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Bridging the Evidence Gap in Obesity Prevention: A Framework to Inform Decision Making A Acronyms and Glossary ACRONYMS AIDS Acquired immunodeficiency syndrome ASSIST American Stop Smoking Intervention Study for Cancer Prevention BMI Body mass index CBO Congressional Budget Office CBPR Community-based participatory research CDC U.S. Centers for Disease Control and Prevention COCOMO Common Community Measures for Obesity Prevention COMMIT Community Intervention Trial for Smoking Cessation CONSORT Consolidated Standards of Reporting Trials EBM Evidence-based medicine EBPH Evidence-based public health EBPP Evidence-based public policy FCC Federal Communications Commission GHG Greenhouse gas GRADE Grading of Recommendations Assessment, Development, and Evaluation HEALCP Healthy Eating Active Living Convergence Partnership HHS U.S. Department of Health and Human Services HIV Human immunodeficiency virus
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Bridging the Evidence Gap in Obesity Prevention: A Framework to Inform Decision Making IOM Institute of Medicine IOTF International Obesity Task Force ISIS Initiative on the Study and Implementation of Systems ITS Interrupted time series L.E.A.D. Locate Evidence, Evaluate Evidence, Assemble Evidence, Inform Decisions MATCH Multilevel Approach to Community Health MIT Massachusetts Institute of Technology NCCOR National Collaborative on Childhood Obesity Research NCI National Cancer Institute NHANES National Health and Nutrition Examination Survey NIH National Institutes of Health PATCH Planned Approach to Community Health RCT Randomized controlled trial RD Regression discontinuity REACH Racial and Ethnic Approaches to Community Health RE-AIM Reach, Effectiveness, Adoption, Implementation, Maintenance RWJF The Robert Wood Johnson Foundation SAMHSA Substance Abuse and Mental Health Services Administration SD Standard deviation SERCA Special Emphasis Research Career Award SSB Sugar-sweetened beverage SUTVA Stable unit treatment value assumption TREND Transparent Reporting of Evaluations with Nonrandomized Designs USDA U.S. Department of Agriculture USPSTF United States Preventive Services Task Force WHO World Health Organization WIC Special Supplemental Nutrition Program for Women, Infants, and Children
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Bridging the Evidence Gap in Obesity Prevention: A Framework to Inform Decision Making GLOSSARY Adaptability The ability to modify an intervention to fit the cultural context in which the intervention will take place and the unique circumstances of the agency and other stakeholders, without contradicting the intervention’s core elements and internal logic. Adoption The decision to use an intervention as the best course of action available. Within the RE-AIM framework, adoption is measured as the absolute number, proportion, and representativeness of settings and/or intervention staff (people who deliver the program) that are willing to initiate a program. Archival study The use of a model based on past evidence or decisions on a behavior or intervention for purposes of predicting future behavior. Assessment In this report, refers to the process of observing, describing, collecting data on, and measuring the quality and effectiveness of an intervention or policy. See also Evaluation. Benefits Positive effects brought about by an intervention or policy (intended or unintended). Body mass index An indirect measure of body fat, calculated as the ratio of a person’s body weight (in kilograms) to the square of a person’s height (in meters): BMI (kg/m2) = weight (kilograms) ÷ height (meters)2 BMI (lb/in2) = weight (pounds) ÷ height (inches) 2 × 703 In adults, a body mass index (BMI) of 25 or greater is considered overweight, and a BMI of 30 or greater is considered obese. In children and youth, BMI is based on growth charts for age and gender and is referred to as BMI for age, which is used to assess underweight, overweight, and risk for overweight. According to the Centers for Disease Control and Prevention (CDC), a child with a BMI for age that is equal to or greater than the 95th percentile is considered obese. A child with a BMI for age that is equal to or between the 85th and 95th percentiles is overweight. BMI z-score Number of standard deviations away from the population mean BMI; in other words, the degree to which an individual’s measurement deviates from what is expected for that individual. Case study research Qualitative research in which the investigator explores a bounded system (a case) or multiple bounded systems (cases) over time through detailed, in-depth data collection involving multiple sources of information (e.g., observations, interviews, audiovisual material, and documents and reports), and reports a case description and case-based themes.
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Bridging the Evidence Gap in Obesity Prevention: A Framework to Inform Decision Making Case-control or case-comparison study, retrospective study Quantitative research in which persons with a disease (or other outcome) of interest and a suitable control group of persons without the disease are studied. The relationship of an attribute to the disease is examined by comparing the diseased and nondiseased with regard to how frequently the attribute is present. Risk is estimated by the odds ratio. Causality The relationship of causes to the effects they produce. A cause is termed “necessary” when it must always precede an effect; this effect need not be the sole result of the one cause. A cause is termed “sufficient” when it inevitably initiates or produces an effect. Any given causal factor may be necessary, sufficient, neither, or both. Cluster randomization design An experiment in which clusters of individuals rather than independent individuals are randomly allocated to the intervention group. Cohort study A method of study in which subsets of a defined population can be identified who are, have been, or in the future may be exposed or not exposed, or exposed in different degrees, to a factor or factors hypothesized to influence the probability of occurrence of a given disease or other outcome. The main feature of cohort studies is observation of large numbers of individuals over a long period (commonly years), with comparison of incidence rates in groups that differ in exposure levels. Risk is estimated by the relative risk. Community A social entity that can be either spatial (based on where people live in local neighborhoods, residential districts, or municipalities) or relational (based on common ethnic, cultural, or other characteristics or similar interests). Community assessment (needs assessment) A procedure used to collect data that describe the needs and strengths of a specific group, community, or population. Comparative effectiveness research Research involving the generation and synthesis of evidence that compares the benefits and harms of alternative methods for preventing, diagnosing, treating, and monitoring health conditions in a real-world setting. Comparative experiment A study that compares the effects of a program or policy against a comparison condition or control group. Content analysis A systematic and objective summary of the concepts of text. Context The set of factors or circumstances that surrounds a situation or event and gives meaning to its interpretation; the broader environment in which a program operates.
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Bridging the Evidence Gap in Obesity Prevention: A Framework to Inform Decision Making Context evaluation See Needs assessment. Cost/benefit analysis Used to compare the various costs associated with an investment in a program or initiative with its proposed benefits. Cost-effectiveness analysis Used to assess the most efficient method for achieving a program or policy goal. The costs of alternatives are measured in terms of their requisite estimated dollar expenditures. Effectiveness is defined by the degree of achievement of a goal and may be measured in dollars. Cost-feasibility analysis A method used to determine whether an option or intervention is affordable. Cost-minimization analysis A method used to assess the least costly way of achieving the same outcome in which consequences of competing interventions are the same, and only costs are taken into consideration. Cost-utility analysis Used to assess the relative economic value (e.g., cost-utility ratio) of alternative strategies aimed at achieving similar outcomes. This type of analysis converts effects into personal preferences and describes how much it costs for some additional quality gain (e.g., cost per additional quality-adjusted life-year). Cross-sectional study or survey, prevalence study Quantitative research involving the observation of a defined population at a single point in time or time interval. Decision maker In this report, refers to any individual who makes a decision to implement an intervention affecting obesity prevention or another public health problem. Examples of decision makers are state legislators, mayors, public health officials, city council members, school board members, employers, and community organization officials. Disparities A term used to describe differences in quality of health and health care across racial, ethnic, and socioeconomic groups. Dissemination In the context of this report, the targeted distribution of information and intervention materials to a specified audience. The intent is to diffuse knowledge and the associated evidence-based interventions. Ecological model A model that suggests the importance of addressing individual, interpersonal, organizational, community (including social and economic features), and health policy factors because of their effect on individual behavior change and their direct effect on health.
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Bridging the Evidence Gap in Obesity Prevention: A Framework to Inform Decision Making Economic cost analysis A study that assesses the direct and indirect costs associated with a health problem or intervention. Effect The change in an outcome that results from an intervention. Effect size The estimated magnitude of an effect. Effectiveness The extent to which an intended effect or benefits that could be achieved under optimal conditions are also achieved in practice. Efficacy The extent to which an intervention can be shown to be beneficial under optimal conditions. Energy balance A state in which caloric intake is equivalent to energy expenditure, resulting in no net weight gain or weight loss. Energy expenditure Calories used to support the body’s basal metabolic needs plus those used for themogenesis, growth, and physical activity. Energy intake Calories ingested as foods and beverages. Evaluability assessment A method of determining whether activities necessary for a successful full-scale evaluation are in place, whether the activities include program objectives that are well defined and plausible, whether a program can realistically achieve its intended goals, and whether the intended uses of information from evaluation have been clearly specified. Evaluation Systematic assessment of the quality and effectiveness of an intervention or policy and its effects to produce information that can be used by those with an interest in the intervention’s improvement or effectiveness. Evidence-based medicine The conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence-based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. Evidence-based public health The development, implementation, and evaluation of effective programs and policies in public health through the application of principles of scientific reasoning, including systematic uses of data and information systems and appropriate use of behavioral science theory and program planning models.
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Bridging the Evidence Gap in Obesity Prevention: A Framework to Inform Decision Making Evidence farming A flexible, infrastructural digital tool that enables systematic attention to, acquisition of, and utilization of local experience to improve clinical practice and patient outcomes. Evidence synthesis An approach that involves the application of techniques for combining multiple sources of evidence. Experimental design A study that explores the effects of manipulating, allocating, and timing an intervention. Expert knowledge (opinion) The views of professionals with expertise in a particular form of practice or field of inquiry, such as clinical practice or research methodology. Expert knowledge may refer to one person’s views or to the consensus view of a group of experts. External validity The property that permits research results to be generalized to other population units, including other individuals, settings, contexts, and time frames, and thereby to inform practice. Feasibility The likelihood of successful implementation of an intervention. Fidelity The degree to which an intervention was implemented according to protocol, as intended, or as planned. Also referred to as “integrity” of implementation. Focus group A qualitative research method whereby a moderator convenes a group of participants who often have common characteristics (e.g., age, gender, ethnicity) to discuss the attributes of a particular concept or product. Focus groups are often used in the marketing development phase to generate ideas and provide insight into consumer reactions and perceptions. Framework Defined in this report to mean a process for identifying, evaluating, and compiling evidence relevant to various potential decision-making scenarios for obesity prevention and other complex public health problems based on clearly specified concepts, assumptions, or rules. Frequency The number of observations of a variable under investigation. Frequency of a disease or risk factor as discussed in this report refers to obesity or obesity-related diseases. Generalizability The extent to which the results produced by a particular intervention or set of interventions under specific conditions can be expected to produce similar findings in different settings or contexts with different populations. See also External validity.
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Bridging the Evidence Gap in Obesity Prevention: A Framework to Inform Decision Making Geographic mapping A method used to identify graphically the location of an outcome or variable of interest. Gray literature Research reports that are not found in traditional peer-reviewed publications but in, for example, government agency monographs, symposium proceedings, and unpublished company reports. Guidelines In the present context, standardized information describing the best practices for addressing health problems commonly encountered in public health practice. The information is based on scientific evidence for the effectiveness and efficiency of the practices described. Where such evidence is lacking, guidelines are sometimes based on the consensus opinions of public health experts. Harm Adverse effects brought about by an intervention. Health disparities Differences in the occurrence, frequency, mortality, and burden of diseases and other unfavorable health conditions that exist among specific population groups, including racial and ethnic minorities. Health impact assessment A combination of procedures, methods, and tools by which a policy, program, or project can be evaluated in terms of its potential effects on the health of a population and the distribution of those effects within the population. Impact The potential effects of an intervention on the health of a population. Impact evaluation (or assessment) A measure of whether an outcome is the result of an intervention. To support a cause-and-effect conclusion, an impact evaluation incorporates research methods that eliminate alternative explanations for an outcome and shows how much difference an intervention can make compared with the effect seen when no intervention is used. In public health programs, an impact evaluation often occurs over a long period of time. Implementation The act of putting an intervention into practice. Within the RE-AIM framework, implementation is measured in terms of the intervention agents’ fidelity to the various elements of the intervention’s protocol, including consistency of delivery as intended and time and cost. Incidence The frequency of new cases of a condition or disease within a defined time period. Incidence is commonly measured in terms of new cases per 1,000 (or 100,000) population at risk per year.
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Bridging the Evidence Gap in Obesity Prevention: A Framework to Inform Decision Making Indicated intervention A preventive intervention that targets high-risk individuals, in the present context those identified as having a minimal but detectable amount of excess weight that foreshadows obesity. Internal validity The property that permits an observed effect to be attributed with certainty to a specific intervention, allowing for inferences about causality or a link between a given intervention and client/patient outcomes. Randomization is viewed as one of the best means of maximizing internal validity. Interrupted time series study A quantitative study in which the initial observations serve as a control, and after an intervention is introduced, the remaining observations are experimental. Intervention A policy, program, or action intended to bring about identifiable outcomes. Knowledge integration The effective incorporation of knowledge into the decisions, practices, and policies of organizations and systems. Knowledge translation An encompassing term that denotes the exchange, synthesis, and ethically sound application of research findings within a complex system of relationships among researchers and knowledge users; the incorporation of research knowledge into policies and practices, thus translating knowledge into improved health of the population. Logic model A diagram that illustrates the sequencing of program activities that should occur for planning, organizing, implementing, and producing desired results. Longitudinal study, cohort study, prospective study A study that examines quantitatively the specific characteristics of individuals, subgroups, or populations over time. Market research Research involving the gathering of information about markets and customers. Market research can include information on target markets and their needs, competitors, market trends, and customer satisfaction with products and services. Matched cohort study A cohort design in which the groups are matched on many variables (e.g., economic or health status) so the variable of interest (e.g., BMI) can be isolated. Matching, mapping, pooling, and patching The use of theory, professional experience, and indigenous wisdom to adapt evidence to local settings, populations, and times. Mediator The mechanism by which one variable affects another.
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Bridging the Evidence Gap in Obesity Prevention: A Framework to Inform Decision Making Meta-analysis A systematic, quantitative method for combining information from multiple studies to derive the most meaningful answer to a specific question. Mixed-method design The use of methodologies drawn from a variety of disciplines. The research employs both qualitative and quantitative data gathering and analysis methods that combine extensive descriptions of context and the experiences of program participation with standardized assessments of changes in institutions or systems, the environment, and individual or population behaviors. Moderator A variable that changes the impact of one variable on another. Monitoring The collection and analysis of data on an intervention or policy as it progresses to ensure the integrity of its planned implementation. Multifaceted intervention An intervention involving multiple components that are delivered concurrently to a target group in combination. Multilevel intervention An intervention that targets groups at multiple levels of an ecological model. Multisector intervention An intervention that mobilizes multiple sectors of society, such as government, civil society, the public, and the private sector. Narrative review A process by which a body of literature is collected, reviewed, and summarized using unsystematic methods. Natural experiments Naturally occurring circumstances in which different populations are exposed or not exposed to a potentially causal factor such that the circumstances resemble a true experiment in which study participants are assigned to exposed and unexposed groups. Needs assessment An evaluative study that answers questions about the social conditions a program is intended to address and the need for the program. Nonrandomized experiment See Observational study, Quasi-experimental study. Obesity See Body mass index. Observational study (nonexperimental) A design in which variables are observed rather than manipulated. Outcome The changes that result from an intervention’s activities and outputs. Depending on the nature of an intervention and the theory of change that guides it, an outcome
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Bridging the Evidence Gap in Obesity Prevention: A Framework to Inform Decision Making can be short-, intermediate-, or long-term. Indicators or indices are used to assess whether progress has been made toward achieving specific outcomes as a result of an intervention. Outcome evaluation An approach to assessing whether anticipated changes have occurred as a result of an intervention. This type of evaluation assesses the extent of change in targeted attitudes, values, behaviors, policies, programs, environments, or conditions between the baseline measurement and subsequent points of measurement over time. Overweight See Body mass index. Parallel evidence Evidence of the effectiveness of an intervention that is being considered to address a problem such as obesity prevention in addressing another public health issue using similar strategies. Policy A written statement reflecting a plan or course of action of a government, business, community, or institution that is intended to influence and guide decision making. For a government, a policy may consist of a law, regulation, ordinance, executive order, or resolution. Policy analysis An interdisciplinary field that involves research into the nature of policy and its types, the making of policies, and their implications and consequences. Policy maker In this report, refers to a decision maker who has the authority to pass legislation affecting obesity prevention or other public health problems. Examples of policy makers are federal or state legislators, governors, and mayors. Policy scan, policy tracking A quantitative survey of recommendations and actions, as well as facts, trends, and opinions, related to a specific issue over a predetermined period of time. Population-based A term used to describe obesity prevention interventions aimed primarily at the macro level, for example, initiatives that are undertaken to improve environments for eating and physical activity in ways that will reduce the likelihood of excess weight gain among people in general. Population health The state of health of an entire community or population as opposed to that of an individual. It is concerned with the interrelated factors that affect the health of populations over the life course and the distribution of patterns of health outcomes. Practice-based interventions (or evidence) Interventions, or evidence derived therefrom, that have been developed, implemented, and documented in practice but have not been tested in a more formal, research study.
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Bridging the Evidence Gap in Obesity Prevention: A Framework to Inform Decision Making Predictive studies The use of models to identify or predict more accurately a behavior or other outcome of interest. Pretest–posttest desig A quasi-experimental study design that includes a baseline measure of the outcome of interest (pretest), the treatment, and a posttest measure of the outcome to evaluate the effects of an intervention. Prevalence The number of instances of a condition or disease in a population at a designated period of time, usually expressed as a percentage of the total population. Prevention With regard to obesity, primary prevention represents avoiding the occurrence of obesity in a population, secondary prevention represents the early detection of disease through screening with the purpose of limiting its occurrence, and tertiary prevention involves preventing the sequelae of obesity in childhood and adulthood. Program An integrated set of planned strategies and activities that support clearly stated goals and objectives and lead to desirable changes and improvements in the well-being of people, institutions, environments, or all of these. Qualitative data (or research) Nonnumerical observations made using approved methods such as participant observation, group interviews, or focus groups. Qualitative data can enrich the understanding of complex problems and help explain why things happen. Quantitative data (or research) Data in numerical quantities, such as continuous measurements or counts. Quasi-experimental study A quantitative experiment in which the investigator lacks full control over the allocation or timing of an intervention. Randomized controlled trial A study design in which groups of patients are randomized to an experimental and a control condition. The groups are monitored for the variables or outcomes of interest. Randomized encouragement design An experiment in which treatment assignment is encouraged instead of enforced because of ethical or feasibility issues. Randomized study An experiment in which units (i.e., individuals, groups, communities) are assigned randomly to conditions. Reach The absolute number, proportion, and representativeness of individuals who participate in an intervention. Within the RE-AIM framework, reach is measured as the absolute number, proportion, and representativeness of individuals who are willing to participate in a given intervention.
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Bridging the Evidence Gap in Obesity Prevention: A Framework to Inform Decision Making RE-AIM framework A systematic way of reporting research results and translating research into practice. RE-AIM stands for reach, effectiveness, adoption, implementation, and maintenance. Realist review A relatively new strategy for synthesizing research that has an explanatory rather than a judgmental focus. The aim is to understand how complex programs work (or why they fail) in particular contexts and settings. Realism is a methodological orientation that has roots in other fields, but is as yet largely untried as an approach to the synthesis of evidence in health care. Reductionist research A model that approaches statements of causality by isolating, simplifying, and holding constant key conditions as an attempt is made to understand effects by controlling or removing all potential confounders. Regression discontinuity design A study design that requires assignment of participants to treatment or control groups based on whether they fall above or below a cutoff score on a variable measured prior to the treatment. Representativeness A component of external validity. With respect to settings, one should ask whether comparisons are made of the similarity of settings under study to the target program settings or to those settings that decline to participate; with respect to individuals, one should ask whether analyses are conducted of the similarities and differences between people who participate in a study and either the target audience or those who decline to participate. Safety The condition of being either protected from or unlikely to cause danger, risk, or injury that may be either perceived or objectively defined. Scientific literature The body of theoretical and research publications in scientific journals, reference books, textbooks, government reports, policy statements, and other materials on the theory, practice, and results of scientific inquiry. Secondary analysis A method used to analyze an existing pool of data to pursue a research interest that differs from that of the original work. Sector A distinct subset of a market, society, industry, or the economy in which the members share similar characteristics. Examples of the sectors discussed in this report include government or the public sector, communities, nonprofit and philanthropic organizations, health care, business or the private sector, schools, and households. Selective intervention A preventive intervention targeting a subgroup of the population whose risk of developing obesity is above average or high.
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Bridging the Evidence Gap in Obesity Prevention: A Framework to Inform Decision Making Sensitivity analysis A technique for systematically changing parameters in a model to determine the effects of such changes. This technique is useful when one is attempting to determine the impact on the actual outcome if a particular parameter differs from what was previously assumed. Simulation modeling A tool to help one understand the interaction of the parts of a system and a system as a whole. A model (a simplified representation of an actual system) is manipulated in such a way that it operates on time or space to compress it, allowing one to see the interactions that would not otherwise be apparent because of their separation in time or space. Social determinants The features and pathways by which societal conditions affect health and can potentially be altered by action. Social determinants discussed in this report include environmental conditions that contribute to disease or risk factors. Stakeholder An individual or organization with an interest in an intervention, policy, or outcome. Strategic planning In the context of this report, detailed plans that include objectives and a set of essential actions (preventive, therapeutic) believed sufficient to control a health problem. Survey An investigation in which information is systematically collected but the experimental method is not used. The information collected almost always requires editing, coding, data entry, and data analysis. Survey data differ from surveillance data in that they are not ongoing but sporadic. Sustainability The likelihood that a program will continue over a period of time after grant funding has ended; in broader terms, society’s ability to shape its economic and social systems to maintain both natural resources and human life. Sustainability improves quality of life in the present while ensuring continued prosperity in the future. System dynamics A methodology for mapping and modeling the forces of change in a complex system to better understand their interaction and govern the direction of the system. It enables stakeholders to combine input to form a dynamic hypothesis that uses computer simulation to compare various scenarios for achieving change. Systematic review A review of a clearly formulated question that uses systematic and explicit methods to identify, select, and critically appraise relevant research and to collect and analyze data from the studies that are included in the review. Statistical methods (meta-analysis) may or may not be used to analyze and summarize the results of the included studies.
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Bridging the Evidence Gap in Obesity Prevention: A Framework to Inform Decision Making Systems approach A paradigm or perspective involving a focus on the whole picture and not just a single element, awareness of the wider context, an appreciation for interactions among different components, and transdisciplinary thinking. Systems investigation A promising new frontier for research and action in response to complex and critical challenges, based on a systems approach. Systems perspective See Systems approach. Systems science Research related to systems theory that offers insight into the nature of the whole system that often cannot be gained by studying the system’s component parts in isolation. Systems theory An interdisciplinary theory that requires a merging of multiple perspectives and sources of information and deals with complex systems in technology, society, and science. Systems thinking An iterative learning process in which one takes a broad, holistic, long-term perspective on the world and examines the linkages and interactions among its elements. Target population A group of individuals at risk targeted by an intervention. Transdisciplinary Researchers working jointly using a shared conceptual framework drawing together disciplinary-specific theories, concepts, and approaches to address a common problem. Transferability The generalizability or applicability of inferences obtained in a study to other individuals or entities, settings or situations, time periods, or methods of observation and measurement. See also External validity, Generalizability, and Knowledge translation. Translation The process of exchange between research and practice to foster the widespread dissemination of research results and enhance policy and practice initiatives. See also Knowledge translation. Trend The rate of increase of disease or determinants over time. Universal intervention A preventive intervention designed for everyone in the eligible population. Validity The extent to which an instrument directly and accurately measures what it is intended to measure. Variable Anything that is not constant but that can and does change in different circumstances.
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