Category Archives: Research
We’ll never know if it was the spirited discussions or Tropical Storm Debby, which is pummeling northern and central Florida, that kept most of the 2,000-plus attendees at this year’s AcademyHealth Annual Research Meeting—this year in Orlando—indoors and packed into the sessions and the exhibit hall at just about every minute of the meeting this year. Public Health was a featured topic, according to AcademyHealth president and CEO Lisa Simpson, and a session on the IOM report on the integration of public health and primary care, led by the committee chair, Paul Wallace, MD, was a featured, and well-attended, session as well.
Not surprisingly, many public health officials made their way into a ballroom very early Tuesday morning to hear three health law scholars, Sara Rosenbaum of the George Washington University, Timothy Jost of Washington and Lee and Mark Hall of Wake Forest, talk about the issues likely contemplated by the Supreme Court Justices as they considered the cases brought against the Affordable Care Act. Critical for public health were the discussion points aired just before the session ended, concerned with continued state and federal budget cuts including cuts to the Centers for Disease Control and Prevention and other divisions of the Department of Health and Human Services, which could impact public health service delivery now underway, as well as implementation of the Affordable Care Act, if it is upheld.
Health disparities were also a focus of several sessions, as well as the topic that won the student poster award of the conference. Stephen Vance, a fourth-year medical student at the University of North Carolina at Chapel Hill School of Medicine, won the best student poster award for his work with Aida Lugo-Somolinos, MD, of the medical school, on clinical trial enrollment barriers faced by the Hispanic population in North Carolina. Vance’s research found that the barriers identified by the Hispanic participants in the study differ from those expected by clinical investigators.
The study provided a questionnaire for physicians on their perceptions of why more members of the Hispanic community don’t enroll in clinical trials, and also collected patient questionnaires on trial participation from close to 400 members of the Hispanic community.
The physician responses showed that they viewed language and transportation as the key barriers. But the patient responses showed other concerns including worries about what participating might cost them, concern about missed work time and a lack of understanding about the potential benefits of trial participation, including access to health care. The researchers say the following should be considered as a means to enroll more members of Hispanic communities in trials:
- Provide information about studies to health care providers in areas with large Hispanic populations
- In large cities, create partnerships with Hispanic advocacy groups
- Communicate that trial participation is not necessarily costly and may take no more time than a regular doctor’s appointment
- Include a person fluent in Spanish on the research team
“Before this study, I would have thought that transportation and language were the key barriers,” says Vance. “It’s really a lack of understanding of what a clinical research project entails.”
“Perhaps as clinicians, we’re asking the wrong questions,” says Vance, who is on track to get an MBA as well as his MD degree, and plans to go into health management. “This study focuses on the Hispanic community, but should push us to look at the reasons why other groups are underrepresented in trials.”
Frontiers in Public Health Services & Systems Research: Making Critical Research Accessible, Quickly
Idea Gallery is a recurring editorial series on NewPublicHealth in which guest authors provide their perspective on issues affecting public health. Today, Glen Mays, MPH, PhD, F. Douglas Scutchfield Endowed Professor of Health Services and Systems Research at the University of Kentucky College of Public Health, talks about the launch of a brand new online journal covering public health systems and services research, and why it is so critical right now, to inform smart investments in public health and prevention. The new journal, Frontiers in PHSSR, is designed to disseminate the most critical early findings from PHSSR research much faster—making these findings accessible far in advance of the fully-developed scientific manuscript. To be eligible for inclusion in Frontiers, findings must have the potential to guide future public health practice, health policy, and research. Mays is the editor in chief of the new journal.
Portions of the post below are adapted from the opening commentary in Frontiers, authored by Mays, F. Douglas Scutchfield, Paul K. Halverson, William Riley and Peggy Honore.
The need for a strong and effective public health system in the United States is perhaps more urgent today than at any other time in our nation’s history. Preventable diseases and injuries account for more than three-fourths of the $2.6 trillion in health care expenditures incurred annually in the U.S. The growing prevalence of obesity, diabetes and other preventable conditions constrains the nation’s economic productivity and global competitiveness. The American public health system—the diffuse constellation of governmental public health agencies and their peers and partners in community-based settings and the private sector—is tasked with developing and delivering strategies that promote health and prevent disease and injury on a population-wide basis. They share the mission of creating conditions in which people can be healthy.
The public health system is uniquely positioned—but not optimally equipped or resourced—to take on these challenges. Only about 3 percent of the nation’s $2.6 trillion in annual health expenditures is devoted to public health activities. Some of our greatest uncertainties now lie in how best to organize, finance, and deliver effective public health prevention strategies to communities across the U.S. The field of public health services and systems research (PHSSR) has emerged to fill this void.
Frontiers in PHSSR
The American public health system and the populations it serves do not have the luxury of waiting the 15 years typically required to get research-tested solutions widely adopted into practice. The costs associated with missed opportunities for disease prevention and health promotion are straining government and household budgets now.
To help develop and grow this scientific learning community, we have launched a new, open-access, peer-reviewed journal, Frontiers in Public Health Services and Systems Research. This journal provides a platform for rapidly and widely communicating emerging findings and lessons learned from studies of public health services and delivery systems. Frontiers will feature brief descriptions of preliminary findings from ongoing or recently completed empirical studies and quality improvement projects that answer important questions regarding the organization, financing, and delivery of public health services.
Debra Joy Pérez, MA, MPA, PhD, assistant vice president for Research and Evaluation at the Robert Wood Johnson Foundation, was a keynote speaker at the Keeneland Conference yesterday and spoke about the evolution of public health services and systems research (PHSSR). NewPublicHealth asked Debra Pérez about that evolution.
>>Follow our continuing coverage of the Keeneland Conference.
NPH: Why is the field of PHSSR a priority for the Robert Wood Johnson Foundation?
Debra Pérez: Right now, I think more than ever we need evidence to provide decision-makers with the evidence for how best to apply limited resources. We know in the last year alone over 40,000 public health jobs were eliminated, so that means that health departments are struggling with staffing and infrastructure issues, and they need evidence to help them best apply the limited resources they have now.
NewPublicHealth: What’s the scope of the conference this year compared to previous years?
The annual Keeneland Conference kicked off today, where more than 300 public health services and systems researchers (PHSSR), public health officials and policy-makers have convened to discuss the latest issues in this growing field of research. PHSSR is aimed at establishing an evidence base to allow public health officials to make smarter, more-informed decisions with regard to resource allocation, staffing, operations and service provision.
NewPublicHealth is on the ground in Kentucky to capture the critical conversations and Q&As from leaders in the field. We spoke with F. Douglas Scutchfield, MD, director of the National Coordinating Center for PHSSR and the Peter Bosomworth endowed faculty in the University of Kentucky College of Public Health, to get his take on where the PHSSR field stands and the anticipated highlights of conference.
NewPublicHealth: What are the critical areas for public health as you head into the Keeneland Conference?
Dr. Scutchfield: I think there are several agendas that will be a backdrop against which Keeneland is taking place. One is a reformed healthcare system, with the Affordable Care Act and its implications for public health and public health’s relations with a variety of other service delivery systems, such as primary care and hospitals.
We will also see the rollout of a new research agenda, published as a supplement to the American Journal of Preventive Medicine,that will give us a new direction to pursue in terms of how we’re going to begin to try improving the infrastructure in the public health system.
NPH: What has been your sense in speaking with colleagues in the field about what kind of research is most in demand for public health leaders and decision-makers right now?
A new report released this week by the Robert Wood Johnson Foundation-sponsored Institute of Medicine Committee on Public Health Strategies to Improve Health calls for significant reforms to refocus America’s public health system toward prevention of the chronic diseases that are taking a toll on the nation’s health and economy.
The report, For the Public’s Health: Investing in a Healthier Future, is the final in a series that is intended to help guide efforts by public health leaders, policymakers and other stakeholders to address the nation’s health challenges in the 21st century and beyond. The committee’s 10 recommendations include one that is focused on setting national targets for life expectancy, and another on establishing a basic array of programs and services that would enable every health department to provide a standard level of health protection in the communities they serve. The committee also recommended creating a stable, dedicated funding source. They favored a medical care transactions tax, and examined other taxes as well as less traditional funding sources such as community benefits, social investment bonds and collaboration with community development financial institutions.
NewPublicHealth spoke with Marthe Gold, MD, MPH, chair of the report committee and professor and chair of the Department of Community Health and Social Medicine at the Sophie Davis School of Biomedical Education of City College, and Steven Teutsch, MD, MPH, vice chair of the committee and Chief Science Officer for the Los Angeles County Department of Public Health, about the committee’s recommendations.
>>Read our earlier Q&A with Marthe Gold on the second report in the IOM series, titled For the Public’s Health: Revitalizing Law and Policy to Meet New Challenges.
NewPublicHealth: What’s the big picture on the committee’s report and the recommendations around public health financing and how do you hope it will be used?
Today is Diabetes Alert Day. Sponsored by the American Diabetes Association (ADA) , the goal of the day is to encourage Americans to take the Diabetes Risk Test to find out if they are at risk for developing type 2 diabetes.
The test includes questions on weight, age, family history and other potential risk factors for prediabetes or diabetes. According to the ADA, 25.8 million children and adults in the United States, or 8.3 percent of the population, have diabetes. About 7 million of those are undiagnosed. Read more on diabetes prevention.
This week’s final plenary at the AcademyHealth annual National Health Policy Conference focused on the media’s role in health policy and featured Austin Frakt of The Incidental Economist (which is supported in part by the Robert Wood Johnson Foundation), Ezra Klein of the Washington Post and Merrill Goozner of The Fiscal Times. Frakt, a health economist, touched on virtually all of the points the speakers made during the one hour session, in a post on his blog the day of the plenary. Most important perhaps was that researchers need to do more than just issue a press release in order to disseminate their results. “I encourage researchers to get involved on Twitter and blogs. Promote the work of the community when it is timely and relevant,” wrote (and said) Frakt. Ezra Klein, who has an extensive following, invited researchers to email him and not shy away because they think he might be inundated. “Let me manage my inbox,” Klein said.
NewPublicHelath spoke with Frakt about the role of social media in reporting critical health information.
NewPublicHealth: Your training was not in health. What did you do before and did you get into the health field?
Austin Frakt: My training is in physics and engineering. I went through a PhD program in electrical engineering at MIT, and although what I was really doing was kind of applied math, I recognized during my studies that I really was interested in questions pertaining to policy. So I did finish my PhD, and the math and the rigor of it was valuable. I was intrigued by [health policy work at Abt Associates] and that’s where I ended up. It wasn’t that I was, at the time, particularly drawn to health, I just wanted to do something in the policy direction and I was particularly drawn to a rigorous, mathematical kind of evidence-based study.
NPH: And what made you focus on health policy?
Public Health Law Research (PHLR), a Robert Wood Johnson Foundation program at Temple University, recently held its annual meeting in New Orleans. The theme of this year’s meeting, the first such conferences open to non-grantees of the program, was "Public Health Law Targets of Opportunities." The conference offered an opportunity to highlight research about how law can be used to improve population health. Read full NewPublicHealth coverage of the PHLR conference here.
NewPublicHealth spoke with Scott Burris, JD, director of the Public Health Law Research program.
NewPublicHealth: What’s key about this year’s conference?
Scott Burris: This is a transitional conference for us. We have been planting the orchard for the last two and a half years since we started the program. Now we are starting lot get some fruit. Our grantees are reporting on their results. And we’re getting as many paying people coming to the conference as we have new grantees coming to the conference.
NPH: Needle exchange is a key topic at the conference this year. Why is that?
**UPDATE: The results are in!
The top five most influential RWJF research articles of 2011 (including one of NewPublicHealth's picks!) have been announced:
Tied for #5
Read the original post below.**
Your vote counts—and not just when it comes to American Idol. The Robert Wood Johnson Foundation (RWJF) has released its list of top 20 most influential research articles of 2011, and it's up to the voting public to determine the "Final 5." RWJF-funded articles covering topics that range across the Foundation’s program areas were chosen based on the significance and strength of their research findings and popularity as measured by online views.
Public voting to select the "Final 5" most influential articles of the year opened last week, and will end December 23 at midnight. The final tally will be released in early 2012.
As you throw your vote in the virtual hat, keep a few key criteria in mind:
- whether the research articles guided the field of policy and practice;
- whether the research influenced how the public thinks about health and health care issues; and
- whether the research changed long-held perceptions of the health field.
We at NewPublicHealth have a few public health favorites among the top 20—but we leave it to you to judge their merit for yourself! Here are our top public health research picks:
- Measuring the Health of Communities (article #7): The authors of this article, published in the Journal of Public Health Management and Practice in September, note that the health of each person is inextricably linked to the health of their community, and in this article they examine the complexities of trying to measure community health. The authors look at how measurement of community health has changed over time, including newer frameworks like the County Health Rankings, developed by the University of Wisconsin and RWJF. The authors argue that a priority on measuring community health will help us to better allocate scarce resources.
- Health Impact Assessments are Needed in Decision Making About Environmental and Land-Use Policy (article #15): Urban land use, transportation and environmental decisions can have important consequences for the public's health. This article looks at the emerging practice of health impact assessment and its critical role in assessing the health effects of decisions across sectors, such as the potential impact of highway air pollution on proposed housing for seniors. The article was published in Health Affairs last May.
Other articles in the top 20 include a look at the role of social factors like stress and exposure to lead in racial disparities in hypertension (article #4), the use of Twitter to track flu outbreaks (article #5) and the effect of school policy on student consumption of sugary drinks (article #16).
The Chicago Sun Times is reporting this morning that a second set of tests done on Enfamil Premium Newborn infant formula by its manufacturer Mead Johnson found no trace of the bacteria tied to the death of a ten-day-old Missouri baby.
Hospital tests show that the baby died of a rare infection caused by a bacteria called Cronobacter sakazakii. The source of the bacteria hasn't been determined, but it can be found in powdered formula, and the baby had been given the Enfamil product. Retailers have taken a batch of the formula off their shelves and the Food and Drug Administration and the Missouri Department of Health are investigating the baby’s death. Get more food safety updates.
The National Institutes of Health (NIH) has established the National Center for Advancing Translational Sciences to help translate scientific discoveries into new drugs, diagnostics and devices. NIH Director Francis Collins says the new center will significantly speed up the availability of tested discoveries, making them available to patients. Read more research news.
The Substance Abuse and Mental Health Services Administration (SAMHSA) has announced a new working definition of recovery from mental disorders and substance use disorders. SAMHSA and partners in the behavioral health field and beyond worked on the definition over the course of a year. SAMHSA took on the quest for the working definition as part of its Recovery Support Strategic Initiative.
SAMHSA now defines recovery as: "a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential." Read more mental health updates.