Community Preventive Services Task Force Research Articles

Aligning the Work of Two U.S. Task Forces on Behavioral Counseling Recommendations.

This paper highlights the collaboration and alignment between topics and recommendations related to behavioral counseling interventions from the U.S. Preventive Services Task Force (USPSTF) and Community Preventive Services Task Force (CPSTF). Although the scope and mandates of the USPSTF and CPSTF differ, there are many similarities in the methods and approaches used to select topics and make recommendations to their key stakeholders. Behavioral counseling recommendations represent an important domain for both Task Forces, given the importance of behavior change in promoting healthful lifestyles. This paper explores opportunities for greater alignment between the two Task Forces and compares and contrasts the groups and their current approaches to making recommendations that involve behavioral counseling interventions. Opportunities to enhance behavioral counseling preventive services through closer coordination when developing and disseminating recommendations as well as future collaboration between the USPSTF and CPSTF are discussed.

Community Preventive Services Task Force Issues2014–2015 Annual Report to Congress

Community Preventive Services Task Force Issues<i>2014–2015 Annual Report to Congress</i>

Recommendation for use of immunization information systems to increase vaccination rates.

Based on findings of a systematic review, the Community Preventive Services Task Force recommends immunization information systems on the basis of strong evidence of effectiveness in increasing vaccination rates. Evidence is considered strong, based on the findings from 108 published articles and 132 conference abstracts showing that immunization information systems are effective in increasing vaccination rates and reducing vaccine-preventable disease through their capabilities to (1) create or support effective interventions such as client reminder and recall systems, provider assessment and feedback, and provider reminders; (2) generate and evaluate public health responses to outbreaks of vaccine-preventable disease; (3) facilitate vaccine management and accountability; (4) determine client vaccination status for decisions made by clinicians, health departments, and schools; and (5) aid surveillance and investigations on vaccination rates, missed vaccination opportunities, invalid dose administration, and disparities in vaccination coverage.

High school completion programs recommended to improve health equity.

The Community Preventive Services Task Force recommends high school completion programs for students at high risk for non-completion, based on strong evidence of effectiveness. The Task Force also recommends high school completion programs for a subset of students who are at risk for non-completion because they are pregnant or have children, based on strong evidence of effectiveness.

Vaccinations for pregnant women.

In the United States, eradication and reduction of vaccine-preventable diseases through immunization has directly increased life expectancy by reducing mortality. Although immunization is a public priority, vaccine coverage among adult Americans is inadequate. The Institute of Medicine, the Community Preventive Services Task Force, and other public health entities have called for the development of innovative programs to incorporate adult vaccination into routine clinical practice. Obstetrician-gynecologists are well suited to serve as vaccinators of women in general and more specifically pregnant women. Pregnant women are at risk for vaccine-preventable disease-related morbidity and mortality and adverse pregnancy outcomes, including congenital anomalies, spontaneous abortion, preterm birth, and low birth weight. In addition to providing direct maternal benefit, vaccination during pregnancy likely provides direct fetal and neonatal benefit through passive immunity (transplacental transfer of maternal vaccine-induced antibodies). This article reviews: 1) types of vaccines; 2) vaccines specifically recommended during pregnancy and postpartum; 3) vaccines recommended during pregnancy and postpartum based on risk factors and special circumstances; 4) vaccines currently under research and development for licensure for maternal-fetal immunization; and 5) barriers to maternal immunization and available patient and health care provider resources.

Value of lifestyle intervention to prevent diabetes and sequelae.

The Community Preventive Services Task Force recommends combined diet and physical activity promotion programs for people at increased risk of type 2 diabetes, as evidence continues to show that intensive lifestyle interventions are effective for overweight individuals with prediabetes. To illustrate the potential clinical and economic benefits of treating prediabetes with lifestyle intervention to prevent or delay onset of type 2 diabetes and sequelae. This 2014 analysis used a Markov model to simulate disease onset, medical expenditures, economic outcomes, mortality, and quality of life for a nationally representative sample with prediabetes from the 2003-2010 National Health and Nutrition Examination Survey. Modeled scenarios used 10-year follow-up results from the lifestyle arm of the Diabetes Prevention Program and Outcomes Study versus simulated natural history of disease. Over 10 years, estimated average cumulative gross economic benefits of treating patients who met diabetes screening criteria recommended by the ADA ($26,800) or USPSTF ($24,700) exceeded average benefits from treating the entire prediabetes population ($17,800). Estimated cumulative, gross medical savings for these three populations averaged $10,400, $11,200, and $6,300, respectively. Published estimates suggest that opportunistic screening for prediabetes is inexpensive, and lifestyle intervention similar to the Diabetes Prevention Program can be achieved for ≤$2,300 over 10 years. Lifestyle intervention among people with prediabetes produces long-term societal benefits that exceed anticipated intervention costs, especially among prediabetes patients that meet the ADA and USPSTF screening guidelines.

Contribution of excessive alcohol consumption to deaths and years of potential life lost in the United States.

IntroductionExcessive alcohol consumption is a leading cause of premature mortality in the United States. The objectives of this study were to update national estimates of alcohol-attributable deaths (AAD) and years of potential life lost (YPLL) in the United States, calculate age-adjusted rates of AAD and YPLL in states, assess the contribution of AAD and YPLL to total deaths and YPLL among working-age adults, and estimate the number of deaths and YPLL among those younger than 21 years.MethodsWe used the Centers for Disease Control and Prevention’s Alcohol-Related Disease Impact application for 2006–2010 to estimate total AAD and YPLL across 54 conditions for the United States, by sex and age. AAD and YPLL rates and the proportion of total deaths that were attributable to excessive alcohol consumption among working-age adults (20-64 y) were calculated for the United States and for individual states.ResultsFrom 2006 through 2010, an annual average of 87,798 (27.9/100,000 population) AAD and 2.5 million (831.6/100,000) YPLL occurred in the United States. Age-adjusted state AAD rates ranged from 51.2/100,000 in New Mexico to 19.1/100,000 in New Jersey. Among working-age adults, 9.8% of all deaths in the United States during this period were attributable to excessive drinking, and 69% of all AAD involved working-age adults.ConclusionsExcessive drinking was responsible for 1 in 10 deaths among working-age adults in the United States. AAD rates vary across states, but excessive drinking remains a leading cause of premature mortality nationwide. Strategies recommended by the Community Preventive Services Task Force can help reduce excessive drinking and harms related to it.

Publicized sobriety checkpoint programs to reduce alcohol-impaired driving: recommendation of the Community Preventive Services Task Force.

The Community Preventive Services Task Force recommends publicized sobriety checkpoint programs based on strong evidence of effectiveness in reducing alcohol-impaired driving.

Publicized sobriety checkpoint programs: a community guide systematic review.

Publicized sobriety checkpoint programs deter alcohol-impaired driving by stopping drivers systematically to assess their alcohol impairment. Sobriety checkpoints were recommended in 2001 by the Community Preventive Services Task Force for reducing alcohol-impaired driving, based on strong evidence of effectiveness. Since the 2001 review, attention to alcohol-impaired driving as a U.S. public health problem has decreased. This systematic review was conducted to determine if available evidence supports the effectiveness of publicized sobriety checkpoint programs in reducing alcohol-impaired driving, given the current context. The economic costs and benefits of the intervention were also assessed. This review focused on studies that evaluated the effects of publicized sobriety checkpoint programs on alcohol-involved crash fatalities. Using Community Guide methods, a systematic search was conducted for studies published between July 2000 and March 2012 that assessed the effectiveness of publicized sobriety checkpoint programs. Fourteen evaluations of selective breath testing and one of random breath testing checkpoints met the inclusion criteria for the systematic review, conducted in 2012. Ten evaluations assessed the effects of publicized sobriety checkpoint programs on alcohol-involved crash fatalities, finding a median reduction of 8.9% in this crash type (interquartile interval=-16.5%, -3.5%). Five economic evaluations showed benefit-cost ratios ranging from 2:1 to 57:1. The number of studies, magnitude of effect, and consistency of findings indicate strong evidence of the effectiveness of publicized sobriety checkpoint programs in reducing alcohol-involved crash fatalities. Economic evidence shows that these programs also have the potential for substantial cost savings.

Recommendation for Full-Day Kindergarten for Children of Low-Income and Racial/Ethnic-Minority Families

The Community Preventive Services Task Force recommends full-day kindergarten programs to improve the health prospects of minority children and children from low-income families, based on strong evidence that, compared with half-day kindergarten or full-day kindergarten on alternating days, full-day programs substantially improve reading and mathematics achievement-determinants of long-term academic and health-related outcomes (e.g., reduced teen pregnancy and risk behaviors). The achievement gains apparent at the beginning of first grade do not, themselves, guarantee academic achievement in later years. Ongoing school environments that support learning and development are essential.

The 50th Anniversary of the US Surgeon General's Report on Tobacco: What We've Accomplished and Where We Go From Here

January 11, 2014, marks the 50th anniversary of a significant milestone in our nation's public health. It was on this date in 1964 that US Surgeon General, Dr. Luther Terry, courageously released the first Surgeon General's Report on Smoking and Health.[1][1] This landmark report transformed the way

Capsule Commentary on Davis et al., Improving Mammography Screening among the Medically Underserved

Davis et al.1 report on the effectiveness and cost-effectiveness of approaches to increase mammography screening among 1,181 women in Federally Qualified Health Centers (FQHCs) in Louisiana. The three arms evaluated were enhanced usual care (i.e., recommendation for and scheduling of mammogram), health literacy informed education (i.e., enhanced usual care plus educational materials), and health literary+nurse support (i.e., health literacy informed education plus nurse navigation). While all significantly increased mammography screening rates over baseline, the health literacy+nurse support arm was the most effective. Surprisingly, health literacy informed education was less effective than enhanced usual care, leading the authors to speculate that education to increase knowledge and awareness about breast cancer and mammography may not be necessary in this population, many of whom had previously received a mammogram. An important strength of this study is the inclusion of a cost-effectiveness analysis. The Community Preventive Services Task Force has identified types of interventions that successfully increase mammography screening.2 Previous research has demonstrated that women reporting a provider recommendation were significantly more likely to receive a mammogram.3 Further, studies suggest that patient navigation facilitates mammography screening, particularly among the traditionally medically underserved.4 To increase the application of this work, there may be opportunities for public health entities to implement innovative approaches to identify women who need screening services, encourage participation, and monitor results.5 Importantly, the authors note that the nurse support arm may not be feasible for lower resource clinics. The navigation activities described in this study may be successfully completed by lay and other health professionals at lower cost. Caution is warranted before determining that women do not still require education to increase knowledge and awareness about screening mammography—the need for education may vary by the population being served. Additional research is needed to identify and monitor additional barriers and facilitators to receipt of routine screening in this population, determine the individual-level and system-level characteristics of effective patient navigation programs, and demonstrate how electronic medical records can be used more effectively to track patients in safety-net clinics, hospitals, and systems.

Towards SunSmart school policies in South Africa

Solar ultraviolet radiation exposure is the major cause of cancers of the skin and cataracts of the eyes. Skin cancer rates in South Africa, particularly among white individuals, are among the highest in the world. Moreover, recent data have raised new concerns about increasing non-melanoma skin cancer incidence among black South Africans who are HIV positive. Cataracts are the leading cause of blindness in South Africa. Prevention of these adverse health effects requires an appropriate behavioural response in the form of sun protection. Sunscreen, clothing, hats, umbrellas and shade structures offer varying degrees of photoprotection against excess personal solar ultraviolet radiation exposure. Schools have an important part to play in supporting children to make healthy sun choices. The International Community Preventive Services Task Force released a statement that supported 'strong evidence' for the effectiveness of interventions in primary schools aimed at the prevention of skin cancer that combine education and policy approaches to increase preventive behaviours, specifically, child sun protective practices that reduce sunburn incidence and new melanocytic mole development.

Analysis of Physical Activity Mass Media Campaign Design

Mass media campaigns are a necessary tool for public health practitioners to reach large populations and promote healthy behaviors. Most health scholars have concluded that mass media can significantly influence the health behaviors of populations; however the effects of such campaigns are typically modest and may require significant resources. A recent Community Preventive Services Task Force review on stand-alone mass media campaigns concluded there was insufficient evidence to determine their effectiveness in increasing physical activity, partly due to mixed methods and modest and inconsistent effects on levels of physical activity. A secondary analysis was performed on the campaigns evaluated in the Task Force review to determine use of campaign-building principles, channels, and levels of awareness and their impact on campaign outcomes. Each study was analyzed by 2 reviewers for inclusion of campaign building principles. Campaigns that included 5 or more campaign principles were more likely to be successful in achieving physical activity outcomes. Campaign success is more likely if the campaign building principles (formative research, audience segmentation, message design, channel placement, process evaluation, and theory-based) are used as part of campaign design and planning.

Commercial Host (Dram Shop) Liability

Commercial host liability (CHL, also called dram shop liability) holds alcohol retailers liable for alcohol-attributable harm caused by serving alcohol, illegally, to a patron who is already intoxicated (adult liability) or underage (underage liability). The Community Preventive Services Task Force, based on a systematic research literature review, concluded that CHL is an effective strategy for reducing excessive alcohol consumption. The current article describes the key components of CHL, its grounding in American jurisprudence, its adoption in the 50 states, and changes since 1989, when a similar assessment of these policies was conducted. The current paper focuses on three legislatively enacted restrictions: (1) increased evidentiary requirements; (2) limitations on damage awards; and (3) limitations on who may be sued. Data were collected in 2011 and analyzed in 2012 and 2013. There has been substantial erosion of CHL during the past 2 decades. Fewer states recognized CHL in 2011 than in 1989, and more statutory restrictions were imposed during the study period among states that did recognize CHL; states are more likely to recognize underage than adult liability; and six states recognized a Responsible Beverage Services Practices affirmative defense in both 1989 and 2011. Implications of these findings for public health practitioners are discussed.

AMIGAS: building a cervical cancer screening intervention for public health practice.

Many barriers to cervical cancer screening for Hispanic women have been documented, but few effective interventions exist. The Community Preventive Services Task Force recommends increasing cervical cancer screening through various methods. Building on this evidence, the Centers for Disease Control and Prevention funded the research and testing phases for an evidence-based and theoretically grounded intervention designed to increase cervical cancer screening among never and rarely screened Hispanic women of Mexican descent. In this article, we describe the development process of the AMIGAS (Ayudando a las Mujeres con Información, Guía, y Amor para su Salud) intervention, highlight the integration of scientific evidence and community-based participatory research principles, and identify opportunities for dissemination, adaptation, and implementation of this intervention. The AMIGAS team was a collaboration among researchers, promotoras (community health workers), and program administrators. The multiyear, multiphase project was conducted in Houston, Texas; El Paso, Texas; and Yakima, Washington. The team completed several rounds of formative research, designed intervention materials and methodology, conducted a randomized controlled trial, created a guide for program administrators, and developed an intervention dissemination plan. Trial results demonstrated that AMIGAS was successful in increasing cervical cancer screening among Hispanic women. Adaptation of AMIGAS showed minimal reduction of outcomes. Dissemination efforts are underway to make AMIGAS available in a downloadable format via the Internet. Developing a community-based intervention that is evidence-based and theoretically grounded is challenging, time-intensive, and requires collaboration among multiple disciplines. Inclusion of key stakeholders-in particular program deliverers and administrators-and planning for dissemination and translation to practice are integral components of successful intervention design. By providing explicit directions for adaptation for program deliverers, relevant information for program administrators, and access to the intervention via the Internet, AMIGAS is available to help increase cervical cancer screening among Hispanic women and other women disproportionately affected by cervical cancer.

State Pre-Emption, Local Control, and Alcohol Retail Outlet Density Regulation

The substantial health and economic costs of excessive alcohol consumption make its reduction a major public health and economic concern. The Community Preventive Services Task Force, based on a systematic review of the research literature, concluded that restricting alcohol retail outlet density through local land use and zoning regulations is an effective strategy for reducing these costs. Yet the implementation of the Task Force's recommendation is limited by state pre-emption, which determines the extent to which states allow local government to adopt policies and enact legislation. This article summarizes the state pre-emption doctrine, its status in the 50 states pertaining to alcohol retail outlet density regulation, and findings from state legal analyses conducted in six states. Data reflect state laws in effect as of January 1, 2012. Analyses were conducted during the 2012 calendar year. An examination of relevant state laws found five distinct pre-emption categories: exclusive state licensing, exclusive state licensing and concurrent local zoning, joint licensing, exclusive local licensing, and a mixed system. The analysis demonstrated wide variability across the states, ranging from exclusive state pre-emption to broad state delegation of authority to local governments. Pre-emption is applied differentially in many states based on retail outlet characteristics. In many cases, state pre-emption laws are ambiguous in terms of their application, leading to inconsistent and confusing court interpretations. Reforms targeting the adverse impact of state pre-emption on alcohol retail outlet density have the potential for reducing the harm associated with excessive alcohol consumption. State and local public health departments can support such reforms by implementing educational, analytic, monitoring, and technical assistance activities.

Noninfluenza Vaccination Coverage Among Adults—United States, 2011

Vaccinations are recommended throughout life to prevent vaccine-preventable diseases and their sequelae. Adult vaccination coverage, however, remains low for most routinely recommended vaccines and well below Healthy People 2020 targets. In October 2013, the Advisory Committee on Immunization Practices (ACIP) approved the adult immunization schedule for 2014. With the exception of influenza vaccination, which is recommended for all adults each year, vaccinations recommended for adults target different populations based on age, health conditions, behavioral risk factors (e.g., injection drug use), occupation, travel, and other indications. To assess vaccination coverage among adults aged ≥19 years for selected vaccines, CDC analyzed data from the 2012 National Health Interview Survey (NHIS). This report summarizes the results of that analysis for pneumococcal, tetanus toxoid-containing (tetanus and diphtheria vaccine [Td] or tetanus and diphtheria with acellular pertussis vaccine [Tdap]), hepatitis A, hepatitis B, herpes zoster (shingles), and human papillomavirus (HPV) vaccines by selected characteristics (age, race/ethnicity, and vaccination target criteria). Influenza vaccination coverage estimates for the 2012-13 influenza season have been published separately. Compared with 2011, only modest increases occurred in Tdap vaccination among adults aged 19-64 years, herpes zoster vaccination among adults aged ≥60 years, and HPV vaccination among women aged 19-26 years; coverage among adults in the United States for the other vaccines did not improve. Racial/ethnic gaps in coverage persisted for all six vaccines and widened for Tdap, herpes zoster, and HPV vaccination. Increases in vaccination coverage are needed to reduce the occurrence of vaccine-preventable diseases among adults. The Community Preventive Services Task Force and other authorities have recommended that health-care providers incorporate vaccination needs assessment, recommendation, and offer of vaccination into routine clinical practice for adult patients.

News from the CDC: collaborations to build capacity at the community level in cancer prevention and control

The Cancer Prevention and Control Research Network (CPCRN) is a national network of ten academic centers funded by the Centers for Disease Control and Prevention and the National Cancer Institute, whose mission is to accelerate the adoption of evidence-based cancer prevention and control practices in communities through increased understanding of program dissemination and implementation. CPCRN researchers collaborate to raise awareness, provide education, guidance, and technical assistance to reduce cancer incidence and mortality rates in their communities. The CPCRN capacity building at the community level involves implementing evidence-based programs, policies, and strategies recommended by the Community Preventive Services Task Force to decrease obesity, increase physical activity, promote healthier behaviors, decrease tobacco use, and improve the appropriate use of cancer screening tests. These accomplishments demonstrate how the collaboration of federal, academic, and community-based organizations can be mutually beneficial by developing partnerships, research infrastructure, and community capacity that can catalyze behavior change.

Stand-Alone Mass Media Campaigns to Increase Physical Activity: Updated Findings from the Community Preventive Services Task Force

The Community Preventive Services Task Force concludes there is insufficient evidence to determine the effectiveness of stand-alone mass media campaigns to increase physical activity at the population level. Additional research is needed to determine effectiveness.