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Selected Contributions to Public Health

Environmental and Policy Changes

Examples of achievements are summarized here and regularly updated. Achievements associated with CDC’s Winnable Battles are noted. This term describes public health priorities having large-scale impact on health and for which effective strategies are known.

Obesity Winnable BattleTulane University PRC researchers assessed the promising built environment strategy of creating bicycle lanes to increase physical activity in New Orleans. The city of New Orleans installed its very first on-street bicycle lanes in the spring of 2008, and gave the researchers the unique opportunity to observe and evaluate the before and after effects of this new infrastructure on bicycle ridership. Researchers collected data for 14 days, both 6 months before installing of the bike lanes and 6 months after. They found that the daily average number of adult riders significantly increased—the largest increase was among female adult riders, which more than doubled. The percentage of cyclists riding in the correct direction, with the flow of traffic, also increased from 73% to 82%. After completing the study, the researchers noted a limitation in their study, stating that they had not included observations of a comparison street in the area. In 2010, the researchers, wanting to follow up with more data to show the effect of bicycle lanes, conducted a similar study with the installation of new bicycle lanes on another street in New Orleans. This time, they observed and compared the number of bicycle riders on 3 parallel streets, 1 with bicycle lanes and 2 without, both before and 3 months after installing the bicycle lanes. The results again showed a significant increase in the overall number of people riding bicycles in the neighborhood—the number of riders more than tripled after the bicycle lanes were added. There was a decrease in ridership on the streets without the bicycle lanes, which suggests that some cyclists started using the dedicated bicycle lanes over the non-marked side streets. Researchers discovered that the total cost of the installation of the 2010 bike lanes was less than 1% of the total road resurfacing project. The results from these 2 studies suggest that bike lanes may be a low-cost way to positively affect physical activity and safer streets in diverse urban neighborhoods.

CDC Winnable Battle: Nutrition, Physical Activity, and Obesity

Read journal article abstracts of the first study and the follow-up study (through PubMed).

Tobacco Winnable BattleResearchers from the University of Washington PRC and their partners at health departments in Washington State and Oregon assessed health care costs and smoking rates associated with three tobacco-control strategies for the state of Washington:

  1. A comprehensive tobacco prevention and control program in Washington State (2000-2011);
  2. Washington’s statewide ban on smoking in public places (Initiative 901), in force since late 2005;
  3. Washington’s multiple increases in cigarette taxes, which added $1.20 to the per-pack price from 2000 to 2008.

Data from the Oregon Department of Health had shown that a comprehensive tobacco-control program in Oregon was associated with a decline in smoking from 1997 to 2002 greater than the national rate of decline during the same period. After the program was defunded in 2003, the rate increased, and after program funding was restored in 2007, the rate again declined. In Washington, smoking rates declined from 1990 to 2009. When the impact of the three individual strategies (program, policy, and pricing) was assessed, only the decline associated with the comprehensive program was statistically significant and remained so even after the researchers accounted for a nationwide decline in smoking. In addition, over a period of 10 years (2000–2009), the program saved the state of Washington about $1.5 billion—more than a 5-to-1 return on investment in the program. In January 2012, the Washington State Secretary of Health reported findings from the study in testimony to state legislators considering a state senate bill to increase the tobacco tax and partially re-fund the program.

Update February 2013: Since the completion of the study, there has been an additional $1.00 increase in cigarette pricing per pack. During the 2012 legislative session, available funding was directed to restore a portion of the comprehensive program for one year.

CDC Winnable Battle: Tobacco

Read the journal article reporting these findings.

Harvard University PRC researchers assess the quality of playgrounds in Boston parks and provided their observational data to city leaders. Before the data were shared, playgrounds in low-income areas tended to be renovated at a slightly lower rate than those in other city areas. However, after the playground assessments were shared with city leaders, lower quality playgrounds were more likely to have been renovated than higher quality ones. From an analysis of the city budget, researchers found that collecting and sharing playground quality scores with city leaders can affect whether playground renovation is completed where it is most needed.

Read journal article in which researchers report findings from sharing playground quality assessments.

Obesity Winnable BattleThe PRC at the University of Texas Health Science Center at Houston was part of the research team that created CATCH—the Coordinated Approach to Child Health. This elementary school program is proven effective in producing diet and physical activity improvements that persist into early adolescence. Staff associated with the PRC’s CATCH Program educated policymakers in Texas about the potential of school health programs to influence children’s physical activity and nutrition. The efforts resulted in the development and passage of Senate Bill 19 in 2001 mandating that all elementary schools have a coordinated school health program by 2007. CATCH has been adopted by more than 1,500 schools in Texas and in schools in 7 other states.

CDC Winnable Battle: Nutrition, Physical Activity, and Obesity

Read the case study about CATCH.

HIV/AIDs Winnable BattlesResearch conducted through the University of North Carolina at Chapel Hill PRC found that giving antiretroviral drugs to HIV-infected breastfeeding mothers in sub-Saharan Africa or giving an HIV-fighting syrup to their babies are both effective. In part because of these results, the World Health Organization recommended that HIV prevention guidelines for breastfeeding HIV-infected mothers, who were still in the early stages of HIV infection, be modified to offer them a choice of approaches.

CDC Winnable Battle: HIV prevention

Access an abstract of an article about the research results published (through PubMed).

Update June 2011: A scientific article reporting the research results and published in the New England Journal of Medicine received the 2011 Charles C. Shepard Science Award in the category of prevention and control. This achievement exemplifies what can be achieved through the PRC model—particularly in how it enables CDC researchers to work closely with external researchers.

Obesity Winnable BattleThe Tulane University PRC is a member of and provided technical assistance and data analysis to the Healthy Food Retail Study Group, established by the Louisiana Senate in 2008. The center coordinated the study group and prepared the report that made recommendations for a Louisiana Healthy Food Retail Financing Program, enacted in 2009. The law provides grants and loans to supermarkets, farmers’ markets, and food retailers to make fresh fruits and vegetables available in low-income communities.

CDC Winnable Battle: Nutrition, Physical Activity, and Obesity

Read the policy brief, Healthy Food Retail Act [PDF-437KB], developed by the PRC.

Read the study group’s report [PDF-600KB].

Obesity Winnable BattleThe Saint Louis University (with Washington University) PRC worked with partners in Latin America to develop the Guide for Useful Interventions for Physical Activity (GUIA) by using a process similar to that of the U.S. Guide to Community Preventive Services. The team searched the scientific literature in English, Spanish, and Portuguese for effective physical activity interventions; recommended that school-based physical activity programs be offered to schoolchildren in the Americas; evaluated a citywide (Recife, Brazil) exercise program (Academia da Cidade); and continue to study ways to encourage physical activity among people of all ages. Project GUIA and related work in Latin America produced 20 peer-reviewed scientific publications, including a supplement to the Journal of Physical Activity and Health. Building on this work, researchers from the San Diego PRC are now translating Academia da Cidade for U.S. Latino communities along the Mexico border in California. The San Diego researchers also are working with public health partners in Mexico to produce a resource of interventions, comparable to GUIA, for the Mexican population and Latino communities in the United States.

CDC Winnable Battle: Nutrition, Physical Activity, and Obesity

Read the feature story about GUIA.

Tobacco Winnable BattleThe Internet Cigarette Vendors (ICV) Study (University of North Carolina at Chapel Hill) examined the sales and marketing practices of ICV and their impact on public health and policy issues such as cigarette excise tax evasion and youth access to tobacco. The researchers identified, catalogued, archived, and analyzed more than 2,800 ICV websites. The research brought the regulation of Internet cigarette sales to the attention of many state and federal legislators, and 33 states passed laws regulating Internet and mail order cigarette sales. In 2010, the U.S. Senate cited the ICV Study in its unanimous decision to pass the Prevent All Cigarette Trafficking Act. The act curtails the sale of untaxed cigarettes and other tobacco products over the Internet and bans the delivery of tobacco products through the U.S. mail.

CDC Winnable Battle: Tobacco

Motor vehicle injuries winnable battleResearch and community-capacity building by the University of Iowa PRC resulted in a statewide beer keg registration law, enacted in 2007. A registered keg found at an event where underage youths are drinking, can be traced to the person who purchased it and penalties imposed. The researchers trained community organizations in ten counties to get local ordinances passed, and this grassroots effort led to passage of the statewide law.

CDC Winnable Battle: Motor vehicle injuries

Read the University of Iowa news release about the law.

Read about keg registration at the state of Iowa’s website.

Obesity Winnable BattleIn 2000, the Maine Bureau of Health and the Maine Center for Public Health joined with Harvard University’s PRC to create a new center focusing on the statewide problem of childhood obesity. Research results led to a statewide ban (2007) on advertising of unhealthy snacks on school property. The Harvard-Maine PRC subsequently sponsored statewide conferences that prompted advocacy on legislation requiring calorie labeling on menus of chain restaurants (20 or more establishments; signed into law June 17, 2009).

CDC Winnable Battle: Nutrition, Physical Activity, and Obesity

Read a summary of the law.

A Tulane University PRC intervention reduced exposure to lead-based paint among children in inner-city New Orleans. The researchers used low-cost methods to increase knowledge, use of nutritional supplements, home cleanup, and community involvement. In tandem, the PRC spearheaded the Lead Working Group, convened in February 2000 by the New Orleans Mayor’s Office of Environmental Affairs. The work group evaluated the exposure hazard from dry-sanding exterior leaded paint and drafted legislation regulating the activity. In September 2001, the City Council unanimously passed an ordinance banning dry-sanding of lead-based paint.

Access an abstract about the development of the law (through PubMed).

Global Immunization Over a 5-year period (2004–2009), the University of Michigan PRC supported CDC’s National Immunization Program by conducting rapid studies and reporting timely information to guide immediate and future efforts in child and adult immunization. Four studies conducted each year among health care providers and policymakers informed policy recommendations for new vaccines, strategies to improve immunization coverage, contingency plans for urgent issues, and public health messages to promote immunization.

CDC Winnable Battle: Global Immunization

See a list of publications in which the studies’ results were reported.

Obesity Winnable BattleThe set of five PRCs that collaborate as the Physical Activity Policy Research Network — funded by CDC’s Division of Nutrition, Physical Activity, and Obesity since 2004 — developed developed and published a national research agenda on environmental and policy approaches for promoting physical activity.

CDC Winnable Battle: Nutrition, Physical Activity, and Obesity

Access an abstract of an article about the research agenda (through PubMed).

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