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Am J Public Health. 2009 September; 99(9): 1576–1583.
PMCID: PMC2724448

Understanding Evidence-Based Public Health Policy

Abstract

Public health policy has a profound impact on health status. Missing from the literature is a clear articulation of the definition of evidence-based policy and approaches to move the field forward. Policy-relevant evidence includes both quantitative (e.g., epidemiological) and qualitative information (e.g., narrative accounts).

We describe 3 key domains of evidence-based policy: (1) process, to understand approaches to enhance the likelihood of policy adoption; (2) content, to identify specific policy elements that are likely to be effective; and (3) outcomes, to document the potential impact of policy.

Actions to further evidence-based policy include preparing and communicating data more effectively, using existing analytic tools more effectively, conducting policy surveillance, and tracking outcomes with different types of evidence.

IT HAS LONG BEEN KNOWN that public health policy, in the form of laws, regulations, and guidelines, has a profound effect on health status. For example, in a review of the 10 great public health achievements of the 20th century,1 each of them was influenced by policy change such as seat belt laws or regulations governing permissible workplace exposures. As with any decision-making process in public health practice, formulation of health policies is complex and depends on a variety of scientific, economic, social, and political forces.2

There is a considerable gap between what research shows is effective and the policies that are enacted and enforced. The definition of policy is often broad, including laws, regulations, and judicial decrees as well as agency guidelines and budget priorities.24 In a systematic search of “model” public health laws (i.e., a public health law or private policy that is publicly recommended by at least 1 organization for adoption by government bodies or by specified private entities), Hartsfield et al.5 identified 107 model public health laws, covering 16 topics. The most common model laws were for tobacco control, injury prevention, and school health, whereas the least commonly covered topics included hearing, heart disease prevention, public health infrastructure, and rabies control. In only 6.5% of the model laws did the sponsors provide details showing that the law was based on scientific information (e.g., research-based guidelines).

Research is most likely to influence policy development through an extended process of communication and interaction.6 In part, the research–policy interface is made more complex by the nature of scientific information, which is often vast, uneven in quality, and inaccessible to policymakers. Several models for how research influences policymaking have been described,79 most of which involve moving beyond a simple linear model to more nuanced and indirect routes of influence, as in gradual “enlightenment.”10 Such nonlinear models of policymaking and decision-making take into consideration that research evidence may hold equal, or even less importance, than other factors that ultimately influence policy, such as policymakers' values and competing sources of information, including anecdotes and personal experience.11 Although not exhaustive, Table 1 highlights several important barriers that should be considered when one is attempting to develop effective policy.1216

TABLE 1
Barriers to Implementing Effective Public Health Policy

Although there have been many calls for more systematic and evidence-based approaches to policy development,5,6,1721 missing from the literature is a clear articulation of the definition of evidence-based policy along with specific approaches that will enhance the use of evidence in policymaking.

TYPES OF EVIDENCE FOR EVIDENCE-BASED POLICY

Policy change involves both science and art and, therefore, evidence for policymaking can take several forms. The concept of evidence often originates from legal settings in Western soceties. In law, evidence comes in the form of stories, witness accounts, police testimony, expert opinions, and forensic science.22 For policy-relevant evidence, both quantitative data (e.g., epidemiological) and qualitative information (e.g., narrative accounts) are important.

Although the use of research-derived evidence may be a key feature of most policy models,7,9,23 it is not a certainty that scientific evidence will carry as much weight in “real world” policymaking settings as other types of evidence. Policymakers operate on a different hierarchy of evidence than scientists,17 leaving the 2 groups to live in so-called parallel universes.14 According to interviews with policymakers, many respondents reported that they were not trained to distinguish between good and bad data, and were, therefore, prone to the influence of misused “facts” often presented by interest groups.24 Similarly, McDonough reported that in policy debates in state legislatures, data were used as “rhetorical weapons used to bolster competing values.”25(p210) Because numbers exert a powerful and widespread influence on policy debates, they can lose their objective meaning.26

Quantitative Evidence

Quantitative evidence for policymaking (i.e., data in numerical quantities) can take many forms, ranging from scientific information in peer-reviewed journals, to data from public health surveillance systems, to evaluations of individual programs or policies.27,28 Many consider the strongest evidence to be that from systematic reviews (e.g., the Guide to Community Preventive Services29 or the Cochrane Reviews30), which sum up the results of primary scientific studies that meet explicit criteria (i.e., decision rules). Using data from reviews of public health laws, Moulton et al. searched the English language literature over the past 5 years. They identified 65 systematic reviews and found that of 52 public health laws, 27 were found effective, 23 had insufficient evidence to judge effectiveness, 1 was harmful, and 1 was found to be ineffective.31 Yet single studies and evaluations are more commonly used to support policy than are systematic reviews,32,33 in part because of the time and expense of conducting a systematic review or the insufficient number or quality of studies on a particular topic.

Other quantitative data can be collected from policymakers themselves to provide general guidance on policy approaches and strategic information on specific public health issues. For example, in a survey of 292 US state policymakers,34 respondents expressed a strong preference for short, easy-to-digest data. Younger respondents were more likely to use electronic information than were older policymakers. The most trusted sources of information were those not having a stake in the outcome and those providing state-by-state comparisons. Surveys of policymakers can provide useful data on priorities and obstacles for specific health issues,35,36 attitudes and voting intentions,37 and perceptions of lobbyists and lobbying.38

Qualitative Evidence

Qualitative evidence involves nonnumerical observations, collected by methods such as participant observation, group interviews, or focus groups. Qualitative evidence can make use of the narrative form as a powerful means of influencing policy deliberations, setting priorities, and proposing policy solutions by telling persuasive stories that have an emotional hook and intuitive appeal. This often provides an anchor for statistical evidence, which, in turn, offers the powerful persuasive impact of the law of large numbers, in addition to being verifiable and having high credibility.39 In studying the impact of evidence on policy to address health disparities, qualitative data, such as the effects of policy initiatives on children and families, has been persuasive and powerful in shaping the agenda.40

The incorporation of quantitative evidence within a compelling story can provide a powerful lever in the policy process. Studies from the communication field have examined the effectiveness of using statistical data versus stories for persuasion. These have shown that, although quantitative evidence alone more frequently has a stronger persuasive effect than qualitative evidence alone,41 the combination of the 2 types of evidence appears to have a stronger persuasive impact than either type of evidence alone.42

POLICY SYSTEMS

Governmental policy systems vary widely in their structure and scope, ranging from totalitarian to democratic governments. We focused the descriptions of evidence-based policy on multicentric (democratic) governments. Whether at a local, state, or federal level, the purpose of a representative body is to enact rules, laws, or ordinances that are in turn implemented by executive or administrative agents. We focused primarily on “big P” policies (e.g., formal laws, rules, regulations enacted by elected officials) as contrasted with “small p” policies (e.g., organizational guidelines, internal agency decisions or memoranda, social norms guiding behavior).43,44

Evidence-based policymaking has largely been an incremental progression.45 For example, tobacco control advocates have long sought comprehensive restrictions on tobacco use, access, and secondhand smoke exposure. However, public policies on these topics were developed over decades. In 1987, the US House of Representatives banned smoking on domestic flights of 2 hours or less; in 1992, Congress passed the Synar Amendment46 requiring states to adopt and enforce restrictions on tobacco sales to minors; in 1996, the US Food and Drug Administration published a final rule that restricted youth access to tobacco products (which was later overturned by the US Supreme Court)47,48; and in the past decade and a half, states and municipal governments have been extremely active in developing laws and regulations aimed at smoke-free worksites and public places.4951

THREE DOMAINS OF EVIDENCE-BASED POLICY

We propose that evidence-based policy can be conceptualized as a continuum spanning 3 domains—process, content, and outcome (Table 2). Furthermore, as discussed earlier, there is no single, “best” type of evidence.

TABLE 2
Domains of Evidence-Based Public Health Policy

Policy Process

Recognizing and identifying key factors that inform the policy process is also critical to furthering evidence-based policy. Policymaking is complicated and the factors that inhibit or facilitate the process are equally complex.17 There are very distinct stages or “streams” as Kingdon noted that, when coupled together, increase the odds of a policy being adopted. The first stream is the problem––agenda setting and how certain problems or conditions come to be regarded as problems worthy of governmental intervention. The second stream is policy––the alternative policy approaches that may be taken to address those problems.4 The third stream, politics, recognizes those factors both inside and outside government that influence the policymaking process. Public policies must be not only “technically sound, but also politically and administratively feasible.”52(p311)

Documenting influential political factors can comprise an evidence base for the process domain of evidence-based policy. Factors such as the national mood, organized political forces (e.g., interest groups, lobbyists), changes in governmental participants such as legislative or administrative turnover, jurisdictional boundaries or turf “wars” between governmental agencies, and the necessity of compromise or bargaining all affect the policy process.4,53 According to numerous accounts, one of the reasons that health care reform legislation failed in the early to mid-1990s was a failure to understand the politics involved with policymaking.4,53 Furthermore, the approach taken by the executive branch at the time was very much a rational, comprehensive approach to policymaking that sought to identify all of the possible alternatives, weigh the costs and benefits of each alternative, and choose the best approach among the alternatives. Proponents of that approach failed to learn from the lessons of past health care reform efforts, which indicated the need for an incremental approach to change rather than aiming for an all or nothing strategy.4,53,54

Many factors affect the policymaking process, including successful advocacy. In the study of social movements, progress hinges on the standing of those articulating an issue and the presence of a policy “sparkplug.”55,56 Case studies show that policy entrepreneurs or champions (i.e., leaders from professional, political, or interest groups who effectively advocate policy) have played key roles in policy reforms, including making major reforms in the historically intractable arena of Chicago, Illinois, public schools57 and the rise of managed care as a dominating force in the US health care system.58 From the health policy field, several authors20,5962 describe successful examples of evidence-based advocacy and provide a guide for those who seek to move from research to advocacy. A strong partnership of researchers and advocates ensures that policies are grounded in science, so messages are tailored to the target audience, and models of persuasive communication (e.g., social marketing) are applied.

Policy Content

Policy content focuses on identifying the specific policy elements that are likely to be effective. As noted earlier, both quantitative and qualitative data can be used by policymakers to determine the appropriate policy intervention. Such information may be gleaned from systematic reviews and other scientific research including content analyses that offer an evidence base to inform decisionmaking.29 For example, the Institute of Medicine has recognized that trans fatty acids (trans fats) do not provide any known health benefit and that they are linked to coronary heart disease.63 One way to reduce or eliminate exposure to trans fats is to regulate their inclusion in food products.64 As of August 2008, 7 US cities or counties had limited or restricted trans fats65,66 and California is the first state to enact a law banning trans fats.66

We need to better understand and describe evidence-based elements within existing or proposed policy. For example, in examining 6.5 years of state legislation on physical education, Eyler67 used systematic reviews and national standards to identify 4 specific bill components that are scientifically supported (i.e., minutes in physical education, physical education activity, teacher certification, and an environmental element including facilities and equipment).6870 Eyler conducted a content analysis and found that 28% of state laws had at least 1 evidence-based element yet only 0.5% had all 4 evidence-based elements.67

Policy Outcome

Documenting the effects of implemented policies (policy outcome) is equally important in supporting evidence-based policy. Policy evaluations are critical to the understanding of the impact of policies on community- and individual-level behavior changes. They should include “upstream” (e.g., presence of zoning policies supportive of physical activity), “midstream” (e.g., the enrollment in walking clubs), and “downstream” (e.g., the rate of physical activity) factors.71 By far, the majority of quantitative measures are available for downstream outcomes.71 One evaluation framework, the RE-AIM framework,72 can be applied to evaluations of a policy and its impact.73 RE-AIM has 5 dimensions: (1) reach (who or how many will be affected by the policy), (2) effectiveness (proximal or distal impacts and unintended consequences), (3) adoption (policy diffusion and participation level), (4) implementation (costs as well as enforcement and compliance), and (5) maintenance (institutionalizing the policy or program).

Policy evaluations may employ both qualitative and quantitative methodologies and may make use of “natural experiments” surrounding the adoption and implementation of the policy. These evaluations involve naturally occurring circumstances where different populations are exposed or not exposed to a potentially causal factor (e.g., a new policy) such that it resembles a true experiment in which study participants are assigned to exposed and unexposed groups. For example, scientific evidence led to the change in polio vaccination policy in the United States from that of an entirely oral poliovirus vaccine prior to 1997, to a schedule of inactivated poliovirus vaccine followed by oral poliovirus vaccine in 1997 through 1999, to a schedule of entirely inactivated poliovirus vaccine in 2000. When the policy changed from oral poliovirus vaccine only to inactivated poliovirus vaccine followed by oral poliovirus vaccine, the mean number of cases of vaccine-associated paralytic poliomyelitis declined by 54%. Since the conversion to an entirely inactivated poliovirus vaccine schedule in 2000, no cases of vaccine-associated paralytic poliomyelitis have been reported in the United States.74

Feedback Among the Domains

Making public policy is a continuous or recursive process that relies heavily upon scientific evidence and other influences (Figure 1).75,76 Scientific evidence that examines the impact of public policies on systems and individual-level behavior change is one possible source of feedback. “Policy reinvention” is another step in the feedback loop—i.e., policies evolve as they diffuse.77 The development and diffusion of smoke-free air laws in states and municipalities in the United States began with restricting smoking to designated areas, followed by restricting smoking to separately ventilated and separately enclosed areas, and, in the past several years, to complete bans on smoking.50,51

FIGURE 1
The interplay of factors influencing evidence-based public health policy.

In addition, how the policy issue is framed is as important as the process and content. As Jewell and Bero recently noted, research-based evidence

must be packaged to incite and persuade, to translate that knowledge into something that is understandable by the average legislator, average citizen.24(p196)

For example, efforts to ban or restrict the content of vending machines in schools did not mobilize until the issue was framed in a way such that vending machines were considered a vector for risk factors and behaviors that may be linked to obesity (such as the relationship between soft drink consumption and childhood overweight and obesity).24 The feedback and framing processes are enhanced by partnerships among researchers, practitioners, and policymakers.

A WORKING DEFINITION TO MOVE THE DEBATE FORWARD

This short review of the nature of evidence-based policy sets the stage for 6 issues that will help in advancing the field, organized across the 3 domains of process, content, and outcome. Although the list that follows is not exhaustive, it involves the themes that we believe are among the highest priorities. Building on our review and past literature,32,33,78 we propose the following working definition: to improve public health outcomes, evidence-based policy is developed through a continuous process that uses the best available quantitative and qualitative evidence.

Process Issues

Prepare data for quick and proactive dissemination.

Seneca, a philosopher in ancient Rome, noted that “luck is what happens when preparation meets opportunity.”79 This notion applies to modern-day policymaking. Luck and timing undoubtedly play important roles in policy success and we know that scientific studies are not always conducted at the right time to influence policy decisions.80,81 For success in the process, one often needs to proactively analyze and assemble data so that evidence is ready when a policy window or opportunity emerges.82,83

Seek new ways of communicating data.

Although it is well established that data can be powerful in shaping policy decisions,84 they are sometimes not in the form most useful for policymakers.85 One study of long-term care policymaking indicated “loud and clear, that academic-quality research is not reaching” policymakers.86(p320) For example, surveillance data often provide disease or risk factor data at the national or state level, yet these reports can be lengthy and are often lacking local-level data on health disparities.87 Data need to be in a form that (1) shows public health burden, (2) demonstrates priority of an issue over many others, (3) shows relevance at the local (voting district) level, (4) shows benefits (or sometimes harms88) from an intervention, (5) personalizes an issue by telling a compelling story of how peoples' lives are affected,14 and (6) estimates the cost of intervention. Such data need to be presented in short and concise formats (e.g., issue briefs) that directly address the issue that is being debated.

Content Issues

Identify the elements that lead to evidence-based policy.

On the basis of credible evaluations, it is possible to sift apart the “active ingredients” of various policy interventions (i.e., the essential elements that contribute to effectiveness). Thus, the content of legislation can be developed based on the key elements that are likely to have the greatest public health impact, balancing effectiveness and population impact. This is the concept underpinning model legislation, yet even when model language exists, it is often lacking a scientific basis or has not been widely tested.5

Effectively use existing tools.

A diverse and rich set of tools puts information at the fingertips to shape the content of evidence-based policy. These tools include meta-analysis, decision analysis, cost-effectiveness analysis, and simulation modeling; all are underutilized.89,90 The existence of the tool alone is not enough; often training and technical assistance are needed to enhance uptake among potential users.

Outcome Issues

Develop systems for policy surveillance.

To examine the adoption, implementation, and impact of evidence-based policy, we need systems in place to help us monitor patterns and trends in policies.9193 A few early efforts are underway to develop public health policy surveillance systems. For example, a group of federal and volunteer-based agencies have developed policy surveillance systems for tobacco, alcohol, and, more recently, school-based nutrition and physical education.9497

Rely upon numerous forms of evidence for tracking outcomes.

Evidence comes in numerous forms. It may be helpful to consider policy evidence in a typology rather than a hierarchy because adherence to a strict hierarchy of study designs may reinforce an “inverse evidence law” by which interventions most likely to influence whole populations (e.g., policy change) are least valued in an evidence matrix emphasizing randomized designs.98,99 In addition, policy outcomes can be monitored with triangulated methods (accumulation of evidence from a variety of sources to gain insight into a particular topic, often combining quantitative and qualitative data) to understand content and track progress. Successful monitoring of outcomes will also require sources beyond the usual public health data sets (e.g., tax revenue data, polling data, marketing information).

CONCLUSION

Policy has had, and will continue to have, a vast impact on our daily lives and on public health indicators in part because of its long-term effects and relative low cost. Many of the public health programs now being implemented have a significant focus on policy change. To improve these programs and to further evidence-based policy, we need to use the best available evidence and expand the role of researchers and practitioners to communicate evidence packaged appropriately for various policy audiences; to understand and engage all 3 streams (problem, policy, politics) to implement an evidence-based policy process; to develop content based on specific policy elements that are most likely to be effective; and to document outcomes to improve, expand, or terminate policy.

Governments spend significant sums on health-related research (about $30 billion annually in the United States) with the implied obligation that this investment will improve the health of the public. Better application of the tenets of evidence-based policy is likely to accelerate this improvement.

Acknowledgments

This work was funded through the National Institutes of Health (grant NCI 1R01CA124404-01) and the Centers for Disease Control and Prevention, Prevention Research Centers Program (contract U48/DP000060).

Human Participant Protection

No approval was required.

References

1. Centers for Disease Control and Prevention Ten great public health achievements–United States, 1900-1999. MMWR Morb Mortal Wkly Rep 1999;48:241–243 [PubMed]
2. Spasoff RA. Epidemiologic Methods for Health Policy. New York, NY: Oxford University Press; 1999
3. Anderson JE. Public Policymaking. Boston, MA: Houghton Mifflin Company; 2006
4. Kingdon JW. Agendas, Alternatives, and Public Policies. New York, NY: Addison-Wesley Educational Publishers Inc; 2003
5. Hartsfield D, Moulton AD, McKie KL. A review of model public health laws. Am J Public Health 2007;97(Suppl 1):S56–S61 [PMC free article] [PubMed]
6. Black N. Evidence based policy: proceed with care. BMJ 2001;323:275–279 [PMC free article] [PubMed]
7. Rutten A, Luschen G, von Lengerke T, et al. Determinants of health policy impact: a theoretical framework for policy analysis. Soz Praventivmed 2003;48:293–300 [PubMed]
8. Davies H, Nutley S, Walter I. Assessing the Impact of Social Science Research: Conceptual, Methodological and Practical Issues. St Andrews, Scotland: Research Unit for Research Utilisation, School of Management, University of St Andrews; 2005
9. Schmid T, Pratt M, Witmer L. A framework for physical activity policy research. J Phys Activ Health 2006;3(Suppl 1):S20–S29
10. Weiss CH. Research for policy's sake: the enlightenment function of social research. Policy Anal 1977;3:531–547
11. Lomas J. Connecting research and policy. ISUMA: Can J Policy Res 2000;1:140–144
12. Innvaer S, Vist G, Trommald M, Oxman A. Health policy-makers' perceptions of their use of evidence: a systematic review. J Health Serv Res Policy 2002;7:239–244 [PubMed]
13. Anderson LM, Brownson RC, Fullilove MT, et al. Evidence-based public health policy and practice: promises and limits. Am J Prev Med 2005;28(Suppl 5):226–230 [PubMed]
14. Brownson RC, Royer C, Ewing R, McBride TD. Researchers and policymakers: travelers in parallel universes. Am J Prev Med 2006;30:164–172 [PubMed]
15. McGinnis JM. Does proof matter? Why strong evidence sometimes yields weak action. Am J Health Promot 2001;15:391–396 [PubMed]
16. Terris M. Epidemiology as a guide to health policy. Annu Rev Public Health 1980;1:323–344 [PubMed]
17. Choi BC, Pang T, Lin V, et al. Can scientists and policy makers work together? J Epidemiol Community Health 2005;59:632–637 [PMC free article] [PubMed]
18. Davis P, Howden-Chapman P. Translating research findings into health policy. Soc Sci Med 1996;43:865–872 [PubMed]
19. Rychetnik L, Wise M. Advocating evidence-based health promotion: reflections and a way forward. Health Promot Int 2004;19:247–257 [PubMed]
20. Friedlaender E, Winston F. Evidence based advocacy. Inj Prev 2004;10:324–326 [PMC free article] [PubMed]
21. Steinberg EP, Luce BR. Evidence based? Caveat emptor! Health Aff (Millwood) 2005;24:80–92 [PubMed]
22. McQueen DV. Strengthening the evidence base for health promotion. Health Promot Int 2001;16:261–268 [PubMed]
23. Tugwell P, Bennett KJ, Sackett DL, Haynes RB. The measurement iterative loop: a framework for the critical appraisal of need, benefits and costs of health interventions. J Chronic Dis 1985;38:339–351 [PubMed]
24. Jewell CJ, Bero LA. “Developing good taste in evidence”: facilitators of and hindrances to evidence-informed health policymaking in state government. Milbank Q 2008;86:177–208 [PMC free article] [PubMed]
25. McDonough JE. Using and misusing anecdote in policy making. Health Aff (Millwood) 2001;20:207–212 [PubMed]
26. Stone D. Policy Paradox. The Art of Political Decision Making. Rev ed. New York, NY: WW Norton & Co; 2002
27. Brownson R, Fielding J, Maylahn C. Evidence-based public health: a fundamental concept for public health practice. Annu Rev Public Health 2009;30:175–201 [PubMed]
28. Chambers D, Kerner J. Closing the gap between discovery and delivery. Presented at: Dissemination and Implementation Research Workshop: Harnessing Science to Maximize Health; March 26, 2007; Rockville, MD
29. Zaza S, Briss PA, Harris KW, editors. , eds The Guide to Community Preventive Services: What Works to Promote Health? New York, NY: Oxford University Press; 2005
30. The Cochrane Collaboration Available at: http://www.cochrane.org. Accessed September 4, 2008
31. Moulton AD, Mercer SL, Popovic T, et al. The scientific basis for law as a public health tool. Am J Public Health 2009;99:17–24 [PMC free article] [PubMed]
32. Davies P, Newcomer K, Soydan H. Government as structural context for evaluation. In: Shaw I, Greene J, Mark M, editors. , eds The Sage Handbook of Evaluation. Thousand Oaks, CA: Sage; 2006:163–183
33. Segone M, editor. , ed Bridging the Gap. The Role of Monitoring and Evaluation in Evidence-Based Policy Making. Geneva, Switzerland: UNICEF, the World Bank, and the International Development Evaluation Association; 2008
34. Sorian R, Baugh T. Power of information: closing the gap between research and policy. When it comes to conveying complex information to busy policy-makers, a picture is truly worth a thousand words. Health Aff (Millwood) 2002;21:264–273 [PubMed]
35. Davis JR, Kern TG, Perry MC, Brownson RC, Harmon RG. Survey of cancer control attitudes among Missouri state legislators. Mo Med 1989;86:95–98 [PubMed]
36. DeRoeck D. The importance of engaging policy-makers at the outset to guide research on and introduction of vaccines: the use of policy-maker surveys. J Health Popul Nutr 2004;22:322–330 [PubMed]
37. Goldstein AO, Cohen JE, Flynn BS, et al. State legislators' attitudes and voting intentions toward tobacco control legislation. Am J Public Health 1997;87:1197–1200 [PMC free article] [PubMed]
38. Cohen JE, Goldstein AO, Flynn BS, et al. State legislators' perceptions of lobbyists and lobbying on tobacco control issues. Tob Control 1997;6:332–336 [PMC free article] [PubMed]
39. Lindsey LLM, Ah Yun K. Examining the persuasive effect of statistical messages: a test of mediating relationships. Commun Stud 2003;54:306–321
40. Whitehead M, Petticrew M, Graham H, Macintyre SJ, Bambra C, Egan M. Evidence for public health policy on inequalities: 2: assembling the evidence jigsaw. J Epidemiol Community Health 2004;58:817–821 [PMC free article] [PubMed]
41. Allen M, Preiss RW. Comparing the persuasiveness of narrative and statistical evidence using meta-analysis. Commun Res Rep 1997;14:125–131
42. Allen M, Bruflat R, Fucilla R, et al. Testing the persuasiveness of evidence: combining narrative and statistical forms. Commun Res Rep 2000;17:331–336
43. Milio N. Glossary: healthy public policy. J Epidemiol Community Health 2001;55:622–623 [PMC free article] [PubMed]
44. Schmid TL, Pratt M, Howze E. Policy as intervention: environmental and policy approaches to the prevention of cardiovascular disease. Am J Public Health 1995;85:1207–1211 [PMC free article] [PubMed]
45. Lindblom CE. The science of muddling through. Public Adm Rev 1959;19(Spring):79–88
46. Synar Amendment, Pub L No. 102–321, §1926 (1992)
47. FDA v Brown & Williamson Tobacco Corp, (98–1152); 0529 US 120 (2000)
48. US Food and Drug Administration Regulations restricting the sale and distribution of cigarettes and smokeless tobacco to protect children and adolescents. Final Rule 21 CFR §801 et seq (1996). [PubMed]
49. Centers for Disease Control and Prevention State smoking restrictions for private-sector worksites, restaurants, and bars–United States, 1998 and 2004. MMWR Morb Mortal Wkly Rep 2005;54:649–653 [PubMed]
50. Centers for Disease Control and Prevention State smoking restrictions for private-sector worksites, restaurants, and bars–United States, 2004 and 2007. MMWR Morb Mortal Wkly Rep 2008;57:549–552 [PubMed]
51. Shelton DM, Alciati MH, Chang MM, et al. State laws on tobacco control—United States, 1995. MMWR CDC Surveill Summ 1995;44(SS-6):1–28 [PubMed]
52. Sallis JF, Cervero RB, Ascher W, Henderson KA, Kraft MK, Kerr J. An ecological approach to creating active living communities. Annu Rev Public Health 2006;27:297–322 [PubMed]
53. Galvin R. The surprising optimist: why Tom Daschle believes that the country is ready for comprehensive health reform. Interview by Robert Galvin. Health Aff (Millwood) 2006;25:w26–w33 [PubMed]
54. Johnson H, Broder DS. The System: The American Way of Politics at the Breaking Point. Boston, MA: Little Brown and Company; 1996
55. Benford RD, Snow DA. Framing processes and social movements: an overview and assessment. Annu Rev Sociol 2000;26:611–639
56. Economos CD, Brownson RC, DeAngelis MA, et al. What lessons have been learned from other attempts to guide social change? Nutr Rev 2001;59(3 Pt 2):S40–S56;discussion S57–S65. [PubMed]
57. Lieberman JM. Three streams and four policy entrepreneurs converge: a policy window opens. Educ Urban Soc 2002;34:438–450
58. Oliver TR. Policy entrepreneurship in the Social Transformation of American Medicine: the rise of managed care and managed competition. J Health Polit Policy Law 2004;29(4–5):701–733; discussion 1005–1019 [PubMed]
59. Carlisle S. Health promotion, advocacy and health inequalities: a conceptual framework. Health Promot Int 2000;15:369–376
60. Chapman S, Lupton D. The Fight for Public Health. Principles and Practice of Media Advocacy. London, UK: BMJ Publishing Group; 1994
61. Wallack L, Dorfman L, Jernigan D, Themba M. Media Advocacy and Public Health: Power for Prevention. Newbury Park, CA: Sage; 1993
62. Selig WK, Jenkins KL, Reynolds SL, Benson D, Daven M. Examining advocacy and comprehensive cancer control. Cancer Causes Control 2005;16(Suppl 1):61–68 [PubMed]
63. Institute of Medicine Carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids. In: Dietary Reference Intakes for Energy. Washington, DC: The National Academies Press; 2002 [PubMed]
64. Gostin LO. Law as a tool to facilitate healthier lifestyles and prevent obesity. JAMA 2007;297:87–90 [PubMed]
65. National Conference of State Legislatures Trans fat and menu labeling legislation. Available at: http://www.ncsl.org/programs/health/transfatmenulabelingbills.htm. Accessed August 20, 2008
66. Steinhauer J. California bars restaurant use of trans fats. New York Times. July 26, 2008. Available at: http://www.nytimes.com/2008/07/26/us/26fats.html?emc=rss&partner=rssnyt. Accessed March 9, 2009
67. Eyler A. How common is evidence-based state physical education legislation? Paper presented at: Prevention Research Centers Annual Program Meeting; March 26, 2008; Atlanta, GA.
68. Hoehner CM, Soares J, Perez DP, et al. Physical activity interventions in Latin America: a systematic review. Am J Prev Med 2008;34:224–233 [PubMed]
69. Kahn EB, Ramsey LT, Brownson RC, et al. The effectiveness of interventions to increase physical activity. A systematic review. Am J Prev Med 2002;22(4 Suppl):73–107 [PubMed]
70. National Association for Sport and Physical Education Moving Into the Future: National Standards for Physical Education. Reston, VA: McGraw-Hill; 2004
71. McKinlay JB. Paradigmatic obstacles to improving the health of populations—implications for health policy. Salud Publica Mex 1998;40:369–379 [PubMed]
72. Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health 1999;89:1322–1327 [PMC free article] [PubMed]
73. Jilcott S, Ammerman A, Sommers J, Glasgow RE. Applying the RE-AIM framework to assess the public health impact of policy change. Ann Behav Med 2007;34:105–114 [PubMed]
74. Alexander LN, Seward JF, Santibanez TA, et al. Vaccine policy changes and epidemiology of poliomyelitis in the United States. JAMA 2004;292:1696–1701 [PubMed]
75. Green LW. Public health asks of systems science: to advance our evidence-based practice, can you help us get more practice-based evidence? Am J Public Health 2006;96:406–409 [PMC free article] [PubMed]
76. Sterman JD. Learning from evidence in a complex world. Am J Public Health 2006;96:505–514 [PMC free article] [PubMed]
77. Hays SP. Patterns of reinvention. Policy Stud J 1996;24:551–566
78. Kohatsu ND, Robinson JG, Torner JC. Evidence-based public health: an evolving concept. Am J Prev Med 2004;27:417–421 [PubMed]
79. Seneca quotes Available at: http://thinkexist.com/quotes/seneca/2.html. Accessed June 22, 2009
80. Foltz AM. Epidemiology and health policy: science and its limits. J Ambul Care Manage 1986;9:75–87 [PubMed]
81. Foxman B. Epidemiologists and public health policy. J Clin Epidemiol 1989;42:1107–1109 [PubMed]
82. Greenlick MR, Goldberg B, Lopes P, Tallon J. Health policy roundtable—view from the state legislature: translating research into policy. Health Serv Res 2005;40:337–346 [PMC free article] [PubMed]
83. Huston AC. From research to policy and back. Child Dev 2008;79:1–12 [PubMed]
84. Fielding JE, Frieden TR. Local knowledge to enable local action. Am J Prev Med 2004;27:183–184 [PubMed]
85. McBride T, Coburn A, Mackinney C, Mueller K, Slifkin R, Wakefield M. Bridging health research and policy: effective dissemination strategies. J Public Health Manag Pract 2008;14:150–154 [PubMed]
86. Feldman PH, Nadash P, Gursen M. Improving communication between researchers and policy makers in long-term care: or, researchers are from Mars; policy makers are from Venus. Gerontologist 2001;41:312–321 [PubMed]
87. Gold M, Dodd AH, Neuman M. Availability of data to measure disparities in leading health indicators at the state and local levels. J Public Health Manag Pract 2008;14(Suppl):S36–S44 [PubMed]
88. Freudenberg N, Bradley SP, Serrano M. Public health campaigns to change industry practices that damage health: an analysis of 12 case studies [published online ahead of print December 12, 2007]. Health Educ Behav 2009;36(2):230–249 [PubMed]
89. Colditz GA, Emmons KM, Vishwanath K, Kerner JF. Translating science to practice: community and academic perspectives. J Public Health Manag Pract 2008;14:144–149 [PubMed]
90. Kerner JF, Guirguis-Blake J, Hennessy KD, et al. Translating research into improved outcomes in comprehensive cancer control. Cancer Causes Control 2005;16(Suppl 1):27–40 [PubMed]
91. Committee on Prevention of Obesity in Children and Youth Preventing Childhood Obesity. Health in the Balance. Washington, DC: The National Academies Press; 2004
92. McGowan A, Schooley M, Narvasa H, Rankin J, Sosin DM. Symposium on public health law surveillance: the nexus of information technology and public health law. J Law Med Ethics 2003;31(4 Suppl):41–42 [PubMed]
93. Spangler KJ, Caldwell LL. The implications of public policy related to parks, recreation, and public health: a focus on physical activity. J Phys Act Health 2007;4(Suppl 1):S64–S71 [PubMed]
94. Chriqui JF, Frosh MM, Brownson RC, et al. Measuring Policy and Legislative Change. Evaluating ASSIST: A Blueprint for Understanding State-Level Tobacco Control. Bethesda, MD: National Cancer Institute; 2006
95. Masse LC, Chriqui JF, Igoe JF, et al. Development of a Physical Education-Related State Policy Classification System (PERSPCS). Am J Prev Med 2007;33(4 Suppl):S264–S276 [PubMed]
96. Masse LC, Frosh MM, Chriqui JF, et al. Development of a School Nutrition-Environment State Policy Classification System (SNESPCS). Am J Prev Med 2007;33(4 Suppl):S277–S291 [PubMed]
97. National Institute on Alcohol Abuse and Alcoholism Alcohol Policy Information System. Available at: http://alcoholpolicy.niaaa.nih.gov. Accessed August 31, 2008
98. Nutbeam D. How does evidence influence public health policy? Tackling health inequalities in England. Health Promot J Aust 2003;14:154–158
99. Ogilvie D, Egan M, Hamilton V, Petticrew M. Systematic reviews of health effects of social interventions: 2. Best available evidence: how low should you go? J Epidemiol Community Health 2005;59:886–892 [PMC free article] [PubMed]

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