Public health program capacity for sustainability: a new framework.

BACKGROUND: Public health programs can only deliver benefits if they are able to sustain activities over time. There is a broad literature on program sustainability in public health, but it is fragmented and there is a lack of consensus on core constructs. The purpose of this paper is to present a new conceptual framework for program sustainability in public health. METHODS: This developmental study uses a comprehensive literature review, input from an expert panel, and the results of concept-mapping to identify the core domains of a conceptual framework for public health program capacity for sustainability. The concept-mapping process included three types of participants (scientists, funders, and practitioners) from several public health areas (e.g., tobacco control, heart disease and stroke, physical activity and nutrition, and injury prevention). RESULTS: The literature review identified 85 relevant studies focusing on program sustainability in public health. Most of the papers described empirical studies of prevention-oriented programs aimed at the community level. The concept-mapping process identified nine core domains that affect a program's capacity for sustainability: Political Support, Funding Stability, Partnerships, Organizational Capacity, Program Evaluation, Program Adaptation, Communications, Public Health Impacts, and Strategic Planning. Concept-mapping participants further identified 93 items across these domains that have strong face validity-89% of the individual items composing the framework had specific support in the sustainability literature. CONCLUSIONS: The sustainability framework presented here suggests that a number of selected factors may be related to a program's ability to sustain its activities and benefits over time. These factors have been discussed in the literature, but this framework synthesizes and combines the factors and suggests how they may be interrelated with one another. The framework presents domains for public health decision makers to consider when developing and implementing prevention and intervention programs. The sustainability framework will be useful for public health decision makers, program managers, program evaluators, and dissemination and implementation researchers.

Perceptions of personal risk about smoking and health among Bosnian refugees living in the United States.

More than 60% of Bosnian refugees in the United States may be current smokers. Examining health beliefs can provide insight into smoking behaviors in this community. Four hundred ninety-nine Bosnians were interviewed about health beliefs and personal health risks related to smoking. ANOVA was used to compare current, former, and never smokers. General health beliefs were significantly different by smoking status with medium effect sizes (P < .001; η(2) = 0.04-0.06); current smokers were less likely to agree that smokers live shorter lives and that smokers are more likely to get heart disease. Significant differences with large effect sizes (P < .001; η(2) = 0.11-0.29) were found in perception of personal risk of lung cancer and heart disease among current, former, and never smokers. Current smokers perceived their own health risks as less severe than those of other smokers. High smoking rates and smokers' optimism related to health indicate that culturally tailored educational and cessation interventions are needed for Bosnian refugee communities.

The best practices: use of the guidelines by ten state tobacco control programs.

BACKGROUND: The Best Practices for Comprehensive Tobacco Control Programs by the Centers of Disease Control and Prevention was the first national resource to define the nine required components of a comprehensive state tobacco control program. This evaluation examined how states used the guidelines in their program planning, and identifies strengths and weaknesses of the guidelines. METHODS: During 2002-2003, data were collected and analyzed from ten state tobacco control programs on familiarity, funding, and use of the guidelines. Data were collected via written surveys and qualitative interviews with key tobacco control partners in the states. The typical number of participants interviewed was 17, representing an average of 15 agencies per state. RESULTS: Lead agencies and advisory agencies were the most familiar with the guidelines, while other state agencies were less aware of the guidelines. Participants' prioritization of the nine components was closely related to the lead agencies' estimated category expenditures. Three states modified the guidelines to develop more-tailored frameworks. Major strengths of the guidelines included providing a basic program framework and state-specific funding recommendations. The guidelines did not address implementation strategies or tobacco-related disparities, and had not been updated with current evidence-based research. CONCLUSIONS: The guidelines are important recommendations for state tobacco control programs. To continue to be useful to states, the guidelines need to be updated to address implementation and tobacco disparities, and include additional evidence-based examples. Active dissemination of updated guidelines needs to be increased beyond typical consumers to other tobacco control partners such as coalitions and other state agencies.