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

Synthesizing Evidence About Effective Public Health Policies Assessing quality of evidence Systematic reviews Example sources of public health policy reviews Identifying policy options November 26, 2018 Public Health Policy Institute

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 Start with things that have actually been done elsewhere November 26, 2018

Pubmed can help, but… Do basic search, then narrow by Review, Systematic Review, Meta-analysis

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

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

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

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

Start with an answerable question Are mass media (or school- or community-based) interventions effective in preventing smoking in young people? PICO(T) Chart Problem, population Intervention Comparison Outcome Types of studies Young people under 25 years of age a) Television b) Radio c) Newspapers d) Bill boards e) Posters f) Leaflets g) Booklets a) School-based interventions b) No intervention a) objective measures of smoking (saliva thiocyanate levels, alveolar CO) b) self-reported smoking behaviour c) Intermediate measures (intentions, attitude, knowledge, skills) d) Media reach a) RCT b) Controlled before and after studies c) Time series designs Source: Armstrong, R and E Waters, 2007 http://ph.cochrane.org/past-workshops-and-events

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 November 26, 2018

The first place to look: The Community Guide from CDC November 26, 2018

Across the border: Health Evidence November 26, 2018

Across the pond: Evidence for Policy and Practice November 26, 2018

Other sources: CDC programs November 26, 2018

Foundations, e.g., RWJF November 26, 2018

Advocacy Organizations, e.g., Health Living Research November 26, 2018

University Research Centers, e.g., UCLA November 26, 2018

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 November 26, 2018