If we want more evidence-based practice, we need more practice-based evidence.*

 

If we want more evidence-based practice, we need more practice-based evidence.*

CHAPTER 6:
ADMINISTRATIVE AND POLICY ASSESSMENT: TURNING THE CORNER FROM PRECEDE TO PROCEED - Archived Headlines

Albany Chiefs Want To Spend More To Fight Tobacco Use. NY (NY Times, June 3, 1999, p. A21) Richard Perez-Pena. Legislative leaders in New York called for a major increase in funding for the state's tobacco control programs yesterday, and Governor George Pataki said he would be open to a substantial increase in tobacco control funding. Assembly Speaker Sheldon Silver (D) proposed a $90 million a year program, financed in part by a five-cent cigarette price increase, and 10 percent of the state's tobacco settlement money. Senator Joseph Bruno (R), the majority leader, said that he, too, wanted to see a major increase in the state's tobacco control programs and that a portion of the settlement should be used for "anything having to do with education on the pitfalls of smoking." The state currently spends $8.2 million a year, including Federal grants -- significantly less per capita than a number of other states.

Florida Anti-Smoking Program Forced To Cut Staff (Julie Hauserman, "Anti-Smoking Program Takes Hit," St. Petersburg Times, June 3, 1999, p. B1.) The Florida anti-smoking campaign was forced to eliminate 11 of its 31 staff positions and cut back hours for teens who worked part-time on the program. The 11 employees will be offered other jobs within the Department of Health. The budget for the program was recently cut by the Legislature from $70 million to $32 million. "It's troubling to see a tobacco prevention program that is more effective than any program in the country struggle for its life," said Ralph DeVitto, lobbyist for the American Cancer Society. State officials said the "Truth" ads would still be produced, but they will have less money to work with. The marketing staff was cut from four to two, and the marketing director was let go.

California Assembly Approves Stronger Cigar Warning Labels (Jennifer Kerr, "Assembly Passes Bill Requiring Cancer Warnings On Boxes," ASSOCIATED PRESS, June 2, 1999). The California State Assembly approved a bill requiring cigar manufacturers and importers to carry new warnings on retail cigar packaging beginning January 1, 2000. One of the three new warnings states: "Warning: Cigars contain many of the same carcinogens found in cigarettes and cigars are not a safe substitute for smoking cigarettes. Quitting smoking now greatly reduces serious risks to your health. This product contains chemicals known to the State of California to cause cancer." Opponents of the bill said it was not needed, because the state already requires warnings indicating that cigars contain carcinogens. The author of the bill, Assemblywoman Carole Migden (D), said, "What we are trying to do is discourage young people from smoking, but what we do (now) is vilify cigarettes and reward cigars." Failure to comply with the new label law would result in a civil fine not to exceed $2,500 a day. The bill will now go to the Senate.

Shock health warnings backfire - (London, BBC News, May 26, 1999). Health promotion campaigns which use shock tactics to discourage people from harmful behaviour actually have the opposite effect, researchers have said. The researchers identified three types of unwanted effect: Warning fatigue - This is when people become desensitised to health messages and pay no attention whatsoever; Risk factor phobia - Some people become increasingly fearful about the hazards posed by their lifestyle and diet, often over-reacting; Forbidden fruit effect - A deliberate defiance of authoritarian health warnings. For instance, warnings about the dangers of eating beef on the bone resulted in a rush for just such products before they were banned by the government... A SIRC spokesman said: "That is the danger of crying wolf. When there really is a wolf, you come up against warning fatigue: your audience has simply switched off." Risk factor phobics tend to be avid readers of health pages and health magazines, the researchers found... SIRC found that the third response, that of doing the exact opposite, was particularly common among rebellious teenagers. Researchers believe that this may be why warnings about the dangers of tobacco, drugs and alcohol often seem to have little effect... Dr Peter Marsh, director of science and research, said: "..."In some cases, we seem to be seeing science by press release with one maverick scientist releasing the results of his research prematurely. "People do not know who to believe or how to react, and there is a danger that when there is a real risk it will not be heard above all this noise."...
http://news.bbc.co.uk/hi/english/health/newsid_352000/352150.stm

WHO Launches Project to Support Africa's Elderly - Senegal. (Panafrican News Agency - May 26, 1999). - The team leader of WHO's program on "Ageing and Health" (AHE), Dr. Alexandre Kalache, said the project which begins in July will, among other things, involve the collection and analysis of relevant data from Ghana, Tanzania, South Africa and Nigeria.
http://www.africanews.org/PANA/science/19990526/feat1.html

Drkoop announces partnership with ACSH. (American Council on Science and Health, May 25 1999.)

Save the Kids, Fight Tobacco - Washington Post. Op-ed by US Surgeon General David Satcher. The single most promising public health intervention today is not the development of a new drug but the opportunity to invest part of the recent $246 billion settlement with the tobacco companies into public health and proven programs that would prevent our nation's children from smoking... Effective tobacco control programs require: (1) Public education... (2) Community-based programs... (3) Treatment for tobacco addiction... (4) School-based programs... (5) Enforcement, evaluation, surveillance... We have not had a case of Y-virus polio in the United States since 1979, and we are moving rapidly toward global eradication. If we work together and make a commitment to tobacco control, one day we will be able to say the same thing about smoking-related diseases.  Fight Tobacco

Scientific Panel Applauds New USDA Rules for Meat Irradiation, Scoffs at Fear Mongers. (American Council on Science and Health, February 12 1999.)

FEDERAL LAWSUIT MAY SEEK $0.2 TRILLION+ (White House Press Release, Jan 20,1999) -The Federal lawsuit against the tobacco industry announced by President Clinton in his State of the Union address this week may seek hundreds of billions of dollars to recover government costs of treating smoking-related illnesses, Administration officials said Wednesday. The leading tobacco companies just two months ago reached a settlement of another lawsuit, under which they will pay $206 billion to 46 states and submit to advertising and marketing restrictions. The President said Tuesday night that smoking had cost hundreds of billions of dollars to Medicare, veterans' programs, benefits to members of the armed services. and other Federal programs. "The potential liability is certainly in the hundreds of billions of dollars," an unidentified "senior administration official" told Reuters news service. A tobacco industry statement said it would "vigorously defend itself against this entirely political lawsuit," while the American Heart Association supported the impending action. A Justice Department task force has been formed to prepare the lawsuit, officials said. No deadline has been set for bringing the case. One "senior official" told Reuters the Justice Department had been reviewing the matter for months and had decided there were "viable grounds for recovery against the industry." The officials said the Federal government began considering a suit against tobacco companies after the Senate last June failed to pass a $516 billion anti-smoking bill. White House officials said Attorney General Janet Reno decided recently there was a legal basis to go forward, and that Clinton slipped it into his speech to provide a news nugget among a laundry list of policy proposals that had already leaked to the press. The administration officials said Clinton would again seek anti-smoking legislation this year to force the industry to take steps to reduce youth smoking. Clinton plans to propose in his budget request for fiscal 2000 a 55-cent-per-pack increase in the Federal cigarette tax to raise $8 billion over five years to offset the health care costs of smoking. More information on this matter is available on the World Wide Web at: http://nt.excite.com/news/r/990121/00/news-tobacco Numerous Web news sites may be found via this page of links: http://tigerx.com/sites/news.htm

Investment in health yields global returns - (Toronto Star, Feb. 4, 1999). - Ill health is one of the great cost burdens faced by societies around the world. Yet it is a cost that could be much reduced if more attention was paid to investing in health rather than focusing narrowly on health care... Medical doctors understand this. So it's not surprising that Gro Harlem Brundtland, a medical doctor with a graduate degree in public health, is emphasizing the determinants of health in her new job as director-general of the World Health Organization... Because of her concern about health, Brundtland is, for example, targeting tobacco as one of the principal sources of ill health in the world. May 31 is designated as World No-Tobacco Day this year. At the World Economic Forum, Brundtland gave shocking statistics on tobacco's contribution to ill health, and the cost implications this has for economies around the world... And by 2020, she said, ``the burden of disease due to tobacco is expected to outweigh that caused by any single disease. From its 1990 level of being responsible for 2.6 per cent of all disease burden worldwide, tobacco is expected to increase its share to close to 10 per cent.'' So if societies are worried by rising health care costs, targeting culprits such as tobacco makes more sense than eroding the health-care system through user fees or moving to a two-tier system. This means that [Canadian] Finance Minister Paul Martin could also be a health minister if he used his budget to significantly increase tobacco taxes, with an offsetting tax cut elsewhere... This epidemic is driven in part, Brundtland said, by ``industry which is massively focusing its marketing efforts on youth and women'' in developing countries. ``Nicotine is addictive. Habits start in youth. Eighty per cent of smokers start their dangerous habit before the age of 18,'' she stressed. ``We are talking about 12-, 13-, 14-year-old kids embarking on addiction. That is not freedom of choice.'' So at the World Economic Forum, Brundtland announced a new partnership with three major pharmaceutical companies - Glaxo Wellco, Novartis Consumer Health and Pharmacia & Upjohn - to reduce tobacco-related death and diseases among smokers in Europe, Russia and the Central Asian republics. The three pharmaceutical companies all produce treatment products to help people fight nicotine addiction...   For more information, visit http://www.thestar.com/editorial/money/990204BUS02_FI-CRANE4.html

Wine labels may tout health benefits. WASHINGTON (AP, Feb. 4, 1999) - Scientific studies have suggested it, and now winemakers finally may get a chance to tout it through their labeling: A glass or two of the grape each day could be good for you. The Treasury Department announced Friday two proposed changes for wine labels to include references to some of the positive health effects of drinking wine. Wine labels already warn that pregnant women should not drink alcohol and that alcohol can impair driving and cause health problems. But they say nothing about studies suggesting that moderate alcohol intake can reduce the risk of heart disease in some people. The change would not become final until after a public comment period that could last 90 days and a review by the Treasury Department.

 

Study says smoking ban works. SAN FRANCISCO (AP, Dec. 8, 1998) - Since California banned smoking in bars early this year, bartender Oscar Delcastillo has noticed a few things - he's less tired, his eyes don't bother him as much and he can breathe a lot easier. Researchers say the Los Angeles bartender is not alone. Scientists interviewed 53 San Francisco bartenders before the smoking ban took effect in January. At that time, about three-fourths of them reported symptoms of respiratory distress, things like wheezing, coughing and phlegm. Two to three months after the ban was imposed, 59% of the bartenders said their symptoms were gone, according to a study in Wednesday's issue of The Journal of the American Medical Association. See full story in JAMA, December 9, 1998.

Panel: Diversify medical workforce. WASHINGTON (AP, Dec. 9, 1998) - The nation's health system must recruit a more diverse workforce to face the complex health problems of an increasingly multiracial America, a commission concludes in a sweeping report released Wednesday. Blacks, Hispanics and other racial minorities are becoming a larger portion of the population, yet with the exception of Asian Americans, few become doctors and the number entering medical school has dropped over the last couple of years. Minorities are much more likely to work in inner cities and other underserved minority communities, making recruitment a crucial issue, argues the fourth and final report from the Pew Health Professions Commission, which has been working for a decade.

Wider use of methadone urged. WASHINGTON (AP, Dec. 9, 1998) - The administration's push to expand the use of methadone treatment is getting a boost from a panel of scientists who say the synthetic narcotic helps decrease drug use and criminal activity among heroin addicts. The 12 scientists convened by the National Institutes of Health acknowledge that methadone is not a panacea for substance abuse. But in a report published Wednesday in the Journal of the American Medical Association, the panel finds that heroin addiction is a treatable disease and urges the government to expand the availability of methadone programs. JAMA, Dec. 9, 1998.

MAJOR NEW TOBACCO RESEARCH FUNDS (US DHHS press release, Dec. 4, 1998). Vice President Gore has announced major new tobacco research funding initiatives that, in the words of an NCI statement, "will alter the way tobacco control research has been traditionally conducted." This infusion, combined with new research funds from the tobacco settlement, could set the stage for major advances. The funding efforts are based on recommendations from the National Cancer Institute's (NCI) Tobacco Research Implementation Group (TRIG), which recommended "nine unique, overarching research opportunities" that need "immediate implementation." NCI is working to implement the recommendations quickly. "As the first step in following the plan, we are launching two major research initiatives that will be funded at $142 million over five years," says NCI Director Richard Klausner. These are...
TRANSDISCIPLINARY TOBACCO RESEARCH CENTERS PROGRAM. The program is co-funded by NCI ($50 million) and the National Institute on Drug Abuse (NIDA, $20 million). NIH states that "advances in molecular biology, genetics, and behavioral science now provide unparalleled opportunities to study the tobacco problem in ways that will integrate biological and psychosocial models of tobacco and addiction." The Research Centers program will address questions such as: "Why do children start smoking? How can people be helped to quit smoking? Are there genes that predispose people to tobacco addiction?"
    STATE AND COMMUNITY TOBACCO CONTROL INTERVENTION RESEARCH. Funded at $72 million by NCI, the program will evaluate state and community tobacco control interventions with an emphasis on mass media and policy interventions aimed at prevention and cessation.
    The other seven research opportunities identified by TRIG: * Basic biobehavioral research on the multidisciplinary factors that influence tobacco use initiation, progression, and cessation; * How best to tailor tobacco cessation interventions to specific subgroups; * The best dissemination mechanisms for proven prevention and treatment interventions;   * Impact of various tobacco control policies;  * Basic biological research on biomarkers of tobacco exposure and on tobacco-induced cellular events linked with stages of carcinogenesis;  * Genetic and environmental interactions in susceptibility to tobacco-related cancers; * Expanded surveillance systems to monitor behaviors and tobacco-related interventions.
==> TRIG Plan and general information:  http://rex.nci.nih.gov/massmedia/pressreleases/tobacco.htm.
==> Transdisciplinary Tobacco Use Research Centers information:
http://deainfo.nci.nih.gov/concepts/TobaccoCentersRFA.htm.
==> Research in State and Community Tobacco Control Interventions
information: http://deainfo.nci.nih.gov/concepts/TobaccoComRFA.htm


TOBACCO SETTLEMENT (US DHHS Press release, Dec. 4, 1998). The recent multi-state tobacco settlement, while falling short in important areas, includes provisions that could dramatically increase funding for tobacco related research and interventions. Most important is the National Public Education Fund.
    The Fund's purposes "will be to support (1) the study of and programs to reduce youth tobacco product usage and youth substance abuse in the states; and (2) the study of and educational programs to prevent diseases associated with the use of tobacco products in the states," according to the settlement. Among the Fund's multiple responsibilities:
* Commission studies, fund research, and publish reports on factors that influence youth smoking and substance abuse.  * Track and monitor youth smoking and substance abuse with a focus on the reasons for increased or failure to decrease tobacco and substance use rates. * Develop, disseminate, and test the effectiveness of counter advertising campaigns.  * Carry out a nationwide, sustained advertising and education program to counter youth tobacco use and educate consumers about the cause and prevention of diseases associated with tobacco use.
    The Fund will be established by the National Association of Attorneys General, and will be funded by annual $25 million contributions from the tobacco industry.
    Some questions remain: Will the money come through? Will it be allocated according to the needs of public health? Advocates encourage concerned individuals to get involved at the state level to ensure settlement funds are available and well spent. Even if funds are well spent, many — both in the advocacy community and in the general public; feel that the settlement is insufficient. A new Center for Tobacco Free Kids survey found that the majority of Americans "believe it is important for the new Congress to pass comprehensive legislation to implement additional tobacco control measures not included in the settlement."
    TAKE ACTION
==> Read the settlement legislation: http://www.naag.org/issues/tobacco/index.php?smod=399  
==> Contact your state's Attorney General to request that settlement funds be spent on tobacco and other public health programs:  http://www.naag.org.
==> Join the Campaign for Tobacco Free Kids national action network:  http://tobaccofreekids.org/campaign/.  

AGENCY FOR HEALTH CARE POLICY & RESEARCH
The banner headline on the Agency for Health Care Policy and Research's (AHCPR) website reads, "Attention Researchers: Grant Money Available!" The website continues, "AHCPRs Fiscal Year 1999 budget of $171.055 million will allow the Agency to double the amount it awarded last year for investigator-initiated grants and to pursue critical national priorities, including research on quality and outcomes."
    Currently, there are scant data on such issues as behavioral and social intervention cost, cost effectiveness, and patient satisfaction. Lack of data is a barrier to integrating interventions into the mainstream of health care. The time is ripe for initiating more collaborative projects between health and behavior researchers and health services researchers, and for using AHCPR grants to train more health and behavior researchers in health services research.
    AHCPR has particular interest in proposals that advance the following priorities: outcomes for the elderly and chronically ill; clinical preventive services; centers for education and research's therapeutics; improving the quality of children's health; pharmaceutical outcomes research; evidence-based practice; primary care research; shared decision-making; consumer decision-making; costs, quality, and outcomes; quality measurement and improvement. Proposals that place extra focus on vulnerable populations, and that promote partnerships with potential users of the findings will be favored.  ==> AHCPR website: http://www.ahcpr.gov

BEHAVIORAL RESEARCH IN DIABETES
The NIH's National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) currently receives a relatively small number of grant applications related to behavioral science in diabetes, according to Sanford Garfield, PhD, Senior Advisor for Biometry and Behavioral Research in NIDDK's Division of Diabetes Endocrinology and Metabolism.  Garfield emphasizes that "type 2 diabetes is a disease that requires behavioral intervention," and urges behavioral scientists and trainees to submit high quality applications.
    What sort of proposals does NIDDK want? Garfield describes NIDDK's diabetes/ behavior research priorities as "fairly broad," including psychosocial aspects of diabetes, the psychological implications of diabetes and their effects on control of diabetes or on physical outcomes, translational research, screening, diagnosis, and self-awareness of diabetes. He notes that NIDDK is working on an outline of priorities in preparation for a Fall 1999 conference on diabetes and behavior. The Health and Behavior Alliance has also  given Garfield a copy of its list of "extraordinary research opportunities" in diabetes, which it recently sent to the congressionally-mandated Diabetes Research Working Group.
==> For information about NIDDK and its grants and activities:
http://niddk.nih.ogv/.
==> To discuss a research idea: Sanford Garfield, Senior Advisor for Biometry and Behavioral Research, garfields@ep.niddk.nih.gov.
==> To view the Health and Behavior Alliance's letter to the Diabetes Research Working Group: http://www.cfah.org/alliance/letter5.htm