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The Value of Prevention Research Centers: Breaking New Ground in Prevention Research

  • Daniel S. Blumenthal
    Affiliations
    American College of Preventive Medicine, Washington, District of Columbia

    Department of Community Health and Preventive Medicine, Morehouse School of Medicine, Atlanta, Georgia
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  • Gary Raskob
    Correspondence
    Address correspondence to: Gary Raskob, PhD, University of Oklahoma Health Sciences Center, 801 Northeast 13th Street, Room 139, P.O. Box 26901, Oklahoma City OK 73126-0901
    Affiliations
    Association of Schools and Programs of Public Health, Washington, District of Columbia

    College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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      Established in 1986 with the funding of three centers, the Centers for Disease Control and Prevention’s (CDC’s) Prevention Research Centers (PRC) Program has pushed university-based research in directions that it might not otherwise have taken. By 2009, when the PRC Program had reached its peak strength of 37 centers (later reduced to 26), these new emphases had also influenced research at universities that did not have a PRC and at other federal funding agencies. The PRCs have had a major impact on research across the country in several ways.
      First, the PRC Program put a new emphasis on prevention research in community settings. Historically, NIH, the largest federal funder of research, has primarily promoted basic science research—new discoveries at the molecular and genetic level. Pharmaceutical companies are the largest overall funders of research and they, of course, focus on new curative drugs. But health status is largely determined by lifestyle
      • Mokdad A.H.
      • Marks J.S.
      • Stroup D.F.
      • Gerberding J.L.
      Actual causes of death in the United States, 2000.
      and social determinants.
      • Marmot M.
      Social determinants of health inequalities.
      Prevention has the potential to save more lives and reduce healthcare expenditures as compared with treatment of disease, but it has historically played a minor role in most universities’ research portfolios. Prevention research has been a priority at schools of public health, but not in the national research establishment. The PRCs have been key in helping move prevention research to a more prominent emphasis in the national portfolio.
      Second, the PRC Program has given prominence to addressing health disparities in ways that have not been the case elsewhere. Perhaps it is not coincidental that the Secretary’s Report on Black and Minority Health,
      U.S. DHHS, Task Force on Black and Minority Health
      Report of the Secretary’s Task Force on Black and Minority Health.
      the first government document calling attention to health disparities, was published the same year that the PRC Program was created. Now, by focusing their work largely on underserved minority communities, PRCs are conducting research that has great potential for reducing and eventually eliminating disparities. Though achieving equity in medical care is important, it is prevention that can have the biggest impact toward achieving equity in health.
      Third, the PRCs have uniquely advanced the cause of conducting research with communities, rather than “on” or “in” communities—that is, community-based participatory research. In such research, the community, or community representatives, play an equal role with the university research team in identifying the research question, developing the methods, conducting the study, and analyzing and disseminating the results. Through such community engagement, it is more likely that effective interventions will be sustained and disseminated in the community. Moreover, a community empowered as a full partner in prevention research may go on to address additional determinants.
      Between the founding of the PRC Program and the present, the number of publications identified on PubMed using the search term community-based participatory research has increased from 0 to more than 600 every year since 2013—a cumulative total exceeding 4,500 in the PubMed database. Although many of these studies did not originate in PRCs, the PRC Program has been a leader in the field, establishing community-based participatory research as a preferred approach to research across the centers. The PRC Program has a National Community Committee, comprising representatives from the community boards of all centers. In the past, the National Community Committee presented selected centers with awards for conducting outstanding community-based participatory research. Further, taking a cue from the PRC Program, NIH has made “community engagement” an integral part of its Clinical and Translational Science Award Program; each of the 64 Program Hubs is asked to include community engagement as a component of its Program.
      Fourth, PRCs have modeled collaboration among institutions to achieve “wholes that are more than the sums of their parts.” Through a set of Thematic Research Networks, groups of three to eight PRCs collaborate to address a single health issue. There are currently seven Thematic Networks studying cancer, epilepsy, obesity, cognitive impairment, global health, physical activity, and workplace health. Previously, CDC has supported Thematic Research Networks that addressed oral health, tobacco use prevention, school health, women’s health, healthy aging, and cardiovascular health.
      Fifth, PRCs serve as a bridge among academic institutions and state and local health departments as well as with other community institutions, such as medical practices, community health centers, and social service agencies. Historically, there has been a gulf between academia and health departments, which has prevented research findings from being translated rapidly (or at all) into practice. But PRCs typically conduct much research in partnership with health departments and are able to see their findings translated into public health practice where new prevention strategies can have an impact on the health of the public.
      In summary, the PRC Program has provided a sound, evidence-based platform for health promotion and disease prevention and has been successful in translating research findings into community-based practice and policy. It has led the way in creating partnerships with communities and in addressing health disparities.
      In 1997, when there were nine PRCs, CDC commissioned the Institute of Medicine (now known as the National Academy of Medicine) to conduct an evaluation of the Program. In that evaluation, the Institute of Medicine committee articulated a vision for the PRCs in which it made three main points
      Institute of Medicine, Committee to Review the CDC Centers for Research and Demonstration of Health Promotion and Disease Prevention
      :
      • 1
        “Increasing numbers of researchers are recognizing the importance … of community involvement in the conduct of health research—that is, setting the research goal or question, developing community-appropriate methodology, interpreting results, and disseminating findings. Through the PRC program, CDC could lead the way in generating needed knowledge about this new community-based approach to research.”
      • 2
        “CDC could use the PRC program as a way to build capacity for public health practice outside its Atlanta headquarters.”
      • 3
        “CDC could use the PRC program as a way to work with disadvantaged communities on critical public health problems.”
      Vision statements are by definition aspirational and often beyond reach. The Institute of Medicine’s vision for the PRCs, however, has largely been achieved. Perhaps it is time for a new vision statement, one that will inspire the PRCs to reach even further.

      Acknowledgments

      This publication is a product of the Prevention Research Centers Program at the Centers for Disease Control and Prevention. The findings and conclusions in this publication are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
      This work was funded in part by Centers for Disease Control and Prevention grant 5U48DP000049 (Prevention Research Center) to Morehouse School of Medicine. The Centers for Disease Control and Prevention had no role in the writing of the report.
      No financial disclosures were reported by the authors of this paper.

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