Performance Improvement 1998. Centers for Disease Control and Prevention

02/01/1998

Contents

Sexually Transmitted Disease (STD) Prevention in the United States: Integrated Evaluation of Public and Private Sector Disease Reporting and Service Delivery

Evaluation of ICD-10 for Morbidity Reporting in the United States

Suicide Intervention and Prevention: Evaluation of Community-Based Programs in Three American Indian Communities

Evaluation of the Fatality Assessment and Control Evaluation (FACE) Program: Phase II Final Report

Assessment of the National Laboratory Training Network

Race Reporting on Birth Records by Multiracial Women: An Evaluation of Question Format Alternatives

Management and Operational Impacts of HIV Prevention Community Planning: Lessons Learned at Mid-Course and Implications for Future Activities

CDC's Early Implementation of GPRA: A Case Study-- July 1995 to November 1996

Collaborating with Managed Care Organizations for Mammography Screening and Rescreening: Guidance for NBCCEDP Grantees

Reaching Women for Mammography Screening: Successful Strategies of National Breast and Cervical Cancer Early Detection Program (NBCCEDP) Grantees

Evaluation Design for the Business Responds to AIDS (BRTA) Program

Case Studies of the Prevention Marketing Initiatives (PMI) Local Demonstration Site Projects: Experiences During Planning and Transition Phases

Evaluability Assessment of CDC-Funded Traumatic Brain Injury and Spinal Cord Injury Programs

Community Context Study: Minors' Access to Tobacco

Directions for Research on the National Immunization Survey: Final Report

In Her Own Words: A Focus Group Study of Risk and Protective Factors in Intimate Partner Violence

Linking Research and Public Health Practice: A Review of CDC's Program of Centers for Research and Demonstration of Health Promotion and Disease Prevention

Syphilis in the South: A Case Study Assessment in Eight Southern Communities

Evaluation of the Effectiveness of CDC Surveillance for Drug-Resistant Streptococcus pneumoniae (Baltimore, MD)

Evaluation of the Effectiveness of CDC Surveillance for Drug-Resistant Streptococcus pneumoniae (San Antonio, TX)

Assessment of the Programmatic Impact of One-Percent Evaluation Studies

Directory of Evaluations Administered by the CDC Office of Program Planning and Evaluation 1990-1995

TITLE: Sexually Transmitted Disease (STD) Prevention in the United States: Integrated Evaluation of Public and Private Sector Disease Reporting and Service Delivery

ABSTRACT: The Centers for Disease Control and Prevention (CDC) Division of Sexually Transmitted Disease (STD) Prevention provides financial and technical assistance to State and local agencies to support a range of prevention, research, policy development, and surveillance activities. Two parallel STD surveillance systems are currently operated by CDC, both of which rely upon regular, voluntary reporting of STD incidence by State and local agencies. Both systems are thought to suffer from less-than-complete reporting of STDs by diagnosing practitioners. Estimates of this underreporting range from 25 to 90 percent. The focus of this project, therefore, was to design and pilot test a methodology for validating the STD data routinely collected, analyzed, and published by the Division. The study's main objective was to test the feasibility of using a provider-based survey (1) to quantitatively validate CDC's data on STD diagnoses, and (2) to assess the extent to which clinicians follow CDC's treatment guidelines for STDs. The study was designed to generate estimates of STD incidence through a survey of a random sample of STD data providers in four States, and to compare these estimates with State-reported STD incidence for the same time period. The report finds that (1) the four pilot States differ in terms of their STD data-gathering policies and practices, including which diseases are reported, how cases are defined for reporting purposes, how laboratory reporting is utilized, and which date information is recorded for each case; (2) syphilis, gonorrhea, and chlamydia are reportable diseases in all four States, and in two States many additional diseases are reportable; (3) in two States, physicians must report diseases for them to be recorded, while in two others laboratory reports are sufficient; (4) STDs are considerably underreported by providers; and (5) most STD cases are seen by individual private practitioners. (Final report: 82 pages, plus appendices.)

AGENCY SPONSOR: National Center for HIV, STD and TB Prevention

FEDERAL CONTACT: John Moran

PHONE NUMBER: (404) 639-8272

PIC ID: 5348

PERFORMER ORGANIZATION: Abt Associates, Incorporated, Boston, MA

TITLE: Evaluation of ICD-10 for Morbidity Reporting in the United States

ABSTRACT: This report evaluates (1) whether the International Classification of Disease (ICD)-10 is a significant improvement over the ICD-9; (2) whether these improvements warrant its implementation in the United States; (3) the modifications needed to improve its use for morbidity applications; and (4) whether there are any codes or concepts in ICD-9, but not in ICD-10, that should be considered for inclusion. The Technical Advisory Panel and project staff conclude that there are many strengths in ICD-10 in comparison with ICD-9. Many of the chapters contain a wealth of useful expansion in detail for which diagnostic information is typically available and which represent important clinical distinctions. These expansions will facilitate future specificity in statistical tabulations of diseases and conditions, provide some additional means for severity coding, and provide for enhanced applicability of the classification to primary care reporting. The logic and detail of ICD-10 will also contribute to progress toward the computerization of medical records. Although a number of limitations in ICD-10 are identified, the recommended modifications will overcome most of them. Therefore, it is strongly recommended that the National Center for Health Statistics implement a revised version as soon as possible.

AGENCY SPONSOR: National Center for Health Statistics

FEDERAL CONTACT: Amy Blum

PHONE NUMBER: (301) 436-7050

PIC ID: 5503

PERFORMER ORGANIZATION: Center for Health Policy Studies, Columbia, MD

TITLE: Suicide Intervention and Prevention: Evaluation of Community-Based Programs in Three American Indian Communities

ABSTRACT: Suicide is the second leading cause of death for Native Americans aged 15 to 24. American Indian/Alaska Native young people are more likely to attempt suicide; to choose a highly lethal method, such as firearms or hanging; and to be successful at committing suicide. This report evaluates the local community-based suicide intervention and prevention programs of three geographically diverse American Indian tribes (the Jicarilla Apache Tribe, the Western Athabaskan Tribe, and the Northern Woodlands Tribe). In two tribes, suicide intervention efforts had been in place since 1989 and 1990, respectively; in the third, a suicide crisis in late 1992 precipitated community response. The report finds that (1) the local nature of the evaluation process opened itself to problems of diffuse authority and lack of focus on the evaluation process; (2) suicide prevention issues, tribal identity issues, and staffing issues took precedent over the actual evaluation activities; (3) a major recommendation arising from this study was to have process evaluation activities conducted by an external (non-community member) evaluator not supervised by local staff; (4) the Jicarilla Apache program represents a suicide prevention program in a very small, cohesive, and well-coordinated community response, which depends upon a staff model; (5) at the Western Athabaskan reservation, the prevention program used several special initiatives loosely coordinated with an existing Behavioral Health Services program using a staff model; (6) using a volunteer network, the Northern Woodlands tribe produced an excellent manual describing a grassroots community approach to suicide prevention; and (7) in all three tribes, attempted and successful suicide rates were reduced. The report concludes that the staff models used in the two small and centralized reservation communities were more successful than the diffuse, volunteer effort. (Final report: 120 pages.)

AGENCY SPONSOR: National Center for Injury Prevention and Control

FEDERAL CONTACT: Lloyd Potter

PHONE NUMBER: (770) 488-1557

PIC ID: 5504

PERFORMER ORGANIZATION: Indian Health Service, Rockville, MD

TITLE: Evaluation of the Fatality Assessment and Control Evaluation (FACE) Program: Phase II Final Report

ABSTRACT: The Fatality Assessment and Control Evaluation (FACE) program of the National Institute for Occupational Safety and Health seeks to prevent workplace fatalities by identifying and investigating fatal occupational injuries and disseminating prevention strategies to those who can intervene in similar situations. Publications based on information from fatality investigations identify occupational hazards and prevention measures, and are disseminated to persons who can influence work conditions and information availability in related occupations and work settings.

This report (1) describes the dissemination of five recent FACE documents (4 tear-sheet Alerts and one monograph), (2) compiles users' assessments of their usefulness, and (3) identifies examples of prevention efforts and other impacts attributable to the documents. The report finds that (1) publications are generally considered technically accurate and focused on significant occupational hazards by users; (2) workers participating in focus groups see job-related chronic illnesses and nonfatal injuries as more significant than the risk of fatality, and are less convinced of tear sheets' relevance to them; (3) workers consider the tear sheets' recommendations accurate and appropriate, but are concerned by the inclusion of "common sense" recommendations; (4) the tear sheets' terminology and generally high literacy level may limit their usefulness to their target audiences; (5) the publications are generally disseminated by distributing them directly or by modifying them for inclusion in other informational materials; and (6) information from the publications is used to improve worker training, identify existing hazards, and improve safety standards. The report concludes that the FACE publications are a useful source of authoritative occupational safety information. The report includes several recommendations. See also PIC ID No. 5506. (Final report: 30 pages, plus appendices.)

AGENCY SPONSOR: National Institute for Occupational Safety and Health

FEDERAL CONTACT: Theodore Pettit

PHONE NUMBER: (304) 285-5972

PIC ID: 5506.1

PERFORMER ORGANIZATION: Research Triangle Institute, Research Triangle Park, NC

TITLE: Assessment of the National Laboratory Training Network

ABSTRACT: The National Laboratory Training Network (NLTN) was established in 1989 to provide training in new methodologies and theoretical concepts for laboratory workers. This report assesses whether the NLTN has had a beneficial impact on public health by improving laboratory practice. Data were gathered through a series of surveys of local health department and physician office laboratory employees who participated in training, as well as comparison groups of those who did not. Other surveys of State training coordinators (STCs), laboratory inspectors, microbiology directors, microbiology program participants, and NLTN co-sponsors were also conducted. The report categorizes its findings in three groups, based upon the responses of (1) STCs, laboratory inspectors, and co-sponsors; (2) microbiologists; and (3) course participants and their comparison groups. The report finds that: (1) STCs felt supported in their jobs and used NLTN resources (88 percent were somewhat or very satisfied with NLTN services, and 90 percent were satisfied with programs); (2) laboratory inspectors often recommended training as a means to correct deficiencies, but only a small percentage used the NLTN as a training source; (3) co-sponsors rate relevance, quality, and currency of course content very highly; (4) microbiology directors rated NLTN fees, convenience, relevance, quality, currency of content, and pertinence of issues addressed favorably; (5) one-third of microbiology course participants instituted a change in practice as a result of training (80 percent rated quality and currency of content highly); and (6) course participants in the third group rated their training highly and most instituted changes or saw positive results subsequent to training. The report includes recommendations for further improving the NLTN. (Final report: 147 pages, appendices bound separately in Volume II.)

AGENCY SPONSOR: Public Health Practice Program Office

FEDERAL CONTACT: Eunice Rosner

PHONE NUMBER: (770) 488-4129

PIC ID: 5507

PERFORMER ORGANIZATION: Battelle Corporation, Arlington, VA

TITLE: Race Reporting on Birth Records by Multiracial Women: An Evaluation of Question Format Alternatives

ABSTRACT: This report examines the implications of changing the format of the race item on the birth record filled out for every birth in the United States at the location where the birth occurred. Procedures for filling out birth certificates vary from State to State and in some States, from hospital to hospital. To provide uniform information to the vital registration system, the Federal government, in cooperation with the States, developed the U.S. Standard Certificate of Live Birth that collects relevant information about the race and Hispanic origin of the parents, but not of the baby. This study (1) evaluates how women of multiracial and Hispanic backgrounds interpret the race question on the birth certificate; (2) evaluates experimental race questions, such as the use of a multiracial cue and the use of a "mark all that apply" format; and (3) learns more about the response processes that women use when answering questions about race. Nine States and the District of Columbia recruited 763 women to participate in this study. The study tests the effects of different questions on race, both in a mail and a followup telephone survey. The mother's self-reported race is compared with what she reported on the actual birth record. Further, for those residents with two children, the study compared consistency of race reporting between the last two birth records. The report concludes that (1) the number of women reporting more than one race increases when the race questions include a multiracial cue or "mark all that apply" format; (2) women who report more than one race are more likely to enter two specific races rather than a term like multiracial; (3) among the mothers whose parents who were two or more races, self-reports of race on the last two birth records are inconsistent 25 percent of the time; and (4) self-reports of race are different 40 percent of the time between the birth record and the standard version of the mail survey. (Final report: 48 pages, plus appendices.)

AGENCY SPONSOR: National Center for Health Statistics

FEDERAL CONTACT: Susan Schechter-Ryan

PHONE NUMBER: (301) 436-7111

PIC ID: 5918

PERFORMER ORGANIZATION: Westat, Incorporated, Rockville, MD

TITLE: Management and Operational Impacts of HIV Prevention Community Planning: Lessons Learned at Mid-Course and Implications for Future Activities

ABSTRACT: HIV Prevention Community Planning, implemented in January 1994, represented a major policy change in Centers for Disease Control and Prevention funding policy. Prior to that time, State, territorial, and local health department grantees with prevention funds were required to spend most of their cooperative agreement funds on counseling and testing services. A new emphasis on planning through HIV Prevention Community Planning requires grantees to set their own HIV prevention priorities locally through a process that emphasizes input from the affected communities and relevant technical experts. This project broadly evaluated the policy impact of this new planning process on grantees' HIV prevention programs as demonstrated by budgetary and operational indicators. This is an issue of national importance, as the HIV prevention community planning process affects over $200 million dollars in HIV prevention funds across the country. This first phase of a two-phase project ascertained how community planning is confirming, enhancing, and changing HIV prevention programs. A methodology for obtaining information on the indicators for a retrospective study was also developed and piloted during this phase of the study. The report finds that (1) a prospective and iterative approach to planning, implementation, and assessment is the most valuable approach; (2) in a prospective approach, the baseline is the set of circumstances extant at the beginning of the process, and site-specific goals and objectives are developed and tracked; and (3) more detailed guidance addressing these issues could help operationalize this kind of approach. Finally, the report finds that the indicators offering the most promise are (1) correspondence between the community plan, proposed activities, and undertaken activities; (2) quality assurance for implementation; and (3) capacity building and infrastructure development. (Final report: 28 pages, plus appendices.)

AGENCY SPONSOR: National Center for HIV, STD and TB Control

FEDERAL CONTACT: Carol Robinson

PHONE NUMBER: (404) 639-0952

PIC ID: 5927

PERFORMER ORGANIZATION: Macro International, Incorporated, Atlanta, GA

TITLE: CDC's Early Implementation of GPRA: A Case Study--July 1995 to November 1996

ABSTRACT: The Government Performance and Results Act of 1993 (GPRA) stresses the importance of government agencies' monitoring their results or outcomes in order to improve their management of associated processes and outputs. GPRA mandates that each agency produce a 5-year strategic plan and a 1-year performance plan by September 1997. This report offers a record of the experience of the Centers for Disease Control and Prevention in its early implementation of GPRA. It documents the process, summarizes key findings, and recommends strategies and approaches for the ongoing implementation of GPRA. The report finds that (1) implementation during the study phase did not proceed at the anticipated rate (instead of a fully developed strategic plan and pilot performance plans, most of the effort has concentrated on a strategic plan that is not yet drafted-little attention has been paid to the performance plans); (2) the role and responsibilities of the GPRA Implementation Team (GIT) evolved over the study period; (3) the GIT suffered from shifting membership, lack of continuity in meeting attendance, and an overall insufficient level of effort; (4) more effective and comprehensive planning and coordination was needed; and (5) despite the large amount of time and effort devoted to GPRA, the levels and types of commitment and resources fell short of what was needed. The report also concludes that insufficient momentum, commitment, and resources were a greater problem than ineffective planning; the process could have benefitted from greater executive staff involvement early on; and the process was often frustrating for participants. The report recommends that (1) organizational change efforts be unified under a high-level champion or team; (2) the Office of Program Planning and Evaluation's charge of implementing GPRA requirements be maintained; (3) the GIT be revamped; and (4) realistic budget be developed, requested, and executed.

AGENCY SPONSOR: Office of the Director

FEDERAL CONTACT: Wilma G. Johnson

PHONE NUMBER: (404) 639-7090

PIC ID: 5928

PERFORMER ORGANIZATION: Research Triangle Institute, Research Triangle Park, NC

TITLE: Collaborating with Managed Care Organizations for Mammography Screening and Rescreening: Guidance for NBCCEDP Grantees

ABSTRACT: Clinical trials show that mammography screening among women aged 50-69 years can reduce mortality from breast cancer by as much as 30 to 40 percent. Thus, more complete mammography screening coverage is needed throughout the Nation. This project was undertaken with a dual purpose: (1) to evaluate strategies used in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) to reach women 50 years and older for the early detection of breast cancer; and (2) to assess potential partnership opportunities between public health and managed care organizations to increase the coverage of mammography screening. Currently, all States, the 5 territories, and 25 American Indian tribes are funded by the NBCCEDP to establish and manage comprehensive breast and cervical cancer screening services for women who are minorities, low-income, and age 50 or older, a population that seeks mammography services less often than other women because of cost, knowledge, and other barriers. The report notes that the increased use of managed care organizations (MCOs) by State Medicaid programs offers new opportunities and incentives to build partnerships between NBCCEDP grantees and MCOs. The report finds that (1) because grantees give priority to women who are low-income, uninsured, racial minorities, or Native American, special attention must be paid to educating and building relationships with MCOs in outreach, case management, and followup; (2) both sectors will benefit from data partnerships and community collaborations; (3) most current MCO efforts in the area of breast and cervical cancer detection are data-driven and office-based; and (4) health plans target providers more than patients to increase their attention to the prevention effort. The report also addresses opportunities for collaboration, barriers to and facilitators of such collaboration, and strategies that programs might use to enhance screening efforts. See also PIC ID No. 6273.1.

AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion

FEDERAL CONTACT: Nancy Nowak

PHONE NUMBER: (404) 488-4306

PIC ID: 6273

PERFORMER ORGANIZATION: Macro International, Incorporated, Atlanta, GA

TITLE: Reaching Women for Mammography Screening: Successful Strategies of National Breast and Cervical Cancer Early Detection Program (NBCCEDP) Grantees

ABSTRACT: This guide presents successful strategies used by grantees of the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) to reach women in need of mammography screening-in particular low-income women, underserved and uninsured women, and women from communities of color. This information is presented to help grantees reach these marginalized populations by sharing strategies that their peer grantees have found successful. This information will also be useful for private sector and other organizations that are working to provide prevention services to hard-to-reach groups. Five categories of strategies are examined: inreach, public education, outreach, policies and procedures, and coalition and partnership development. While all of these strategies are different, several common themes underlie them all: (1) organizations must consider broad partnerships to reach marginalized populations who, because of their complicated lives, may not seek out care for themselves; (2) aggressive outreach may be needed to work with agencies and individuals who are most frequently in contact with these populations; (3) organizations should consider their infrastructure, not just outreach, to bring women in (health care organizations or health plans with a designated group of clients will find inreach more effective than outreach in the short term); (4) while the natural tendency is to focus on the relationship between the direct caregiver (especially the physician) and the patient, women are more likely to return for rescreening and to comply with followup regimens if a welcoming atmosphere is created by the entire office; and (5) the successful strategies show that there are diverse resources available for programs, but that innovation is needed when developing partnerships. See also PIC ID No. 6273. (Final report: 104 pages, plus appendices.)

AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion

FEDERAL CONTACT: Nancy Nowak

PHONE NUMBER: (404) 488-4306

PIC ID: 6273.1

PERFORMER ORGANIZATION: Macro International, Incorporated, Atlanta, GA

TITLE: Evaluation Design for the Business Responds to AIDS (BRTA) Program

ABSTRACT: The Business Responds to AIDS program (BRTA) is a public-private initiative partnership undertaken by the Centers for Disease Control and Prevention's Division of HIV/AIDS Prevention to help businesses create and implement comprehensive HIV/AIDS workplace programs. To better understand how worksites are engaged in health promotion efforts, the BRTA Program conducted a national probability survey (the BRTA Benchmark Survey) to track progress since 1992. This project conducts a secondary analysis of the BRTA Benchmark Survey in order to provide recommendations about future evaluation designs that rely heavily on national communication channels. While much of the survey addressed issues related to HIV/AIDS, a number of questions were included that help track trends in worksite policies, screening programs, and health promotion activities. Results from this survey were compared to those gathered in a 1992 Office of Disease Prevention and Health Promotion survey of health promotion and disease prevention in the worksite. The report finds that (1) recent trends in worksite health promotion efforts seem to show increases in worksite policies, but no changes or decreases in classes or screening programs; (2) having a worksite policy may be less costly to implement than classes or screening programs (these policy interventions may also be more cost-effective than other types of interventions); and (3) the downward trend may result from some measurement bias introduced by asking questions about health promotion classes and screening programs only of those respondents to the BRTA Benchmark Survey who said they had had some health promotion program in the past 12 months. (Final report: 14 pages, plus appendices.)

AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion

FEDERAL CONTACT: Cynthia Jorgensen

PHONE NUMBER: (404) 639-0952

PIC ID: 6277

PERFORMER ORGANIZATION: Research Triangle Institute, Research Triangle Park, NC

TITLE: Case Studies of the Prevention Marketing Initiatives (PMI) Local Demonstration Site Projects: Experiences During Planning and Transition Phases

ABSTRACT: The Prevention Marketing Initiative (PMI) is a social marketing program intended to influence behaviors that contribute to the sexual transmission of HIV and other sexually transmitted diseases among young people below 25 years of age. PMI includes among its components locally funded demonstration sites, which combine community participation with social marketing and behavioral science methodology and theory in order to design, implement, and sustain viable prevention programs. The PMI case study gathered in-depth information at these sites to describe the experiences of program participants over a 2-year period spanning two major project phases: planning and transition to implementation. The study highlights participants' reflections on what was done to foster achievement of PMI's goals, as well as what could be avoided in the future. The qualitative information gathered will be used to contextualize quantitative evaluation data collected as sites move through the implementation phase of PMI. The report finds that PMI had the following effect: (1) increased collaboration among community organizations and individuals on HIV prevention; (2) increased youth involvement in planning HIV prevention activities after some initial floundering in this area; (3) there is some weak evidence of increased support for HIV prevention programs within the community; and (4) increased participants' knowledge of, and sensitivity to, social marketing methodologies. The report also makes several recommendations on two levels: those that can be applied to new PMI sites and to other community-based ventures and those that pertain to PMI in particular. A,ong these recommendations are (1) define and become familiar with the community, (2) learn to manage issues and be realistic, (3) maintain diversity and enforce rules, (4) be clear with the lead agency, and (5) have the staff in place to provide needed technical and management services. (Final report: 204 pages, plus appendices.)

AGENCY SPONSOR: Office of the Director

FEDERAL CONTACT: Nancy Cheal

PHONE NUMBER: (404) 639-7095

PIC ID: 6337

PERFORMER ORGANIZATION: Battelle Corporation, Arlington, VA

TITLE: Evaluability Assessment of CDC-Funded Traumatic Brain Injury and Spinal Cord Injury Programs

ABSTRACT: In 1988, the Centers for Disease Control and Prevention (CDC) created the Disabilities Prevention Program (DPP) to reduce the incidence and severity of primary and secondary disabilities in the United States and to promote the independence and productivity of persons with disabilities. This report was commissioned to assess the feasibility of conducting an evaluation of the traumatic brain injury and spinal cord injury (TBI/SCI) programs funded through the DPP, the National Center for Environmental Health, and CDC. Interviews were conducted with Federal and State staff with a background or interest in DPP, external stakeholders, and with program staff in eight States. Interview data were used to prepare a logic model of State-level TBI/SCI programs, along with a set of measurable program components that match the activities and the objectives set forth in the logic model. The report finds that (1) there is a consensus among all stakeholders on the goals, activities, and objectives of the TBI/SCI capacity building programs' intended goals and on indicators that can be used to measure attainment; and (2) identifying the logic model and framework of measurable components for these programs offers many benefits. In order to strengthen CDC-State partnerships, the report recommends: (1) an appropriate balance in the partnership that allows States to be flexible but also provides parameters to ensure consistency; (2) the provision of regular, consistent feedback on State plans, activities, quarterly reports, and surveillance data; (3) grounding program design and decisions on valid data, whenever possible (in the absence of data, programs should proceed with a phased approach involving both the CDC and the States in the evolutionary learning process); and (4) the expansion of partnerships at the Federal, State, and community levels. (Final report: 33 pages plus appendices.)

AGENCY SPONSOR: National Center for Injury Prevention and Control

FEDERAL CONTACT: Doug Browne

PHONE NUMBER: (404) 488-7098

PIC ID: 6338

PERFORMER ORGANIZATION: Susan Toal, Atlanta, GA

TITLE: Community Context Study: Minors' Access to Tobacco

ABSTRACT: This project represents the first phase of a national study designed to profile the relationship between youths' access to tobacco and the contextual variables that define communities' policies, attitudes, and activities regarding youth and tobacco. The results of the study have implications for local, State, and Federal policies and programs. The basic conceptual model postulates that community forces will initiate and/or enhance local enforcement efforts. Enforcement will affect vendor behavior, which will then restrict minors' access to-and thereby, use of-tobacco. To address the questions raised by the conceptual model, data collection and analysis for this project were conducted in three parts: (1) telephone interviews with tobacco vendors and community leaders, and purchase attempts in stores in 20 communities; (2) in-person interviews with community leaders in ten case-study communities; and (3) analysis of teen tobacco use data from the 1995 Youth Risk Behavior Study (YRBS), collected by CDC for the same 20 communities. The report finds that (1) adolescents have little difficulty buying cigarettes in retail outlets; (2) even in restrictive communities, some stores would sell tobacco to minors; (3) the most important deterrent of sales to minors is asking for proof of age; (4) the presence of tobacco sales warning signs is associated with a lower sale rate; (5) community support for tobacco control promotes merchant compliance with the law; and (6) even a perception of enforcement acts as a strong deterrent to selling tobacco to minors. The report recommends that (1) the study should be expanded as a followup to the 1997 YRBS in sampled communities, (2) a question about the location of sources of retail purchase should be added to the YRBS, and (3) the expanded community context study should be fielded as soon as possible. (Executive summary: 7 pages; final report: variously paginated, plus appendices.)

AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion

FEDERAL CONTACT: Gary A. Giovino

PHONE NUMBER: (770) 488-5703

PIC ID: 6474

PERFORMER ORGANIZATION: Battelle Corporation, Arlington, VA

TITLE: Directions for Research on the National Immunization Survey: Final Report

ABSTRACT: The National Immunization Survey (NIS) measures the immunization levels among young children in each State and in large metropolitan areas on a quarterly basis. This survey recently came under review, and questions about the cost of the survey and the utility of the data were raised. This report reviews the survey and develops a plan for determining whether less expensive methods could be used and still yield a statistically sound survey that meets the needs of the National Immunization Program. The report finds that (1) the NIS is a well-designed response to a very difficult set of goals posed by the Centers for Disease Control and Prevention; (2) dramatic cost reductions (i.e., 30 percent or larger) could not be achieved without major changes in survey objectives or quality; (3) there is greater potential for cost savings in the area of data collection than in analysis, since the volume of the survey makes refined systems for data collection economically feasible; (4) the high data analysis costs for the survey are well justified; (5) the survey meets the need for monitoring trends at the national level and can also be used to identify Immunization Action Plan (IAP) areas with either very poor or outstanding immunization levels; and (6) the survey can differentiate the immunization rates for reasonably small demographic groups annually, and can be used to monitor immunization trends at the IAP level, but only on an annual or biennial basis. The report concludes that the relative emphasis on IAP-level statistics and on national statistics should perhaps be adjusted-in the justification of the survey, in the design of the household interview, and in the choice of statistics to publish. It recommends that the schedule for publication of IAP-level statistics be cut back to an annual schedule and that new publications on national statistics for domains of interest be developed to fill the publication schedule.

AGENCY SPONSOR: National Immunization Program

FEDERAL CONTACT: Jacquelyn Williams

PHONE NUMBER: (301) 443-4493

PIC ID: 6477

PERFORMER ORGANIZATION: Research Triangle Institute, Research Triangle Park, NC

TITLE: In Her Own Words: A Focus Group Study of Risk and Protective Factors in Intimate Partner Violence

ABSTRACT: This study was designed to provide insights into how African-American and Caucasian women in urban and rural settings perceive the factors that placed them at risk for an abusive relationship, as well as the factors that protected them from further violence during and after the relationship. The model used as the conceptual framework for the study (Prochaska's and DiClemente's Transtheoretical Model) depicts a sequence of five stages that culminate in lasting behavior change. Twenty-two focus groups were conducted in urban and rural areas in Georgia, Illinois, Pennsylvania, and Oregon. One hundred and sixty-eight women participated in the study, ranging in age from 18 to 60; all had been out of their abusive relationships from 6 months to 24 years. The report finds that (1) the long-term effects of emotional and physical abuse are worse than the actual violence and resulting injuries themselves; (2) a wide range of psychologically and physically abusive acts were described by focus group participants, including abuse not only of themselves but also of children and of pets; (3) most focus group participants concluded that anything could be a trigger to violence, and that this realization was a significant contributor to the terror, fear, and desperation they felt in their relationships; (4) participants agreed that a number of problem behaviors, such as a history of violence at home, extreme charm, possessiveness, and explosive rage, are early warning signs of abuse; and (5) women describe the decision to leave the abusive relationship as the result of a breaking point. The report concludes that this study's findings should be validated in a national telephone survey of women's risk and protective factors for intimate partner violence. (Final report: 135 pages.)

AGENCY SPONSOR: National Center for Injury Prevention and Control

FEDERAL CONTACT: Lynn Short

PHONE NUMBER: (770) 488-4285

PIC ID: 6515

PERFORMER ORGANIZATION: Macro International, Incorporated, Atlanta, GA

TITLE: Linking Research and Public Health Practice: A Review of CDC's Program of Centers for Research and Demonstration of Health Promotion and Disease Prevention

ABSTRACT: In order to advance research in health promotion and disease prevention, the Centers for Disease Control and Prevention (CDC) established a program of university-based Centers for Research and Demonstration of Health Promotion and Disease Prevention. The prevention research center (PRC) program began in 1986 with funding to three universities; in 1996, there were 13 PRCs. This report examines the extent to which the PRC program is providing the public health community with workable strategies to address major public health problems in disease prevention and health promotion. The report finds that (1) by forging links with academia, CDC has created a gateway for access to a cadre of well-trained, university-based researchers who could serve to inform and collaborate with the agency and the public health community regarding health promotion and disease prevention; (2) the PRC has made substantial progress in advancing the scientific infrastructure in support of disease and health promotion policy, programs, and practices; (3) each of the centers has made some contributions toward one or more of the goals of the program (research, dissemination, and developing connections with the community and public health practitioners); (4) there are substantial differences among the PRCs in the kinds of activities they have undertaken and the success realized (only a few have made substantial progress in all areas); and (5) CDC's management of the program has been creative in the face of limited resources relative to its mandate-dogged in pursuing the mandate over a 10-year period in a bureaucratic environment that was not created or structured for the management of university-based research programs, and skilled in enhancing a sense of community and networking among the funded centers in a time of disappointing funding levels. (Final report: 67 pages, plus appendices.)

AGENCY SPONSOR: National Center for Chronic Disease Prevention and Health Promotion

FEDERAL CONTACT: Patricia Riley

PHONE NUMBER: (770) 488-5277

PIC ID: 6535

PERFORMER ORGANIZATION: National Academy of Sciences, Washington, DC

TITLE: Syphilis in the South: A Case Study Assessment in Eight Southern Communities

ABSTRACT: This two-volume report presents the results of a comparative case study of local-level syphilis prevention efforts that are conducted as part of sexually transmitted disease (STD) prevention programs supported by the Centers for Disease Control and Prevention (CDC). The case studies were conducted in eight communities in four Southern States: Alabama, Mississippi, South Carolina, and Tennessee. The project investigated past and current responses of the public and private health sectors to a syphilis epidemic that occurred in the southern United States between 1990 and 1992. Study findings were developed around four key questions: (1) who is at greatest risk of syphilis infection and transmission, (2) what institutions are best able to reach those at greatest risk, (3) what are the barriers to syphilis prevention and control in communities, and (4) what innovative ways have been found to transcend these barriers? The report finds that (1) interviewees perceived African Americans to be the demographic group most at risk for infection and transmission of syphilis, especially those who exchanged sex for drugs, homeless people, and incarcerated individuals; (2) adolescent high-risk sexual behavior was of concern as a possible precursor to infection once practitioners reached their 20s; (3) local health departments are the only community organizations focusing directly on syphilis and other STD control and prevention; (4) public health agencies assigned priority to disease control and engaged in few agency-based prevention activities, and schools were limited in their ability to be venues for STD prevention messages due to the local restrictions on sexually explicit materials in health education curricula; and (5) barriers to those at greatest risk of syphilis infection are cultural, programmatic, and political. Recommendations are offered in a manner designed to allow practical implementation. (Vol. I: 121 pages, plus appendices; Vol. II: 100 pages.)

AGENCY SPONSOR: National Center for HIV, STD and TB Prevention

FEDERAL CONTACT: Janelle Dixon

PHONE NUMBER: (404) 639-8344

PIC ID: 6579

PERFORMER ORGANIZATION: Battelle Corporation, Arlington, VA

TITLE: Evaluation of the Effectiveness of CDC Surveillance for Drug-Resistant Streptococcus pneumoniae (Baltimore, MD)

ABSTRACT: The three aims of this project were to (1) establish population-based surveillance for invasive Streptococcus pneumoniae infection; (2) evaluate the validity of the current Centers for Disease Control and Prevention (CDC) sentinel surveillance system; and (3) identify the optimal methods for determining antimicrobial resistance patterns in the United States. Active, population-based surveillance for invasive pneumococcal infection was established in all hospitals in the Baltimore metropolitan area over a 2-year period. Various additional data collection methods were employed, including bimonthly contact/followup to participating sites to obtain cases not reported spontaneously, yearly laboratory audits to identify cases not reported through active surveillance, and retrospective chart reviews. During the 2-year project period, 1,415 cases were reported: 685 in 1995 and 730 in 1996. Additionally, the contractor conducted two nasopharyngeal culture surveys of 300 children each in 5 pediatric clinics within the Baltimore metropolitan area. Sputum surveys were also conducted in three large Baltimore area hospitals. All data and isolates from the project have been sent to CDC. See also PIC ID Nos. 6580.1 and 6580.2. (Final report: 4 pages.)

AGENCY SPONSOR: National Center for Infectious Diseases

FEDERAL CONTACT: Anne Schuchat

PHONE NUMBER: (404) 639-2215

PIC ID: 6580

PERFORMER ORGANIZATION: Johns Hopkins University, Baltimore, MD

TITLE: Evaluation of the Effectiveness of CDC Surveillance for Drug-Resistant Streptococcus pneumoniae (San Antonio, TX)

ABSTRACT: Five major activities were conducted as part of this study to determine the effectiveness of the Centers for Disease Control and Prevention's (CDC's) current surveillance system for drug-resistant Streptococcus pneumoniae. These activities included (1) active population-based surveillance of invasive pneumococcal isolates in San Antonio and Bexar County, Texas for a period of 2 years; (2) microbiologic studies in which all isolates were submitted to a central laboratory for final identification, storage, and cataloging, and for eventual additional susceptibility testing; (3) microbiologic studies, in which 221 sputum isolates were collected and identified for Streptococcus pneumoniae and antibiotic resistance; (4) period prevalence surveys of non-invasive respiratory isolates; and (5) a case-control study among patients with invasive pneumococcal disease. Additionally, data were entered into appropriate data bases for further analysis at CDC. For example, invasive isolate data were entered into EpiInfo and microbiologic study data were entered into the Public Health Laboratory Information System. Results were disseminated to the community via hospital reports, local meetings, national and State meetings, manuscripts, and newsletters. See also PIC ID Nos. 6580 and 6580.2. (Final report: variously paginated.)

AGENCY SPONSOR: National Center for Infectious Diseases

FEDERAL CONTACT: Anne Schuchat

PHONE NUMBER: (404) 639-2215

PIC ID: 6580.1

PERFORMER ORGANIZATION: University of Texas, Health Science Center, San Antonio, TX

TITLE: Assessment of the Programmatic Impact of One-Percent Evaluation Studies

ABSTRACT: This three-volume report provides a systematic evaluation of the programmatic impact of 1-percent evaluation studies carried out by the Centers for Disease Control and Prevention (CDC) between 1990 and 1995. The study was also designed to elicit information about what the Office of Program Planning and Evaluation could do to enhance the impact of 1-percent evaluation studies. The study resulted in findings in three major areas: (1) the perception at CDC of evaluation in general, (2) the perception at CDC of the 1-percent process in particular, and (3) the programmatic impact to date of 1-percent evaluation studies at CDC. Among the findings were that: (1) although pressure for program accountability is mounting, evaluation still engenders anxiety among some CDC program staff-although these attitudes are changing slowly; (2) program staff are concerned that the 1-percent evaluation process in particular is unpredictable-staff do not know from one year to the next how much 1-percent funding they will receive, and the time allowed between the issuance of 1-percent guidance and the deadline for submissions is perceived as too short; (3) despite numerous obstacles to implementation, nearly 70 percent of the recommendations developed in the evaluation studies examined for this report have been considered for implementation and about 50 percent have been implemented in some form; and (4) CDC evaluations have produced programmatic impact leading to changes in practices and procedures, activities, responsibilities, changes in full-time equivalents, budgets, organizational and administrative structures, and policy. Specific recommendations are made in the report and are arrayed according to project phases (study selection, design, implementation, recommendation, and dissemination stages). See also PIC ID No. 6581.1. (Final report: 69 pages, plus appendices A-E; Appendix F separately bound; Appendices G, H, and I separately bound.)

AGENCY SPONSOR: Office of the Director

FEDERAL CONTACT: Wilma G. Johnson

PHONE NUMBER: (404) 639-7090

PIC ID: 6581

PERFORMER ORGANIZATION: Battelle Corporation, Arlington, VA

TITLE: Directory of Evaluations Administered by the CDC Office of Program Planning and Evaluation 1990-1995

ABSTRACT: This directory is one of the products of a study conducted for the Office of Program Planning and Evaluation (OPPE) of the Centers for Disease Control and Prevention (CDC) entitled "Assessment of the Programmatic Impact of (CDC) One-Percent Evaluation Studies." During a process of reviewing nearly 50 CDC evaluations completed between 1990 and 1995 and about 40 additional studies in various stages of completion, it became apparent that these studies were important to CDC program staff in particular and to the field of public health in general. Many common themes ran through these evaluations: (1) the difficulties of monitoring the performance of public health programs; (2) the growing importance of community outreach and mobilization; (3) the evolving role of health communications in CDC's work; and (4) concerns over the impact of managed care on the public health sector. This directory includes both completed and in-process studies. Project summaries reflect a project's reported status as of August 1995. The volume is arranged according to the study ID number assigned to each project as it is initiated through OPPE. See also PIC ID No. 6581. (Final report: variously paginated.)

AGENCY SPONSOR: Office of the Director

FEDERAL CONTACT: Nancy Cheal

PHONE NUMBER: (404) 639-7095

PIC ID: 6581.1

PERFORMER ORGANIZATION: Battelle Corporation, Arlington, VA

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