The Guide to Community Preventive Services: What Works to Promote Health? by Task Force on Community Preventive Services, edited by Stephanie Zaza, Peter A. Briss, and Kate W. Harris. New York: Oxford University Press; 2005. 506 pages, paperback, $35.00.
The Task Force on Community Preventive Services has compiled a primary resource of techniques that all healthcare professionals can use to improve health, prevent disease, and lower costs. The resource is derived from systematic reviews of thousands of population-oriented health intervention scientific studies. The task force was particularly interested in findings about effectiveness, economics, and feasibility. These reviews produced scientific evidence based on study design and execution. The evidence supports the task force's recommendations for urgent health issues that most threaten a burden of distress and that most offer a broad range of opportunities for interventions. These issues are risky behaviors (eg, tobacco use, physical inactivity, violence); particular health conditions (eg, cancer, diabetes, motor vehicle occupant injury, vaccine-preventable diseases, oral health); and broader social health-determinant elements (eg, education, culturally competent care, housing, care access).
As a complement to the task force's 1996 Guide to Clinical Preventive Services focused on prevention interventions at an individual level, this resource focuses on prevention interventions at healthcare systems' levels. The authors remind readers that the interventional focus is one part of comprehensive program planning. Therefore, readers should consult resources in the areas of assessment, objective setting, intervention selection, and intervention implementation and evaluation. The authors also remind readers that the recommendations summarize or conceptually categorize a number of individual interventions. They do not represent "particular intervention programs." Readers may be in communities, schools, work sites, healthcare organizations, academia, research, and/or government agencies.
Part I presents changing risk behaviors and addresses environmental challenges in the areas of tobacco, physical activity, and social environment. Part II discusses reducing stress, injury, and impairment in the areas of cancer, diabetes, vaccine-preventable disease, oral health, motor vehicle occupant injury, and violence. Part III presents methodological background in the areas of methods used to review evidence and link evidence to recommendations, economic focus, and ongoing research needs.
A methodical pattern presents each topic area in Parts I and II: title page, recommendations from other advisory groups (includes Healthy People 2010 goals and objectives), methods, economic efficiency, recommendations and findings, interventions that are grouped per strategy, summary of published findings for each intervention, use of the recommendations, and conclusion. The authors remind readers that suggested interventions may overlap and serve as recommendations in more than one topic area (eg, physical activity, oral health, and vaccine-preventable disease might collectively fit with a childhood wellness goal).
A helpful "Introduction" section orients the reader to the book, related publications, and the http://communityguide.org Web site. There is a glossary, an appendix that alphabetically lists all recommendations and findings, and an index.
A number of useful tables depict direct relationships between the topic area of the given chapter (eg, social environment, vaccine-preventable diseases, violence prevention) and Healthy People 2010 goals and objectives. Logic frameworks visually illustrate the conceptual approach used in the systematic reviews of interventions. They visualize the broad picture of relationships within the public health context. For example, the logic framework for oral health depicts interventions such as community water fluoridation, school-based sealant delivery systems, community-wide sealant promotion programs, cancer awareness and screening programs, and promoting use of oral protectors in contact sports. Further elements of the framework include modifiable determinants, intermediate outcomes, and reduction in oral disease outcomes. These models depict the various ways that readers might address a problem and select fitting interventions. Analytic frameworks illustrate the more complex picture of "relationships between preventive interventions and outcomes" (p. 433).
In all, this resource text offers interventional recommendations based on a rigorous scientific review process. The task force examined broad and detailed pictures of relationships in multiple arenas to determine its recommendations. The emphasis on health promotion, disease prevention, and economic considerations is timely and applicable for all levels of healthcare systems. The present and the future demand ongoing systematic appraisal and publication of scientific findings to guide an array of stakeholders. Research needs continue to surface in areas such as the sufficiency of evidence, quality of intervention research, and prioritization of research agendas and funding.
Dot Baker, RN, MS(N), CS, EdD
Associate Professor, Nursing, Wilmington College, Georgetown, Del