Category Archives: Research
Happy National Public Health Week! All week we've been sharing stories on the value of public health across all aspects of life, and all ages and stages.
Public Health Law Research (PHLR), a grantee of the Robert Wood Johnson Foundation, has also been participating in the week by contributing graphics and posts on the particular role of public health law—when backed by evidence and grounded in research—to save lives and make a difference. Below, we are highlighting some of the critical statistics PHLR has shared, along with some context on the research behind the numbers.
Child Seat Safety
Today, every state has a law requiring children to be restrained in federally-approved child safety seats while riding in motor-vehicles. These laws differ from state to state based on number of factors (e.g., age, height and weight of the children requiring safety seats). All current child safety seat laws allow for primary enforcement, meaning a police officer can stop a driver solely for a violation of such laws.
Read more about the research behind child seat safety laws:
In 1990 approximately 20 percent of all U.S. children had elevated levels of lead in their blood. However, only a decade later that percentage was down to 1.6 percent, thanks to public health laws researched and crafted to look out for the wellbeing of children. One of the most significant pieces of legislation was The Lead Contamination Control Act of 1988, which was already on the path to improving public health in 1990.
Read more about the research behind lead laws:
Eating too much sodium can cause high blood pressure, which raises the risk for heart disease and stroke—the first- and fourth-leading causes of death in this country. A variety of laws and legislatively enabled regulations attempt to reduce sodium in the food supply, including lowering the amount of salt in foods served in schools and child care facilities or purchased by state-regulated elder and health care facilities and prisons. Almost half of all U.S. states have laws to help reduce tghe sodium in processed foods.
Read more about the research behind laws to reduce sodium levels in food:
Sports-Related Traumatic Brain Injuries
As many as 300,000 kids suffer traumatic brain injuries (TBIs) from playing sports each year. TBIs can have serious short- and long-term health effects. Can public health law make a difference? The latest study finds that while all 50 states have laws in place to combat this problem, they haven't helped stop kids with concussions from playing. However, the research does help provide some context on how those laws have been implemented and how they might be revamped to work better.
Read more about the research behind sports-related traumatic brain injury laws:
A surprising piece of information at this week’s AcademyHealth National Health Policy Conference came during a session on what additional evidence is needed to move forward in the prevention and treatment of obesity. Linda Billheimer, PhD, deputy director of the health, retirement and long term analysis office at the Congressional Budget Office, said that one weakness of some obesity clinical trials is that they may not reflect the number of people who drop out during the trial. For example, while a study may show the success rate for 400 participants, it may not account for the number of people who left the trial and have not lost weight—or even gained weight—since their trial participation.
Billheimer noted that retaining patients can be difficult because people who plateau are often frustrated, which can combine with other reasons to lead them to leave.
Attempting to keep participants in the trial can be critical because the modality offered may be a strong opportunity for the participants to lose weight, since the trials often have novel approaches. There is also the support from the clinical trials team. Researchers at the session noted that trial funders might add criteria to the trial on follow up for participants who withdraw to possibly increase participation time among a larger group of patients.
Recent novel obesity trials listed by the U.S. National Institutes of Health on ClinicalTrials.gov include
- A trial comparing low and high financial incentives for weight loss
- Using virtual reality to help trial participants work on weight loss
- Community based obesity prevention among black women
Recommended Reading: ‘Retweet This’—Researchers See Rise in Use of Twitter to Share Scientific Journal Articles
The top two tweeted peer-reviewed science articles between 2010 and 2012 were about the effect of radiation on humans, according to a study published in the Journal of the Association for Information Science and Technology. Researchers reviewed 1.4 million articles to determine the most tweeted studies. Runners up in the top 15 of the most tweeted articles included studies on acne in teenagers and the link between physical activity and mortality rates. Nature, a highly regarded journal, received the most tweets: 13,430 Twitter mentions of 1,083 papers.
However, the researchers found that a retweet rate doesn’t necessarily correlate with a high rate of citations for an article in other studies, which is a standard measurement of significance for a scientific study. The most tweeted study—on genetic changes during radiation exposure—was tweeted 963 times but was cited in journals only nine times.
"The most popular scientific articles on Twitter stress health implications or have a humorous or surprising component. This suggests that articles having the broadest scientific impact do not have the widest distribution," said Stefanie Haustein, of the University of Montreal School of Library and Information Science, and a co-author of the study.
Still, the researchers say the increase in tweets that include a link or description of scientific studies is important even if the rates don’t correlate with journal citations. For one thing, the number of scientific researchers on Twitter is still low and “the fact that more and more articles are tweeted [at all] is good news because it helps scientific communication [and] regardless of whether non-scientists are sending this information, it proves that science is an aspect of general culture,” said Vincent Larivière, PHD, a co-author of the study and professor at the University of Montreal, who holds the Canada Research Chair on the Transformation of Academic Communication.
Read the full study.
Critical Opportunities: New Journal Article, Videos Offer Proposed Legal and Policy Changes that Can Impact Public Health
Ten new videos released today by Public Health Law Research (PHLR), a national program of the Robert Wood Johnson Foundation, with direction and technical assistance from Temple University, offer suggestions of proposed changes to laws and policies that can impact public health, such as fortifying corn masa flour to prevent neural tube defects and increasing taxes on alcohol to reduce consumption. The five-minute videos offer examples of PHLR’s “Critical Opportunities” initiative—brief presentations which showcase legal approaches to improving public health.
“Laws can be cost-efficient and popular tools for achieving public health goals. This initiative captures specific actionable, evidence-based ideas for creative ways of using law or legal interventions to improve a public health problem,” said Scott Burris, JD, director of the PHLR program.
The release of the videos is accompanied by an article published this week in the American Journal of Public Health, “Critical Opportunities for Public Health Law: A Call to Action.” It outlines five high-priority areas where evidence suggests legal interventions can have big impacts on health, and calls for a national conversation to continue to identify and prioritize opportunities for legal and policy action.
“The Centers for Disease Control and Prevention, the Institute of Medicine, and others have called for better, smarter use of legal interventions to advance public health,” said Michelle Mello, JD, PhD, the lead author of the article and professor of law and public health at Harvard University. “That’s no small task, but there’s a treasure trove of great ideas to draw on and evidence to back them up.”
PHLR has also developed a toolkit for use by organizations or instructors to host Critical Opportunities sessions at their meetings or in classrooms. The toolkit offers a how-to guide for using the format to identify ways laws can be used to address public health issues.
All ten of the new Critical Opportunities videos are available here. To highlight just one of the presentations, NewPublicHealth recently spoke with Adam Finkel, ScD, of the University of Pennsylvania Law School, about his Critical Opportunity presentation on the benefit and limitations of “smart disclosures,” an alternative to regulations and laws for improving public health.
A major theme at this year’s AcademyHealth Annual Research Meeting was the need to become more aggressive on translating and disseminating health research. Just last month, the Mailman School of Public Health at Columbia University announced that is was becoming the first school at the university and one of the first of U.S. schools of public health to adopt an open access resolution. The resolution calls for faculty and other researchers at the school to post their papers in openly available online repositories such as Columbia’s Academic Commons, where content is available free to the public, or in another open access repository, such as the National Institutes of Health’s PubMed Central.
“A wider dissemination of research and information has been a number one priority of our faculty, who are motivated by the belief that scientific knowledge belongs to everyone,” said Linda P. Fried, MD, MP, the dean at Mailman. “It is in the interest of all of us to take every measure possible to improve and simplify the process of gaining access to our research findings,” Fried said.
NewPublicHealth spoke with Bhaven N. Sampat, PhD, Assistant Professor of health policy and management at Mailman and a lead faculty member on the open access endeavor.
NewPublicHealth: Why haven’t many journals been open access before and what is making researchers, particularly in the field of public health, interested in more widely disseminating their research?
An anniversary session at the AcademyHealth Annual Resarch Meeting yesterday looked back at the organization’s thirty years of translating research into policy. It’s an important topic. A number of recent meetings focusing on public health, including last week’s public meeting of the Commission to Build a Healthier American, stressed the need for evidence in order to consider planning and community improvement decisions. The Affordable Care Act has a number of new initiatives that call on clinical and public health practitioners to seek and rely on an evidence base, including the Patient-Centered Outcomes Research Institute (PCORI), which is authorized by Congress to evaluate the best available evidence to help patients and their health care providers make more informed decisions.
Decades of research is beginning to pay off, according to the panelists. For example, according to Sherry Glied, PhD, professor of health policy and management at the Columbia University Mailman School of Public Health, the experts involved in crafting the Affordable Care Act drew on a body of research to inform the expected cost of implementing the law.
Gail Wilensky, senior fellow at Project HOPE, an international health foundation, who directed the Medicare and Medicaid programs from 1990 to 1992, pointed out that sometimes evidence has limitations. “Getting legislation passed also has to do with, among other things, the political mood of the country,” said Wilensky, who added that sometimes policy passes and sometimes it doesn’t, which is important for younger researchers to realize. “Important legislation has passed with minimal analysis including Medicaid and Medicare,” Wilensky pointed out.
NewPublicHealth is on the road this week at the AcademyHealth Annual Research Meeting in Baltimore, Maryland and the International Making Cities Livable Conference meeting in Portland, Oregon.
AcademyHealth is a key organization in the United States for the study of health services research—a discipline that looks at how people get access to health care, how much care costs and what happens to patients as a result of this care. The main goals of health services research are to identify the most effective ways to organize, manage, finance and deliver high-quality care; reduce medical errors; and improve patient safety.
An important focus of this week’s Annual Research Meeting is the translation and dissemination of research into health practice. The Public Health Systems Interest Group, AcademyHealth’s largest interest group with close to 3,000 members, is meeting this week as well and has a particular focus on translating and disseminating public health systems and services research to the public health practitioners who could benefit from practical findings.
NewPublicHealth recently spoke with Paul Erwin, MD, MPH, and head of the department of public health at the University of Tennessee School of Public Health, about the importance of having strong evidence available for public health practitioners.
NewPublicHealth: Why is the translation and dissemination of Public Health Services and Systems Research (PHSSR) so important?
Paul Erwin: Ultimately PHSSR is meant to go out into the practice community so that research can actually make a difference. I think historically that is part of what has set PHSSR apart from closely related research disciplines. PHSSR really is intended to help produce the kinds of evidence-based practices that are more effective with limited resources, and likely to move the needle on population health.
During opening remarks at this year’s Keeneland Conference, hosted by the National Coordinating Center for Public Health Systems and Services Research (PHSSR) based at the University of Kentucky in Lexington, Professor Douglas Scutchfield, director of the Center, proudly announced that three of the first health departments to be accredited by the Public Health Accreditation Board (PHAB) earlier this year were in Kentucky. Accreditation had its own track during the conference scientific sessions, including a presentation from Jessica Kronstadt, MPP, PHAB’s director of research and evaluation.
NewPublicHealth caught up with Kronstadt to talk about her presentation on some very early findings from an internal evaluation of the accreditation process.
>>Read more on national public health department accreditation.
NewPublicHealth: What information is PHAB seeking to gain from an evaluation of the accreditation process?
Jessica Kronstadt: Just as we’re asking health departments to engage in quality improvement, PHAB is very much committed to engaging in quality improvement of the accreditation program. So these evaluation efforts will really help us understand what is working well in our accreditation program, and what the experience was like from the perspective of the health departments and the site visitors. This evaluation will allow us to continue to improve the accreditation process.
The last session of the Keeneland Conference focused on translation and dissemination of public health systems and services research, with the critical goal of more efficient and effective delivery of public health services and improving population health. NewPublicHealth spoke with Ross Brownson, PhD, of the Prevention Research Center at Washington University in St. Louis. Dr. Brownson has received funding from the Robert Wood Johnson Foundation to explore evidence-based decision making at local health departments.
NewPublicHealth: How far back does evidence-based public health go?
Ross Brownson: The formal underpinnings of evidence-based public health were developed in the late 1990s, so at least the formal literature has been around for probably about 15 years. Of course, research on effective interventions has been around for many more decades. The newer field of public health services and systems research is much newer, just within the last five years or so, and these different bodies of research are now converging.
The early research focused a lot on identifying evidence-based interventions. The newer research is more on the process of evidence-based public health—regardless of the intervention, how do you develop and implement an evidence-based health department?
We identified five domains that are really important:
- leadership of the agency;
- ability to develop, formalize and maintain good partnerships within the community;
- workforce training and development;
- focus on organizational climate and culture; and
- effective financial and budgeting processes.
The ultimate goal is to make the population healthier and we know that the way to improve the overall health of the public is largely through state and local governmental public health. To reach that ultimate goal you want to have the most effective health department possible and also make the most efficient use of resources. We’re always in a time of tight resources, but probably now more than ever. That calls on us to be as effective and efficient as we can be in the delivery of public health services.
NPH: How will you disseminate these best practices and this evidence base to state and local public health officials?
Today’s plenary speaker at the 2013 Keeneland Conference is William Roper, MD, MPH, dean of the school of medicine, vice chancellor for medical affairs and CEO of the UNC Health Care System at the University of North Carolina at Chapel Hill. Earlier in his career, Dr. Roper was senior vice president of Prudential HealthCare, president of the Prudential Center for Health Care Research, director of the Centers for Disease Control and Prevention and administrator of the Health Care Financing System, the precursor to the Center for Medicare and Medicaid Services.
NewPublicHealth spoke with Dr. Roper on his way to the Keeneland Conference about the drive to better use data, instead of anecdotes and personal beliefs, to drive decision-making.
NewPublicHealth: What were some of the early efforts you were involved in that set the stage for the field of public health services and systems research we know today?
Dr. Roper: I didn’t do this by myself; I did it with a lot of other people, but one of the critical early efforts was the publication of Medicare mortality information on all American hospitals beginning in 1986 and continuing for a number of years thereafter. Another was creation of the Agency for Healthcare Policy and Research in 1989, which has since been renamed the Agency for Healthcare Research and Quality. Another was the launching of the Prevention Effectiveness Initiative at CDC in the early 90s. And then subsequently, work that I’ve done at the University of North Carolina, first at the School of Public Health and then at the School of Medicine using the tools of health services research broadly in health care and in public health.
NPH: What are some of the fruits of those efforts?