced extended stays before a live birth or pregnancy loss, and 2.1% experienced pregnancy loss. Hospitalizations were more common among younger women, women with multiple gestations, and women in the northeastern United States. Women who had a live birth were primarily hospitalized for preterm labor (24%), hyperemesis (9%), hypertension (9%), kidney disorders (6%), and prolonged premature rupture of membranes (6%). Charges totaled over $36 million. CONCLUSION: Antenatal hospitalizations are common.