From Evidence-Based Implementation Guides to Meaningful Action: Public Health Practitioners Use Readiness Assessments to Build Bridges to Successful Community Prevention Implementation.

Readiness has been cited as a determining factor in whether a community can effectively implement, support, and sustain an initiative. Through readiness assessments and technical assistance, public health practitioners can be the bridge between the gap of reaching goals outlined in Healthy People 2030, or another funder's guides, and actionable, successful, implementation. Readiness assessments are practical tools for implementing change in public health. Here we discuss three readiness assessment activities that we developed for four Texas counties: a partnership mapping tool, an Ease and Impact score, and a round table discussion. Through the assessments, we ascertained both readiness and the relevance of Policy, Systems and Environment opportunities. We used readiness assessments to translate our funder's implementation guide to meet the needs of four counties. Data allowed us to determine whether communities were ready to move forward with minimal technical assistance, needed further assessment to better understand relevance and feasibility within the community to implement the initiative, or whether this opportunity was not a good fit at the time. We adapted readiness tools based on components of the R = MC2 framework so we could assess the readiness (motivation [M]; general organizational capacity [C]; and innovation-specific capacities [C]) of the participant groups and based on that assessment, we provided appropriate, tailored technical assistance. Public health practitioners and local supporters can use readiness tools and technical assistance to build a bridge from implementation guide(s) to effective community program implementation.

From Practice to Publication: The Promise of Writing Workshops.

Practitioners in health departments, university extension programs, and nonprofit organizations working in public health face varied challenges to publishing in the peer-reviewed literature. These practitioners may lack time, support, skills, and efficacy needed for manuscript submission, which keeps them from sharing their wisdom and experience-based evidence. This exclusion can contribute to literature gaps, a failure of evidence-based practice to inform future research, reduced ability to educate partners, and delays in advancing public health practice. Our article describes the writing workshops offered to Division of Nutrition, Physical Activity, and Obesity (DNPAO), Centers for Disease Control and Prevention (CDC) funded programs in 2021. This project consisted of three 60-minute introductory writing webinars open to all recipients, followed by a Writing for Publications workshop, an 8- to 9-week virtual learning/writing intensive for selected writing team applicants. The Society for Public Health Education staff, consultants, and CDC/DNPAO staff developed, refined, and presented the curriculum. The workshop for public health practitioner writing teams was offered to two cohorts and included extensive coaching and focused on potential submission to a Health Promotion Practice supplement, "Reducing Chronic Disease through Physical Activity and Nutrition: Public Health Practice in the Field" (see Supplemental Material), which was supported by CDC/DNPAO. We describe the webinars, the workshop design, modifications, evaluation methods and results.

A Media Campaign to Increase Health Care Provider Assistance for Patients Who Smoke Cigarettes.

Although most smokers visit a health care provider annually, only half report being provided evidence-based assistance with quitting, defined as brief counseling and an offer of medication. The New York State Department of Health designed a provider-targeted media campaign to increase provider-assisted quitting, which was implemented in 2016. Messaging focused on the addictive nature of tobacco products and evidence-based interventions. Online surveys of 400 New York State health care providers measured advertising awareness, associations between awareness and assistance with quit attempts, and perceptions that patients expect providers to assist with quitting. Forty-three percent of providers were aware of at least 1 advertisement, and providers who had seen an advertisement were more likely to provide evidence-based assistance (AOR = 2.55, P = .01), which includes recommending or prescribing cessation medications. Provider-targeted media is a promising approach to reach health care providers and encourage evidence-based smoking cessation treatment.

State tobacco control expenditures and tax paid cigarette sales.

This research is the first nationally representative study to examine the relationship between actual state-level tobacco control spending in each of the 5 CDC's Best Practices for Comprehensive Tobacco Control Program categories and cigarette sales. We employed several alternative two-way fixed-effects regression techniques to estimate the determinants of cigarette sales in the United States for the years 2008-2012. State spending on tobacco control was found to have a negative and significant impact on cigarette sales in all models that were estimated. Spending in the areas of cessation interventions, health communication interventions, and state and community interventions were found to have a negative impact on cigarette sales in all models that were estimated, whereas spending in the areas of surveillance and evaluation, and administration and management were found to have negative effects on cigarette sales in only some models. Our models predict that states that spend up to seven times their current levels could still see significant reductions in cigarette sales. The findings from this research could help inform further investments in state tobacco control programs.

State Tobacco Control Program Implementation Strategies for Smoke-Free Multiunit Housing.

Multiunit housing residents are at risk of secondhand smoke exposure from adjoining units and common areas. We developed this case study to document state-level strategies undertaken to address this risk. We explored program documents to identify facilitators, barriers, and outcomes. Three states (Montana, Michigan, and Nebraska) provided detailed information on multiunit housing efforts in the study time frame. We conducted a qualitative analysis using inductive coding to develop themes. Several facilitators relating to existing infrastructure included traditional and nontraditional partnerships, leadership and champions, collecting and using data, efficient use of resources, and strategic plans. We also report external catalysts, barriers, and outcomes. Significant state leadership and effort were required to provide local-level technical assistance to engage traditional and nontraditional partners. Information needs were identified and varied by stakeholder type (i.e., health vs. housing). States recommend starting with public housing authorities, so they can become resources for affordable and subsidized housing. These lessons and resources can be used to inform smoke-free multiunit housing initiatives in other states and localities.

Measuring infrastructure: A key step in program evaluation and planning.

State tobacco prevention and control programs (TCPs) require a fully functioning infrastructure to respond effectively to the Surgeon General's call for accelerating the national reduction in tobacco use. The literature describes common elements of infrastructure; however, a lack of valid and reliable measures has made it difficult for program planners to monitor relevant infrastructure indicators and address observed deficiencies, or for evaluators to determine the association among infrastructure, program efforts, and program outcomes. The Component Model of Infrastructure (CMI) is a comprehensive, evidence-based framework that facilitates TCP program planning efforts to develop and maintain their infrastructure. Measures of CMI components were needed to evaluate the model's utility and predictive capability for assessing infrastructure. This paper describes the development of CMI measures and results of a pilot test with nine state TCP managers. Pilot test findings indicate that the tool has good face validity and is clear and easy to follow. The CMI tool yields data that can enhance public health efforts in a funding-constrained environment and provides insight into program sustainability. Ultimately, the CMI measurement tool could facilitate better evaluation and program planning across public health programs.

Strategies to Support Tobacco Cessation and Tobacco-Free Environments in Mental Health and Substance Abuse Facilities.

We identified and described strategies for promoting smoking cessation and smoke-free environments that were implemented in Oregon and Utah in treatment centers for mental illness and substance abuse. We reviewed final evaluation reports submitted by state tobacco control programs (TCPs) to the Centers for Disease Control and Prevention and transcripts from a call study evaluation. The TCPs described factors that assisted in implementing strategies: being ready for opportunity, having a sound infrastructure, and having a branded initiative. These strategies could be used by other programs serving high-need populations for whom evidence-based interventions are still being developed.

Trends in Quit Attempts Among Adult Cigarette Smokers - United States, 2001-2013.

What is already known on this topic? Quitting smoking is beneficial to health at any age, and cigarette smokers who quit before age 35 years have mortality rates similar to those of persons who never smoked. What is added by this report?During 2001­2010, the proportion of adult cigarette smokers who had made a quit attempt in the past year increased significantly in 29 states and the U.S. Virgin Islands. During 2011­2013, the proportion who had made a quit attempt increased in Hawaii and Puerto Rico and decreased in New Mexico. In 2013, the proportion who had made a quit attempt ranged from 56.2% (Kentucky) to 76.4% (Puerto Rico and Guam) with a median of 65.9%, and was generally lower in older age groups. What are the implications for public health practice? Continued implementation of effective evidence-based public health interventions can reduce the health and costs impacts of smoking-related disease and death and accelerate progress toward meeting the Healthy People 2020 target to increase to ≥80% the proportion of U.S. adult cigarette smokers who made a quit attempt in the past year. These interventions include increasing the price of tobacco products, implementing comprehensive smoke-free laws, conducting educational mass media campaigns, and providing insurance coverage for all effective cessation treatments as well as access to quitlines.

The component model of infrastructure: a practical approach to understanding public health program infrastructure.

Functioning program infrastructure is necessary for achieving public health outcomes. It is what supports program capacity, implementation, and sustainability. The public health program infrastructure model presented in this article is grounded in data from a broader evaluation of 18 state tobacco control programs and previous work. The newly developed Component Model of Infrastructure (CMI) addresses the limitations of a previous model and contains 5 core components (multilevel leadership, managed resources, engaged data, responsive plans and planning, networked partnerships) and 3 supporting components (strategic understanding, operations, contextual influences). The CMI is a practical, implementation-focused model applicable across public health programs, enabling linkages to capacity, sustainability, and outcome measurement.

Developing Your Evaluation Plans: A Critical Component of Public Health Program Infrastructure.

A program's infrastructure is often cited as critical to public health success. The Component Model of Infrastructure (CMI) identifies evaluation as essential under the core component of engaged data. An evaluation plan is a written document that describes how to monitor and evaluate a program, as well as how to use evaluation results for program improvement and decision making. The evaluation plan clarifies how to describe what the program did, how it worked, and why outcomes matter. We use the Centers for Disease Control and Prevention's (CDC) "Framework for Program Evaluation in Public Health" as a guide for developing an evaluation plan. Just as using a roadmap facilitates progress on a long journey, a well-written evaluation plan can clarify the direction your evaluation takes and facilitate achievement of the evaluation's objectives.

The environmental assessment instrument: harnessing the environment for programmatic success.

This article describes the Environmental Assessment Instrument (EAI), a tool designed to help public health professionals analyze and then engage the environment in which programs operate. The prevailing environment is an important force that must be considered in an integrated systems approach when implementing programs and policies. The Division of Oral Health of the Centers for Disease Control and Prevention developed the EAI to facilitate the ability of a state oral health program to understand their environment and the impact it has on the achievement of performance objectives. EAI results are plotted on a four-quadrant grid that depicts four types of change-stagnant, disruptive, continuous, and sporadic. General strategies are suggested based on these categories of change. By assessing environmental influences, program and policy planners can determine salient leverage points within their environment, identify strategies to address barriers to success, and build on supportive features in the environment.