# Presentation: 616901

## Identifying Evidence-Based Resources in Public Health

- Sharon Telleen, Ph.D.
- Hatheway Simpson, MPH
- Skills Building Session
- March 5, 2006
- Association of Maternal and Child Health Programs Annual Conference

**Notes:**
This skills building session, Identifying Evidence-Based Resources in Public Health, was presented at the 2006 Association of Maternal and Child Health Programs (AMCHP) Annual Conference on March 5, 2006.

## Identifying Evidence-Based Practices in Public Health

- Sharon Telleen, Ph.D., Research Associate Professor, University of Illinois at Chicago. Email: _[telleen@uic.edu](mailto:telleen@uic.edu)_
- Hatheway Simpson, MPH, Public Health Project Coordinator, University of Massachusetts Medical School Library. Email: _[Hathy.Simpson@umassmed.edu](mailto:Hathy.Simpson@umassmed.edu)_

## Evidence-Based Practice for Public Health Projecthttp://library.umassmed.edu/ebpph 

**Partners in Information Access for the Public Health Workforce Project**_[http://PHPartners.org](http://phpartners.org/)__ _** **

## Evidence-Based Practice for Public Health Projecthttp://library.umassmed.edu/ebpph 

- Dr. Elaine Martin, Principal Investigator
- Lamar Soutter Library
- University of Massachusetts Medical School
- Funded by the Centers for Disease Control and Prevention and the Association of Teachers of Preventive Medicine
- 2002 - 2005

## National Library of MedicineRegional Medical Library

- National Network of Libraries of Medicine, New England Region
- _[http://nnlm.gov/ner](http://nnlm.gov/ner)__ _
- 222 Maple Avenue, Shrewsbury, MA 01545
- University of Massachusetts Medical School _[http://library.umassmed.edu](http://library.umassmed.edu/)__ __55 Lake Avenue, Worcester, MA 01655_

## Objectives

- Overview of evidence-based public health resources
- Identify portals of access
- Develop a search pathway

## “the conscientious, explicit, and judicious use of current best evidence in making decisions about
the care of communities and populations in the domain of health protection, disease prevention, health maintenance and improvement.”

Source:
Jenicek M. Epidemiology, evidenced-based medicine, and evidence-based public health. J Epidemiol. Dec 1997;7(4):187-197.

- the care of communities and populations in the domain of health protection, disease prevention, health maintenance and improvement.”
- Source:
- Jenicek M. Epidemiology, evidenced-based medicine, and evidence-based public health. J Epidemiol. Dec 1997;7(4):187-197.

- Evidence-Based

- +

- Public Health

**Notes:**
What is EBPH? It can be broken down into two parts.
Evidence-Based Practice - The conscientious, explicit, and judicious use of the current best evidence in making decisions for practice – based on David Sackett’s definition of EBM.
Public Health – The health and care of communities and populations. Public health practice involves preventing diseases and promoting and protecting the health of populations, improving the wellbeing of communities.

This definition is from Milos Jenicek, adapted from David Sackett’s def of EBM.

## Public Health: Health of Populations

- Clinical Medicine: Health of Individuals

**Notes:**
	Public health practice focuses on the health of communities and the individuals that comprise a population. 
	The population can be defined by such things as age, gender, geographical area, ethnic background, occupation, health behavior...
	The health of a population is determined by multiple social, behavioral, and environmental factors.
	Clinical medicine focuses on the health of individuals and the diagnosis and treatment of disease.
	Individuals are part of a population > medical care is part of public health care.
	An important part of public health practice is trying to make sure that every individual in a population has access to basic medical care.

## The Public Health Workforce

- Epidemiologists
- Statisticians
- Environmental Engineers
- Animal Control Officers
- Sanitarians
- Food Scientists
- Industrial Hygienists
- Health Care Administrators
- Health Economists
- Politicians

- Social Workers
- Mental Health Workers
- Substance Abuse Counselors
- Doctors
- Nurses
- Teachers
- Disaster Relief Workers
- Nutritionists
- Lab Technicians
- Librarians

**Notes:**
	The field of public health is very broad and there are multiple disciplines within the field of public health.
	Public health practice includes: 
investigating new disease outbreaks 
making sure the water we drink is safe – local health and environment officials
designing programs to reduce childhood obesity – health educators, school teachers
ensuring that children get immunized – health clinicians, doctors, nurses
Reducing healthcare costs – health economists
Deciding how to spend of govt health programs, medicare/ Medicaid - politicians

- General Public Health
- Epidemiology
- Biostatistics
- Vital Statistics & Surveillance
- Environmental Health
- Occupational Health
- Health Services Administration
- Social & Behavioral Sciences
- Health Promotion & Education
- Community Health
- Maternal & Child Health

- Public Health Nursing
- Disaster Control & Emergency Services
- Communicable Diseases
- HIV/AIDS
- Nutrition
- Chronic Diseases
- Public Health Laboratory Sciences
- Public Health Informatics
- Global Health

**Identified Knowledge Domains**
**Public Health**

**Notes:**
	A major challenge of EBPH is the great breadth of the public health discipline. The Evidence-Based Practice for Public Health Project outlined and defined the field of public health by determining knowledge domains (areas) within the field of public health.
	We examined sources that represented prominent public health associations, government health agencies, national health objectives, essential public health services, public health occupations, public health literature, and library indexes for ph.
	These public health resources included:
Accreditation Criteria from Council on education for public health
American Public Health Association: Sections & interest groups 
Government health agencies
Healthy People 2010 national health objectives (focus areas)
PH occupational categories
Public health literature: collection categories from the American Journal of Public Health & public health reference books.
NLM  MeSH and Library of Congress catalog public health subject headings

	We identified 20 Knowledge Domains of Public Health and 155 subdomains of public health that represent multiple subjects of knowledge within the broad field of public health.
	These knowledge domains have been used to identify and classify public health journal literature, databases, websites, and other information resources on specific public health topics.

## Why EBPH?

- Need credible filtered information to make informed decisions.
- Research evidence is valued.
- So much information, too little time!

**Notes:**
	During the last decade there has been an increasing push for clinicians to use the best evidence when making medical decisions, there has been more recent emphasis for PH practitioners to use the best evidence when developing PH interventions. The 2005 APHA annual meeting’s theme was “Evidence-based Policy and Procedure”.
	There is a trend in PH to say we want to implement this program because it is evidence-based. Decisions need to be backed up by sound scientific evidence.
	We interviewed 19 PH professionals at the Mass Dept of PH to find out more about their information accessing needs.
	Issues that we found included:
Information overload and time constraints; there is an increasing amount of relevant research in PH  and related disciplines; easy to become overwhelmed; vast amount of information and scientific literature.
 A big challenge for them is trying to cope with the vast amount of information out there from emails, listservs, news sources, colleagues, published lit, conferences, govt. agencies and the Internet.
Challenge to sift through a lot of irrelevant information to find credible, quality information do to time constraints.	
	 Using an evidence-based approach helps to manage the amount of literature to review and to use one’s time efficiently. 
	PH problems can be addressed more easily if credible info. a/b effective practices is readily available and easy to access.

## Evidence for Public Health Practice and Policy Decisions

- “I make a lot of decisions about how money is going to be spent, and I would like to always be able to back it up and say that this is proven, or evidence-based.”

- Politicians need evidence to make decisions about public health programs.

**Notes:**
PH – limited resources
Money and staff must be used in the most efficient way, don’t want to spend money on things that don’t work.
It has become increasingly important to back up decisions for PH practice with evidence based on scientific findings. Evidence is needed to justify proposed PH programs. 
Need to spend money on projects that have been proven to work; some kind of proof that the money that they spend on a particular PH intervention will be money well spent.
Need to choose PH programs that are effective and rule out or discontinue ones that are not.
Many projects a the state & local level are funded by grants.  Applicants for PH grants need to use evidence to justify their proposals.

Elected officials- make decisions for allocation of public funds.
Politicians w/ limited health backgrounds need to be provided with evidence to make informed decisions about public health programs.
Legislators & PH policy makers must be provided with quality information that is understandable & evidence-based so that they can make informed decisions on which programs should receive and continue to receive funding.

## CDC/ATPM Qualitative StudyInvestigation of Information Needs of Public Health Professionals

- Nancy La Pelle, PhD
- Roger L. Luckmann, MD, MPH
- E. Hatheway Simpson, MPH
- Elaine R. Martin, DA
- Identifying Strategies to Improve Access to Credible and Relevant Information for Public Health Professionals: A Qualitative Study
- 2006

## Findings from Study of Public Health Workforce Information Needs

- There are many relevant websites to search: need for one portal access.
- Bombarded with unfiltered, irrelevant information: need filtered searches.
- Too little information on legislation and policy change and newly identified health threats.

## Findings Continued

- Need information from areas beyond biomedical domains.
- Need access to systematic reviews and summary information.
- Need access to full-text journal articles, government reports (grey literature), and conference proceedings.
- Need for training in accessing evidence-based resources.

**Notes:**
Areas beyond biomedical domains (outside traditional public health domains):
Marketing, human resources management, organizational behavior, operations management.
Examples:
Return on investment for worksites implementing health programs
Programs that have been developed in worksites related to communicable or chronic disease prevention
Effective educational strategies to reach employees in worksites
Effective interventions to motivate, men, women, elders and other specific population groups to take care of their health
Effective quality improvement projects in healthcare organizations
Best practices related to communicable diseases in emergency rooms. 

## Evidence-Based Public Health

- Decisions for Public Health Practice
-  Interventions
-  Programs
-  Policies

- Social values,
- Politics,
- Economics
- $

- Expertise,
- Knowledge

- Best Evidence
- from
- Research

**Notes:**
Evidence-based public health involves integrating:
the best available evidence from systematic research findings
With:
professional expertise & knowledge

And also take into account:
Available resources: money & personnel, including skills 

Regulatory  requirements & political environment > Important to get the support of stakeholders: community leaders & the public (fluoride in water)

Social & cultural values >Culturally sensitive (especially when developing interventions for changing health behavior – changes in diet, sexual behavior)
Example: school interventions to change diet and physical activity behavior – children’s behavior are influenced by a broad social context of family and culture.

> When developing public health interventions, programs and policies.

The best available evidence is selected, appraised, and used to make informed decisions for public health practice.

## Evidence Pyramid

- Systematic Reviews & Meta-analyses

- Adapted from: The Medical Research Library of Brooklyn, _[http://servers.medlib.hscbklyn.edu/ebm/2100.htm](http://servers.medlib.hscbklyn.edu/ebm/2100.htm)_

**Notes:**
Evidence Pyramid based on concepts of EBM.
RCTs considered in clinical medicine to be the gold standard of evidence.
For public health research, often observational or quasi-experimental studies (no randomization of who is exposed) are more appropriate than RCTs. B/c public health interventions often very complex; (Sometimes group-randomized trials are used in PH). 
For example, unethical and impractical to randomly assign individuals to smoke cigarettes for thirty years and another group to not smoke and observe who develops lung cancer 

Cohort and case-control studies are observational studies: comparison groups not assigned by the investigator. Provide information on the association of exposure and the risk of disease. 

Cohorts studies: Researchers categorize people with have been exposed and not exposed; Observe the two groups over time and compare rates of disease in exposed and unexposed group. Does the consumption of fish reduce the risk of stroke? Nurses Health Study and  Framingham Heart Study.

Case-control studies: Researchers identify cases who have a particular health outcome/ disease, controls w/out the disease; compare rates of exposure in both groups. Did people who have lung cancer smoke cigarettes?

Case Series/ Case Reports: Descriptive Studies: no comparison groups: describe person, place & time.  Use this type of study to identify problems: clustering of unusual cases can be a sign of an epidemic; offer clues to the cause of a disease; This type of study also provides baseline data on which to evaluate PH interventions.

## Evidence Matrix

| Research Question | Qualitative Research | Survey | Case-control Studies | Cohort Studies | Quasi- Experimental Studies | Non Experimental Evaluations | RCTs | Systematic Reviews |
| --- | --- | --- | --- | --- | --- | --- | --- | --- |
| Effectiveness |  |  |  |  |  |  |  |  |
| Process of Service Delivery |  |  |  |  |  |  |  |  |
| Salience |  |  |  |  |  |  |  |  |
| Safety |  |  |  |  |  |  |  |  |
| Acceptability |  |  |  |  |  |  |  |  |
| Cost Effectiveness |  |  |  |  |  |  |  |  |
| Appropriateness |  |  |  |  |  |  |  |  |
| Satisfaction with the Service |  |  |  |  |  |  |  |  |

- Petticrew M, Roberts H. Journal of Epidemiology and Community Health, 2003

**Notes:**
Hierarchy of evidence – source of debate

For assessing effectiveness, Hierarchy of evidence is often appropriate.

Different types of research questions are best answered by different types of studies.

Match research questions to specific types of research studies

Real world risk factors – smoking – best answered by prospective cohort study

What can go wrong, unexpected adverse effects – qualitative studies, surveys, & expert opinion.

Above matrix  - refers of social interventions in children
Salience – does it matter?
Safety – will it do more harm than good?

## Sources of Public Health Evidence

- Journal literature
- Books
- Conference proceedings & abstracts
- Dissertations & theses
- Unpublished scientific papers
- Government reports
- Policy statements, laws & regulations

- Surveillance data
- Newsletters
- Teleconferences & webcasts
- Alert systems
- Listservs
- Internet sources
- Expert knowledge & opinion

**Notes:**
Evidence =  Broadly defined as Facts/data on which a conclusion can be based.

“evidence” – often comes from the peer-reviewed material –published in journals, books; conference proceedings
studies published in peer-review journals: gone through a scientific review process, enhances the quality of the information

Sometimes one needs to go beyond what gets published in a peer-review journal: grey literature: non-conventional sources of knowledge: dissertations & theses, unpublished papers, all types of government reports,  technical reports, conference proceedings, policy statements, and other sources of alternative material. 

Why may need to get evidence from non-peer reviewed  sources?
Evidence you need may not always be available in a peer-review journal:
 very current information: time lag: information can take several months before it a study is published; ph practitioners often need information quickly (trend towards faster publication of research studies).
Many researchers and practitioners fail to write up research because of time demands competing projects.
Professional meetings are a good source of information especially on new or controversial topics. (Unfortunately, it can be difficult for ph practitioners to attend professional meetings that require travel as travel funds are limited.)
Also problem of publication bias: more studies are published with positive results than negative results 
Expert opinion and listservs can be a very good source of information when asking, “what can go wrong with an intervention?”

## 
Define the public health problem.
Search and find the best evidence.
Critically appraise the evidence for validity and relevance.	
Apply the evidence to practice.
Evaluate the results.

- Define the public health problem.
- Search and find the best evidence.
- Critically appraise the evidence for validity and relevance.
- Apply the evidence to practice.
- Evaluate the results.

- Evidence-Based Public Health Process

- Adopted from:
- Source: Sackett DL, Rosenberg WM. The need for evidence-based medicine. *J R Soc Med. *Nov 1995;88(11):620-624.
- Sibbald WJ. Some opinions on the future of evidence-based medicine. *Crit Care Clin. *1998;14(3):549-558.

**Notes:**
Evidence-base practice: Provides a way to systematically approach a solution to an identified health problem. Evidence-based practice involves filtering and appraising  the information, making sure the information gets to people who need it.

Librarians are usually involved with the first 3 steps.
Steps 4 & 5 – done in collaboration with a public health practitioner.

1. Convert problem into focused questions
2. Search and select the best evidence to answer the questions.
3. Critically appraise the evidence for validity & relevance and usefulness: can the evidence be applied to the problem?
4. Apply the evidence to PH practice > 
	developing new programs and interventions
Determining the cost-benefits of health interventions
5. Evaluate the results. 
Did the intervention meet its objectives?
Evaluate the effectiveness of newly developed programs and existing programs
Programs should be continued because they have been shown to be effective, not because “we’ve always done it that way”.

## Define the public health problem

- Convert the information needs
- into focused questions

**Notes:**
Convert problem into focused answerable questions.

Develop an issue statement
Statement of PH problem/issue, its significance, potential solution & outcomes
Determine what is known
Problem background: causes, populations affected.
Possible interventions & their effectiveness.

Find data to define the significance of the problem – often need to find statistical information to define the problem.

Important to understand the problem, make sure all involved are on the same page.

## Forming a Searchable Public Health Question PICO

**P **- Population
**I **- Intervention
**C** - Comparison
**O** - Outcome

**Notes:**
Form a searchable public health question using the PICO framework; P-Population; I-Intervention; C-Comparison; O-Outcome

P - What are the characteristics of the population? 
How old is the population? Children? What ages?
Gender? Ethnicity? Geographic Location?
Setting – very important for public health – school setting, small business, correctional institution, day care center, nursing home

I –for public health, usually a program or policy to address the specific public health problem.
Examples include – mammography screening to reduce breast cancer; immunization programs to reduce influenza for seniors; health education to reduce teen pregnancy; laws and regulations to enhance food safety.

C – May or may not be comparison intervention – what may work better than something else - examples -  interventions to reduce smoking rates – health education programs vs. smoking bans. Cost of one intervention may be much more the cost of another – important to consider when comparing interventions.

O – Outcome – reduce cancer rates, decrease number of people who contract aids for dirty needles, reduce number of unwanted pregnancies, increase immunization of school age children.

## Sample Question

- You will be working with health teachers in a rural Southern high school.  They have heard girls talking about what sounds like STD symptoms and you the teachers want to start teaching safer sex education.  The principal espouses abstinence-only education.  You want to compile some evidence about the effectiveness of sex education curricula to bring to a discussion with the superintendent and the principal.

## Search and find the best evidence

Critically appraise the evidence 
for validity and relevance

- Critically appraise the evidence
- for validity and relevance

**Notes:**
Search and select the best evidence to answer the questions.

Critically appraise the evidence for validity & relevance and usefulness: 
Are the results valid?
Can the evidence be applied to the problem?
Do your search results answer the questions in step 1?

## Search Pathway

- Evidence-Based Guidelines
- Systematic Reviews
- Pre-formulated Searches
- Best and Model Practices
- Bibliographic Databases
- Public Health Journals
- Health Data and Statistics
- Legislation and Policy
- Government Reports

**Notes:**
First 6 resources available from the EBPH website; 7-9 are available from the PHPartners website.

## EBPPH Project Web Site: http://library.umassmed.edu/ebpph 

## Evidence-Based Resources for Public Health Practice

- Evidence-Based Guidelines
- Systematic Reviews
- Pre-formulated Searches
- Best & Model Practices
- Public Health Bibliographic Databases
- Public Health Journals

- Project Web Site: http://library.umassmed.edu/ebpph

**Notes:**
Evidence-based guidelines: (Practice Guidelines)

Great source of evidence for public health practice because a lot of the effort in searching the literature, finding, and evaluating the evidence has already been done.
Time saver

Ideally, should be based on a systematic review of the literature. 
Offer recommendations for practice
Often include summaries of the evidence
Often has grading system (strongly recommended) or insufficient evidence for recommendation
Often include cost-benefit evaluation – useful for putting the evidence into practice.
developed by authoritative organizations: government agencies, institutions, or by convening expert panels.

## Guide to Community Preventive Serviceshttp://www.thecommunityguide.org

**Guide to Community Preventive Services**_http://www.thecommunityguide.org_

**Notes:**
Example of Evidence-Based Guideline for public health practice.

Guide to Community Preventive Services: produced in collaboration with the CDC by the Task Force on Community Preventive Services. 
Modeled after the Guide to Clinical Preventive Services

Also available in book format.

Task force made up of a panel of public health experts looks at specific population-based health interventions; 

Presents strategies to promote healthy lifestyles & prevent disease.
Tool for PH program planning and grant writing.

Topics (left frame) – Some still under development.

Includes ratings of the quality of the evidence, systematic reviews of the literature, summaries, and recommendations plus economic costs & benefits.

Can use search took, but best way to use the guide is to click on appropriate topic.

## Slide 29

**Notes:**
Guide Provides: 
Overview of the findings 
Recommendations 
Effectiveness ratings – graded evidence

## Tobacco Use Prevention & Control

**Notes:**
Outcomes (green) & Interventions (blue headings)

Dots- ratings based on # of available studies, strength of study design & execution, and consistency of study results.
Strong evidence ••
Sufficient evidence •
Insufficient evidence ? - doesn’t mean the intervention does not work, it just means that additional studies with suitable study designs are needed to asses its effectiveness. – Means more research needs to be done – good to cite this for grant writing purposes.
Guide also identifies research issues for all the interventions.

Strong evidence > smoking bans and restrictions to reduce environmental tobacco smoke.
Sufficient evidence > provider reminder systems (i.e. stickers on patient’s charts to prompt healthcare providers to discuss & advise patients to quit smoking.)
Insufficient evidence > smoking cessation series (recurring messages to encourage people to quit smoking). 

## Guide to Community Preventive ServicesSummary of Findings: Tobacco Use Prevention and Control

- Guide to Community Preventive ServicesSummary of Findings: Tobacco Use Prevention and Control

**Notes:**
One page summary of recommendations – clicking on any of these provides more information of the evidence and recommendations.

Example – Strategies to reduce tobacco use by children & adolescents. 
(PICO)
Population: Adolescents & children at risk at taking of the habit of smoking.

Intervention: Increasing the unit price of tobacco products by raising the product excise tax through legislation at the state or national level. 

Outcome: Decrease in # adolescents who use tobacco. 
Evidence shows that increasing the price of tobacco does decrease use of tobacco products by adolescents and adults.
Another outcome of the intervention is increased revenue to states for use in prevention & control programs.

The median estimates from the reviewed studies suggest that a 10% increase in the price of tobacco products will result in a 3.7% decrease in the number of adolescents who use tobacco 

This is an example of an intervention applied at the legislative level.

## Link to Full-Text Article from the American Journal of Preventive Medicine

**Notes:**
Full text article in the American Journal of Preventive Medicine
Advantage of using Guide to Community Preventive Medicine – experts have compiled and evaluated the evidence and provided recommendations for practice –saves time to start here.

We found that there are some limitations to using the Community Guide:
Can take 2 years or more to develop each guideline, material could become outdated.
Not comprehensive in its coverage of public health topics
some topics that they have listed such as are still underdevelopment: alcohol, mental health, substance abuse and pregnancy prevention not yet developed.
How many PH practitioners use this resource? What effect does it have on public health practice? 

## National Guideline Clearinghouse http://www.guideline.gov 

**National Guideline Clearinghouse** http://www.guideline.gov

**Notes:**
The National Guideline ClearinghouseTM (NGC) is a comprehensive database of evidence-based practice guidelines – often with a more clinical focus, but many guidelines are applicable to public health practice.
NGC is an initiative of the Agency for Healthcare Research and Quality (AHRQ), U.S. Department of Health and Human Services. 

Sources of guidelines – US government agencies (CDC), international health agencies, professional societies (American Academy of Pediatrics), private organizations, and health care organizations or plans.

It provides:
Structured abstracts (summaries) about the guideline and its development 
Links to full-text guidelines, where available, and/or ordering information for print copies 

## Slide 34

## National Guideline Clearinghouse

**Notes:**
Immunization schedule

## Slide 36

**Notes:**
A Guideline Comparison utility that gives users the ability to generate side-by-side comparisons for any combination of two or more guidelines. 
Comparison of guidelines developed in different countries, providing insight into commonalities and differences in international health practices. 

## Evidence-Based Resources for Public Health Practice

- Evidence-Based Guidelines
- Systematic Reviews
- Pre-formulated Searches
- Best & Model Practices
- Public Health Bibliographic Databases
- Public Health Journals

- Project Web Site: http://library.umassmed.edu/ebpph

**Notes:**
Excellent type of resource for evidence-based practice.

Systematic Reviews: Different from a Narrative review of the literature. A Narrative review  usually discusses a health topics in broad terms – good way to learn about something, get an overview – but can be tendency toward bias if the author reviews a topic from one perspective. 

Systematic Reviews: review of the literature that uses specific methods and criteria to locate, appraise, and synthesize evidence from scientific studies,. Better source of evidence than a narrative review or a summary because ideally all relevant evidence is searched for and appraised. This minimizes bias.
Systematic Reviews contain conclusions that acknowledge strengths & weaknesses of the evidence – identifies gaps in the research.

Meta-analyses: special type of systematic reviews: 
systematic reviews that combine statistics from multiple research studies -  perform a quantitative analysis of the data from several studies. 

Advantage of using SRs: time saver – extensive search of the literature – already been done for you.

## Cochrane Health Promotion and Public Health http://www.vichealth.vic.gov.au/cochrane/activities/reviews.htm

**Cochrane Health Promotion and Public Health**** **http://www.vichealth.vic.gov.au/cochrane/activities/reviews.htm

**Notes:**
Cochrane Systematic Reviews from the Cochrane Collaboration – international volunteers, using Cochrane methodology.
Cochrane Systematic Reviews are considered to be the gold standard in the medical community for reviews of RCTs.
The Cochrane Health Promotion and Public Health Field, part of the Cochrane Collaboration
Promotes and identifies systematic reviews relevant to health promotion/public health

## Cochrane Library http://www3.interscience.wiley.com/cgi-bin/mrwhome/106568753/HOME?CRETRY=1&SRETRY=0 

**Cochrane Library **http://www3.interscience.wiley.com/cgi-bin/mrwhome/106568753/HOME?CRETRY=1&SRETRY=0

## Slide 40

**Notes:**
Structured Abstract  includes:
Background
Objectives 
Search Strategy
Selection Criteria (usually RCTs)
How they collected & analyzed the data
Main Results
Reviewers’ conclusion

This review looked at several interventions for preventing tobacco sales to minors – b/c other studies have found that minors have very little difficulty purchasing cigarettes.
Population: retailers who make illegal tobacco to minors

Interventions:
Enforcement of laws prohibiting the sale of tobacco to minors. 
Education – Providing retailers with a copy of laws, letters from community leaders, posting signs to stores

Outcome: changes in retailers compliance with legislation to not sell to minors.
Conclusion of review: 
Giving information to retailers about the law is was less effective than active enforcement of the law > having fines imposed.
few of the communities studied in this review achieved sustained levels of high compliance. 
Difficult to demonstrate whether smoking behavior by minors has changed – minors may go to other retailers, steal cigarettes from stores or their parents, ask someone else to make the purchase them, buy from Internet or be given them by their peers or parents.

Limitation of Cochrane reviews: subscription, full text reviews lengthy – 44 pages.

## Health-Evidence.ca http://health-evidence.ca

**Health-Evidence.ca** http://health-evidence.ca

**Notes:**
Project funded by the Canadian Institutes of Health Research 

Online registry of systematic reviews on the effectiveness of public health and health promotion interventions. 

This resource is very good because it is specifically targeted to  public health interventions – key-worded according to commonly-used public health and health promotion terms.

## heath-evidence.ca

**Notes:**
Browse by health topic

## health-evidence.ca search tool

**Notes:**
Or use Search tool
Public Health topic
Review type (not limited to systematic review)
Population characteristics (limit to preschool children)

## health-evidence.ca search tool 

- health-evidence.ca search tool

**Notes:**
Search continued
Intervention Location (day care center)
Intervention strategies

## Slide 45

**Notes:**
All reviews provide an abstract and sometimes a summary statement -outlines policy and practice implications associated with the evidence. 

All reviews are assessed and given a rating of strong, moderate, or weak.

This systematic review quantified the effects of out-of-home day-care for preschool children.
Population: Children < 5 yrs in the U.S. of low economic status.
Intervention: Provision of non-parental day care.
The  authors identified 8 studies, all conducted in the U.S. after examining 920 abstracts and 19 books.
Outcome: day-care has beneficial effects on children’s development, school success and adult life patterns including mother’s education and employment.
This review also points out weaknesses in the studies they reviewed including – high rates of attrition, inadequate lengths of follow-up to examine the long-term effects of daycare, and failure to blind the outcome assessor.
Need to register and then be approved by the site’s administer  to gain access to restricted and licensed content and have opportunity to rate resource – 1-10 scale. This particular review has so far been given a rating of 7 out 10 (based on 1 vote).

## Evidence-Based Resources for Public Health Practice

- Evidence-Based Guidelines
- Systematic Reviews
- Pre-formulated Searches
- Best & Model Practices
- Public Health Bibliographic Databases
- Public Health Journals

- Project Web Site: http://library.umassmed.edu/ebpph

## Healthy People 2010 Information Access Projecthttp://phpartners.org/hp  

**Healthy People 2010 Information Access Project**http://phpartners.org/hp

**Notes:**
Collaboration of staff from the National Library of Medicine & the Public Health Foundation.

Librarians and public health experts work together to design a PubMed search for a specific Healthy People 2010 national health objective.

Also links to relevant resources.

## Slide 48

## Slide 49

**Notes:**
I will discuss PubMed more and give you some tips for searching it.

## Slide 50

**Notes:**
Example of a single research study published in a peer-reviewed journal - the Am J PH – by researchers at the Univ of North Carolina Injury Prevention Research Center.

Factors that increase the use of protective sports equipment by students were small school size, low player/coach ratio, high proportion of team usage, and history of previous injury.

## Evidence-Based Resources for Public Health Practice

- Evidence-Based Guidelines
- Systematic Reviews
- Pre-formulated Searches
- Best & Model Practices
- Public Health Bibliographic Databases
- Public Health Journals

- Project Web Site: http://library.umassmed.edu/ebpph

## Model Practices Database http://archive.naccho.org/modelPractices  

**Model Practices Database** http://archive.naccho.org/modelPractices

**Notes:**
Collection of model & promising practices in used by local public health agencies – put together by NACCHO – 
National Association of County & City Health Officials

Goal of model practice program is to nationally honor and recognize outstanding local public health practice & promote sharing on these resources among local health departments.

Model practice – an imitative, program, resource, practice or tool that demonstrates exemplary and replicable qualities in response to a local public health need.

Promising practice – exhibits the potential to become a model practice.

Local health departments can submit their practices.

## Model and Promising Practices

## Example of Model Practice

**Notes:**
Outreach focus on children that live in inner city, predominantly minority communities; have limited access to health care; have high levels of poverty; and live in deteriorating multi-family housing. 

Intervention: Home visits to asthmatic children by nurse educator and housing inspector.

## Promising Practices Network on Children, Families and Communities http://www.promisingpractices.net/default.asp 

**Promising Practices Network on Children, Families and Communities** http://www.promisingpractices.net/default.asp

## Promising Practices Network on Children, Families and Communities

**Big Brothers Big Sisters of America**

**Notes:**
Big Brothers Big Sisters (BBBS) is a program that matches non-related adult mentors with children to promote positive development and social responsibility. 

Research by Tierney, Grossman, and Resch (1995) compared BBBS youths with non-participating youths. 
BBBS youths less likely to:
Initiate illegal drug use.
Initiate alcohol use
Hit someone

BBBS youths better grades, less likely to skip schools

## Evidence-Based Resources for Public Health Practice

- Evidence-Based Guidelines
- Systematic Reviews
- Pre-formulated Searches
- Best & Model Practices
- Public Health Bibliographic Databases
- Public Health Journals

- Project Web Site: http://library.umassmed.edu/ebpph

## Evidence-Based Practice for Public Health Project – Bibliographic Databases http://library.umassmed.edu/ebpph/dblist.cfm  

**Evidence-Based Practice for Public Health Project – Bibliographic Databases** http://library.umassmed.edu/ebpph/dblist.cfm

**Notes:**
We compiled an extensive list of bibliographic databases that provide access to citations to:
journal articles
books 
conference proceedings & abstracts
dissertations
government reports
association newsletters
trade magazine articles
research reports

 Some provide full-text documents. 

## Maternal and Child Health Library http://www.mchlibrary.info

**Notes:**
Maternal Child Health Library from Georgetown University is one of the free databases available from the project’s list of free PH databases.

It provides access to citations to published studies and reports, guidelines and manuals, curricula, policy documents, and survey instruments. 

It also provides links to websites and you can subscribe to a  weekly electronic newsletter, MCH alert.

## Slide 60

## PubMed (MEDLINE)

**PubMed (MEDLINE)**
- http://pubmed.gov

**Notes:**
The world’s premiere biomedical bibliographic database

Free online access to the Medline database 

Developed & maintained by the National Center for Biotechnology Information (NCBI) at the National Library of Medicine (NLM)
4,600 journals published worldwide are indexed
Some freely available full text documents

PubMed also contains information on
Health policy
Bioinformatics
Health administration
Standards and practice guidelines
Health-related technology
Patient education materials and consumer health information

Enter search terms – use search terms you developed when forming a searchable question using PICO –
population - teens 
outcome - prevention unwanted pregnancy 
in the search box and click go.

## Slide 62

**Notes:**
1197 results

Summary results of citation include authors, title of article, journal title, issue, and pages. The title of the journal is abbreviated.
Icon means that this citation has an abstract – clicking on the blue line you will see the abstract.
Sort by author, journal, or publication date.

## Details of PubMed Search

- Mapped to Medical Subject Heading (MeSH)
- teen pregnancy = pregnancy in adolescence

**Notes:**
Provides information on how PubMed ran the search.

PubMed matches terms you enter to MeSH, journal titles and authors names.

## Slide 64

## Slide 65

**Notes:**
This box has search terms to find information on school education programs for preventing injuries from the Healthy People 2010 Information Access Project pre-formulated search.

## Slide 66

## PubMed Limits

**Notes:**
Many ways to limit number of return – limit to words in title only; limit by language; publication dates

Limit by publication type – Meta-Analysis & Practice Guideline for EBPH.

## Slide 68

**Notes:**
There is a limit for meta-analysis studies.

To limit to systematic reviews: type “AND systematic[sb]” after search term.

## Slide 69

## Slide 70

## History of PubMed Search Session

**Notes:**
Use history page to combine searches. For example #1 AND #3.

## Slide 72

**Notes:**
Can save searches and receive email updates. 

## Slide 73

## Slide 74

**Notes:**
Use My NCBI to save search strategies; have automatic updates
Sent monthly, weekly, or daily.

For example, PubMed will automatically run your search every Monday and email you any new citations that match your search.

## Evidence-Based Resources for Public Health Practice

- Evidence-Based Guidelines
- Systematic Reviews
- Pre-formulated Searches
- Best & Model Practices
- Public Health Bibliographic Databases
- Public Health Journals

- Project Web Site: http://library.umassmed.edu/ebpph

## Evidence-Based Practice for Public Health– Public Health Journals 

**Evidence-Based Practice for Public Health– Public Health Journals**
- http://library.umassmed.edu/ebpph/journallist.cfm

## Slide 77

## Evidence-Based Practice for Public Health– Maternal & Child Health Journals http://library.umassmed.edu/ebpph/journalsKNaction.cfm

**Evidence-Based Practice for Public Health–** **Maternal & Child Health Journals** http://library.umassmed.edu/ebpph/journalsKNaction.cfm

## Evidence-Based Practice for Public Health– 

**Evidence-Based Practice for Public Health–**
**Free Public Health Journals** http://library.umassmed.edu/ebpph/freephjournals.cfm

## Evidence-Based Practice for Public Health Project Web Site: http://library.umassmed.edu/ebpph

**Evidence-Based Practice for Public Health** Project Web Site: http://library.umassmed.edu/ebpph

## EBPPH Project Web Site: http://library.umassmed.edu/ebpph 

## Continuing the Pathway:Evidence-Based Resources for Public Health Practice

- Health Data and Statistics
- Legislation and Policy
- Government Reports

- Public Heath Web Portal: http://PHPartners.org

## Public Health Web Portal: http://PHPartners.org    

**Notes:**
Moving onto to our 2nd website – PHPartners.org

## List of Partners

## Public Health Web Portal: http://PHPartners.org    

**Notes:**
Partners page organized by main topics on left.
Search tool
News
PHPartners.org listserv
Tutorial
Healthy People 2010 Information Access Project – available here as well as on the EBPPH webpage.

## PHPartners.org Suggest a Link

## PHPartners.org: Public Health Tutorial

## Training and Resources from the National Network of Libraries of Medicinehttp://nnlm.gov 

- Training and Resources from the National Network of Libraries of Medicinehttp://nnlm.gov

## Continuing the Pathway:Evidence-Based Resources for Public Health Practice

- Health Data and Statistics
- Legislation and Policy
- Government Reports

- Public Heath Web Portal: http://PHPartners.org

## Public Health Web Portal: http://PHPartners.org    

- Health Data & Statistics

## PHPartners.org: Health Data Tools & Statistics

## Slide 92

## Child Trends Data Bank http://www.childtrendsdatabank.org

**Child Trends Data Bank** http://www.childtrendsdatabank.org

## Slide 94

## National Survey of Children’s Health Data Resource Center http://nschdata.org 

**National Survey of Children’s Health Data Resource Center** http://nschdata.org

## Slide 96

## Slide 97

## Continuing the Pathway:Evidence-Based Resources for Public Health Practice

- Health Data and Statistics
- Legislation and Policy
- Government Reports

- Public Heath Web Portal: http://PHPartners.org

## Public Health Web Portal: http://PHPartners.org    

- Legislation and Policy

## Slide 100

## Maternal and Child Health Policy Research Center

**Maternal and Child Health Policy Research Center**
- _[http://](http://www.mchpolicy.org/)__[www.mchpolicy.org](http://www.mchpolicy.org/)_

## Maternal and Child Health Policy Research Center

## Maternal and Child Health Policy Research Center

- State Medicaid Coverage of Selected Services
- Important to Children in the Absence of the EPSDT Mandate, 2005** **

## http://www.amchp.org/legislative/index.php   

**AMCHP Legislative Center**
- http://www.amchp.org/legislative/index.php

## Continuing the Pathway:Evidence-Based Resources for Public Health Practice

- Health Data and Statistics
- Legislation and Policy
- Government Reports

- Public Heath Web Portal: http://PHPartners.org

## Public Health Web Portal: http://PHPartners.org    

- Government Reports

## PHPartners.org: Government and Other Reports

## Slide 108

## Slide 109

## PHPartners.org: Reports & Other Publications

- _PHPartners.org: Reports & Other Publications_

## Slide 111

**Notes:**
Example of Grey Literature – Government Report
Assuring Better Child Health and Development program, National Academy for State Health Policy
Surveyed Medicaid, maternal and child health, and children’s mental health agencies in all 50
States and the District of Columbia to gather information on how states are addressing the
Healthy mental development of children ages birth to three.

## Search Pathway

- Evidence-Based Guidelines
- Systematic Reviews
- Pre-formulated Searches
- Best and Model Practices
- Bibliographic Databases
- Public Health Journals
- Health Data and Statistics
- Legislation and Policy
- Government Reports

## Easy Access to Evidence-Based Public Health Resources

**Evidence-Based Practice for Public Health Project**_[http://library.umassmed.edu/ebpph](http://library.umassmed.edu/ebpph)_
**Partners in Information Access for the Public Health Workforce Project** **http://PHPartners.org **