Measuring infrastructure: A key step in program evaluation and planning

TL;DR: The ultimate purpose of the evaluation in any field, including in medical education, is to look for the anticipated change, whether it has happened or not.

TL;DR: Barriers and facilitators to program sustainability among state tobacco control programs are identified and discussed. The study advances understanding of program sustainability capacity and technical assistance for public health programs.

TL;DR: A four-component organization transformation model that incorporates transformation pillars, transformation strategies, organization capacity, and organization outputs and outcomes is described.

Abstract: Community violence intervention and prevention (CVI) programs aim to reduce gun violence and its associated harms through community-driven strategies. Programs’ long-term sustainability is challenged by inconsistent and insufficient funding, however, which can be detrimental to the individuals who depend on these services as they navigate recovery from a violent injury. As states explore new funding mechanisms, Medicaid reimbursement has emerged as a viable option, however little implementation guidance exists specific to this policy option in the CVI context. This study combines the implementation science and public health infrastructure literatures with data from a recent multistate case study (n = 17 key stakeholder interviews) to produce a readiness assessment for funding CVI through Medicaid. The readiness assessment is organized by the stages of the EPIS (Exploration-Preparation-Implementation-Sustainment) framework and provides tangible guidance to states looking to improve their CVI infrastructure. The assessment includes recommendations that reflect key challenges and facilitators of implementation, as dictated by those who have recently navigated this process. Given the urgency of reducing gun violence and its harms, this study underscores the importance of structured policy planning to enhance CVI program viability and sustainability. This study contributes to the growing implementation science and public health infrastructure literatures by offering a theoretically grounded and evidence-informed tool to support policymakers in establishing sustainable funding mechanisms for CVI.

TL;DR: To assess progress toward the Healthy People 2020 target of reducing the proportion of U.S. adults aged ≥18 years who smoke cigarettes to ≤12.0% (objective TU-1.1), the CDC analyzed data from the 2016 National Health Interview Survey (NHIS) and found that the prevalence of current cigarette smoking among adults was 15.5%, which was a significant decline from 2005 but no significant change has occurred since 2015.

TL;DR: A conceptual framework that explicates the relationships among the various components of the public health system is an essential step toward providing a science base for the study of public healthSystem performance.

TL;DR: Although the prevalence of cigarette smoking among youth decreased significantly from the late 1990s to 2003, the rate of decline has slowed in recent years, and several factors may have contributed, including smaller annual increases in the retail price of cigarettes, decreased exposure among youth to effective mass media tobacco control campaigns, and less funding for comprehensive statewide tobacco control programs.