Prioritizing Obesity Strategies    Obesity Integration Steering Committee Meetings                                2.29.12,...
Welcome & ImportanceObesity is:  a Colorado winnable battle top priority of the Prevention Services  DivisionPSD has r...
Obesity Integration Project                       in PSD Purpose: Identify, prioritize, align with CDPHE’s role, and impl...
IntroductionsBriefly state yourNameOrganizationPositionWhat is your biggest hope for this process?
Agenda Review Welcome and Project Purpose Where We Are Now/Recap of Process Where We Are Headed Roles of Committees O...
Where we are now:    A recap of what has been done to dateGabriel Kaplan, PhD, Director, Epidemiology,   Planning, and Eva...
Obesity in Colorado       Prevalence of obesity has doubled in the past 15 years                                          ...
Why use Evidence-BasedPublic Health?Evidence-based public health is a systematic method for identifying and selecting pub...
An Evidence-based Public Health Framework                                                  Step 1             Step 7      ...
Comparing & Overlaying PSD’s EBPH  to OPP’s CHAPs EBPH in PSD          Colorado Health Assessment and Planning System (CHA...
Steps 1 & 2: UnderstandingObesity in Colorado Understand the population Ensure interventions will  maximize benefit to  ...
Step 1: Community AssessmentWhat questions were answered?1.   What are the characteristics of our community?2.   What are ...
Step 2: Quantify the issueWhat questions were answered?Q1. Obesity prevalence, trend, disparitiesQ2. Physical activity pre...
Step 3: Develop a concisestatement of the issue The state health department has been  charged by the governor with develo...
Step 3: Concise Statement The prevalence of obesity in Colorado is increasing,particularly among adults, and the state’s ...
Step 3: Concise Statement Few (1/14) adult workers use active means to commute  to work. Only 1/5 adolescents and childr...
Step 3: Concise Statement Programmatic Issues:The public health challenge of obesity is underfunded.  Obesity results fro...
Step 4: Literature Review Comprehensive Literature Review  Focus on evidence-based public health   strategies to improve...
Step 4: Literature ReviewLiterature Review Process  3 Boot Camps (December 16, 2011 &   January 19, 2012, and February 6...
Step 4: Literature ReviewLiterature Review Process    Task 1: Formulate a search strategy using PICO    Task 2: Search ...
Step 4: Literature Review Systematic reviews (Meta-analysis)                                                             ...
Step 4: Literature Review Typology                       How Established                     Considerations for Level of S...
In a nutshell…Levels ofEvidence in PSD Proven: systematic or narrative reviews; considers study design  and execution, ex...
Step 4: Literature Review ResultsSECTOR               EVIDENCE RATINGSSchools              7 Likely Effective; 2 Promising...
Next Step 5: Prioritization ofEvidence-Based Strategies To be completed by the obesity  integration steering committee K...
Roles of Committees           Karen Trierweiler, MS, CNM      Director, Programs and Services          Prevention Services...
Steering Committee Membership:  sector team leads and other key PSD staff,  state partners, and  local public health p...
Steering Committee Role Review (homework #1) and approve (2nd mtg):  Final summary of community assessment (Step 1) and ...
Steering Committee Role Rank or prioritize strategies (homework #2) Submit recommendations of prioritized strategies to ...
Executive CommitteeMembership: PSD leadership team plus  Representative expert from CDC on   obesity strategies  Repres...
Executive Committee Role        and Responsibilities Non-voting members of the steering committee Review and vet steerin...
Summary of Timeline By 2/29/2012, identify evidence-based strategies toimprove physical activity and promote healthy eati...
How We’ll Get There:Prioritization ProcessWhen               Purpose/ActionsMeeting 1 (2/29)   • Getting Started          ...
Handouts Power Point Project charter (with roster) Final sector reports on strategies Typology of evidence Timeline o...
Questions and AnswersObesity Integration Steering Committee Meetings                            2.29.12, 3.19.12, 4.2.12
Thank You and ClosureOn the index card provided let us know           What is still on your mind? Leave note sheets on ta...
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2.29.2012 Obesity Integration Steering Committee Presentation

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CO Department of Public Health and Environment, Prevention Services Division Obesity Integration Steering Committee Presentation

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  • (If you didn’t say during title slide) I want to welcome everyone to the first of 3 meetings to prioritize evidence-based strategies to address obesity.   I’d like to introduce Andrea Hoaglin, who has been coordinating the logistics and sending emails to everyone on the steering committee.  I’d also like to introduce the external facilitators for the 3 meetings:  Janna West Kowalski and Laurie Schneider from the Center for Public Health Practice at the Colorado School of Public Health.   And Kristin McDermott and Barbara Gabella from EPE are observing today, because they worked on the surveys to get your input in developing the prioritization process.Obesity is a Colorado winnable battle and a priority of the governor.Preventing obesity is the top priority of the Prevention Services Division.PSD has begun an evidence-based approach to this public health problem. PSD has rated the evidence on strategies to increase physical activity and healthy eating to address obesity. .PSD needs your help in prioritizing these evidence-based strategies.
  • Slide 3 (titled Obesity Integration Project in PSD):Purpose: Identify, prioritize, align with CDPHE’s role, and implement evidence-based strategies that prevent obesity. Goal: stop the obesity epidemic Steering committee purpose: prioritize evidence-based strategies by 4/6
  • NOTE: Obesity is a nationwide problem. In Colorado, we have gone from having 1 in 10 obese adults in Colorado to 1 in 5 obese adults. Because of doubling rates of obesity, obesity has become a number one priority of Governor, CDPHE, and PSD. (WINNABLE BATTLE)
  • This slide is “preaching to the choir.” (BG: GK could drop this slide.)NOTE: In 1988, the IOM reported that public health is driven by “crises, hot issues, and concerns of organized interest groups”The IOM report went on to recognize the barriers to conducting EBPH: lack of political will, deficits in research, resources, leadership, competencies, and deficits in relevant and timely research
  • So for our partners from local public health, here is a quick look at the similarities between the two versions of the evidence-based public health approach.
  • NOTE: In this step, we use our population-based data sources such as the Child Health Survey, the Behavioral Risk Factor Surveillance System and other surveys to look at obesity, physical activity, and nutrition in-depth. Screen time
  • NOTE: Using what we learned in steps 1 and 2, we can now frame the PUBLIC HEALTH ISSUE. This is our current state of obesity in Colorado. NOTE: This is subject to change since Renee is finalizing concise statement.
  • NOTE: We have numerous strategies to reduce obesity in Colorado, but the two main strategies are focused on increasing physical activity and promoting health eating.
  • 8 sectors represent settings where we can implement physical activity and healthy eating strategiesDuring boot camps, staff: identified key search terms and developed search strategies to locate relevant systematic reviews, peer-reviewed journal articles, and ‘grey literature’Used standardized tools to critique the findings, systematically abstract key information, and rate evidence strength from emerging to proven strategies.
  • 8 sectors represent settings where we can implement physical activity and healthy eating strategiesPSD program staff from a variety of different backgrounds with experience in different sectorsDuring boot camps, staff: identified key search terms and developed search strategies to locate relevant systematic reviews, peer-reviewed journal articles, and ‘grey literature’Used standardized tools to critique the findings, systematically abstract key information, and rate evidence strength from emerging to proven strategies.
  • BG suggestion: Drop Task 8.Note: Task 8 to assign the state-level implementation score was a qualitative approach to start a conversation about implementation. Because this task was a pilot task, we are not using this score in the prioritization.
  • Then, using the literature review typology, we then go on to assign an evidence rating for each strategy. This rating is based off of both the type of research conducted and the results of that research. One of the handouts today is this typology.EXAMPLES: a systematic review that is over 10 years old is not necessarily proven. A systematic review that shows there is no good evidence is most likely in the emerging category because there simply is not enough information.
  • Then, using the literature review typology, we assigned an evidence rating for each strategy. This rating is based off of both the type of research conducted and the results of that research. Can’t go off the data source alone, need to also consider the results. Background about Typology:Focus of this is on Evidence Based Public Health, not Evidence Based Medicine.Adaptation from the Healthy People 2020 typology with added category “Not Recommended” (To define the “Not Recommended” category, the group borrowed from category I (Insufficient Evidence to Make a Recommendation) and D (Not Recommended) from the U.S. Preventive Services Task Force (#5), as well as our own original ideas)EPE/PSD began integrating this typology in November 2011Typology handout has more information about the classifications. EXAMPLES: a systematic review that is over 10 years old is not necessarily proven. A systematic review that shows there is no good evidence is most likely in the emerging category because there simply is not enough information about the results.
  • Tentative results: Total of 59 strategies for increasing physical activity and healthy eating were identified by 8 sector teams ranging from not recommended to proven.
  • Karen Trierweiler, the Director of Programs and Services in the Prevention Services Division will cover the roles of the Steering Committee and Executive Committee related to prioritization of evidence-based strategies.
  • From: Trierweiler, Karen Sent: Thursday, February 09, 2012 11:06 PMTo: Kaplan, Gabriel; Kapsimalis, Colleen; McDermott, Kristin M.; Hoaglin, AndreaCc: Vahling, Jason L.Subject: Paragraph explaining our Obesity process Per our meeting today, here is my email summarizing the overall goals of our Obesity Integration Project. It is a bit rough so please feel free to edit.  I think this reflects or dissussion today.  Jason, I'd appreciate your review as we extended the implementation timeline a bit based on the MCh experience. Thanks!CDPHE has identified obesity as one of 10 winnable battles for Colorado.  Obesity is also the top priority within the Prevention Services Division and, given the importance of this issue, the Healthy Living and Chronic Disease Branch has begun a planning process to identify evidence-based interventions to address the obesity epidemic.  This effort , entitled the Obesity Integration Project, brought together staff from a variety of different backgrounds and sectors  in a 2-day "Boot Camp" to review relevant literature.  The Obesity Steering Committee, composed of partners, stakeholders and sector team leads, will come together in February and March to review and prioritize the evidence in order to determine the most effective strategies for obesity prevention and control. An Executive Committee, composed of PSD staff will review and approve the Steering Committee's recommendations and refer these strategies to both internal and external partners for implementation.  For those strategies where PSD will assume the lead, implementation teams will be formed to develop logic models and action plans by late Fall. This will allow time for staff to complete the divison's obesity plan as outlined for FY12, while also allowing a transition from one focus area to another, should the evidence dictate that a different strategy should be employed during FY13. This same approach has been successfully employed in implementing the MCH priorities and staff has gradually transitioned some or all of their work from "old" to "new" based on the change in strategy dictated by the evidence review. In some cases, the work remained the same.The Obesity Steering and Executive Committees hope to complete the prioritization process by 4/1/12. At that point, sector teams will be reconvened to discuss next steps in the implementation process. Thanks you for your time and assistance in moving this effort forward.
  • This same approach has been successfully employed in implementing the MCH priorities and staff has gradually transitioned some or all of their work from "old" to "new" based on the change in strategy dictated by the evidence review. In some cases, the work remained the same.The Obesity Steering and Executive Committees hope to complete the prioritization process by 4/1/12. At that point, sector teams will be reconvened to discuss next steps in the implementation process. Thanks you for your time and assistance in moving this effort forward.
  • This same approach has been successfully employed in implementing the MCH priorities and staff has gradually transitioned some or all of their work from "old" to "new" based on the change in strategy dictated by the evidence review. In some cases, the work remained the same.The Obesity Steering and Executive Committees hope to complete the prioritization process by 4/1/12. At that point, sector teams will be reconvened to discuss next steps in the implementation process. Thanks you for your time and assistance in moving this effort forward.
  • Note: first date changed to 2/29
  • 2.29.2012 Obesity Integration Steering Committee Presentation

    1. 1. Prioritizing Obesity Strategies Obesity Integration Steering Committee Meetings 2.29.12, 3.19.12, 4.2.12
    2. 2. Welcome & ImportanceObesity is:  a Colorado winnable battle top priority of the Prevention Services DivisionPSD has rated the evidence on strategies to increase physical activity and healthy eating.Need your help in prioritizing these evidence-based strategies
    3. 3. Obesity Integration Project in PSD Purpose: Identify, prioritize, align with CDPHE’s role, and implement evidence-based strategies that prevent obesity. Goal: stop the obesity epidemic Steering committee purpose: prioritize evidence-based strategies by 4/6
    4. 4. IntroductionsBriefly state yourNameOrganizationPositionWhat is your biggest hope for this process?
    5. 5. Agenda Review Welcome and Project Purpose Where We Are Now/Recap of Process Where We Are Headed Roles of Committees Overview of Timeline and Prioritization Process Closure
    6. 6. Where we are now: A recap of what has been done to dateGabriel Kaplan, PhD, Director, Epidemiology, Planning, and Evaluation Branch, CDPHE
    7. 7. Obesity in Colorado Prevalence of obesity has doubled in the past 15 years 21.4 14.2 10.1Source: 1995 – 2010, Colorado Behavioral Risk Factor Surveillance System; Health Statistics Section, ColoradoDepartment of Public Health & Environment.
    8. 8. Why use Evidence-BasedPublic Health?Evidence-based public health is a systematic method for identifying and selecting public health strategies.  Higher likelihood of a successful program  Greater impact on the population  Reduction in costs (streamline funding)
    9. 9. An Evidence-based Public Health Framework Step 1 Step 7 Step 2 Step 6 Step 3 Logic Model(s)based on Steps 4 & 5 Step 5 Step 4 Slide adopted from presentation by Ross Brownson, PhD (2011)
    10. 10. Comparing & Overlaying PSD’s EBPH to OPP’s CHAPs EBPH in PSD Colorado Health Assessment and Planning System (CHAPS) All steps Phase 1: Plan the Process Steps 1, 5, 6 Phase 2: Engage Stakeholders Steps 1, 2 Phase 3: Assess Community Health (Step 1 or 5) Phase 4: Assess System Capacity Steps 1-3 Phase 5: Prioritize Issues (Step 4) Steps 5 & 6 Phase 6: Create a Local Health Plan (prioritize strategies) Steps 6 & 7 Phase 7: Implement, Monitor, and Communicate the Plan & logic model Outputs from all Phase 8: Inform the Statewide Plan steps
    11. 11. Steps 1 & 2: UnderstandingObesity in Colorado Understand the population Ensure interventions will maximize benefit to communities Identify where to focus resources and interventions
    12. 12. Step 1: Community AssessmentWhat questions were answered?1. What are the characteristics of our community?2. What are barriers to physical activity and healthy eating in our community?3. What is important to the community?4. What are the community’s assets?5. What are the threats to increasing physical activity and healthy eating?6. What are the opportunities for increasing physical activity and healthy eating?7. What are the competencies and capacities of the public health system?8. What are the current activities of the public health system?
    13. 13. Step 2: Quantify the issueWhat questions were answered?Q1. Obesity prevalence, trend, disparitiesQ2. Physical activity prevalence, trend, disparities  Physically inactive  Moderate/vigorous activity  Commuting to work  Physical education class  Sports  Screen timeQ3. Nutrition prevalence, trend, disparities  Fruit/vegetable consumption  Soda, sweets, and fast food consumption
    14. 14. Step 3: Develop a concisestatement of the issue The state health department has been charged by the governor with developing and implementing prevention and control strategies to reduce the obesity prevalence in Colorado. Obesity has been identified as a CDPHE Winnable Battle and is a priority for the Prevention Services Division at CDPHE. Six local public health agencies have identified obesity as a Winnable Battle and priority issue as part of their CHAPS planning process. Additional agencies could follow suit.
    15. 15. Step 3: Concise Statement The prevalence of obesity in Colorado is increasing,particularly among adults, and the state’s population isaging. Over the same period the prevalence of physicalactivity and fruit & vegetable consumption have beenstable among adults.However, the majority of adults, adolescents, andchildren do not meet the recommended levels forweekly physical activity or daily fruit and vegetableconsumption. Too many Coloradans eat and drink high-caloric, low-nutrient, and processed food too often.Older adults are less active than younger adults, butthey eat fruits and vegetables more often.The Hispanic population is increasing, and its membershave a higher prevalence of obesity, lower levels ofphysical activity, and lower fruit & vegetableconsumption than Whites.Females and adults with low income or low educationare less active than their counterparts.
    16. 16. Step 3: Concise Statement Few (1/14) adult workers use active means to commute to work. Only 1/5 adolescents and children have daily PE class. Many children exceed recommendations for screen time. The majority of children eat fast food weekly. Breastfeeding exclusivity at 6 months was below the HP2020 target. Perceived barriers to healthy living include lack of time and money more than lack of access to healthy food or facilities for physical activity. About 1/5 parents report that it is difficult for their child to be active in the local park because it lacks adequate space or equipment.
    17. 17. Step 3: Concise Statement Programmatic Issues:The public health challenge of obesity is underfunded. Obesity results from a complex interplay of various, individual, social, economic, and environmental pressures and incentives. Until now, there has not been a coordinated response to the problem that reaches across state and local government, the nonprofit community, and the private sector. Future vision:PSD Programs and Services will use evidence-based strategies in targeted ways to efficiently and effectively address the obesity epidemic in Colorado. PSD Programs and Services will collaborate and coordinate with partners to implement a multi-faceted approach to the obesity problem, which facilitates addressing the socio- ecological root causes.
    18. 18. Step 4: Literature Review Comprehensive Literature Review  Focus on evidence-based public health strategies to improve physical activity and promote healthy eating in 8 sectors:  Schools  Childcare  Food Systems  Health Systems  Worksites  Community  Media  Built Environment
    19. 19. Step 4: Literature ReviewLiterature Review Process  3 Boot Camps (December 16, 2011 & January 19, 2012, and February 6, 2012)  Over 40 CDPHE program staff participated  Sector Team Lead: Program staff responsible for all sector team deliverables here today as a member of the steering committee EPE Coach: EPE staff responsible for providing technical assistance
    20. 20. Step 4: Literature ReviewLiterature Review Process  Task 1: Formulate a search strategy using PICO  Task 2: Search databases  Task 3: Identify materials to read  Task 4: Critique materials  Task 5: Insert into a Literature Library  Task 6: Rate the literature  Task 7: Assign a summary of evidence rating  Task 8: Assign a state-level implementation score
    21. 21. Step 4: Literature Review Systematic reviews (Meta-analysis) Objective Literature from one or more journal articles Public health surveillance data Program evaluations Qualitative data  Community members  Other stakeholders Media/marketing data Word of mouth Personal experienceSlide modified from presentation by Ross Brownson, PhD (2011) Subjective
    22. 22. Step 4: Literature Review Typology How Established Considerations for Level of Scientific Data Source Examples EvidenceProven Peer review via systematic or Based on study design and execution Community Guide narrative review External validity Cochrane reviews Potential side benefits or harms Narrative reviews based on published Costs and cost-effectiveness literatureLikely Effective Peer Review Based on study design and execution Articles in the scientific literature External validity Research-tested intervention programs Potential side benefits or harms Technical reports with peer review Costs and cost-effectivenessPromising Written program evaluation Summative evidence of effectiveness State or federal government reports without formal peer review Formative evaluation data (without peer review) Theory-consistent, plausible, potentially Conference presentations high-reach, low-cost, replicableEmerging Ongoing work, practice-based Formative evaluation data Evaluability assessments* summaries, or evaluation works in Theory-consistent, plausible, potentially Pilot studies progress high-reaching, low-cost, replicable National Institute of Health (NIH) Face validity research (RePORT database) Projects funded by health foundationsNot Recommended Varies. Evidence of effectiveness is conflicting Varies. and/or of poor quality. Weak theoretical foundation Balance of benefit and harm cannot be established or evidence demonstrates that harm outweighs the benefits.* A pre-evaluation activity that involves an assessment to establish whether or program or policy can be evaluated, what the barriersto its evaluation might be. Source: Adapted from Healthy People 2020 and Brownson RC, Fielding JE, Maylahn CM. Evidence-based Public Health: A FundamentalConcept for Public Health Practices . Annual Review of Public Health. Vol. 30: 175-201
    23. 23. In a nutshell…Levels ofEvidence in PSD Proven: systematic or narrative reviews; considers study design and execution, external validity, body of evidence, and results Likely Effective: peer review articles in scientific literature; considers study design and execution, external validity, body of evidence, and results Promising: written program evaluation without formal peer reviews; considers summative evidence of effectiveness, theory, and formative evaluation data Emerging: ongoing work with little evidence so far, but sound theory and evaluation in place Not Recommended: evidence of effectiveness is conflicting and/or of poor quality and/or suggestive of harm
    24. 24. Step 4: Literature Review ResultsSECTOR EVIDENCE RATINGSSchools 7 Likely Effective; 2 Promising; 5 emerging(Jon Gallegos)Child Care 4 Likely Effective; 3 Emerging; 2 Not(Tracy Miller) RecommendedFood Systems 2 Likely Effective; 3 Promising(Patricia Daniluk)Health Systems 1 Proven; 2 Likely Effective; 1 Promising(Zula Solomon)Worksites 5 Proven; 1 Likely Effective(April Sifford)Media 1 Likely Effective; 2 Promising; 2 Emerging; 1(Stephanie Walton) Not RecommendedCommunity 1 Proven; 5 Likely Effective; 1 Emerging(Lorena Zimmer)Built Environment 5 Likely Effective; 2 Emerging(Jessica Osborne)
    25. 25. Next Step 5: Prioritization ofEvidence-Based Strategies To be completed by the obesity integration steering committee Karen Trierweiler will cover the roles of the  Steering Committee and  Executive Committee
    26. 26. Roles of Committees Karen Trierweiler, MS, CNM Director, Programs and Services Prevention Services Division
    27. 27. Steering Committee Membership:  sector team leads and other key PSD staff,  state partners, and  local public health partners Decision-making process:  60% super majority vote,  one vote per steering committee member  executive committee members do not vote
    28. 28. Steering Committee Role Review (homework #1) and approve (2nd mtg):  Final summary of community assessment (Step 1) and quantifying the issue (Step 2)  Concise statement of the issue (Step 3)  Evidence rating of strategies (Step 4) Develop prioritization process to rank potential strategies  Complete survey on potential criteria (homework #1) Give input on CDPHE’s possible role related to each potential strategy  Complete survey (homework #1)
    29. 29. Steering Committee Role Rank or prioritize strategies (homework #2) Submit recommendations of prioritized strategies to the executive committee. Joint role: Communicate outcomes to CDPHE staff and leadership and to external stakeholders
    30. 30. Executive CommitteeMembership: PSD leadership team plus  Representative expert from CDC on obesity strategies  Representative from obesity control and prevention programmingDecision making process: Consensus
    31. 31. Executive Committee Role and Responsibilities Non-voting members of the steering committee Review and vet steering committee’s recommendations:  Final summary of community assessment and quantifying the issue  Concise statement of the issue  Evidence rating of strategies  Ranked/prioritized strategies Refer strategies to sector teams to develop implementation teams Joint role: Communicate outcomes to CDPHE staff and leadership and to external stakeholders
    32. 32. Summary of Timeline By 2/29/2012, identify evidence-based strategies toimprove physical activity and promote healthy eatingamong all Coloradans. By 4/2/2012, prioritize evidence-based strategies toimprove physical activity and promote healthy eatingamong all Coloradans. During April 2012 through June 30, 2013:implementation and evaluation planning 7/1/2013: PSD starts implementing priority strategies
    33. 33. How We’ll Get There:Prioritization ProcessWhen Purpose/ActionsMeeting 1 (2/29) • Getting Started • Agreements For Moving ForwardBetween Meetings Survey Coming Tomorrow (due 3/9)(e-input) • Review/Provide Input on Proposed Criteria • Identify State Roles for StrategiesMeeting 2 (3/19) • Review/Finalize Criteria9:30am -12:30pm • Clarify Strategies • Clarify State RolesBetween Meetings Prioritization Survey (sent 3/21, due 3/26)(e-input) • Rate Strategies Using Final CriteriaMeeting 3 (4/2) • Share Results of Prioritization9:30am – 12:30pm • Gather Additional Input for Ex Committee
    34. 34. Handouts Power Point Project charter (with roster) Final sector reports on strategies Typology of evidence Timeline of meetings and homework Gathering and Using Input to Inform the Prioritization Process
    35. 35. Questions and AnswersObesity Integration Steering Committee Meetings 2.29.12, 3.19.12, 4.2.12
    36. 36. Thank You and ClosureOn the index card provided let us know What is still on your mind? Leave note sheets on table before you leave For those on the phone: email your responses to: Laurie.schneider@ucdenver.edu

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