College of Public Health and Human Sciences

1. College of Public Health and Human Sciences Public Health Policy Institute Synthesizing Evidence about Effective Public Health Policies Presenter: Jeff Luck Date: August 21, 2012

2. Synthesizing Evidence About Effective Public Health Policies • Assessing quality of evidence • Systematic reviews • Example sources of public health policy reviews • Identifying policy options Public Health Policy Institute

3. What do we mean by “evidence?” • Aspects of study quality • Clearly articulated policy or intervention • Evaluation design—target population and comparison group(s) • Measures of cost and health impact (outcomes) • Reproducible in other communities • Sources of evidence • Case studies and Reports • Peer-reviewed publications • Reviews and syntheses • Individual studies are diverse and not always conclusive

4. Pubmed can help, but…

5. Published studies Reviews (narrative/literature/ traditional) Types of reviews Systematic reviews Meta-analysis Source: Armstrong, R and E Waters, 2007 http://ph.cochrane.org/past-workshops-and-events

6. Key elements of a systematic review Start with an answerable question Search comprehensively for evidence Abstract study results objectively Assess quality of studies Synthesize results Assess applicability and transferability of results Document all steps performed Source: Armstrong, R and E Waters, 2007 http://ph.cochrane.org/past-workshops-and-events

7. Example Systematic Review Topics School-based driver education for the prevention of traffic crashes Helmets for preventing head and facial injuries in bicyclists Source: Armstrong, R and E Waters, 2007 http://ph.cochrane.org/past-workshops-and-events

8. Results from systematic reviews Helmets reduce bicycle-related head and facial injuries for bicyclists of all ages involved in all types of crashes including those involving motor vehicles. The results provide no evidence that drive education reduces road crash involvement, and suggest that it may lead to a modest but potentially important increase in the proportion of teenagers involved in traffic crashes. Results from this review suggest that area-wide traffic calming in towns and cities may be a promising intervention for reducing the number of road traffic injuries and deaths. However, further rigorous evaluations of this intervention are needed. Source: Armstrong, R and E Waters, 2007 http://ph.cochrane.org/past-workshops-and-events

9. Start with an answerable question Are mass media (or school- or community-based) interventions effective in preventing smoking in young people? PICO(T) Chart Source: Armstrong, R and E Waters, 2007 http://ph.cochrane.org/past-workshops-and-events

10. Compendia of systematic reviews Reviews vary in scope and quality Precision of question Types of studies included Assessment of study quality How results are synthesized Applicability to local context Several organization therefore compile and assess reviews Can be browsed or searched by public health policy topic

11. The first place to look: The Community Guide from CDC

12. Across the border: Health Evidence

13. Across the pond: Evidence for Policy and Practice

14. Other sources: CDC programs

15. Foundations, e.g., RWJF

16. Advocacy Organizations, e.g., Health Living Research

17. University Research Centers, e.g., UCLA

18. Identifying evidence-based policy options • Multiple potential policy options are better than just one • Allows room for decisions by elected officials or senior leaders • Provides alternatives if initial option is not feasible or does not gain strong stakeholder support • May tap into different potential funding streams • Use reviews or individual studies that: • Clearly describe implementation steps and requirements as a basis for planning • Have a similar enough community context • Provide specifics about impacts of the policy