The downtown Denver area is unique. Here, there's just so much more to do. There's plenty of historic sites, brand new businesses, museums, and cultural events happening every month. Denver is an extremely active city. It's an excellent place to try just about anything. People have come down here both to live and to play. It's full of shops, restaurants. It's really made it an enjoyable place to hang out. The changes to the downtown area are amazing. From Larimer Square into 16th Street Mall. 16th Street Mall is a really diverse area. Each block is a little bit different and unique. I really enjoy the Denver Pavilions, which has an open-air concept that combines outdoorsy Colorado but also a very urban feel. There's the Hard Rock Cafe, Jazz at Jack's. You can also catch a film at the United Artists Theater. I stopped by the iHeart Denver store in the Denver Pavilions. You can find a real gambit, gift items, fine art pieces, prints, t-shirts, and jewelry, all made by local designers, artists, or creative-minded businesses. Denver has a public art ordinance that allocates 1% of any new capital improvement project to public art. So when you're walking around downtown, you will see a large piece or some sort of art installation in almost every building and plaza. 14th Street in the Convention Center area has been revitalized just recently. The Denver Performing Arts Complex is one of the largest in the country. It takes up four city blocks. You can catch the symphony, the opera, the ballet. It really runs the gamut of popular music to classical. Then you can go a little farther down and hit the MCA. They're just very unique, very innovative with their shows. One of the nicest features about Lodo is the scale. Downtown Denver, in general, is extremely walkable. If you look at where Coors Field is, even to the Pepsi Center. Lodo is also very bike-friendly. We had one of the first electronic bike-share systems. B-cycle stations, you can get on one, you can use it all over town. The heart of the city really is downtown. You have lots of bars, dance clubs, to places with really great views like the View House and nice rooftop decks like the Tavern. Denver's just great for those chef-driven, owned-restaurant concepts that you really could pick from about 20 or 30. We have about 92 beers on tap here at Falling Rock. If you're interested in craft beer, Denver is definitely the destination of the United States. Stoic & Genuine is my newest restaurant in Denver Union Station. I love the renovation inside the station itself. It's an incredible transformation of that historic building. They really took care to bring back that era of what it looked like as a train station. So all light rail buses and even Amtrak will be coming out of there. It's our pathway to DIA, which takes you to the world. Some of the great places downtown are these historic hotels. One is the Brown Palace. The other is the Oxford Hotel. Also in our neighborhood is the Tattered Cover, which is one of the most amazing bookstores. You just have that really fun boutique feel when you walk in. It's just the volume that we have here that makes downtown Denver special. There's really a lot of activity for shopping, too. Larimer Square gives you that kind of feeling like Rockefeller Center might in New York. It's the only historic block that still has all the historic buildings. Larimer Square has some really fun little boutiques that I think you can get some unique gifts. I always take people to Rock Mount Ranch Wear. They're attributed with popularizing the snap front western shirt. From rock stars to ranchers, it's people who are looking for something quintessentially Colorado. If I had one word for downtown Denver, it would be exciting. Active. Historic but emerging. It's very funky, very artsy. It's kind of the heart of this city. It's also a melting pot of our Denver culture, so if you're coming down here, you're getting a real sense of Denver. It's just a constant stream of unexpected surprises here. The downtown Denver area is unique. Here there's just so much more to do. There's plenty of historic sites, brand new businesses, museums, and cultural events happening every month. Denver is an extremely active city. It's an excellent place to try just about anything. People have come down here both to live and to play. It's full of shops, restaurants. It's really made it an enjoyable place to hang out. The changes to the downtown area are amazing, from Larimer Square into 16th Street Mall. 16th Street Mall is a really diverse area. Each block is a little bit different and unique. I really enjoy the Denver pavilions, which has an open air concept that combines outdoorsy Colorado but also a very urban feel. There's the Hard Rock Cafe, Jazz at Jack's. You can also catch a film at the United Artists Theater. I stopped by the iHeart Denver store in the Denver pavilions. You can find a real gambit, gift items, fine art pieces, prints, t-shirts, and jewelry, all made by local designers, artists, or creative minded businesses. Denver has a public art ordinance that allocates 1% of any new capital improvement project to public art. So when you're walking around downtown, you will see a large piece or some sort of art installation in almost every building and plaza. 14th Street in the Convention Center area has been revitalized just recently. The Denver Performing Arts Complex is one of the largest in the country. It takes up four city blocks. You can catch the symphony, the opera, the ballet. It really runs the gamut of popular music to classical. Then you can go a little farther down and hit the MCA. They're just very unique, very innovative with their shows. One of the nicest features about Lodo is the scale. Downtown Denver, in general, is extremely walkable. If you look at where Coors Field is, even to the Pepsi Center. Lodo is also very bike friendly. We had one of the first electronic bike share systems. B-cycle stations. You can get on one. You can use it all over town. The heart of the city really is downtown. You have lots of bars, dance clubs, to places with really great views like the View House and nice rooftop decks like the Tavern. Denver's just great for those chef-driven, owned restaurant concepts that you really could pick from about 20 or 30. We have about 92 beers on tap here at Falling Rock. If you're interested in craft beer, Denver is definitely the destination of the United States. Stoic and Genuine is my newest restaurant in Denver Union Station. I love the renovation inside the station itself. It's an incredible transformation of that historic building. They really took care to bring back that era of what it looked like as a train station. So all light rail, buses, and even Amtrak will be coming out of there. It's our pathway to DIA, which takes you to the world. Some of the great places downtown are these historic hotels. One is the Brown Palace. The other is the Oxford Hotel. Also in our neighborhood is the Tattered Cover, which is one of the most amazing bookstores. You just have that really fun boutique feel when you walk in. It's just the volume that we have here that makes downtown Denver special. There's really a lot of activity for shopping, too. Larimer Square gives you that kind of feeling like Rockefeller Center might in New York. It's the only historic block that still has all the historic buildings. Larimer Square has some really fun little boutiques that I think you can get some unique gifts. I always take people to Rock Mount Ranch Wear. They're attributed with popularizing the snap front western shirt. From rock stars to ranchers, it's people who are looking for something quintessentially Colorado. If I had one word for downtown Denver, it'd be exciting. Active. Historic but emerging. Very funky. Be very artsy. It's kind of the heart of this city. It's also a melting pot of our Denver culture. So if you're coming down here, you're getting a real sense of Denver. It's just a constant stream of unexpected surprises here. The downtown Denver area is unique. Here there's just so much more to do. There's plenty of historic sites, brand new businesses, museums, and cultural events happening every month. Denver is an extremely active city. It's an excellent place to try just about anything. People have come down here both to live and to play. It's full of shops, restaurants. It's really made it an enjoyable place to hang out. The changes to the downtown area are amazing, from Larimer Square into 16th Street Mall. 16th Street Mall is a really diverse area. Each block is a little bit different and unique. I really enjoy the Denver Pavilions, which has an open-air concept that combines outdoorsy Colorado but also a very urban feel. There's the Hard Rock Cafe, Jazz at Jack's. You can also catch a film at the United Artists Theater. I stopped by the iHeart Denver store in the Denver Pavilions. You can find a real gambit, gift items, fine art pieces, prints, t-shirts, and jewelry, all made by local designers, artists, or creative-minded businesses. Denver has a public art ordinance that allocates 1% of any new capital improvement project to public art. So when you're walking around downtown, you will see a large piece or some sort of art installation in almost every building and plaza. 14th Street in the Convention Center area has been... Hi, everybody. Good morning. I'm so happy everybody made it today. I am Jordana Rothschild. I'm the founder of Alpine Health as well as an ACPM member, and I'm really excited to welcome you all to the Community Preventive Services Task Force update. In today's session, we're going to talk about what the task force is and how they come to their recommendations, as well as the scope of those recommendations. Then we'll discuss some of the recent recommendations, their effectiveness and economics, and we'll also learn how to access the Community Guide as well as other resources for implementing the Task Force's recommendations. Our speakers today are Dr. Katrina Hedberg and Dr. Holly Weddington. Dr. Weddington received her PhD in social psychology, and she works for the CDC now as a coordinating scientist in the Community Guide office. Before that, she spent most of her career at the CDC doing research in the area of obesity prevention and control. She's really passionate about healthy eating and healthy lifestyle, and she loves doing yoga, hiking trails around Atlanta, and spending time with her family, who shares her passion for eating healthfully, even her dog, who loves bananas. Dr. Hedberg has served on the Task Force as a content expert on interventions related to HIV prevention, on the subcommittee focused on the Task Force report to Congress, and as the chair of the prioritization subcommittee. She recently retired from her position as health officer and state epidemiologist with the Public Health Division of the Oregon Health Authority, where she worked for 29 years and has a really, really broad range of experiences, ranging from the HIV AIDS epidemic to managing public health ramifications of marijuana legalization and Oregon's Death with Dignity Act. Although she's been interviewed on multiple news outlets for all of the work she's done, her true claim to fame is her cameo appearance in the Netflix series Wild Wild Country, dating back to her time investigating a salmonella outbreak in 1984 that was later revealed as the Rangeshi bioterror attack. And now I will turn it over to Dr. Hedberg. So, thank you all very much. It's really my pleasure to be here to all of you. Next slide. So I'm going to be providing a little bit of the background, and then we'll turn it over to Holly, who will talk a little bit more about the methodology of the Task Force. Next slide, please. So in terms of background, in 1996, the U.S. Department of Health and Human Services established the Preventive Services Task Force to identify population improvement. And I think it's important to understand that a lot of people are aware of the Clinical Guide to Preventive Services. The Community Guide provides not just what's happening within the doctor's office, if you will, or the clinical setting, but what's happening outside the healthcare setting walls. And we'll talk a little bit more about the overlap between these. So the population-based interventions, the Task Force looks at what's scientifically proven to save lives, as well as to increase lifespan and improve quality of life. CDC is the HHS agency that provides technical and administrative support, and I will say as a Task Force member, we couldn't be doing the work of the Task Force without CDC. They're doing the lion's share of teeing up the issues that the Task Force discusses. So as I mentioned, the CPSTF complements the work of the Preventive Services Task Force. Next slide, please. So the Community Preventive Services Task Force is an independent body. It's non-federal, it's unpaid, so we're all volunteers on this, and a variety of folks with both public health and prevention expertise. There are 15-member total, currently there are 14 members on the Task Force, and we serve five-year terms, and new members, so there's a rotating cycle with a fair amount of overlap every two years. The Task Force produces recommendations and identifies gaps in evidence to help inform decision-making, and I will say, as someone who used to work at a state health department, it was very, very useful for us to look at the Task Force recommendations, both to develop policy that we would implement at the state level as well as local level, as well as allocation of resources and doing public health advocacy in that context. Next slide, please. So currently, as I mentioned, there are 14 Task Force members. This is a list of the folks, and you can see that they bring a variety of expertise to the Task Force in areas of both population health research, public health practice and implementation, as well as health equity. We serve, so the Task Force is kind of divided up into different groups. We discuss various topic specifics, and so we have experts in each of those areas, but then there are also broader committees that are looking at things like the methodology that's used and helping to establish the priorities for both current and future reviews. All of this information, and I know Holly will talk about it, but it is on the website if you want more information about who the current members are. Next slide, please. So as I mentioned, the Community Preventive Services Task Force is really complementary of the work of the Clinical Preventive Services Task Force, and you can see the overlap here. So the Community Preventive Services considers policy and community-level interventions, and these include things like the built environment, worksites, and schools are within the scope of the work, whereas the Preventive Services Task Force really has primarily a clinical focus. One of the areas that overlaps, I think, has to do with the health systems interventions. So when we think of what happens within the Preventive Services Task Force might look at recommendations, and I know there was a recent recommendation that was coming out about the level, the age where people should consider screening for colorectal cancer. So that would be an example of a clinical preventive services. The Community Preventive Services Task Force would look at how that might be implemented within a healthcare setting. So what are the things that would need to be done in order to ensure that the people in the age categories get the correct screening that they should be? Next slide, please. So again, just as an example, the U.S. Preventive Services Task Force is screening for cervical cancer using Pap tests effective in reducing cancer-related morbidity and mortality. So that's pretty straightforward, but the Community Guide is looking at those as clinical reminder, client reminder, clinical services, the reminders effective in increasing the screening policies that are recommended. So again, these are clearly complementary. It's not just enough to say, well, here's the guideline. You ought to be screening these people. The question is, how do you implement that within a systems approach? Next slide, please. So this slide demonstrates really how the Community Guide can be used. The Community Guide is used to inform decision-making regarding practice, policymaking, as well as research and future areas that need to be explored, as well as funding for research and these programs. So some of the questions that we look at are how well has, what has worked for others and how well does it work? What's the cost of the intervention? So we know there's some interventions which would make sense, but really are cost-limiting when you look at implementing them on an entire population. And the other way around, there may be some interventions which don't have quite the same magnitude of effect, but don't cost anything to implement, and then you're thinking, well, on a population basis, a recommendation would make a lot of sense because it doesn't cost anything to implement it. And then again, we do identify what the evidence gaps are, not that the task force is implementing those or looking at future, but we'd like to be able to guide others what information we might need at a community level in order to implement these services. Next slide. So the audience for the Community Guide includes CDC programs. Again, we're an external advisory group, if you will, too, and so the CDC programs do look at what the task force deliberations as well as what our recommendations are. So CDC, and I mentioned governmental public health, state, tribal, local, and territorial health departments, but there are also large organizations and agencies that are accountable for the health of the population who benefit from improved population health. This includes hospital and healthcare systems. I talked a little bit about that already. Other federal agencies like the military, CMS, and HRSA, as well as some large employers who are trying to improve health programs. And again, here, I'm in Oregon, and so, for example, Nike can implement programs that have to do with overall wellness of their employees and might be looking at the Community Guide. Next slide. So the community preventive services are quite diverse, and they, examples of some of the things that we look at are team-based care to improve blood pressure control. So again, that's something that's being done within the healthcare system. We also look at broader things, behavioral or social programs. So examples of that include interventions to reduce risky behavior, HIV, other STDs, pregnancy among youth. So these are broader issues. And then, even more upstream, we're looking at environmental or policy approaches, such as a built environment that might combine elements of pedestrian as well as bicycling transportation systems. So people are physically active because the bike lane is there, and it's very easy to use. It's hard. I lived in Atlanta for a while when I was at CDC, and, you know, it was very hard to bike anywhere. They had five-lane roads, but there were absolutely no sidewalks or bike paths. Here in Portland, we've turned over many of our roads and bike paths. So it was very easy for me to commute as a bicyclist while I was working at the public health division. So next slide, please, looking at the time. So some of the critical aspects, and we've already talked about this a little bit. We look at the effectiveness of interventions. That's pretty straightforward. But there are two other aspects which are really important to the work that we do at the clinical guide. And one of them is to look at health equity or look at disparities in access to various services. And then, again, I mentioned a little bit about the economics and the importance of looking at how much these interventions cost if we're really going to be able to recommend that people implement them. It has to also be something that their resource is allocated to do. So we examine effectiveness by looking at some questions like, does the intervention work? How well? For whom? Under what conditions does it work? And so we'll talk a little bit more about the methods that we use for these. But in interventions that have found to be effective, we also, as I mentioned, look at the economics of implementing those interventions. Next slide. So this is a list of the topics with intervention reviews and community guide findings and recommendations. And you can see there's a pretty long list. And it varies. There's some of these that are very topic-specific. You can look at things like asthma or cancer or obesity. And then there's some of them that are focused a little bit more on a specific population. And that would be something like adolescent health, what we need to do with that. And then there are other things around how do we implement them. And that's health communication and health information technology. So it's really interesting because it is a spectrum from the disease-specific to looking at some of these more broad categories about how we might implement interventions. And again, an intervention might work. But as I always say, very different things are happening. We're having now, this is a Zoom conference, and a lot of clinical care is now being provided via Zoom. Well, that's great. In rural parts of Oregon, there isn't even internet access, much less cell phone access. So how are you possibly going to do that in rural parts of the state? So that's an example of something that we evaluate and even look at health equity, not just things like racial inequities or systemic racism, et cetera, but really look at things like access to care for urban, rural, et cetera. In most of the studies, we do look at which populations, again, benefit from the interventions and which populations do not. Next slide. So this is a list of the recently completed reviews in the past couple of years. And I'm not going to read these over again. All of this information is on the website, so I would highly encourage everyone to go. And there's the both complete reviews that are on there, but there are also a number of them that have boiled down to kind of one-pagers. So if you don't want to read the entire review and the findings, we do try to make them very accessible in the form of one-pagers. But again, you can see from this, the cancer and number of the cancer screenings. This is one where it isn't just the screening, but looking at community health workers to implement some of the findings for screening. So that's one, again, that's focused on the health equity piece and how do you actually deliver some of these cancer screenings that would be recommended by the Clinical Preventive Services Task Force. And at the bottom of this list is the HIV prevention, clinical decision support system. And I'll just say that was one of the areas that I had focused on when I joined the task force. And it's very interesting because, again, you can say screening and the recommendations will now you need to screen the entire population and people at higher risk need regular screening. How do you make sure that's happened? How do you implement that within an electronic medical record? How do you reach out not only to clinicians, but to patients or the community to ensure they get screened according to guidelines? Next slide, please. So again, this, I won't read this, it's all on the website, but this gives an example of for obesity and prevention, it really talks about digital health interventions. Back to what I had said a minute ago, we're all moving into the technology age, but some people don't have easy access to cell phones. And so looking at how you can deliver something for most of the population and yet what are the things that, again, that some of the population might be left behind. So again, all of this is on the website. Looking at the time, I'll speak quickly. I just have a couple more slides in my part. This was actually very exciting to me. So I talked about what the priorities were for the past five years. We recently did a process to look at what the priorities were going to be for the next five years, 2025. And it was a very robust process. This was not something that was just decided on by the task force itself, but we had active engagement of not only experts within CDC, experts outside, so partner agencies, as well as an opportunity for public comment. So it was a data-driven process engaging multiple criteria and we, I'm sorry, multiple partners using criteria to help. So some of the criteria were the overall burden of the condition, disparities again, what would the impact be, and again, some balance across these topics. So one of the things that I had really appreciated is the move, and again, from, we're still doing some topic specifics, things like you can see on here, heart disease and stroke is still on the list, injury prevention, tobacco use, very, very important issues. But one of the focuses of the next five years is going to be looking more upstream, both mental health, and I know there was some, there was a focus on that in the past as well, but a continued focus on mental health and the impacts of substance use. We're starting to see the huge impacts, especially during this pandemic. We know that a lot of people, mental health has really suffered and substance use has gone up and up and up. And then even more upstream to look at some of the social determinants of health. And so again, for me, that's quite exciting to see, not just how do we prevent someone from smoking, but which are the populations who are using tobacco, and how do you actually try to address some of the issues that are getting people to start in the first place with this very addictive substance, and then again, supporting people who want to quit tobacco. But again, from the population perspective, et cetera. So now I will turn it over to Holly. All right. Can you hear me okay? Yes. Okay. All right. All right. So thank you, Katrina. So I'm Holly Weddington, and I am currently a coordinating scientist at the community guide office. And I'll be focusing a little bit more on our systematic review methods, our economic reviews and dissemination are at a very high level. Okay. Systematic review methods. So this slide right here shows that there are essentially five elements to conceptualizing a systematic review. they consist of the intervention definition, inclusion and exclusion criteria, research questions, the analytic framework that we draft to demonstrate the pathway from exposure to the intervention to the outcomes we are hoping to see, and then any applicability factors. And I'll talk about applicability on a future slide. So the team will develop each of these elements, and they're all sort of interrelated, so a change in one would, you know, lead to a change in another. So the whole, the review is continued to be refined over the course of the systematic review process. So while we're thinking of how we're conceptualizing the review, then the next step of that would be to do a search in a screen for the evidence that would make up the body of evidence for the systematic review. So we always work with a CDC librarian who is trained in developing systematic review search strategies. We have a set number of databases that we always look at, so you see those right here with Cochrane, Embase, Medline, Psychinfo, and PubMed. But depending on the review, we might add in additional databases, whatever's appropriate and whatever the librarian would recommend us including. And then the screening for the evidence, we really have to follow those inclusion and exclusion criteria that we had set forth. So our next step would be once we finish that search and screening process and we have our list of included studies, then we have to, like, really do the work. We have to abstract information from each included study, and this information will help the task force draw their conclusion. But the information that we abstract from each study, of course, would be study design, any intervention characteristics such as dose, intensity, you know, exactly what the implementers of the intervention would be looking to cause change in. And then we'll abstract results, so those would be the outcomes of interest for that particular review, any potential harms, and we do also collect any other potential benefits. And then we'll collect information to inform our applicability assessment. And then each included study also undergoes quality scoring. So this is where we're assigning limitations to each study based on a series of questions related to bias and validity. And then once we come up with a total number of limitations, that study is categorized into good, fair, or limited, depending on the number of limitations it has. And for community guide reviews, once a study has greater than four limitations, it is removed from the review. It does not...the results of that study are not incorporated with the results of the good and fair studies, and it's essentially not used for our body of evidence beyond that. Okay. And then, of course, we have to analyze the data from all of the recommendation outcomes for all of that data that we had collected. And so because we're looking at population health interventions, we don't have clean outcomes that we're always looking at. The measures are often very heterogeneous. There's many different ways that researchers can measure certain behaviors or certain disease statuses. An example would be fruit and vegetable consumption. There's many different ways to collect that data and then analyze it. But we do our best. We will collect enough data where we can try to do a summary effect estimate for every...we'll combine every study that has the same outcome, and then we'll come up with the range or the interquartile interval. And then for studies that we simply cannot synthesize and combine with other studies on a scatterplot, we'll report that information narratively in tables. And so as you can imagine, our reviews are typically a mixture of quantitative and qualitative reporting. And like I was alluding to before, because we have different study designs and heterogeneous measures, it's almost impossible for us to do meta-analyses. We have done a few, but it's few and far between. And then it's very important for us to assess applicability. So this is where we're looking at not just the included studies, but we might also look to broader literature or even expert opinion to look to see if there would be differential effects across these different applicability factors. So we'll always look at geographic and population characteristics. So those would be for geographic, a degree of urbanicity. So are they in rural...did the study take place in a rural area or an urban area? And then population characteristics. So those would be race, ethnicity, gender, maybe income level, if we have that, or level of education. And then of course, we'll look at intervention characteristics to see if there might be any sort of difference based on dose or intensity. And as I said earlier, the conclusions on applicability, we'll look at what the included studies have reported, but we might go outside of our particular systematic review and look at the broader literature and also expert opinion. Okay. So how does the CPSTF draw a conclusion on effectiveness? So what the community guide staff will do, we'll conduct a systematic review and we're basically presenting the results of that systematic review to the CPSTF for them to draw a conclusion on this. So they will be looking at the body of evidence. So how many included studies were there? What were the study designs and what was the quality of execution? And then they will determine the intervention effectiveness based on the consistency and the meaningfulness of those results. So there are different categories of CPSTF recommendations and findings. There's recommended. So that's when the intervention showed effectiveness and the CPSTF is recommending to try to implement this intervention. And then there's recommended against. That's when the results of the systematic review did not just didn't show any sort of not just didn't show any sort of change, but may have also demonstrated a change in an unfavorable direction. So that would be a recommend against. I will make a note in the history of the community guide, we've only had two of those. So those are very infrequent finding statements. And then there's insufficient evidence. And so that's when the task force is unable to recommend for or against that particular intervention. Let me say more about that. So a special note on insufficient evidence. It really just means that there was not adequate evidence to determine if the intervention is or is not effective. It does not mean that the intervention does not work. It's usually too soon to draw a conclusion on it. And so there, that's where in that sort of situation, the task force is really careful with the evidence gaps section of our reports at the end that we're making sure that we're very clear that additional research or evaluation is needed to determine whether or not the intervention is effective. Now for economic reviews. So when is an economic review? So Katrina talked about this earlier. So one unique aspect of the CPSTF is that we do do these economic reviews and they're only conducted when the intervention is found to be effective. So that's when it's in that top category of recommended. And they're really conducted because they provide really important information to a potential implementer on the cost, the economic benefits, cost benefit, and cost effectiveness of the intervention. And we know that implementers are definitely interested in the upfront cost of interventions that would be recommended. So we're really trying to provide adequate information to an implementer to see, based on their budget, would they be able to implement this particular intervention in their community? And so the economic evidence really strengthens support for the intervention that's already recommended based on effectiveness. So systematic economic reviews, these follow a process very similar to our effectiveness reviews and they're looking to summarize evidence on intervention cost. So that would be the cost to implement the intervention, any economic benefits from the intervention, and then the intervention's net benefit or benefit to cost ratios. And then this is to check whether the economic benefits from the intervention exceed the intervention cost of that particular intervention. And then the economic team also looks at cost effectiveness. So that would be cost per unit of health-related outcomes, such as QALYs or DALYs. And so what would be averted through that? And then they also look to check whether an additional unit of health outcome can be obtained at a reasonable price. So our economic reviews, we have an economic team filled with economic staff. So they really are looking to summarize the evidence that they're able to obtain on an effective intervention. Some additional information on our economic reviews. So the CPSTF issues an economic finding where the evidence from a systematic economic review is showing economic benefits. So showing that the intervention exceeds the intervention cost. And then the intervention is cost-effective or not cost-effective. And all of this information is described in the reports that are written up about the systematic reviews. And so the CPSTF may also issue an economic finding to highlight any additional economic aspect of the intervention that the CPSTF deems is important for a potential implementer to know. Dissemination. So dissemination is very important for our work. This is really to not just raise awareness and promote use of the Community Guide and the CPSTF findings, but it's also to help potential implementers give them the information that was obtained from the different reviews that we're doing, whether across different types of programs, that we're doing, whether across different topics and the different types of reviews, whether it's a review on effectiveness or economics. But this is really to be a service for implementers to be able to implement these interventions within their communities. And so we do our best to kind of spread the word about what the CPSTF has been recommending. So part of our dissemination process is working very closely with 32 different liaisons. At the moment, we have these 32 liaisons, and they're from a variety of different organizations, from public health to healthcare to federal agencies or large employers. And they really help us get And so as Katrina and I have both said, we really try to produce products of these CPSTF findings. And so once the review is completed and the CPSTF has issued their finding, that's where we'll go to the next slide. And so the CPSTF has issued their findings, and so we'll go to the next slide. So once the review is completed and the CPSTF has issued their finding, that's where we'll produce different reports that are all available on our website. We have a longer report called the Task Force Finding and Rationale Statement that provides the details of the systematic review. And then we have a briefer web intervention summary. And then additional promotional materials are shown on this slide. And again, a few more, some success stories. And those are really interesting because they are examples of communities or states that have taken a CPSTF recommendation and implemented it in their area. And so these reports describe their process and what they did. And so in summary, so the CPSTF is an independent panel of public health and prevention experts, a public health and prevention experts who make recommendations on evidence-based population health interventions. These recommendations are informed by the systematic reviews that are conducted on effectiveness, on health equity, and the economics of the intervention. And as Katrina said earlier, the CPSTF and USPSTF are complementary. So how can the CPSTF benefit you? So first, you can find the CPSTF recommendations and other related resources on our website. It's shown here. And you can also use the CPSTF recommendations to inform public health activities in your healthcare organization or in your community. You could maybe use CPSTF evidence gaps that are included in our reports and any insufficient evidence findings to inform any of your research proposals to help fill those evidence gaps. And then of course, you can keep up to date by following us on Twitter or sign up on the website to receive email notices. Okay. So that concludes our presentation. I thank you for your time. I think Jordana will open it up for discussion. Okay. Hi, everyone. Thank you for your presentation. I learned a lot. The first question we have, can everybody hear me? Thumbs up if you can hear me. Yes. Yes. Okay. The first question that we have is the USPSTF membership is limited to physicians who are in primary care practice. Is there an educational or occupational background requirement for the community task force membership? Katrina, I can take that one. So there's no strict requirement like that, but typically our CPSTF members have, they're more senior in their careers. They have many years of public health practice of experience or research experience. And they're more senior of experience or research experience. And we have a mix of PhDs, so more research oriented track, and MDs. So it's a mix, but we do open, we have public announcements when our, we have a task force member slots open. So I recommend you keep an eye out for those. And if you are interested, go on and fill out the application. Every application we receive is reviewed. Thanks Holly. Next question. Does the CPSTF look at community and business-based interventions such as work where you live incentives that incentivize cleaning up and improving neighborhoods to identify best practices that avoid marginalizing the impoverished addiction homeless populations that often reside in those areas? Do you want me to repeat that? That was a really long question. Sure. I'll read that. I'll read that one more time. Do, does the task force look at community and business-based interventions such as work where you live that incentivize cleaning up and improving neighborhoods to identify best practices that avoid marginalizing otherwise marginalized populations that live there? So I'm happy to start. I'm not sure that I was going to say that question had all kinds of different elements in it. But as I mentioned earlier, I'm really excited about this move towards more of the social determinants of health and what some of those impacts might be. Right when I started on the task force, there were a number of interventions looking at housing and this idea of housing first, for example. So a discussion about looking at the data about people who had problems with addiction. And in some places it's like, well, you need to clean up and then we'll find you an apartment. And actually the data show that many people in order to manage their chronic disease, including addiction and other mental health issues, do better if you can actually house people first and then work to treat the addiction. So it doesn't answer that entire question, but it does, this idea of looking at some of the things that really do relate to where people live, what the neighborhoods are like. We were just looking at one that had to do with housing, and the big question is, you know, we were looking at public housing programs versus vouchers, and of course I think a lot of things have moved towards vouchers, and then the question is, well, is it the voucher that work, or is it the people who then move to a neighborhood that has a higher SES, and what does that do for the neighborhoods that they've moved from, and so you're looking at both the individual and then the impacts that that might have on different neighborhoods. So I guess the short answer is, not exactly everything the question said, but if you tease apart some aspects of it, that is one of the things that the task force is looking at are very, you know, some of the smaller or the more specific aspects of it, and it is one of the things that I have been quite excited about when it comes to the focus of the task force during the next five years. So Holly, you might want to add to that. I think that was a perfect response. You know, to add to that, you know, that social determinants of health, health equity was one of the prioritized topic areas. So that type of intervention that was asked within the question would fall under that topic area. I think the one question I have is what the body of evidence might be. Are there evaluations of these types of interventions that could inform a systematic review? And that's just, it's outside of my personal field of expertise, so that would be probably the first question the community guide would ask. All right, thank you. Next question. What population level interventions are available or in process to increase access to technology for those in lower SES and rural areas? So for access to technology, so currently right now, we don't have any interventions that we're reviewing regarding access to technology. We are reviewing different types of interventions, you know, for example, digital health interventions to try to get people to live healthier lifestyles, like improve their dietary behaviors or increase their physical activity levels. But you know, in terms of the assumption there is, and the studies describe this, that people tend to already bring their own devices to these types of interventions. So as far as actually providing any sort of device, we have not looked at that type of intervention. Next question. Is there a coordinating body for research related to CPSTF identified research gaps? I like that question. Go ahead, Holly. So as far as a coordinated body, I guess I don't really understand the question. So what we do is in each of our reports, we have an evidence gap section. So in that section exists regardless if the intervention is recommended by the CPSTF or not. So if the intervention is recommended, those evidence gaps tend to be a little bit more specific such as, does this intervention work among population X and population Y? Because the included studies may have demonstrated effectiveness, but may not have stratified results by, say, men and women or by different races and ethnicity. So we would have specific questions calling out. We need more information to answer these specific questions. And then for our insufficient evidence findings, those evidence gaps are more high level. We need more studies to demonstrate if this intervention is effective or not. And we still might have some more detailed evidence gaps questions, but that main question, is this intervention effective? That's what needs to be answered. So we do have through, I know through some of CDC's FOAs, they will look for if people will say that they're looking at particular evidence gaps that have been identified by CPSTF or not. But in terms of a coordinated body looking at that, I'm not aware. I don't know, Katrina, you have anything to add? No. Yeah. No, what I was going to say is that it's part of the broader is that there is some tension when it comes to the work of the task force. Part of that is that we want the task force to be relevant, but by its nature, the task force is reviewing data or studies that have already been published. And for things to be published, there has to be a research study, there has to be a protocol, there have to be findings, and then even the publication process can take a year or more, as those of us who've published studies know very well. So back to this sort of saying, well, this is research that needs to be done. So some of these broader issues are really important and we support those, but it's hard for us to say, well, there needs to be more research on, let's just take the previous answer on access to technology for certain populations, making sure, you know, it's hard for the task force to then, you know, who's at the receiving end of that? I mean, it may actually be that the big tech companies are on the receiving end of that. So I would say there has not been a coordinated response, but that is kind of an ongoing tension between a lot of the studies, as we all know who published, you know, it's very specific questions, but the evidence graphs are some of these broader issues. So yeah. Yeah. Okay. And we're short on time, so I'm going to give you guys one last question. Hang on. Is the uptake rate of CPSTF recommended interventions tracked? And if so, what are the types of interventions that tend to be operationalized? That's a great question. That's a great question. So we don't at the community guide office officially track uptake. However, we do have examples on our website of states, state and local health departments or other organizations who have implemented CPSTF recommendations. And you know, we have the success stories that I mentioned earlier that are on our website to show how other communities may be able to implement, you know, that particular recommendation in their own area. So I mean, we have, and we're accumulating those over and over. And I want to say, I'm not on the dissemination team, but I want to say the dissemination team has several that they can be working on, you know, so we do, we are, they do reach out to us and say, oh, you know, I just want you to know we did do this and dah, dah, dah. So that's when we're interested in having them as a success story. So I think if anyone is listening to this and you are aware of anyone implementing an intervention that's recommended, you know, please contact us and, you know, we'll work to write it up and it can be on our website for, to help other communities implement. You know, I was going to say, I really liked the question because you're asking about data and what's the evidence that the recommendations or that the work that the task force is doing is effective. So it's, it's a great question. I think one of the challenges, as Holly said, is I'll just give another example of something we recently discussed, but active lessons. So this has to do with classrooms. How do you get kids move? And there's been less and less, if you will, physical education or whatever in school. So the question is, can you actually increase physical activity by having kids stand up during, so for example, vote with your feet, everyone who says yes, stand up, you know, no, et cetera. So, you know, those kinds of things. Well, that could be implemented at a, I mean, it could be the state department of education who says you need to implement, it could be school districts, it could be individual schools, or it could be a classroom teacher who sees us and says, okay, we're not going to now raise our hand for yes or no, everyone stands up. And so there are, you know, some of these interventions that cost money. You could see, you know, there is a discrete intervention. It has to get implemented, it has to get funded, et cetera, and there would be data, but some of the other interventions, as the one I just said, are really, I don't know how effective it is in the long run of getting, you know, preventing obesity, let's just say. But at the same time, it clearly increases physical activity among those kids who are participating in this. So while the outcome may not be huge, the intervention is essentially, it doesn't cost anything to implement at all. So back to the question, we'd love to have more data, I think that would be terrific. The question is, the interventions are such that some of them are extremely, well, extremely, they are on the higher end of resources, but very effective. Let's take something like, we were just talking about colorectal cancer, obviously that's an expensive intervention to do both at the clinical level, but when you're implementing systems, et cetera, to my, you know, the active class, you know, active lessons, it takes essentially no resources to implement. So just even picking and choosing which ones, but I do like the question, that might be something that we ought to consider as a task force. Are there certain ones of these interventions that we would actually like to track and see whether or not the findings are implemented? I think that's a great idea. Yeah, I agree. All right, so with that, we will close. Today's contact information is up in the presenter portal and in the conference materials. So we encourage you all to please reach out to all of us and connect. And I speak for myself, as well as both of our panelists, that we would love to hear from you if you have any continued questions or would like to connect. And thank you all so much for coming. Thank you. The downtown Denver area is unique. Here, there's just so much more to do. There's plenty of historic sites, brand new businesses, museums, and cultural events happening every month. Denver is an extremely active city. It's an excellent place to try just about anything. People have come down here both to live and to play. It's full of shops, restaurants. It's really made it an enjoyable place to hang out. The changes to the downtown area are amazing. From Larimer Square into 16th Street Mall. 16th Street Mall is a really diverse area. Each block is a little bit different and unique. I really enjoy the Denver Pavilions, which has an open-air concept that combines outdoorsy Colorado but also a very urban feel. There's the Hard Rock Cafe, Jazz at Jack's. You can also catch a film at the United Artists Theater. I stopped by the iHeart Denver store in the Denver Pavilions. You can find a real gambit, gift items, fine art pieces, prints, t-shirts, and jewelry, all made by local designers, artists, or creative-minded businesses. Denver has a public art ordinance that allocates 1% of any new capital improvement project to public art. So when you're walking around downtown, you will see a large piece or some sort of art installation in almost every building and plaza. 14th Street in the Convention Center area has been revitalized just recently. The Denver Performing Arts Complex is one of the largest in the country. It takes up four city blocks. You can catch the symphony, the opera, the ballet. It really runs the gamut of popular music to classical. Then you can go a little farther down and hit the MCA. They're just very unique, very innovative with their shows. One of the nicest features about Lodo is the scale. Downtown Denver, in general, is extremely walkable. You look at where Careers Field is, even to the Pepsi Center. Lodo is also very bike-friendly. We had one of the first electronic bike-share systems. B-cycle stations. You can get on one. You can use it all over town. The heart of the city really is downtown. You have lots of bars, dance clubs, to places with really great views, like the View House. And nice rooftop decks, like the Tavern. Denver's just great for those chef-driven, owned-restaurant concepts that you really could pick from about 20 or 30. We have about 92 beers on tap here at Falling Rock. If you're interested in craft beer, Denver is definitely the destination of the United States. Stoic & Genuine is my newest restaurant in Denver Union Station. I love the renovation inside the station itself. It's an incredible transformation of that historic building. They really took care to bring back that era of what it looked like as a train station. So all light rail, buses, and even Amtrak will be coming out of there. It's our pathway to DIA, which takes you to the world. Some of the great places downtown are these historic hotels. One is the Brown Palace. The other is the Oxford Hotel. Also in our neighborhood is the Tattered Cover, which is one of the most amazing bookstores. You just have that really fun, boutique feel when you walk in. It's just the volume that we have here that makes downtown Denver special. There's really a lot of activity for shopping, too. Larimer Square gives you that kind of feeling like Rockefeller Center might in New York. It's the only historic block that still has all the historic buildings. Larimer Square has some really fun little boutiques that I think you can get some unique gifts. I always take people to Rockmount Ranchwear. They're attributed with popularizing the snap front western shirt. From rock stars to ranchers, it's people who are looking for something quintessentially Colorado. If I had one word for downtown Denver, it'd be exciting. Active. Historic but emerging. Very funky. Be very artsy. It's kind of the heart of this city. It's also a melting pot of our Denver culture. So if you're coming down here, you're getting a real sense of Denver. It's just a constant stream of unexpected surprises here.

downtown Denver

activities

attractions

Larimer Square

16th Street Mall

Denver Pavilions

Colorado vibe

public art

cultural performances

Coors Field

craft beer destination