Evidence-based Public Health Interventions Research Articles

Inuit family understandings of sexual health and relationships in Nunavut.

To explore Inuit family understandings of sexual health and relationships in order to inform responsive public health interventions that are designed to meet the needs of Nunavummiut. A qualitative indigenous knowledge approach was used for this study with a focus on Inuit epistemology and methodology, as described in the Piliriqatigiinniq Community Health Research Partnership Model. Interviews were conducted with 20 parents in three Nunavut communities in 2011. An immersion and crystallization analytical approach was used to analyze the data and to identify groupings or themes in the data. The stories shared by parents are honoured, keeping their words intact as often as possible in the presentation of results. Parents in this study largely discussed sexual health in the context of historical community events related to settlement and/or residential schools. Residential schools and forced settlement into communities were linked to trauma, family separation, hardship and grief. These experiences were prominent in participants' understandings of sexual health and perceptions of sexual health behaviours among youth in the community. This study highlights the complexity of the landscape of sexual health in Nunavut and the need for public health approaches that are inclusive of Inuit family perspectives on sexual health. Greater understanding of historical and community context can contribute to the development of pertinent, evidence-based public health interventions that will meet the needs of the population.

Predictors of mental health competence in a population cohort of Australian children

BackgroundThe child mental health epidemiology literature focuses almost exclusively on reporting the prevalence and predictors of child mental disorders. However, there is growing recognition of positive mental health or mental...

The impact of compulsory drug detention exposure on the avoidance of healthcare among injection drug users in Thailand

BackgroundAlthough Thailand has relied on the use of compulsory drug detention centres as a strategy to try to address problematic drug use, little is known about the effects of exposure to these centres on people who inject drugs (IDU). Therefore, we undertook this study to explore whether exposure to compulsory drug detention was associated with avoiding healthcare among Thai IDU. MethodsUsing Poisson regression analyses, we examined the relationship between compulsory drug detention exposure and avoiding healthcare among participants in the Mitsampan Community Research Project based in Bangkok. Results435 IDU participated in this study, including 111 (25.5%) participants who reported avoiding healthcare. In multivariate analyses, avoiding healthcare was positively associated with exposure to compulsory drug detention (adjusted prevalence ratio [APR]=1.60; 95% confidence interval [CI]: 1.16–2.21), having been refused healthcare (APR=3.46; 95% CI: 2.61–4.60), and experiencing shame associated with one's drug use (APR=1.93; 95% CI: 1.21–3.09). ConclusionExposure to compulsory drug detention was associated with avoiding healthcare among Thai IDU, suggesting that this system of detention may be contributing to the burden of preventable morbidity among IDU in this setting. Although further research is needed to confirm these findings, the results of this study reinforce previous calls to replace the system of compulsory drug detention with evidence-based public health interventions for IDU.

'Translational formative evaluation': critical in up-scaling public health programmes

The process of generating evidence-based public health interventions is understood to include steps that define the issue, generate and test solutions in controlled settings, replicate and then disseminate more widely. However, to date models have not considered the types and scale of formative evaluation tasks that are needed to up-scale interventions, from efficacy to population-wide dissemination in the real world. In this paper, we propose that an additional stage of 'translational formative evaluation' is necessary for the translation of effectiveness evidence into wide-scale public health practice. We illustrate the utility of translational formative evaluation, through a case study of the Get Healthy Information and Coaching Service(®) (GHS), a population-based telephone service designed to assist adults change lifestyle-related behaviours. The additional translational formative evaluation steps comprised synthesis of efficacy studies, qualitative research with the wider target audience, environmental analysis and stakeholder consultation. They produced precise recommendations to refine GHS design and implementation. Translational formative evaluation is a necessary intermediate step, following efficacy studies and a precursor to population-wide implementation of public health programmes.

Evaluation of rubella immunity in a community prenatal clinic.

Since the introduction of the Rubella vaccine in 1969, prevalence of congenital Rubella syndrome (CRS) has greatly declined in the United States. However, reports of sporadic adult cases of the disease and frequent identification of non-Rubella immune (NRI) women in prenatal units may result in outbreak of CRS in susceptible communities. Identifying populations with high rates of NRI will assist in evidence-based public health intervention that may prevent epidemic of CRS in the United States. Method. This is a retrospective, cross-sectional study involving chart audit of Rubella screening results of 642 women who attended a high-risk prenatal care at a northwestern Iowa clinic between January 1 and December 31, 2007. Results. NRI was found in 6.9% of the study population. The highest prevalence rate of 10.2% was found among adolescents. NRI was highest among Native American women at 17.3%, compared to Whites 7.3%, African Americans 5.9%, and Hispanics 4.6%. Multivariate analysis demonstrated that Native Americans were 2.5 times more likely to be NRI compared to Whites (OR 2.7; 95% CI: 1.1, 6.6). Conclusion. This study demonstrated higher rate of non-Rubella immunity among adolescent pregnant women and supports Rubella booster immunization for all non-pregnant teenage women. The observed high rate of NRI among Native Americans may require further studies and evaluation of Rubella vaccination programs in tribal communities.

Epidemiologic investigation of excess maternal and neonatal deaths and evidence-based low-cost public health interventions - Ignaz Semmelweis: the etiology, concept and prophylaxis of child bed fever[1

aIndian Institute of Health Management Research, Jaipur, India. Correspondence to S D Gupta (e-mail: sdgupta@iihmr.org) Introduction When I look back upon the past, I can only dispel the sadness which fall upon me by gazing into that happy future when the infection will be banished .... The conviction that such a time must inevitably sooner than later arrive will cheer my dying hour. So wrote Ignaz Semmelweis in his last days while he suffered depression due to continued criticism by medical professionals and colleagues. Semmelweis suggested that simple handwashing with chlorinated water could prevent the spread of infection and save the lives of women in maternity.2 His methods showed that maternal deaths due to puerperal fever reduced from 12.2% to 2.4% in maternity wards. He expanded his methods to washing of instruments, which altogether removed puerperal infection in the hospital. However, his observations were in serious conflict with contemporary scientific and medical opinions, which rejected his observations. His suggestion that doctors should wash their hands with chlorinated lime even offended some doctors and his colleagues. They refused to accept that they could be responsible for spreading infection. Semmelweis’s claims were thought to lack scientific basis and his practice of antiseptic use only gained acceptance years after his death, when Louis Pasteur3 invented the germ theory of disease in 1862, and Joseph Lister4 invented methods for antiseptic surgery in 1867.

Adopting an evidence-based lifestyle physical activity program: dissemination study design and methods

BACKGROUND: There is a scarcity of research studies that have examined academic-commercial partnerships to disseminate evidence-based physical activity programs. Understanding this approach to dissemination is essential because academic-commercial partnerships are increasingly common. Private companies have used dissemination channels and strategies to a degree that academicians have not, and declining resources require academicians to explore these partnerships. PURPOSE: This paper describes a retrospective case-control study design including the methods, demographics, organizational decision-making, implementation rates, and marketing strategy for Active Living Every Day (ALED), an evidence-based lifestyle physical activity program that has been commercially available since 2001. Evidence-based public health promotion programs rely on organizations and targeted sectors to disseminate these programs although relatively little is known about organizational-level and sector-level influences that lead to their adoption and implementation. METHODS: Cases (n=154) were eligible if they had signed an ALED license agreement with Human Kinetics (HK), publisher of the program's textbooks and facilitator manuals, between 2001 and 2008. Two types of controls were matched (2:2:1) and stratified by sector and region. Active controls (Control 1; n=319) were organizations that contacted HK to consider adopting ALED. Passive controls (Control 2; n=328) were organizations that received unsolicited marketing materials and did not initiate contact with HK. We used Diffusion of Innovations Theory (DIT) constructs as the basis for developing the survey of cases and controls. RESULTS: Using the multi-method strategy recommended by Dillman, a total of n=801 cases and controls were surveyed. Most organizations were from the fitness sector followed by medical, nongovernmental, governmental, educational, worksite and other sectors with significantly higher response rates from government, educational and medical sectors compared with fitness and other sectors, (p=0.02). More cases reported being involved in the decision to adopt ALED (p<0.0001). Data indicate that a low percentage of controls had ever heard of ALED despite repeated marketing and offering other types of physical activity programs and services. Finally, slightly over half of the adopters reported they had actually implemented the ALED program. CONCLUSION: Dissemination research requires new perspectives and designs to produce valid insights about the results of dissemination efforts. This study design, survey methods and theoretically-based questions can serve as a useful model for other evidence-based public health interventions that are marketed by commercial publishers to better understand key issues related to adoption and implementation of evidence-based programs.

Back to the Future: The American Society of Tropical Medicine and Hygiene, Its Journal and the Continuing Commitment to Global Health

These are exciting and challenging times in the world of global health. The burden of major infectious diseases that disproportionately affect the health of women and children in low- and middle-income countries can, in some circumstances, be reduced substantially by implementing scientifically validated and evidence-based public health interventions, e.g., vaccination for diarrheal disease caused by rotavirus infection, insecticide-treated bed nets for malaria. Global efforts have been implemented that in the foreseeable future have as their stated goal local geographic elimination and ultimately, worldwide eradication of pathogens that historically have caused great suffering and socioeconomic loss in low- and middle-income countries. The paper by Linehan and colleagues 1 in this issue of the AJTMH demonstrating the feasibility of an integrated approach to the elimination or control of five “Neglected Tropical Diseases,” lymphatic filariasis, onchocerciasis, schistosomiasis, soil-transmitted helminthiases, and blinding trachoma, is an outstanding example of how years of basic and clinical research can be translated into locally led national programs that make a real difference in the lives of people in developing countries. At the same time that these ambitious programs are unfolding, the underlying causes and demographics of ill health in the world are changing. Obesity, diabetes, and cardiovascular disease, once uncommon (or unrecognized) among poor people in developing countries, are increasingly common, especially in the megacities of Africa, Latin America, and Asia. Building on the prominence of “Global Health” at the November 2010 Annual Meeting of the American Society of Tropical Medicine and Hygiene, the Society’s Journal will address global health education, research, and advocacy throughout the 2011 issues. Each month a global health article will be highlighted in the AJTMH . We welcome and will solicit perspectives and research papers on topics that pertain to global health advocacy, the metrics of competence in specific areas of global health education, health economics, collaborations that bridge infectious and chronic disease, and model public–private partnerships in developing countries. 2

What are the Evidence Based Public Health Interventions for Prevention and Control of NCDs in Relation to India?

The accelerating epidemics of noncommunicable diseases (NCDs) in India call for a comprehensive public health response which can effectively combat and control them before they peak and inflict severe damage in terms of unaffordable health, economic, and social costs. To synthesize and present recent evidences regarding the effectiveness of several types of public health interventions to reduce NCD burden. Interventions influencing behavioral risk factors (like unhealthy diet, physical inactivity, tobacco and alcohol consumption) through policy, public education, or a combination of both have been demonstrated to be effective in reducing the NCD risk in populations as well as in individuals. Policy interventions are also effective in reducing the levels of several major biological risk factors linked to NCDs (high blood pressure; overweight and obesity; diabetes and abnormal blood cholesterol). Secondary prevention along the lines of combination pills and ensuring evidenced based clinical care are also critical. Though the evidence for health promotion and primary prevention are weaker, policy interventions and secondary prevention when combined with these are likely to have a greater impact on reducing national NCD burden. A comprehensive and integrated response to NCDs control and prevention needs a “life course approach.” Proven cost-effective interventions need to be integrated in a NCD prevention and control policy framework and implemented through coordinated mechanisms of regulation, environment modification, education, and health care responses.

Self-Reported Disability in Adults with Severe Obesity

Self-reported disability in performing daily life activities was assessed in adults with severe obesity (BMI ≥ 35 kg/m2) using the Health Assessment Questionnaire (HAQ). 262 participants were recruited into three BMI groups: Group I: 35–39.99 kg/m2; Group II: 40–44.99 kg/m2; Group III: ≥45.0 kg/m2. Progressively increasing HAQ scores were documented with higher BMI; Group I HAQ score: 0.125 (median) (range: 0–1.75); Group II HAQ score: 0.375 (0–2.5); Group III HAQ score: 0.75 (0–2.65) (Group III versus II P < 0.001; Group III versus I P < 0.001; Group II versus I P = 0.004). HAQ score strongly correlated with BMI and age. Nearly three-fourths of the study participants reported some degree of disability (HAQ score > 0). The prevalence of this degree of disability increased with increasing BMI and age. It also correlated to type 2 diabetes, metabolic syndrome, and clinical depression, but not to gender. Our data suggest that severe obesity is associated with self-reported disability in performing common daily life activities, with increasing degree of disability as BMI increases over 35 kg/m2. Functional assessment is crucial in obesity management, and establishing the disability profiles of obese patients is integral to both meet the specific healthcare needs of individuals and develop evidence-based public health programs, interventions, and priorities.

Preprofessional Curriculum: Is it Time for Another Look?

<h3>Background</h3> The child mental health epidemiology literature focuses almost exclusively on reporting the prevalence and predictors of child mental disorders. However, there is growing recognition of positive mental health or mental health competence as an independent outcome that cannot be inferred from the absence of problems, and requires epidemiological investigation in its own right. <h3>Methods</h3> We developed a novel measure of child mental health competence within the framework of the Australian Early Development Index, a three-yearly national census of early child development. Predictors of this outcome were investigated by linking these census data at individual level to detailed background information collected by a large longitudinal cohort study. <h3>Results</h3> Predictors of competence were consistent with previously described theoretical and empirical models. Overall, boys were significantly less likely than girls to demonstrate a high level of competence (OR 0.60, 95% CI 0.39 to 0.91). Other strong predictors of competence were parent education and a relative absence of maternal psychological distress; these factors also appeared to attenuate the negative effect of family hardship on child competence. <h3>Conclusions</h3> This measure of mental health competence shows promise as a population-level indicator with the potential benefit of informing and evaluating evidence-based public health intervention strategies that promote positive mental health.

Water-Pipe Smoking Among North American Youths

The objectives of this analysis were to identify the sociodemographic characteristics of water-pipe users in a North American context and to describe concurrent psychoactive substance use. Data on sociodemographic characteristics, water-pipe smoking, and use of other psychoactive substances were collected in 2007 through mailed self-report questionnaires completed by 871 young adults, 18 to 24 years of age, who were participating in the Nicotine Dependence in Teens Study, a longitudinal investigation of the natural history of nicotine dependence among adolescents in Montreal, Canada. Independent sociodemographic correlates of water-pipe use were identified in multivariate logistic regression analyses. Previous-year water-pipe use was reported by 23% of participants. Younger age, male gender, speaking English, not living with parents, and higher household income independently increased the odds of water-pipe use. Water-pipe use was markedly higher among participants who had smoked cigarettes, had used other tobacco products, had drunk alcohol, had engaged in binge drinking, had smoked marijuana, or had used other illicit drugs in the previous year. Water-pipe users may represent an advantaged group of young people with the leisure time, resources, and opportunity to use water-pipes. Evidence-based public health and policy interventions are required to equip the public to make informed decisions about water-pipe use.

Public health in the emergency department: overcoming barriers to implementation and dissemination.

This article is the outcome of a consensus building workshop entitled, "Overcoming Barriers to Implementation and Dissemination" convened at the 2009 Academic Emergency Medicine Consensus Conference, ''Public Health in the ED: Surveillance, Screening, and Intervention." The participants were asked to address potential methods for overcoming barriers to the dissemination and implementation in the emergency department (ED) of evidenced-based practices to improve public health. The panel discussed three broad areas of interest including methods for disseminating evidence-based practices, barriers encountered during the process of implementation, and the importance of involvement in activities outside the ED including engagement in policy development and improvement. Four recommendations were discussed in detail and consensus was reached. The recommendations included 1) researchers and advocates should disseminate findings through multiple forums beyond peer-reviewed publications when an ED-based public health intervention has enough evidence to support integration into the routine practice of emergency care; 2) local barriers to implementation of public health interventions should be recognized and well understood from multiple perspectives prior to implementation; 3) innovation must be put into place and adapted based on local institutional context and culture as barriers and the best methods for overcoming them will vary across institutions; and 4) use of legislation, regulation, and incentives outside of the ED should support and strengthen ED-based interventions. For each area of interest, research dimensions to extend the current understanding of methods for effectively and efficiently implementing evidence-based public health interventions in the ED were discussed and consensus was achieved.

Public health development in the Baltic countries (1992-2005): from problems to policy

The focus of the article is on organizational reform measures in public health in Estonia, Latvia and Lithuania from 1992 to 2005 and the associated changes in population health. The study draws on published reports and analyses official statistics over time and cross-nationally. Changes in population health are measured by indicators of population health status and indicators of primary prevention or avoidable mortality, which reflect performance of national health policy. Our study shows some similarities and some important differences in terms of public health development in the Baltic countries since beginning of the 1990s. This study highlights the importance of political stability and support in achieving public health improvements and the pervasive influence of socio-demographic factors on several key health indicators in Baltic countries. It points to the need to introduce evidence-based public health interventions, enhance social trust, address corruption and tackle poverty.

Parental Literacy and Infant Health: An Evidence-Based Healthy Start Intervention

Syracuse Healthy Start, a federally funded infant mortality prevention project in Onondaga County, New York, has undertaken a range of interventions to address parental low literacy as a risk factor for infant mortality. A growing number of studies advocate for health-related information that is easy to read, of a low literacy level, and culturally appropriate. Creation of an evidence-based public health intervention involves analyzing local data, reviewing published studies, assessing available materials, initiating programmatic interventions, and evaluating the outcomes. Preparing health educational materials that are clear, culturally sensitive, and at appropriate reading levels follows Paulo Freire's lead in empowering the disadvantaged to positively affect their health and the health of their infants toward the reduction of infant mortality.

HIV/AIDS in the transitional countries of eastern Europe and central Asia

In the 1990s, HIV/AIDS became a major threat to health, economic stability and human development in countries in eastern Europe and central Asia. Social, political and economic transition exacerbated the structural conditions that allowed HIV/AIDS to flourish as dramatic changes led to increasing drug injection, economic decline and failing health and healthcare systems. There is a need to address the professional and ideological opposition - even in countries considered to be fully functioning democracies - to evidence-based public health interventions like harm reduction, coupled with treating HIV/AIDS for all those in need, if countries are to provide a more effective response.

From research to action: a bridge to be crossed

John Snow’s removal of the handle of the water pump on Broad Street, London, in order to contain an epidemic of cholera in 1854 (1) was not only a classic in epidemiological method but also the application of an evidence-based public health intervention. Nevertheless, 150 years later, in much of the develop-ing world the bridge between research and action still remains to be crossed. Research is necessary, good research is essential, but to translate knowledge generated by research into evidence-based actions is critical.The papers in this issue of the Bulletin by Viroj Tangcharoensathien et al. (pp. 750–756) and Pisake Lum-biganon et al. (pp. 746–749) are clear demonstrations of the potential for good research and the use of its results for shaping national policies on public health. The former is a good example of the research that influenced reform of the health system in Thailand, and the latter demonstrates how a new public health intervention can quickly be applied in practice.Thailand has increasingly recognized the value of research in tandem with its economic transition to a middle-income country. The results are formidable. For example, the Health Systems Research Institute published nine papers in 1995 and 93 in 2000, and Prince of Songkla University had 75 papers published in 1997 and 133 in 2001. Similarly, the number of Thai scientific journals increased from 88 to 133 between 1990 and 2000 — powerful evidence of the dynamic health research system in the country. This is not least due to a number of far-sighted individuals who influenced Thailand’s development and health poli-cies during the past decades. The strong health research system resulted in the establishment of a solid institutional base for health systems research and provides the practical modalities for putting good public health research to use.The movement for health reform generated the need for new knowledge. Prawase Wasi was a central figure in this movement: his triangular model highlights the essential interaction be-tween knowledge generation, political engagement and societal involvement, which is a prerequisite for bridging the “know–do” gap (2). Tangcharoensathien et al. illustrate the specific result of this interaction, and Phoolcharoen has documented the broader systematic ap-proach to the research that underpinned the health reform design (3). The fact that the systems research was planned and executed in close collaboration with the institutions that would use the study results, notably the Ministry of Public Health, was important for its applica-tion. Wasi stated correctly that “research is fun”; he also emphasized that “research should lead to development, and devel-opment lead to more research relevant to development needs”. The lessons learnt from the reform of health financ-ing have recently been published (4), stimulating new studies.From simple things like improving clinic supervision (5) to a new model for the use of epidemiology (6), transla-tional research is essential. But to close the gap between knowing and doing in developing countries remains a major challenge. For example, large injections of significant resources through The Vaccine Fund have resulted in a nar-rowing of the gap in access to vaccines, that is, the time that elapses between the introduction of new vaccines in de-veloped countries and their use in the developing world. Additional financial resources are clearly one of the answers.There are numerous other obstacles that impede the implementation of evi-dence-based practices in poor developing countries. One attractive short-cut is to make use of large-scale systematic reviews (7) rather than rely on national health research systems. This was the basis (8) for the adaptation of the antenatal care intervention in Thailand presented by Lumbiganon et al.If future research processes can effectively blend science, polity and the aspirations of the community, the chasm between research and evidence-based interventions can be narrowed considerably. O