1. BEST ET AL., 2007 ISIS: Initiative on the Study and Implementation of Systems Systems Thinking in Tobacco Control

2. Examines synthesis of four key systems approaches applied to tobacco control Systems organizing Participatory, complex, and adaptive collaborative systems System dynamics Complex dynamic interactions among influencing factors System networks Collaborative relationships among stakeholders Systems knowledge Dissemination, evolution and maintenance of scientifically credible, evidence-based practices

4. Early population-level projects North Karelia Project 1972 – comprehensive, multi-level approach – strong effects Led to 1980’s projects in the US - Stanford 5-city Project, Minnesota Heart Health Program, Pawtucket Heart Health Program – all w modest effects Community Intervention Trial for Smoking Cessation (COMMIT) A community-based RCT – multi-channel effort - modest impact on light smokers quitting ASSIST – extended COMMITT strategy across states Multiple interventions, using a variety of channels to reach multiple populations – 3D cube illustration – modified (next slide) States that participated experienced greater decrease in smoking prevalence than states that did not.

6. Application of systems thinking A transdisciplinary approaches in both research and practice Transcending or integrating diverse organizational cultures and missions Accelerating transfer from discovery to development to delivery (Translation) Setting evidence-based priorities (on prevention rather than treatment) Creating a federation of systems (e.g., Defense Dept.) WHO’s Framework Convention for Tobacco Control Organized setting long-term goals

7. Systems Thinking Systems methods – specialized approaches to understanding complex systems Systems approaches – broader theories that use systems methods to address systems Systems thinking – Use of systems approaches to view the world - used to understand system behaviors and to identify systems principles such as: feedback loops, stocks and flows, open vs closed systems, decentralized versus hierarchical systems, self-organization, autopoiesis (self- production), nonlinear systems, complex adaptive systems (CAS), boundary conditions, scaling and power laws, silo effects, small-world phenomena, emergence, cellular automata, and fractal self-similarity. A worldview than balances part and whole, and focuses on complex interrelationships and patters from multiple perspectives

8. Chapter 3 is a fun read!

9. Chapter 4 – Systems Organizing An adaptive systems perspective for management across organizations Four major interrelated dimensions that are transformative Vision – From leading and managing to facilitating and empowering Structure – From organizing to self-organizing Action – From delegation to participation Learning – From discrete evaluation to continuous evaluation

11. Concept maps for organizing

13. Chapter 5 – Anticipating Change Explored use of system dynamic modeling to develop: A causal map of tobacco control variables Formal simulation models Simulations of tobacco use prevalence and consumption

14. A simple SDM with feedback loops

16. Following development of models like the preceding, develop “stock and flow” models then simulate data This relates to the “smoking as a social norm” portion of Fig 5.10. For example, every year, some fraction of the undecided population moves (“flows”) from the undecided “stock” to public support of tobacco use or public support of control of tobacco use.

17. Validating simulation of SDMs

18. Chapter 6 – Network Theories Example network map illustrating many of the network concepts discussed in this chapter, including centrality, cliques, and referral networks.

19. Contact networks: 2 states with strong and 2 with weak financial and political climates re tobacco control Indiana Mississippi Michigan Oklahoma

20. Chap 7: Managing the Knowledge Content

24. Four Ps of Knowledge Management and Translation Purpose – Agendas, relevance timelines and a business case People - Knowledge champions, brokers/managers, and architects Communities of practice Process – Building consensus and capacity Developing knowledge and networks Products Groupware, knowledge repositories, knowledge development tools and knowledge navigation/access tools Plus infrastructures of: Organization, technology, information and finances

28. Conclusion Simply stated, with more inputs, more stakeholders, and better evaluation and adaptation, the infrastructure of knowledge, networks, and analysis methods needed for the support of this adaptive environment will be the key to transforming the state of public health in the future. It is a philosophy that reflects the basic engine of change in life, whether it is in the form of biology, economic competition, democracy, or nature itself.