1. Community-based research as a tool for empowerment: the Haida Gwaii Diabetes Project example

Carol P Herbert
Can J Public Health 1996;87(2):109-112

The evolution of the Haida Gwaii Diabetes Project exemplifies how community-based family practice research can be a tool for empowerment for both the community of research participants and the community-based members of the research team. The aims of the project are to develop a better understanding of Haida beliefs about diabetes; to develop culturally sensitive approaches to prevention and management; and to attempt to apply this understanding to the development of a model for preventive health for native people in the province of British Columbia. A participatory research paradigm, coupled with explicit working principles by which the research team agreed to operate, addressed the concerns that the Aboriginal community had about the risks of research. A true working partnership has developed among all members of the research team, and with the Haida community.

2. Haida perspectives on living with non-insulin-dependent diabetes

Garry D Grams, Carol Herbert, Clare Heffernan, Betty Calam, Mary Ann Wilson, Stefan Grzybowski, Diane Brown
Can Med Assoc J 1996;155(11):1563-8

Objective: To understand the experience of Haida people living with non-insulin-dependent diabetes mellitus (NIDDIM), in order to provide a basis for a culturally sensitive community-based approach to managing NIDDIM.

Design: Qualitative study using grounded theory.

Setting: The villages of Skidegate and Old Massett in Haida Gwaii (Queen Charlotte Islands), British Columbia.

Participants: Nine focus groups met at the beginning and six at the end of the project. The focus groups had 8 to 12 members each and roughly the same number of men and women overall. The groups included people with diabetes, family members of people with diabetes, community leaders and elders.

Findings: Conceptual findings related to the participants' views on the impact of NIDDIM on their lives, their views on what life was like before the effects of NIDDIM were felt and their beliefs about the prevention and treatment of NIDDIM. Six themes recurred in the discussions: fear; grief and loss; the loss of and desire to regain control; food and eating; physical and personal strength; and traditional ways.

Conclusions: Insights into the illness experience of different cultural groups can inform program development and the creation of culturally sensitive health care interventions.

3. Diabetes prevalence rates among First Nations adults on Saskatchewan reserves in 1990: comparison by tribal grouping, geography and with non-First Nations people

Maggie P Pioro, Roland F Dyck, Debra C Gillis
Can J Public Health 1996;87(5):325-8

Objective: To determine age-specific, sex-specific and total prevalence rates of diabetes mellitus among Saskatchewan First Nations adults and to compare these rates by tribal grouping, geography and with non-First Nations people.

Design: A point prevalence study of all Saskatchewan reserves in 1990.

Results: Age-adjusted rates of diabetes mellitus were higher (risk ratio 1.8) among First Nations adults (9.7%) than among non-First Nations adults (6.1%). These racial differences were greater between women (12.1 vs 6.6%) than men (7.2 vs 5.6%), First Nations diabetes rates were highest among individuals with Saulteaux and Sioux ancestry, and among those living on southern reserves.

Conclusions: The prevalence of diabetes mellitus among Saskatchewan First Nations people has increased from 0% to almost 10% within the adult population since 1934 and has more than doubled from 1980 to 1990. This epidemic manifests itself to a greater extent among women and certain tribal groups, possibly due to differences in exposure to non-traditional lifestyles.

4. Temporal trends in diabetes mortality among American Indians and Hispanics in New Mexico: birth cohort and period effects

Frank D Gilliland, Charles Owen, Susan S Gilliland, Janette S Carter
Am J Epidemiol 1997;145(5)422-31

Rates of diabetes mortality are disproportionately high among ethnic minorities in the United States. To describe ethnic trends and cohort effects in diabetes mortality in New Mexico, the authors examined the trends in mortality rates for non-Hispanic whites, Hispanics, and American Indians in the state during the period 1958-1994. Age-specific rates were examined graphically to qualitatively describe the contribution of calendar period and birth cohort effects to changes in the rates. The authors also fit age-period-cohort models to these data. Age-adjusted diabetes mortality rates for American Indians and Hispanics surpassed rates for non-Hispanic whites for all but the earliest two time periods. In the 1993-1994 period, the age-adjusted mortality rate for American Indians was 3.8 times higher for men and 5.6 times higher for women than for their non-Hispanic white counterparts. Rates for American Indian men and women increased sharply over the 37-year period, by 565% and 1,105%, respectively. Mortality rates increased among Hispanics over the period of study but less rapidly than did rates among American Indians. Graphical analyses of age-specific rates were consistent with birth cohort effects among both American Indians and Hispanics and also with a period effect among American Indians. Results from age-period-cohort models indicate a birth cohort effect starting with the 1912 cohort in American Indians and the 1902 cohort in Hispanics. A period effect was present during the 1960s in American Indians. American Indians have experienced an epidemic rise in diabetes mortality in New Mexico; if current trends continue, diabetes may become the leading cause of mortality among American Indians in the state.

5. Risk of dementia among persons with diabetes mellitus: a population-based cohort study

CL Leibson, WA Rocca, VA Hanson, R Cha, E Kokmen, PC O'Brien, PJ Palumbo
Am J Epidemiol 1997;145(4):301-8

It is unclear whether persons with diabetes are at increased risk for dementia, including Alzheimer's disease. Existing studies are limited by small sample size, selection bias, and case-control designs. This population-based historical cohort study provides estimates of the risk of dementia and Alzheimer's disease associated with adult onset diabetes mellitus (AODM). The sample included all persons with AODM residing in Rochester, Minnesota, on January 1, 1970, plus all persons diagnosed in Rochester or who moved to Rochester with the diagnosis between January 1, 1970, and December 31, 1984. Individuals were followed through review of their complete medical records from AODM diagnosis until dementia onset, emigration, death, or January 1, 1985. Standardized morbidity ratios for dementia and Alzheimer's disease were calculated, using an expected incidence based on age- and sex-specific rates for the Rochester population. Poisson regression was used to estimate risks for persons with AODM relative to those without. Of the 1,455 cases of AODM followed for 9,981 person-years, 101 developed dementia, including 77 who met criteria for Alzheimer's disease. Persons with AODM exhibited significantly increased risk of all dementia (Poisson regression relative risk (RR) = 1.66, 95% confidence interval (CI) 1.34-2.05). Risk of Alzheimer's disease was also elevated (for men, RR = 2.27, 95% CI 1.55-3.31; for women, RR = 1.37, 95% CI 0.94-2.01). These findings emphasize the importance of AODM prevention and prompt additional investigation of the relation between AODM and dementia.

6. Suicide among Manitoba's aboriginal people, 1988 to 1994

Brian Malchy, Murray W Enns, T Kue Young, Brian J Cox
Can Med Assoc J 1997;156(8):1133-8

Objective: To compare and contrast the characteristics of suicides among aboriginal and nonaboriginal people in Manitoba.

Design: Retrospective review of all suicides, based on a confidential analysis of records held by the Office of the Chief Medical Examiner.

Setting: Manitoba between 1988 and 1994. Outcome measures: Standardized suicide rates, age- and sex-specific suicide rates, blood alcohol level at time of death, psychiatric help-seeking behaviour before suicide and residence on a reserve.

Results: Age-standardized suicide rates were 31.8 and 13.6 per 100 000 population per year among aboriginal and nonaboriginal people, respectively. The mean age of aboriginal people who committed suicide was 27.0 (standard deviation [SD] 10.8) years, compared with a mean age of 44.6 (SD 18.8) years for nonaboriginal people who committed suicide (p < 0.001). Blood alcohol levels at the time of death were a mean of 28 (SD 23) mmol/L among aboriginal people and 12 (SD 20) mmol/L among nonaboriginal people (p < 0.0001). Before their death, 21.9% of nonaboriginal suicide victims had sought psychiatric care whereas among aboriginal suicide victims 6.6% had sought care (p < 0.0001). Although the suicide rate was higher among aboriginal people living on reserve than among those living off reserve (52.9 v. 31.3 per 100 000 per year), both of these rates were substantially higher than the overall rates among nonaboriginal people. There were no significant differences in mean age, sex, blood alcohol level and previous psychiatric care among aboriginal people who committed suicide living on and off reserve.

Conclusions: There was a high rate of suicide among Manitoba's aboriginal people between 1988 and 1994; this rate was comparable to earlier estimates of national suicide rates among aboriginal people. The reserve environment does not, by itself, account for the high suicide rate among Manitoba's aboriginal people. Further study of help-seeking behaviour and the association between alcohol abuse and suicide, particularly among aboriginal peoples, is indicated.

7. Effects of smoking on the incidence of non-insulin-dependent diabetes mellitus: replication and extension in a Japanese cohort of male employees

Norito Kawakami, Naoyoshi Takatsuka, Hiroyuki Shimizu, Hiroshi Ishibashi
Am J Epidemiol 1997;145(2):103-9

The effects of smoking on the 8-year (1984-1992) incidence of non-insulin-dependent diabetes mellitus (NIDDM) were investigated in a cohort of 2,312 male employees of an electrical company in Japan. The incidence rate was 2.2/1,000 person-years. After controlling for other known risk factors for NIDDM, a proportional hazards regression analysis indicated that those who were currently smoking 16-25 cigarettes per day had a 3.27 times higher risk of developing NIDDM during the follow-up period than never smokers (p < 0.05); the hazard ratio was similar (3.21) for those who were currently smoking ³26 cigarettes per day. Among ever smokers, proportional hazards regression analysis also indicated that younger age at starting smoking was associated with an increased risk of NIDDM (p for trend = 0.09). These findings suggest that number of cigarettes smoked per day is important in the relation between smoking and NIDDM incidence, although the risks did not increase above a given amount of smoking. Starting smoking at a younger age also might be independently associated with an increased risk of NIDDM.

8. Effects of maternal cigarette smoking and alcohol consumption on blood lead levels of newborns

Marc Rhainds, Patrick Levallois
Am J Epidemiol 1997;145(3):250-7

The purpose of this study was to evaluate the effect of cigarette smoking (active and passive exposure) and alcohol consumption during pregnancy on cord blood lead levels. In 1990, a survey was conducted in two hospitals in Québec City, Québec, Canada, a white-collar agglomeration. The sample included 430 mothers and their newborns. Information on the lifestyles of mothers during pregnancy was obtained by questionnaire. Cord blood lead concentrations were measured by atomic absorption spectrophotometry. A dose-response relation was found between cigarette smoking and alcohol consumption of mothers and cord blood lead levels. An average increase of about 15 percent (0.013 mmol/liter) in cord blood lead levels was estimated for every 10 cigarettes smoked per day. Mean blood lead levels in babies whose mothers did not smoke during pregnancy but who drank alcohol moderately was 17 percent higher than those of nonsmoking mothers who abstained from alcohol intake. Multivariate analyses revealed that both cigarette smoking and alcohol intake make significant and independent contributions to cord blood lead concentrations. Lifestyles of pregnant women thus appear to play an important role in the prenatal lead exposure of newborns. Because of the potential effects of lead exposure on pregnancy outcomes, our study provides further arguments to support public health advisories concerning the harmful effect of smoking and drinking alcohol during pregnancy.

9. Mortality and morbidity of potentially misclassified smokers

Poul Suadicani, Hans Ole Hein, Finn Gyntelberg
Int J Epidemiol 1997;26(2):321-7

Objective. Misclassification of smokers as non-smokers may bias estimates of the excess morbidity and mortality associated with smoking. The issue has been given little, if any, attention in prospective epidemiological studies. This study examined characteristics of potentially misclassified smokers with respect to mortality, morbidity, and risk factors.

Method. A prospective study (within The Copenhagen Male Study, Denmark) used serum cotinine as an objective marker of use of tobacco. A serum concentration of 100 ng/ml was regarded as a relevant threshold for active smoking. In all, 3270 males aged 53-74 years who reported their previous and current tobacco habits, including the use of chew tobacco and snuff, were included. Incidence of all causes of mortality (ACM) during 9 years and death due to ischaemic heart disease (IHD) during 8 years of follow-up were the main outcome measures.

Results. Overall cumulative incidence rates of ACM and IHD were 19.1% and 4.3%, respectively. Of 1405 men who reported being non-tobacco users, i.e no current smoking and no use of chewing tobacco or snuff, 1377 had levels <100 ng/ml, 28 men (2%) had levels equal to or above this threshold value and were considered potentially misclassified smokers. They had significantly higher mortality rates, 35.7% versus 14.7%, P < 0.001, than other self-reported non-tobacco users, and a slightly higher prevalence of tobacco-related cancer, and a highly significant higher prevalence of myocardial infarction, P < 0.001. Compared to non-tobacco users with low cotinine, age-adjusted relative risks (95% CI) were 2.4 (1.3-4.5), P < 0.01, for ACM, and 5.3 (95% CI: 2.1-13.4), P < 0.001, for IHD.

Conclusions. Potentially misclassified smokers deviated strongly from other non-smokers with respect to mortality and morbidity. The importance of this reporting bias when estimating the risk associated with active or passive smoking is discussed.

10. Asthma and limitation of activities in Fort Saskatchewan, Alberta

Patrick A Hessel, Terry Sliwkanich, Dennis Michaelchuk, Hannelore White, Thu-Ha Nguyen
Can J Public Health 1996;87(6):397-400

A study was undertaken to determine the prevalence and impact of asthma in elementary school children in Fort Saskatchewan, Alberta. Questionnaires were distributed at all seven elementary schools and were completed by the parents. Of the 1,457 eligible students in grades one to six, questionnaires were returned for 1,083 (74%). A history of physician-diagnosed asthma was reported for 12.9% of the children: 16.0% of boys and 9.7% of girls. Currently, 9.9% of children had asthma: 11.6% of boys and 8.2% of girls. Compared to children without, those with asthma were more than 10 times as likely to have to limit their activities for a health reason (70.5% versus 6.6%), missed school more often for health reasons (32.7% versus 14.8% missed two or more days in the previous month), reported more "colds" in the previous year and were three times as likely to have had pneumonia. The prevalence of asthma is approximately twice as high as that found in children across Canada and underscores the need to determine risk factors for asthma in this population. The finding that 1 in 10 children had asthma emphasized the need for programs aimed at children with asthma.

11. Skin cancer in a subtropical Australian population: incidence and lack of association with occupation

Adèle Green, Diana Battistutta, Veronica Hart, David Leslie, David Weedon, the Nambour Study Group
Am J Epidemiol 1996;144:1034-40

Because it is not possible to monitor skin cancer accurately using routine methods, special surveys have been undertaken in Nambour, a typical subtropical community in Queensland, Australia. Estimates of incidence reported here are based on skin cancers medically treated between 1985 and 1992 and new cases diagnosed by dermatologists in two examination clinics in 1986 and 1992. Among men and women aged 18-69 years in 1986, age-adjusted incidence rates of basal cell carcinoma were 2,074 and 1,579 per 100,000 per year, respectively-the highest incidence rates of a specific cancer ever reported. Squamous cell carcinoma occurred at half the rate of basal cell carcinoma among men and at about one third the rate among women. Although as expected, fair skin, a history of repeated sun burns, and nonmalignant solar skin damage diagnosed by dermatologists were strongly associated with both types of skin cancer, outdoor occupation was not. Significant self-selection was observed among outdoor workers, whereby people with fair or medium complexions and a tendency to sunburn were systematically underrepresented among those in long-term outdoor occupations although they accounted for more than 80 percent of the community study sample. The mitigating effect of this selection bias may partly explain the paradox of the lack of quantitative evidence of a causal link between sun exposure and skin cancer in humans.

12. Risk factors for childhood melanoma in Queensland, Australia

David C Whiteman, Patricia Valery, William McWhirter, Adèle C Green
Int J Cancer 1997;70:26-31

The causes of cutaneous melanoma among children under 15 years are largely unknown. We report the findings of an epidemiological study of childhood melanoma in Queensland, Australia, which has the highest incidence rates in the world. All 61 cases of melanoma in children less than 15 years notified to the Queensland Cancer Registry 1987-1994 were eligible to participate in a population-based, case-control study. Data were collected through structured, face-to-face interviews with parents and skin examinations of the 52 participating cases and 156 age-and sex-matched controls. The strongest determinants of melanoma risk found among Queensland children were constitutional factors, including the presence of more than 10 naevi greater than 5 mm in diameter (RR 9.9, 95% CI 2.5-38.9), heavy facial freckling (RR 6.4, 95% CI 1.9-21.6), an inability to tan on exposure to the sun (RR 8.8, 95% CI 2.1-36.2) and a family history of melanoma (RR 4.2, 95% CI 1.9-9.3). These factors remained significantly associated with melanoma after adjusting for other risk factors. No measures of acute or chronic exposure to solar UV radiation were associated with childhood melanoma in our study. Established risk factors, including giant congenital naevi and xeroderma pigmentosum, were not present among any of the children in the study. Melanoma in childhood appears to have similar epidemiologic characteristics to the adult form of the disease, being associated with a cluster of phenotypic attributes indicating cutaneous sensitivity to the effects of sun exposure. Our findings support the contention that childhood melanoma occurs in susceptible individuals with a low threshold for pigment cell tumorigenesis. From a public-health perspective, children at elevated risk for melanoma can be identified on the basis of phenotype and family history.

13. Randomization in the Canadian National Breast Screening Study: a review for evidence of subversion

John C Bailar III, Brian MacMahon
Can Med Assoc J 1997;156(2):193-9

The authors assess the randomization strategy that had been used in the Canadian National Breast Screening Study (NBSS). Document experts at a private investigation and security company were hired to assist in reviewing instances in which names of subjects were altered in the "allocation books" (the basic instrument used to assign, at random, participants to either the mammography or the usual-care arm). The review was restricted to records from 3 NBSS centres where women assigned to the mammography arm had a distinctly higher (not necessarily significant) number of deaths from breast cancer than those assigned to the usual-care arm, and to records from 2 centres where, for limited periods, administrative problems were reported. In most cases the underlying, original name could be identified. The document experts found no evidence of a deliberate attempt to conceal the alterations. A search of the NBSS database for the underlying and superimposed names revealed that only 1 of the women whose name had been deleted or superimposed died of breast cancer. She was in the mammography arm. The authors' thorough review of ways in which the randomization could have been subverted failed to uncover credible evidence of it. They conclude that even if there had been acts of subversion, they could only have been few in number and, given that there was only 1 death from breast cancer in the group reviewed, the alterations could have had only a trivial effect on the study findings as reported in 1992.

14. The review of randomization in the Canadian National Breast Screening Study: is the debate over?

Norman F Boyd
Can Med Assoc J 1997;156(2):207-9

The randomization procedure in the Canadian National Breast Screening Study (NBSS) is assessed in this issue [of Can Med Assoc J] by Drs. John C. Bailar III and Brian MacMahon. They conclude that although there was ample opportunity for the randomization process to be subverted, no evidence of subversion was found. This is unlikely to allay all concerns about randomization, because there are still puzzling differences between the arms of the NBSS in a number of baseline variables. For example, the existence of prior health claims for breast cancer for women who entered the NBSS in Manitoba has raised the possibility that subversion occurred. Although the question may never be resolved, one lesson is clear: randomization in clinical trials should be managed in a manner that makes subversion impossible. As for the clinical implications of the NBSS for women in their 40s, physicians may now look to the results of randomized trials that have been published more recently. A meta-analysis of these results suggests that screening mammography reduces deaths from breast cancer among women in their 40s, but continued follow-up over the next few years will be needed to settle the debate.

15. The review of randomization in the Canadian National Breast Screening Study: what does the verdict mean for clinicians?

Heather Bryant
Can Med Assoc J 1997:156(2):213-5

What is the practising clinician to make of the review by Drs. John C. Bailar III and Brian MacMahon (see pages 193 to 199 of this issue [of Can Med Assoc J]) of the randomization procedure used in the Canadian National Breast Screening Study? Their conclusion that any flaws in randomization would not have affected the published data is reassuring. Nevertheless, the review has not resolved the controversy surrounding the recommendations for screening mammography for women aged 40-49. Recommendations must be based on strong evidence that the benefits of population-based testing outweigh the harms. The absence of such evidence for women aged 40-49 should not, however, preclude the use of mammography as a diagnostic test for women in their 40s whose clinical signs require follow-up. Mammography could also be considered for women whose family history or other factors suggest an increased risk for breast cancer, provided that the limitations and potential disadvantages of testing are explained.

16. Single mothers in Ontario: sociodemographic, physical and mental health characteristics

Ellen L Lipman, David R Offord, Michael H Boyle
Can Med Assoc J 1997;156(5):639-45

Objective: To examine the sociodemographic, physical and mental health characteristics of single mothers in Ontario.

Design: Cross-sectional.

Setting: Ontario.

Participants: Ontario residents aged 15 years or older who participated in the Ontario Health Supplement survey conducted between December 1990 and April 1991; of 9953 eligible participants, 1540 were mothers with at least 1 dependent child (less than 16 years of age).

Outcome measures: Prevalence rates of sociodemographic, physical and mental health characteristics.

Results: Single mothers were significantly more likely than the mothers in 2-parent families to be poor, to be 25 years of age or less, to have mental health problems (dissatisfaction with multiple aspects of life, affective disorder ever and 1 or more psychiatric disorders in the past year or ever) and to use mental health services. When compared by income level, poor single mothers had a higher prevalence of all mental health outcomes measured; the difference was significant for anxiety disorder in the past year or ever and for 1 or more psychiatric disorders in the past year or ever. In a logistic regression analysis, single-mother status was found to have the strongest independent effect on predicting mental health morbidity and utilization of mental health services; the next strongest was low income.

Conclusions: Single mothers are more likely to be poor, to have an affective disorder and to use mental health services than mothers in 2-parent families. The risk of mental health problems is especially pronounced among poor single mothers. Further studies are needed to determine which aspects of single motherhood, apart from economic status, affect mental health outcomes.

17. Small area variation in low birthweight: looking beyond socioeconomic predictors

Evelyn A Crosse, Robert J Adler, Truls Østbye, M Karen Campbell
Can J Public Health 1997:88(1):57-61

The main objectives of this study were to determine the geographic distribution of low birthweight rates in London, Ontario and to identify small areas within the city that have low birthweight rates not adequately explained by the areas' socioeconomic characteristics. The following socioeconomic variables were used in a weighted, ecological, multiple regression analysis: % unwed mothers, % teen mothers, % low income, % low education, % unemployment and % immigrants. The overall variation in low birthweight rates was statistically significant and largely, but not entirely, explained by the socioeconomic characteristics of the areas. Two out of 31 census tract clusters were identified as having low birthweight rates which were higher than would be expected based on their socioeconomic profile. This methodologic approach may interest health planners as it draws attention to local factors other than socioeconomic ones which may be important when developing local strategies for low birthweight prevention.

18. Declining sex ratios in Canada

Bruce B Allan, Rollin Brant, Judy E Seidel, John F Jarrell
Can Med Assoc J 1997;156(1):37-41

Objective: To examine the trends in the proportion of annual live births that were male in Canada and to compare the trends with those in the United States.

Design: Analysis of census data.

Setting: Canada as a whole and 4 main regions (West, Ontario, Quebec and Atlantic).

Subjects: All live births from 1930 to 1990.

Outcome measures: Sex ratio (expressed as the proportion of total live births that were male [male proportion]) overall and by region.

Results: The male proportion in Canada decreased significantly after 1970 (p < 0.001); this represented a cumulative loss of 2.2 male births per 1000 live births from 1970 to 1990. Although a decrease was observed in all four regions studied, only that in the Atlantic region was significant (p < 0.001), representing a cumulative loss of 5.6 male births per 1000 live births from 1970 to 1990. A significant decrease in the male proportion was also observed in the United States from 1970 to 1990 (p < 0.001), although to a lesser degree than that observed in Canada, and represented a cumulative loss of 1.0 male births per 1000 live births.

Conclusions: The decreased sex ratio in Canada adds to the growing debate over changes in biological markers and their potential causes. In addition, the study illustrates the potential use of the sex ratio as a widely available, unambiguous measure of the reproductive health of large populations.

19. Suicides associated with the Jacques Cartier Bridge, Montreal, Quebec 1988-1993: descriptive analysis and intervention proposal

Claude Prévost, Marie Julien, Bruce P Brown
Can J Public Health 1996;87(6):377-80

Falls from heights represent an uncommon means of suicide. Regional variations are attributable to the presence of particular sites which attract suicidal individuals. The Jacques Cartier Bridge in Montreal is one such site, though less well known than North American sites such as the Golden Gate Bridge or Niagara Falls. According to Coroner's records, 54 suicides were associated with the bridge for the period 1988 to 1993. All but one of the suicides were the result of jumps from the bridge. The median age of victims was 30 years, and 46 of the victims were male. Bridge-specific verbalization of suicidal intent and prior history of medically diagnosed psychiatric disorders are frequently noted. Based on a review of the effectiveness of preventive measures, we propose limiting access to jumping by means of a fence along the bridge railing.

20. The dissemination of chronic disease prevention programs: linking science and practice.

Roy Cameron, K Stephen Brown, J Allan Best
Can J Public Health 1997;87 Suppl 2:550-3

A strong partnership between researchers and providers is crucial to advance the science of dissemination and to support dissemination of effective chronic disease prevention programs. We reflect on our experience in three recent studies, (a) COMMIT, (b) a National Survey of School Smoking Prevention Programs, and (c) an ongoing study of Training of Providers of Smoking Prevention Programs, to identify specific ways in which research and provider communities might collaborate. We propose that a national working group of researchers and providers be established to support (a) dissemination of programs by creating and continuously updating an inventory of "tested" methods and protocols for use in key community intervention channels (health care offices, worksites, etc.) and (b) dissemination research by establishing a shared set of research priorities and mechanisms to stimulate researcher-provider partnerships during the research process.