generalizable to other public health challenges. For example, the Centers for Disease Control and Prevention’s (CDC’s) Best Practices for Comprehensive Tobacco Control Programs (CDC, 1999a) describes nine programmatic areas (i.e., community programs, school programs, statewide programs, etc.) that have been shown to be effective in reducing tobacco use.2 In practice, these programs are typically delivered “comprehensively,” and it is difficult, if not impossible, to tease out the relative impact of specific program components within these comprehensive, real-life campaigns. For this reason, program evaluations of large-scale public health campaigns tend to assess the collective effort, rather than the impact of individual program components. Because of the difficulty in teasing out the effect of one component of a comprehensive program, evaluations have tended to focus on the overall program impact and on the relationship between financial investment in program activities and changes in health behaviors. Data on the impact of comprehensive programs is strong, both in terms of changes in health behavior, as well as in terms of health outcomes (CDC, 2000). Recent analysis has confirmed that the greater the investment in comprehensive programs, composed of evidence-based programs, the larger the public health benefit (Farrelly et al., 2003).

In addition to tobacco control, recent review articles have analyzed the evidence for the effectiveness of public health interventions for a variety of public health problems, including dietary behavior, underage drinking, and motor vehicle injuries, to name just a few. For example, a recent review by Bowen and Beresford (2002) concluded that although much has been learned about trying to change dietary practices clinically, it is particularly important to learn how to transform the successes obtained from interventions aimed at the individual to community and public health settings. Gielen and Sleet (2003) reviewed the injury prevention literature and concluded that a simplistic belief that imparting information would result in behavior change and injury risk reduction resulted in an over-reliance on engineering solutions alone as the basis for injury prevention programs. These authors reinforce the need for interdisciplinary approaches to injury prevention, using behavioral science theory, coupled with engineering solutions.

These observations from other public health problems (e.g., determining how to expand clinical success to communities, combining behavioral

2

For example, in 1999, the CDC’s Best Practices for Comprehensive Tobacco Control Programs was developed to guide state health departments in planning and allocating funds from the Master Settlement Agreement. The Best Practices document does not explicitly recommend policy or regulatory actions, such as an increase in the excise tax on tobacco products, or clean indoor air laws, because they did not require budget expenditures.



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