Evidence-Based Public Health

Learning Objectives

• Steps in the evidence-based public health process
• Describing public health problems via morbidity & mortality
• Course of disease: incidence, prevalence, case-fatality
• Hypothesis generation from disease distribution
• Identifying contributory causes of disease
• Uses of qualitative data with quantitative data
• Grading evidence-based recommendations
• Identifying intervention options
• Role of evaluation in evidence-based public health

History and Issues of Smoking

• Tobacco introduced to Europe in the 1600s; mass production after 1880s
• Early 1900s: Cigarettes distributed free to soldiers; smoking popularized among men then women
• Mid-1900s: Smoking rates high among adults; health risks not immediately recognized
• Lung cancer rates increased in parallel with smoking prevalence

Evidence-Based Public Health Approach (PERIE)

1. Problem: Health problem definition
2. Etiology: Contributory causes
3. Recommendations: Effective interventions
4. Implementation: Execution of solutions
5. Evaluation: Effectiveness assessment

Describing Health Problems

• Burden of Disease: Disability and death (morbidity and mortality)
• Course of Disease: Incidence, prevalence, case-fatality
• Distribution of Disease: Who, where, when?

Generating Hypotheses

• Use of ecological associations (person, place)
• Historical examples: smoking in men vs women; state disparities

Investigating Causes

• Real vs Artifactual Changes: Consider diagnostic, definitional changes
• Age adjustment to analyze data accurately

Establishing Contributory Causes

• Three Criteria:
  1. Individual association
  2. Cause precedes effect
  3. Altering cause alters effect
• Types of Studies: Case-control, cohort studies, randomized trials
• Supportive Criteria: Strength, dose-response, consistency, biological plausibility

Recommendations for Public Health Interventions

• Grading System: Quality of evidence, magnitude of impact
• Examples: Anti-smoking legislation, media campaigns

Implementation Strategies

• When-Who-How Approach:
  • When: Primary, secondary, tertiary interventions
  • Who: Individuals, at-risk groups, populations
  • How: Information, motivation, obligation

Evaluation of Interventions

• RE-AIM Framework: Reach, Effectiveness, Adoption, Implementation, Maintenance
• Importance of continuous evaluation and adaptation

Discussion Case Studies

• HIV/AIDS: Examining additional factors using the BIG GEMS framework
• Aging Society: Addressing Medicare and care for the frail elderly
• Adolescent Smoking: Applying the P.E.R.I.E. framework to reduce smoking rates

Key Concepts

• Understanding risk factors and their roles in public health
• The role of epidemiology in public health decision-making

Important Terms

• Incidence, prevalence, morbidity, mortality, risk factors, case-control studies, cohort studies, ecological studies, contributory cause.