CENTERS FOR DISEASE CONTROL AND PREVENTION
Volume 15 • Number 1 • Winter 2002

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Translating Science into Action Means Better Health for Everyone

For some scientists, research is a theoretical exercise designed mainly to further the body of knowledge on a particular topic. But for scientists at CDC, research is a means to a specific and practical end—to develop and implement national and international programs that improve public health. 

That’s why CDC’s research agenda for chronic disease prevention and health promotion focuses on applied research. Specifically, the agenda states that “research and practice are interdependent and cyclical; program needs help define research questions, and research findings are translated back into improved programs and policies.” 

“Our research seeks to learn what works in terms of community interventions and how to translate those findings into day-to-day practice,” said NCCDPHP Deputy Director Janet L. Collins, PhD. 

Applied research can be used for several purposes, including 

• Examining how various risk and protective factors affect health so interventions can be more effective (determinant research). 
• Identifying or developing promising programs and examining their effectiveness in reducing disease and promoting health (intervention research). 
• Examining strategies for promoting widespread adoption and maintenance of effective programs (dissemination research).

In addition, researchers are continually working to improve their methods through advances in measurement, research design, and analytic approaches. All of these types of applied research are practiced at CDC. 

One important example of determinant research is the Pregnancy Risk Assessment Monitoring System (PRAMS), developed in 1987 as part of a CDC initiative to reduce rates of infant mortality and low birth weight. This ongoing, population-based surveillance system monitors selected self-reported behaviors and experiences that occur before, during, and after pregnancy among women who deliver a live-born infant. 

PRAMS data are collected in 32 states and New York City and are used to generate statewide estimates of important perinatal health conditions among pregnant women. 

A key objective of PRAMS is to translate results from analyses into usable information for planning and evaluating public health programs and policy. To achieve this goal, CDC documents how participants use the data—to conduct needs assessments, obtain resources, guide policies, or develop or modify programs. Data have been used to get contraceptive coverage added to companies’ employee insurance plans and to convince state legislatures to appropriate funds for contraceptive coverage for the uninsured. 

 
Identifying, Promoting Programs That Work 
Once researchers have identified what factors affect health, the next step is to look for ways to modify or eliminate these factors through effective interventions. A recent example of intervention research is a study of a model dental sealant program promoted by the Ohio Department of Health. Dental sealants are plastic materials applied to the pits and fissures of the back teeth to prevent tooth decay. School-associated dental sealant programs can be effective in targeting vulnerable populations less likely to receive private dental care, such as children eligible for free or subsidized lunch programs. 

The Ohio study reported that for both white and African American children at every income level, those who attended elementary schools with sealant programs had met or exceeded the national Healthy People 2010 objective that 50% of children have dental sealants. 

Previous studies have reported that poor children and those of some ethnic and minority groups are significantly less likely to receive these protective materials. Although 23% of U.S. children surveyed during 1988–1994 had sealants, only 3% of low-income children had them, according to the Third National Health and Nutrition Examination Survey. Among children aged 5–17 years, Mexican American and African American children were one-third less likely than white children to have sealants.

In contrast, the Ohio study reported that 57.2% of students in schools with sealant programs had sealants, compared with 28.2% of students attending schools without such programs. Seventy percent of students who had sealants and were in schools with sealant programs had received their sealants at school. The study, conducted among 11,191 third-grade students during the 1998-99 school year, compared sealant prevalences in 335 schools in 87 of Ohio’s 88 counties. 

“Providing dental sealant programs in all high-risk schools could reduce or eliminate gaps in who receives these preventive tools,” said William R. Maas, DDS, MPH, director of CDC’s oral health program. “State and local health departments should consider this approach to effectively reach children at high risk for dental decay.” 

Although intervention research seeks to identify and develop effective programs, dissemination research takes the next logical step—examining strategies that promote widespread adoption and maintenance of such programs. An example of a project that could be considered dissemination research is the Guide to Community Preventive Services: Systematic Reviews and Evidence-Based Recommendations (Community Guide). 

The Community Guide reports multiple systematic reviews of current evidence on the effectiveness and cost-effectiveness of population-based interventions to promote health and prevent disease, injury, disability, premature death, and exposure to environmental hazards. Under the guidance of a nonfederal, independent panel of experts called the Task Force on Community Preventive Services, reviews have been translated into recommendations for or against specific interventions. Reviews are published as they are completed and are available at http://www.thecommunityguide.org.

CDC Recommends Programs Through the Community Guide 
CDC researchers have participated in Community Guide reviews on several topics, including physical activity, diabetes, tobacco, and oral health. Physical activity recommendations included conducting communitywide campaigns and point-of-decision prompts to encourage the use of stairs; supporting school-based physical education, social support interventions in community settings (e.g., buddy systems), and individually adapted health behavior change programs; and creating or enhancing people’s access to places for physical activity, combined with activities promoting these places (MMWR 2001;50[No. RR-18]). 

“We hope that public health practitioners in the field will see these recommendations as a menu of intervention strategies that have been proven to work and that they can use to promote physical activity in their community,” said Greg W. Heath, DHSc, MPH, a CDC health scientist in nutrition and physical activity. “They don’t have to use trial and error.” 

In the Community Guide chapter on diabetes, the Task Force reviewed seven interventions related to persons with diabetes, health-care systems, families, and public policies (MMWR 2001;5[No. RR-16]). The Task Force strongly recommended disease and case management in health care settings and recommended diabetes self-management education in community gathering places for adults and in the home for children and adolescents with type 1 diabetes. 

In the chapter on tobacco use, the Task Force recommended or strongly recommended 9 of the 14 strategies evaluated (MMWR 2000;49[No. RR-12]). Recommended strategies include (1) instituting smoking bans and restrictions to reduce people’s exposure to environmental tobacco smoke, (2) increasing the price of tobacco products, (3) conducting multicomponent mass media campaigns to reduce tobacco-use initiation, and (4) reducing patient out-of-pocket costs for effective cessation therapies. 

In the chapter on oral health, the Task Force strongly recommended community water fluoridation and school dental sealant programs to prevent and control tooth decay (MMWR 2001;50[No. RR-21]). “These two strategies are particularly useful for reaching entire communities, especially groups at high risk for decay, and they are essential to achieving the national objectives of Healthy People 2010,” said Dr. Maas. 

The Task Force did not make recommendations (either for or against) for all of the interventions examined because some did not have sufficient published evidence to determine their effectiveness. This lack of evidence indicates the need for further research, to which the Task Force hopes researchers will respond. 

“We don’t just put the recommendations out and sit and wait,” said Dr. Heath. “The Community Guide people brought us up to the mountain, and the summary publication is where they leave us. It’s up to us as a program to keep it going.” 

This commitment to move beyond the research is the cornerstone of CDC’s mission—to translate science into practice.

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