Center Uses Partnerships to Broaden its Public Health Impact | Brown School at Washington University in St. Louis
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Center Uses Partnerships to Broaden its Public Health Impact

Public Health; Research

Although the Brown School’s Center for Public Health Systems Science tackles a wide variety of research, its two decades of nationwide success can be traced largely to a single element: collaboration. The center’s largest current project, ASPiRE, is a good example. The $11.6 million tobacco-control effort with teams from Stanford and the University of North Carolina draws on the expertise of academic and community partners around the U.S.

Funded by the National Cancer Institute, ASPiRE (Advancing Science & Practice in the Retail Environment) examines how changes in tobacco retail density and policy could reduce tobacco marketing, limit access to tobacco products, and reduce disparities in tobacco-related health effects. The team works closely with a Community Advisory Board (CAB) comprised of tobacco control practitioners in 30 big U.S. cities.

Although smoking rates have dropped significantly in recent decades, it’s still a major threat to public health. “Tobacco use remains the number one preventable cause of death,” said Douglas Luke, director of CPHSS and the Irving Louis Horowitz Professor of Social Policy at the Brown School. “It’s the most heavily marketed product in the world. ASPiRE’s mission is to research policies and practices at the point of sale, and we’re starting to fill this critical evidence gap. If anybody can walk down to their corner store and easily purchase tobacco products, that’s a bad thing for public health in this country.”

That corner-store scenario is the basis for “Tobacco Town,” the ASPiRE research project at the Brown School led by Luke; Ross Hammond, Betty Bofinger Brown Associate Professor; and Todd Combs, the associate director of CPHSS who manages the project. The research team is using a computer model to estimate the impact of retail policy changes in the 30 U.S. cities partnering with ASPiRE. The models will be tailored to reflect the special characteristics of each city, and could allow communities to tailor retail tobacco control policies to meet the specific demands of their communities.

Including students in ASPiRE’s work has been a priority. “We’re investing in tomorrow’s researchers,” said Combs, assistant research professor. One is Emma Zijlstra, a first-year MPH student and a masters research fellow at the Brown School who’s been working with Combs. She has been completing literature reviews and helping with the quantitative data analysis of surveys of smokers.

“We have a lens of health equity with whatever we do in Tobacco Town,” she added. “Health disparities are very easy to see in the epidemiology of tobacco use, where retailers are located, and where advertising primarily affects racial minorities.” Zijlstra, from Murfreesboro, Tennessee, had been interested in tobacco since she worked with the Tennessee Department of Public Health and experienced youth-led anti-tobacco campaigns. “The Brown School’s focus on social justice and health equity really set it apart from other programs for me,” she said. Her work with ASPiRE was a perfect fit, she said, and will be useful in achieving her career goal of working for a public health policy research firm.

CPHSS is also home to ASPiRE’s Dissemination and Implementation Core, led by Laura Brossart, assistant director for communications & dissemination at the center. The core is responsible for translating ASPiRE’s research and delivering it in useful ways to tobacco-control practitioners, policymakers, and the general public. “We’ve produced more than 200 unique resources, including retail density fact sheets that map the locations of tobacco retailers in the 30 ASPiRE big cities,” Brossart said. That work helped the core score big national attention for ASPiRE last year when it collaborated with the Campaign for Tobacco-Free Kids to publicize the center’s research. Media appearances during the campaign reached over 3 million viewers.

The density fact sheets helped tobacco control advocates in Denver pass new policies, including a new buffer zone limiting tobacco sales near schools. "The Denver fact sheet was just what I needed to be able to give local decision-makers digestible information about retail tobacco,” said CAB member Terry Rousey, Youth Tobacco Policy Specialist with the State Tobacco Education and Prevention Partnership.

Luke founded CPHSS in 2001 at Saint Louis University as the Center for Tobacco Policy Research, then moved to Washington University in 2008. The Center changed its name in 2012 to reflect its broader mission. “From the beginning, our work was a mix of research and evaluation, but over time we started moving beyond tobacco control,” Luke said. “Our focus is on policy to create lasting change; implementation science, to put research findings into practice; and systems science, to target the complex systems where public health problems arise. Other centers do bits of each of those buckets, but our sweet spot is the intersection of those things.”

Other major projects for CPHSS include:

  • Translational Sciences Benefits Model. A collaboration with the Institute of Clinical and Translational Sciences at the School of Medicine, the model is a new framework developed to measure the real-world impact of research.
  • User Guides for tobacco control. Funded by the Centers for Disease Control and Prevention, this series of widely-used guides provides evidence-based strategies and practical guidance for communities working to decrease tobacco use.
  • Sustainability assessment tools. These free online tools and associated trainings help programs and clinical practices rate their capacity for sustainability and develop action plans to help sustain their programs over time.
  • Tobacco 21 Ohio. CPHSS is collaborating with an Ohio-based health foundation to evaluate its work to raise the legal age for the purchase of tobacco to 21. The evaluation focuses on the model policy passed in Cincinnati.
  • Past work has included a wide range of local and national projects, including the evaluation of an innovative program by the Missouri Foundation for Health to combat obesity; and a multi-state evaluation of Best Practices for Comprehensive Tobacco Control Programs.

Luke said the availability of a wide range of expertise enables CPHSS to extend its impact in a variety of public health fields. “We have an embarrassment of riches in terms of policy experts here at the Brown School,” he said. “We have powerful tools to help shape policies on violence, physical activity, obesity and infectious disease. We try to get knowledge, skills and resources into the hands of those who can use them.” The result, he said, are collaborations that increase the power and impact of research to benefit those who most need it.