In this lesson, you will learn about the Community Preventive Services Task Force and how its findings are used in public and community health. You will also apply what you have learned about the CPSTF to scenarios using The Community Guide resource recommendations to respond. Specifically, this lesson will cover the following:
The Community Preventive Services Task Force (CPSTF) is an independent panel established by the U.S. Department of Health and Human Services in 1996. It is dedicated to identifying community health interventions that are scientifically proven to save lives, increase lifespans, and improve the quality of life. The CPSTF provides evidence-based recommendations through The Community Guide, a resource for what works to improve public health (The Community Guide, 2023).
The Community Guide is a resource for evidence-based recommendations on health topics, including adolescent health, asthma, cancer, diabetes, heart disease, stroke prevention, and so many more health issues that public and community health professionals try to address.
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2. How Can CPSTF Be Used in Public Health?
The CPSTF recommendations provide valuable guidance for evidence-based interventions for public and community health issues. The Community Guide helps public health professionals and communities enhance health and safety while advancing health equity. Public and community health professionals, as well as researchers, community leaders, and students, can search The Community Guide for topic-specific recommendations and explore interventions promoted by the task force as being effective in addressing priority issues such as physical activity and food insecurity.
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EXAMPLE
CPSTF evaluates scientific evidence (studies) and recommends effective interventions across various settings, including the community, home, school, and health care.
These recommendations target structural, economic, and social determinants impacting health outcomes (Melnikow & Istas, 2023). The recommendations are based on systematic reviews of evidence/studies regarding effectiveness and economic impact.
The recommendations in italics below are taken directly from the CPSTF. Once you have read the recommendation and the scenario, apply what you have learned about the CPSTF to answer the questions that follow.
2a. School Lunch or Bust
“The Community Preventive Services Task Force (CPSTF) recommends Healthy School Meals for All based on strong evidence of effectiveness in increasing student participation in the U.S. Department of Agriculture’s National School Lunch Program (NSLP) and School Breakfast Program (SBP) and sufficient evidence of effectiveness in reducing school absenteeism. In the broader literature, participation in NSLP and SBP is associated with reduced food insecurity, improved nutritional quality of students’ diets, and improved academic outcomes (County Health Rankings & Roadmaps 2019, Fox et al. 2019, Liu et al. 2021, Ralston et al. 2017).
Healthy School Meals for All is expected to advance health equity in the United States by removing barriers to consistent access to free and healthy foods for students from households with lower incomes. Healthy School Meals for All is often implemented in schools in which a large proportion of enrolled students are from households with lower incomes (Billings et al. 2020, National Archives 2022, USDA 2019), and most of the studies included in the systematic review evaluated outcomes for this population.” Community Preventive Services Task Force (The Community Guide, 2022)
The CPSTF recommends healthy school meals for all to increase participation in the National School Lunch Program (NSLP) and School Breakfast Program (SBP) and reduce school absenteeism. Both programs are associated with reduced food insecurity, improved quality of students’ diets, and improved academic outcomes. To be eligible to participate in these programs, the Community Eligibility Provision, the most widely used federal policy, allows schools and school districts to offer Healthy School Meals for All if at least 40% of enrolled students are directly certified for free meals based on their participation in other means-tested programs, such as the Supplemental Nutrition Assistance Program, Temporary Assistance for Needy Families, or Food Distribution Program on Indian Reservations (Billings et al. 2020; National Archives 2022; USDA 2019).
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Amy’s alarm goes off at 7 a.m., and she knows she needs to get out of bed and rush to get ready for school. Her bus stops in her neighborhood at 7:30 a.m. Her mom, a single mother, has already left to get to work on time. Amy often goes to school without having breakfast. Her mom can sometimes make her lunch, but often they don’t have enough food for that, so Amy needs to have breakfast and lunch in the school cafeteria. Amy knows she is supposed to get breakfast and lunch for free at her school.
Consider the following options. Amy will only be able to get breakfast and lunch in her school if:
- Amy arrives on time to school every day to qualify for receiving meals and she is not failing any of her classes.
- Amy lives in a community that has been approved to offer the National School Lunch Program (NSLP) and the School Breakfast Program (SBP).
- Amy’s mother is employed.
Which of the above options is correct?Amy lives in a community that has been approved to offer the National School Lunch Program (NSLP) and the School Breakfast Program (SBP). The CPSTF recommends healthy school meals for all to increase participation in the National School Lunch Program (NSLP) and School Breakfast Program (SBP), reduce school absenteeism, and improve academic achievement.
2b. I’m Too Old to Exercise!
“The Community Preventive Services Task Force (CPSTF) recommends digital health interventions to promote physical activity among adults 55 years and older based on sufficient evidence of effectiveness in increasing physical activity. Interventions that delivered tailored physical activity guidance and support through the web, by telephone, or by text message were effective in increasing measures of walking and time spent in moderate to vigorous physical activity. Findings included a 28% increase in physical activity in use of ‘any’ digital intervention; web or internet-based interventions also showed a 28% increase in physical activity; telephone-based interventions showed a 42% increase in physical activity and text message-based interventions showed a 23% increase in physical activity.
Findings of this review support the use of tailored digital health interventions to provide physical activity guidance and support to adults aged 55 years and older. Although studies showed differences in effect estimates by mode (i.e., web, telephone, text), the increasing popularity of smartphones among older adults should offer opportunities to examine user preferences.
The rapid evolution of digital health technology is likely to provide researchers with opportunities to evaluate effectiveness of devices with substantially enhanced content and interactivity. These may include the integration of behavior change techniques such as social support, prompts and reminders, rewards, and behavioral self-monitoring (Lyons 2014). Scalability of community-based interventions will likely depend on the use and capabilities of devices owned by recruited participants.
Digital health interventions to promote physical activity among adults 55 years and older use one or more of the following to deliver guidance and support that is tailored to individuals’ activity level, age, and health status:
- Web-based interactive content (e.g., virtual coaching)
- Telephone sessions with intervention providers or automated voice messages and reminders
- Text messages and reminders
- Apps with goal-setting, activity tracking, and reminder functions
- Interventions also may include print materials or devices designed to provide feedback (e.g., pedometers, accelerometers).”
Community Preventive Services Task Force (The Community Guide, 2019)
The CPSTF findings are meant to highlight the value of digitally based interventions to encourage older adults (aged 55 or older for these findings) to engage in moderate to vigorous physical activity to promote and prevent healthier outcomes as they age. Notice that the findings are specific to the types of devices the participants were comfortable using.
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Mark’s grandmother is 62 years old and leads what Mark would call a sedentary lifestyle. She doesn’t like to do much physical activity but will take leisurely walks with Mark when he asks her to join him. She will also garden sometimes. She uses an iPad he gave her for her birthday last year to read fiction and gardening books. Mark is certain that if his grandmother does not move more, she will begin to develop health issues as she ages.
Consider Mark's options:
- He could locate an online program that is accessible through his grandmother’s iPad, explain his concerns and what he knows can happen to her as she ages, and partner with her to register for a program. He could perhaps recruit one of her friends to do it with her.
- He could sign Grandma up for a community program offered twice a week at a local center and tell her she must attend.
- He could do nothing as she’s happy and living life on her own terms.
What would be the best way for Mark to try to engage his grandmother in more physical activity?He could locate an online program that is accessible through his grandmother’s iPad, explain his concerns and what he knows can happen to her as she ages, and partner with her to register for a program. He could perhaps recruit one of her friends to do it with her.
The CPSTF findings are meant to highlight the value of digitally based interventions to encourage older adults (aged 55 or older for these findings) to engage in moderate to vigorous physical activity to promote and prevent healthier outcomes as we age.
2c. Healthy Me, Healthy Baby!
“The Community Preventive Services Task Force (CPSTF) recommends lifestyle interventions delivered during the first two trimesters of pregnancy to reduce the risk of gestational diabetes as it relates to maternal and child health in public and community health. Gestational diabetes is high blood sugar that develops during pregnancy in women who don’t already have diabetes. Risk factors for gestational diabetes include being overweight, having a family history of type 2 diabetes, being an African American, Hispanic or Latino, American Indian, Alaska Native, Native Hawaiian, or Pacific Islander person, and other factors. About half of all women who develop gestational diabetes are likely to develop type 2 diabetes later in life (CDC, 2017). Babies whose mothers have gestational diabetes are at higher risk of being born early, having low blood sugar, and developing obesity later in life (CDC, 2017).
The CPSTF finds strong evidence of effectiveness for lifestyle interventions that provide supervised exercise classes, either alone or in combination with other components to reduce the risk of gestational diabetes. The CPSTF finds sufficient evidence of effectiveness for lifestyle interventions that provide education and counseling for diet or physical activity, diet activities, or a combination of these components to reduce the risk of gestational diabetes. Compared to usual care, lifestyle interventions that provided supervised exercise classes alone or in combination with other components reduced the risk of developing gestational diabetes by 32%. Compared to usual care, education and counseling for diet and physical activity reduced the risk of gestational diabetes by 31%. Lifestyle interventions delivered during the first two trimesters of pregnancy aim to prevent gestational diabetes by actively encouraging women to eat a healthy diet and be physically active. Programs include one or more of the following components:
- Supervised exercise classes
- Diet education and counseling
- Physical activity education and counseling
- Diet activity (e.g., meal plan, food diary, individualized support)
Greater reductions were observed, however, for interventions that provided supervised exercise classes in combination with diet education and counseling.
The intervention should be effective with participants recruited before their second trimester (any gestational age), regardless of pre-pregnancy BMI, maternal age (though interventions were more effective for participants 30 years and older), or risk level for developing gestational diabetes (though interventions were more effective for participants with higher risk levels).”
Community Preventive Services Task Force
The CPSTF findings are meant to emphasize the importance of actively encouraging pregnant women before their second trimester of pregnancy and/or those with a risk of developing gestational diabetes to eat a healthy diet and be physically active.
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Noliyanda used to be an athlete in high school, but it has been at least 10 years since she has done any kind of real exercise. She’s become overweight and is now nervous because she’s pregnant, and her doctor told her she’s at a higher risk of developing gestational diabetes. She doesn’t know what to do because there is so much information in the media about different ways to lose weight, but she doesn’t know what’s safe or effective for her and her unborn baby.
Consider Noliyanda's options:
- Enroll in the new “Healthy Mama” lifestyle class offered at the local health department
- Take the new, highly successful weight loss drug that she read about on social media
- Remove her favorite 32-oz soft drink from her daily fast-food lunch
- Do nothing, because she’s not that overweight and nobody in her family ever had gestational diabetes
In this lesson, you learned what the Community Preventive Services Task Force is and how the CPSTF can be used in public health. You also applied this new content in response to scenarios that challenged you to examine recommendations from the CPSTF to apply to public and community health issues: School Lunch or Bust, which highlighted programs to address food insecurity in school-aged children; I’m Too Old to Exercise, which promoted the importance of physical activity in older adults; and Healthy Me, Healthy Baby!, about the importance of a healthy diet and exercise to reduce the risk of gestational diabetes for the health of the mother and baby.
