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DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR DISEASE CONTROL AND PREVENTION Coordinating Center for Health Information and Service National Center for Health Marketing Board of Scientific Counselors Meeting December 8-9, 2008 Atlanta, Georgia FINAL Record of the Proceedings TABLE OF CONTENTS Page Attachment 1: List of Participants ...........................................................................................A1.1 Attachment 2: Acronyms Used In These Meeting Minutes .....................................................A2.1 Meeting Minutes............................................................................................................................ 1 December 8, 2008 Opening Session..................................................................................................................... 1 Overview of CDC’s Health Promotion Priorities ...................................................................... 2 Overview of NCHM’s Research and Science Review Activities.............................................. 5 NCHM Director’s Report ....................................................................................................... 17 BSC Open Discussion: Session 1......................................................................................... 21 December 9, 2008 BSC Open Discussion: Session 2......................................................................................... 23 Public Comment Session ...................................................................................................... 26 BSC Business Session ......................................................................................................... 26 Closing Session .................................................................................................................... 29 Page A1.1 ATTACHMENT 1 List of Participants BSC Members Dr. Kasisomayajula Viswanath, Chair Dr. David Ahern Dr. Marilyn Aquirre-Molina Dr. Richard Bagozzi Dr. Diana Cassady Dr. Barbara DeBuono Dr. Sonya Grier Ms. Donna Nichols Dr. William Smith Designated Federal Official Dr. Doğan Eroğlu, Associate Director for Science, NCHM CDC Representatives Dr. Tanja Popovic, CDC Chief Science Officer Dr. Steven Solomon, CCHIS Director Dr. Jay Bernhardt, NCHM Director Dr. Katherine Lyon Daniel, NCHM Deputy Director John Anderton Cynthia Baur Joseph Bertulto Diane Brodalski Deron Burton David Clark Erin Edgerton Emily Eisenberg Fred Fridinger Kimberly Gadsen-Knowles Kate Galatas Donna Garland Dawn Griffin Sabrina Harper Wendy Holmes Matthew Jennings Valerie Johnson Margaret Labre Cheryl Lackey Stephen Luce Dionne Mason Diane Manheim Kathleen McDuffie Jeffrey McKenna Jane Mitchko Georgia Moore Janice Nall William Pollard Monica Ponder Christine Prue George Roberts Robin Soler Lynn Sokler James Stephens James Weaver Guest Presenters [via conference call] Vicki Freimuth, University of Georgia Jeffrey Harris, University of Washington Leslie Snyder, University of Connecticut Page A2.1 ATTACHMENT 2 Acronyms Used In These Meeting Minutes AHRQ BSC CBOs CCHIS CDC CHCM COEs DFO DHCM FACA FBOs FOAs HCSOs HHS HMRC NCHM NIH OCSO OMB P.L.A.N.E.T. PSAs RCTs SCCHP SDH — — — — — — — — — — — — — — — — — — — — — — — — Agency for Healthcare Research and Quality Board of Scientific Counselors Community-Based Organizations Coordinating Center for Health Information and Service Centers for Disease Control and Prevention Center for Health Communication and Marketing Centers of Excellence Designated Federal Official Division of Health Communication and Marketing Federal Advisory Committee Act Faith-Based Organizations Funding Opportunity Announcements Health Communication Science Offices Department of Health and Human Services Health Marketing Research Center National Center for Health Marketing National Institutes of Health Office of the Chief Science Officer Office of Management and Budget Cancer Control “Plan, Link, Act Network with Evidence-Based Tools” Public Service Announcements Randomized Controlled Trials Southern Center for Communication, Health and Poverty Social Determinants of Health DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR DISEASE CONTROL AND PREVENTION Coordinating Center for Health Information and Service National Center for Health Marketing BOARD OF SCIENTIFIC COUNSELORS MEETING December 8-9, 2008 Atlanta, Georgia DRAFT Minutes of the Meeting The Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC) Coordinating Center for Health Information and Service (CCHIS) National Center for Health Marketing (NCHM) convened the Board of Scientific Counselors (BSC) meetings. The proceedings were held on December 8-9, 2008 in Building 19 of the Tom Harkin Global Communications Center at the CDC Roybal Campus in Atlanta, Georgia. Opening Session Dr. Kasisomayajula Viswanath, Chair of the BSC, called the proceedings to order at 9:14 a.m. on December 8, 2008. He welcomed the attendees to the NCHM BSC meeting and opened the floor for introductions. The list of participants is appended to the minutes as Attachment 1. Dr. Viswanath noted that NCHM’s activities are extremely critical to advancing public health at both domestic and global levels. To assist NCHM in achieving this goal, he explained that the BSC would develop a vision to strengthen CDC’s health marketing portfolio. He thanked the BSC members for contributing their valuable time and expertise to this important effort. Dr. Jay Bernhardt, Director of NCHM, officially recognized Dr. Doğan Eroğlu, Associate Director for Science in NCHM, in his new role as the Designated Federal Official (DFO) for the BSC. He reminded the BSC members that the role of the DFO is to coordinate all aspects of a federal advisory committee and serve as the point of contact between the government and committee members. Dr. Bernhardt also acknowledged Dr. Kathleen McDuffie, of NCHM, for her outstanding efforts and leadership in establishing the BSC and serving as the former DFO. Dr. Bernhardt pointed out that at the agency level, CDC would continue to leverage the expertise and talent of its scientists, researchers and practitioners to make a public health impact in improving and protecting the lives of individuals, communities and populations. At the National Center level, NCHM would continue to apply solid science and evidence-based NCHM BSC Meeting Minutes December 8-9, 2008 Page 1 research and practice as the cornerstone of its health marketing and health communications activities. He thanked the BSC members for providing NCHM with valuable recommendations and guidance to fulfill its mission, identify priorities and establish future directions. Overview of CDC’s Health Promotion Priorities Dr. Steven Solomon, Director of CCHIS, explained that CDC is currently undergoing a transition in terms of a new Presidential Administration and a new role for public health at the federal level. Most notably, the new HHS Secretary will spend a considerable amount of time and effort focusing on reforming the healthcare delivery system. The new Administration’s emphasis on healthcare delivery will provide extraordinary opportunities for CDC and its federal partners to make a strong case for the need to promote a different concept of managing health in the United States and better understand the role of public health, its interaction with the healthcare system, and its capacity to strengthen disease prevention and health promotion. Expert advice and guidance by the BSC will assist NCHM in reframing CDC’s health marketing and health communications portfolio to focus on individual empowerment and control of health. For example, the health marketing field has dramatically changed over the past four years with new digital devices and other technologies for persons to obtain necessary information in a transparent manner. Moreover, advancements have been made from a hierarchical model of health in which patients previously followed the instructions of physicians, public health departments or other providers to a more participatory model of health in which persons and communities now make informed decisions and exercise control over their individual health. CDC is currently making efforts to determine whether adequately robust scientific evidence is now available or could be gathered in the future to demonstrate that empowering individuals and communities with the ability to control their health through information, knowledge and other tools would result in healthier lives. The BSC will play an important role in helping CDC to convey to the new Administration and the American public that science is now in a position to make society healthier as a whole regardless of the geographic location or size of the community. An important component in achieving this goal will be for CDC to clearly define “communities” in the current environment. In addition to geographical location, “communities” also should be defined based on affiliations, peer relationships and other influences that play a significant role in individuals making choices about their personal behaviors. CDC acknowledges that the BSC and NCHM have a tremendous responsibility in promoting these new concepts within the public health system because the federal government is extremely conservative in nature and has no interest in taking risks. CDC is interested in taking risks at this time by developing new evidence-based models and concepts to empower individuals and communities. CDC is aware that empowerment tools have not been created to date and previous efforts to engage and provide information to the public have been relatively unsuccessful in making measurable differences in individual health. NCHM BSC Meeting Minutes December 8-9, 2008 Page 2 Despite the traditionally conservative nature of the federal government, CDC welcomes the opportunity to embrace “risky” and “cutting-edge” science. Dr. Solomon concluded his overview by asking the BSC to assist CDC in identifying, collecting and appropriately disseminating solid scientific evidence to demonstrate that change, individual decision-making and empowerment could be effective in improving health. He also asked the BSC to encourage CDC to take risks without fear of failure. He was aware that some “risky” and “cutting-edge” programs would be unsuccessful in demonstrating a measurable health benefit. However, he emphasized that the United States would continue to regress rather than progress as a nation in improving health, longevity and quality of life if the same “safe” actions are repeated without taking risks to identify effective cutting-edge programs. Dr. Tanja Popovic, CDC’s Chief Science Officer, explained that the role of the Office of the Chief Science Officer (OCSO) is to focus on scientific quality, relevance, integrity and accountability through internal and external collaboration and partnerships. OCSO primarily provides services to Institutional Review Boards, the Office of Management and Budget (OMB), Paperwork Reduction Act, and oversight of human and animal research. CDC uses its nine BSCs and 15 other types of advisory committees to obtain external guidance and recommendations. CDC recently convened a meeting with the chairs and DFOs of all advisory committees to identify commonalities across groups and discuss the vision of CDC. For example, CDC’s advisory committees have traditionally focused on science, but these groups also must now emphasize the relevance of science to the priorities of CDC and the broader public health community to make a significant health impact. CDC recognizes the need to create new knowledge by gathering evidence to demonstrate the importance of marketing and communication science. CDC also acknowledges the challenges associated with this change due to its historical focus on malaria, infectious diseases, foodborne outbreaks, epidemiology and laboratory research. However, CDC has broadened its public health portfolio over time to include autism, chronic diseases, environmental health and preparedness and emergency response. NCHM is CDC’s focal point in terms of serving customers and collaborating with partners to empower persons to take control over their individual health. However, CDC has been challenged by establishing priorities due to 246 line items in its budget. To address this issue, CDC developed health protection goals in four areas and modified its organizational structure, including the development of NCHM. Efforts have been ongoing over the past four years to increase both internal and external knowledge, understanding and appreciation of NCHM’s valuable contributions to CDC and the broader public health community in the areas of scienceand evidence-based health marketing and communication science. The quality and excellence of CDC’s science, health marketing and communication science are critically important and serve as the foundation for all public health activities throughout the agency. CDC assures its scientific quality through mandatory peer reviews of extramural research, scientific programs, intramural research, communications materials, scientific papers and other documents. CDC also has developed the Excellence in Science Committee with NCHM BSC Meeting Minutes December 8-9, 2008 Page 3 Associate Directors of Science who represent all parts of the agency. CDC allocates ~75% of its budget to >2,500 different grantees through cooperative agreements, grants and other funding mechanisms. CDC has never developed an agency-wide research agenda due to the complexity of its organizational structure with a $10 billion budget and a workforce of 15,000 staff. However, CDC recently drafted its first research agenda that is based on 14 action plans within the four health protection goals. The draft research agenda is only three pages due its focus on the most important public health issues, gaps in these areas, and barriers to accomplishing goals. In addition to creating knowledge, CDC also is attempting to translate science through translation plans. Efforts are underway to include translation language in CDC’s extramural funding opportunity announcements (FOAs), intramural activities and guidance for BSCs. CDC has established a number of indicators to document NCHM’s success. NCHM’s health marketing and communication scientists should publish papers in peer-reviewed scientific journals. NCHM’s scientists should develop scientific manuscripts to be finalists or winners of the Shepard Scientific Award. This honor is awarded each year and is CDC’s highest recognition of scientific excellence. NCHM should play a critical role in strengthening CDC’s partnerships. NCHM’s evidence-based health marketing and communication science and its important contributions to scientific discoveries, health impact and actual practice in the field should be featured on the CDC Web site and other venues. NCHM should be viewed as a critical need among CDC staff, clinicians and the broader public health community. Dr. Popovic concluded her overview by emphasizing the importance of the United States developing a public health system that invests in healthy individuals and assures persons remain healthy. This goal could be achieved by incorporating social and behavioral sciences and broader societal issues, such as poverty and education, into the public health system. CDC will continue its ongoing effort to develop a strong evidence-based business case for health protection and health promotion or prevention. The BSC members made a number of comments and suggestions on CDC’s health promotion priorities. • • • • CDC should serve as the leader in effectively communicating and articulating public health issues to the public. For example, celebrities, web site bloggers and other persons with limited knowledge on the relationship between vaccines and autism and other public health issues continue to provide the public with inaccurate information or convey messages with no scientific evidence basis. CDC should take advantage of existing opportunities at this time to provide leadership in better defining the nexus between the public health system and healthcare delivery system. CDC should explore the opportunity of conducting randomized controlled trials (RCTs) with new scientific models and sufficient sample sizes to show the effect of health marketing and communication science. CDC should use its tremendous leadership and management in HIV community planning as a model to take steps toward engaging communities as true partners in participatory NCHM BSC Meeting Minutes December 8-9, 2008 Page 4 research and other public health activities associated with health marketing and communication science. CDC leadership made a number of remarks in response to the BSC’s comments and suggestions on CDC’s health promotion priorities. Dr. Bernhardt announced that NCHM is engaging new social media and social networks to improve communication on immunization. For example, NCHM produced a video that will be aired on the CDC-TV Web page featuring actual experiences of unvaccinated persons who were adversely affected by or died from influenza. The video serves as an excellent model of NCHM using new technologies, building a strong collaboration with another CDC National Center, and taking a science-based approach to dispel inaccurate public health information that was conveyed to the public from other sources. Drs. Popovic and Solomon agreed with the BSC’s comment that clinical trials could be conducted to gather scientific evidence on health marketing and communication science. However, models and strategies other than clinical trials have been developed to demonstrate the efficacy of public health issues, such as translation to evidence-based practice and the Guide to Community Preventive Services. CDC and the National Institutes of Health (NIH) are currently discussing the need to educate journal editors and members of editorial boards about different approaches to produce scientific evidence. Outcomes from these discussions will be particularly pertinent to NCHM’s health marketing and communication science activities. Dr. Viswanath described the BSC’s next steps in addressing CDC’s health promotion priorities. The BSC would devote a considerable amount of time during the meeting discussing the science of community engagement and information dissemination, scientific evidence to collect in this area, and appropriate goals to establish for this effort. Overview of NCHM’s Research and Science Review Activities Dr. Katherine Lyon Daniel, Deputy Director of NCHM, explained that NCHM’s mission is to develop high-quality research and science; communicate and deliver value to impact the lives of individuals; and protect and promote the health of diverse populations by tailoring and conveying health messages, interventions and products to multiple audiences. NCHM achieves its health marketing goals by using its four divisions to conduct audience and customer research and perform other activities. NCHM’s four divisions also directly collaborate with partner groups, health professionals, customers and the general public. NCHM broadened the traditional scientific model of health marketing by focusing on outcomes and expanding the definition of “customers.” To strengthen health marketing science, NCHM developed materials for ~27 presentations in 2008 and also prepared 63 manuscripts for publication, including 50 journal articles and ten books. NCHM’s goals and strategic priorities are aligned with CDC’s goal to increase the impact of its health marketing sciences. NCHM’s two key strategic priorities are to enhance intramural research and strengthen health marketing activities to reduce health disparities and increase NCHM BSC Meeting Minutes December 8-9, 2008 Page 5 health equity. To achieve these goals, NCHM uses various communication channels and data from research on approaches individuals take to obtain health and medical information. However, NCHM makes every effort to ensure that its health marketing activities are available to persons with no access to digital technologies. NCHM is expanding its strategic and innovative health marketing approaches by adopting and diffusing customer-centric marketing throughout CDC and engaging diverse partners both inside and outside of CDC. NCHM’s senior communications scientists are located in all of CDC’s National Centers to provide health marketing consultation across the agency in a collaborative manner. NCHM also is focusing on its goal to provide consistent and high-quality services and establish strong internal collaborations. The NCHM Director and Deputy Director recently completed a series of discussions with CDC leaders, division directors and senior scientists in other National Centers to describe NCHM’s health marketing portfolio and its potential impact and role in CDC’s other public health activities. Dr. Lyon Daniel concluded her overview by yielding the floor to the NCHM divisions and Principal Investigators of NCHM-funded Centers of Excellence (COEs) to describe their ongoing health marketing and communication activities. Division of Health Communication and Marketing (DHCM). Dr. Cynthia Bauer, Director of DHCM, explained that DHCM’s organizational structure includes the Office of the Director, Community Guide Branch, Emergency Risk Communication Branch, and Marketing and Communication Strategies Branch. DHCM performs secondary data analysis of consumer marketing data and also conducts research on emergency response and pandemic influenza. DHCM’s other activities include co-funding of the health literacy FOA in partnership with NIH and the Agency for Healthcare Research and Quality (AHRQ), leadership on the Community Guide marketing review, and program evaluation. The extraordinary level of innovation and productivity of leadership and staff has resulted in DHCM conducting high-quality research, evaluating programs and developing a strong pandemic influenza communication practice portfolio in only two years. DHCM recently obtained OMB clearance on the revised “Health Message Testing System” that will allow concepts and messages to be tested with multiple questions and methods in a more efficient manner. To date, DHCM has completed >40 different data analyses of pandemic influenza projects for NCHM and Health Communication Science Offices (HCSOs) across CDC. DHCM uses data sets from a variety of sources to perform these data analyses. DHCM is conducting international research on the applicability of Western-derived risk communication principles in other countries. The project is designed to answer two key questions: (1) Are Western-based risk communication principles relevant in China and effective with the Chinese public? (2) Do local health officials incorporate principles into health protection messages after receiving training in risk communication principles from draft guidelines? NCHM BSC Meeting Minutes December 8-9, 2008 Page 6 In terms of emergency response research, DHCM conducts anticipatory activities related to pandemic influenza and is able to be deployed to the field within three to five days of a pending emergency. DHCM established a system to perform media monitoring of pandemic influenza and other emergency response efforts. DHCM also prepares after-action reports to determine the impact of media coverage on an emergency and identify potential revisions to make in this area in the future. DHCM is conducting pandemic influenza formative research on preparedness messages and materials. The overarching goals of the study are to identify effective strategies to disseminate and target research to vulnerable populations and develop a new survey instrument on health protection variables. The key outcomes of the study will be to determine the potential role of social, cultural and environmental determinants in adhering to CDC guidelines and identify population-specific determinants that could actually be leveraged or augmented. The pandemic influenza study has three major areas of focus: (1) public willingness to adopt and adhere to community mitigation strategies; (2) the disproportionate impact of natural disasters on economically, socially and politically vulnerable populations; (3) and the possibility of these populations taking action during a disaster in response to culturally-tailored health messages. The seven populations included in the study were selected based on their distinctive perceptions of pandemic influenza, risk behaviors and preferences in communication sources and channels, and epidemiologically relevant factors associated with increased vulnerability. Participants from at least two distinct locations were chosen for each population group to reduce the potential for geographic bias. The pandemic influenza study was designed with data from organizational interviews, individual in-depth interviews and town hall meetings. Pandemic influenza message research also was conducted with audience testing of informational and educational materials to determine the effectiveness of these materials in providing sufficient and usable information to multiple audiences to perform tasks. The study represents a new approach within CDC of conducting health literacy research to improve understanding in the field of various health literacy issues and the interaction of different factors. Results of the pandemic influenza study will be compiled into a Home Care Guide for persons to care for sick individuals during a pandemic and take other actions based on information outlined in the brochure. DHCM will perform cognitive and in-home utility testing of the Home Care Guide with multiple at-risk populations, including medically underserved individuals, elderly persons, mothers with children