Public Health and Population-focused Interventions

1. Public Health and Population-focused Interventions M9205 November 21, 2000

2. The goal of public health • Preserve, promote and protect health of the public or community • Create conditions within which people can become or remain healthy • Individual assessment of health status (either singular individual or singular condition) not adequate M9205, Fall, 2000

3. Built on infrastructure • Data and information • Competent workforce • Systems and relationships • Resources, including space, budget, political capital M9205, Fall, 2000

4. Few health services research-style studies • Data systems are non-standardized and un-linked • Workforce is not identified • Relevant system components have not been defined • Resource monitoring limited to specific programs M9205, Fall, 2000

5. Current thinking includes • Improving Health in the Community: a Role for Performance Monitoring, IOM • Guide to Community Preventive Services, CDC • Healthy People 2010: Health Objectives for the Nation M9205, Fall, 2000

6. Performance Monitoring • Health improvement based on a broad definition of health and a model of how health is produced within the community • A CHIP should develop its own set of performance measures, linking entities to specific activities expected to lead to desired outcomes Durch et al, Eds. (1997) Improving Health in the Community: a Role for Performance Monitoring Washington, DC: National Academy Press M9205, Fall, 2000

7. Community Health Profile • Socio-demographic characteristics • Health Status • Health Risk Factors • Health Care Resource Consumption • Functional Status • Quality of Life M9205, Fall, 2000

8. Age/race/ethnicity distribution Number/proportion of those with access/ resources problem Number/proportion >25 with <HS education Ratio of HS grads to those entering 9th grade 3 years prior Median household income Proportion of children <15 living <poverty level Unemployment rate Number/proportion of single-parent families Number/proportion lacking health insurance Socio-demographic indicators M9205, Fall, 2000

9. Infant mortality rate by race/ethnicity Number of deaths (age-adjusted rate)for MV crashes, work injuries, suicide, homicide, lung & breast CA, CV disease, and all causes by age, race and gender as appropriate Reported incidence of AIDS, measles, TB, syphilis, by age, race, gender as appropriate Births to adolescents as proportion of live births Number/rate of confirmed child abuse/neglect cases Health Status indicators M9205, Fall, 2000

10. proportion of 2 yo with age-appropriate immunizations Proportion of adults >65 with pneumococcal vaccine; influenza vaccine in last year Proportion smokers, by age, race and gender Proportion 18 and older who are obese Number/type of U.S. EPA air quality standards not met Proportion of assessed rivers, lakes and estuaries that support beneficial uses (fishing, swimming) Health Risk Factors M9205, Fall, 2000

11. Health Care Resources • Per capita health care spending for Medicare beneficiaries M9205, Fall, 2000

12. Functional Status • Proportion of adults reporting that their general health is good toe excellent • Average number of days during the last 30 days for which adults report that their physical or mental health was not good M9205, Fall, 2000

13. Quality of Life • Proportion of adults satisfied with the health care system in the community • Proportion of persons satisfied with the quality of life in the community M9205, Fall, 2000

14. provide information needed for informed decision making on the most effective and cost-effective public health strategies, policies, and programs for their communities target: public health practitioners, community partners, policy makers companion to Guide to Clinical Preventive Services Guide to Community Preventive Services web.health.gov/communityguide M9205, Fall, 2000

15. Chapter logic M9205, Fall, 2000

16. M9205, Fall, 2000

17. the number of studies, the quality of study execution affecting the validity andaccuracy of findings Evidence on effectiveness: M9205, Fall, 2000

18. Quality of study execution: • description and selection of study populations • description of the intervention • measurement of outcomes follow-up or completionrates • presence or absence of important biases M9205, Fall, 2000

19. Execution, cont. • appropriateness of data analysis • ability to minimize the effect of confounding. • Two reviewers read articles on individual studies and abstract information on these and other factors from the article using a standardized abstraction form. M9205, Fall, 2000

20. the number of studies the quality of study execution (affecting the validity andaccuracy of findings) the suitability of a study design to provide convincing evidence oneffectiveness for the particular issue Evidence on effectiveness: M9205, Fall, 2000

21. strong, sufficient insufficient Evidence on effectiveness summarized as M9205, Fall, 2000

22. the existence and type of comparison groups how subjects are allocated to (experimental) or categorized(observational) into study groups time order of exposure to the intervention andmeasurement of the outcome number of measurements made over time. Study design factors M9205, Fall, 2000

23. Information on possible and documented harms of interventions will be summarized. Methods to summarize cost effectiveness information are under development. Other analyses: M9205, Fall, 2000

24. Working Table of Contents Changing Risk Behaviors Tobacco Alcohol Other Addictive Drugs Physical Activity Nutrition Sexual Behavior M9205, Fall, 2000

25. Chronic Disease Heart Diseases Cancer Stroke Lung Disease Diabetes Genetic and Biologic Counseling Infectious Diseases Vaccine Preventable Diseases Maternal, Infant, and Child Health Mental Impairment and Disability Reducing Specific Diseases, Injuries, and Impairments M9205, Fall, 2000

26. Contents, cont. Occupational Health Oral Health Other Physical Impairment and Disability Unintentional Injuries - Motor Vehicle Occupant Injury Prevention Violent and Abusive Behavior M9205, Fall, 2000

27. Environmental and Ecosystem Challenges • Biologic Environment • Physical Environment • Sociocultural Environment M9205, Fall, 2000

28. Healthy People in Healthy Communities Increase Quality and Years of Healthy Life Eliminate Health Disparities Goals Healthy People 2010 M9205, Fall, 2000

29. Healthy People in Healthy Communities Increase Quality and Years of Healthy Life Eliminate Health Disparities Goals Life Expectancy Burden of Illness Quality of Life Health Status Individual and Environmental Interactions Behaviors Social Environment Physical Environment Individual Biology Community Interventions Health Promotion Health Protection Disease Prevention Care and Treatment Determinants of Health Health Intersectoral Policy M9205, Fall, 2000

30. Postexposure Prophylaxis after Nonoccupational HIV Exposure M9205, Fall, 2000

31. Public service announcement perceptions • Goal: identify if and how demographic/background variables affect perceptions of antiviolence PSAs. • Method: Survey of 1480 adolescents in midwestern public schools • Constructed reels of PSAs and questionnaire M9205, Fall, 2000

32. PSA perceptions, cont. • Issues: • representativeness of sample • pretest population (California, below average ability • question on comprehension “The person or narrator in this video was understandable” • Maximum predictive value 10% M9205, Fall, 2000

33. Cellular Phones • Case-crossover analysis • each person is own control • matched time of collision with similar preceding time • Cases • drivers who had been in a collision • reported owning a cell phone • phone bill locatable M9205, Fall, 2000

34. Wagner et al (KFF) • Evaluation of impact at a community level • Based on model of community change leading to individual change • Survey design • Each program measured against its own selected targets M9205, Fall, 2000