Guide Shows Advocates How to Improve Health: Evidence-Based Recommendations Used to Tackle Health Issues

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Residents of Nebraska and North Carolina are breathing easier these days thanks to indoor smoke-free air laws that recently went into effect in both states. Though separated by time zones and geography, the long road that led to the states' tobacco protections shared a common mile marker: "The Guide to Community Preventive Services."

Developed by the Task Force on Community Preventive Services, the "Community Guide," as it is often called, is a free resource providing evidence-based recommendations about prevention programs and policies that are effective in saving lives and increasing the quality of life. The U.S. Department of Health and Human Services established the task force--an independent, non-federal body--in 1996 to develop the guide to serve as a resource for policy-makers, practitioners, researchers, research funders and other public health decisionmakers searching for evidence-based recommendations and findings that will help them allocate their scarce resources to effective programs and policies. The guide tells users what intervention programs and policies work, how well the interventions work, for whom, where and at what cost.

North Carolina health officials have used the Community Guide "as basically a bible" for community-based and policy interventions, said Walter Shepherd, MA, director of the North Carolina Comprehensive Cancer Program at the North Carolina Division of Public Health and executive director of the North Carolina Advisory Committee on Cancer Coordination and Control. Shepherd credits the Community Guide for contributing to the strategies that led to the passage of North Carolina's smoke-free law, which went into effect Jan. 2 and requires enclosed areas of almost all restaurants and bars to be smoke-free. Smoking is also banned in enclosed areas of hotels, motels and inns if food and drink are prepared there.

"The guide was a very important tool," Shepherd, who is an APHA member, told The Nation's Health. "The evidence shows that smoking bans and restrictions work, and we took it to policy-makers. It is just amazing the progress that has been made. This is a state where just a few years ago members could sit on the floor of the General Assembly and light up a cigarette."

Similarly, Charlotte Burke, MS, RD, manager of the Division of Health Promotion and Outreach at the Lincoln-Lancaster County Health Department in Lincoln, Neb., credits the Community Guide for helping to clear the air in Nebraska, which on June 1, 2009, became the 16th state in the nation to implement a law prohibiting smoking in workplaces, restaurants, bars and gaming establishments. Public health practitioners in Lincoln have used many of the Community Guide's tobacco strategies, "and very successfully," Burke told The Nation's Health.

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"We were not only able to accomplish a very strong smoke-free ordinance in Lincoln, but that was used as a model for the statewide law that went into effect last June," Burke said. "Being able to use the proven strategies from the Community Guide as a basis for our processes certainly was beneficial."

At the heart of the Community Guide are evidence-based recommendations developed from systematic reviews examining what works to promote public health, what does not work, the cost of the intervention and the likely return on investment. The task force--members of which are appointed by the director of the Centers for Disease Control and Prevention--receives technical, scientific and administrative support from CDC. A non-paid body, the task force issues the evidence-based recommendations and findings to the public health community based on the systematic reviews. Community Guide users say the recommendations are valuable because the body of scientific literature on specific health problems can be overwhelmingly large, inconsistent and inaccessible.

"In the old days before the Community Guide and all its wonderful resources were available, you would have to do all the heavy lifting to find out how they came up with that recommendation," Shepherd said. …