OBJECTIVE: To explore the amount and type of research funded under relevant Medical Research Future Fund (MRFF) Initiatives that addressed public health and prevention from 2018 to July 2023.
METHODS: Projects funded by six MRFF Initiatives, with objectives relevant to public health and public health nominated as \"field of research\" by >25% of applicants, were evaluated against a set of public health research criteria and were categorised based on levels of prevention.
RESULTS: Fifty-seven per cent of 249 funded projects were categorised as public health research. Projects with curative features, focusing on tertiary (32%) and quaternary (4%) prevention, were as common as projects with earlier preventive features, focussed on primordial (7%) and primary (28%) prevention. The Preventive and Public Health Research Initiative had the lowest proportion of public health research (48%) of the six evaluated Initiatives and a dominance of curative (39%) and non-preventive (26%) research over preventive research (30%).
CONCLUSIONS: This study highlighted variable levels of public health research across public-health-relevant MRFF Initiatives and generally low proportions of primary and primordial prevention. A greater emphasis on primordial and primary prevention research in public-health-relevant Initiatives could advance prevention in Australia.
CONCLUSIONS: There appears to be scope for improvement in the prioritisation of upstream prevention research in public-health-relevant MRFF Initiatives and projects. Addressing this may enhance the benefit of MRFF to Australian public health.

BACKGROUND: With an increasing proportion of older adults and the associated risk of Alzheimer\'s Disease and Related Dementias (ADRD) around the globe, there is an urgent need to engage in ADRD risk reduction efforts. African American (AA) older adults in the U.S. are disproportionally impacted by ADRD compared to other races and ethnicities. Mindful walking integrates two potentially protective factors of ADRD by elevating mindfulness and physical activity (i.e., walking), resulting in a synergistic behavioral strategy that is feasible and safe for older adults. However, the efficacy of applying this intervention for cognitive health outcomes has not been evaluated using experimental designs.
METHODS: This paper documents the goal and protocol of a community-based, mindful walking randomized controlled trial to examine the short- and longer-term efficacy on cognitive and other health-related outcomes in ADRD at-risk AA older adults. The study outcomes include various brain health determinants, including cognitive function, quality of life, psychological well-being, physical activity, mindfulness, sleep, and overall health status. In addition, the estimated costs of program implementation are also collected throughout the study period. This study will recruit 114 older adults (ages 60+ years) with elevated ADRD risk from the Midlands region of South Carolina. Older adults are randomly assigned to participate in 24 sessions of outdoor mindful walking over three months or a delayed mindful walking group (n=57 in each group). Participants in both groups follow identical measurement protocols at baseline, after 12 weeks, after 18 weeks, and after 24 weeks from baseline. The outcome measures are administered in the lab and in everyday settings. Costs per participant are calculated using micro-costing methods. The eliciting participant costs for mindful walking engagement with expected results are reported using the payer and the societal perspectives.
CONCLUSIONS: This study will generate evidence regarding the efficacy of mindful walking on sustaining cognitive health in vulnerable older adults. The results can inform future large-scale effectiveness trials to support our study findings. If successful, this mindful walking program can be scaled up as a low-cost and viable lifestyle strategy to promote healthy cognitive aging in diverse older adult populations, including those at greatest risk.
BACKGROUND: ClinicalTrials.gov number NCT06085196 (retrospectively registered on 10/08/2023).

Despite the high tobacco use rates (~80%) and tobacco-related cancers being the second leading cause of death among people experiencing homelessness within the United States, these individuals rarely receive tobacco use treatment from homeless-serving agencies (HSAs). This qualitative study explored the enablers and inhibitors of implementing an evidence-based tobacco-free workplace (TFW) program offering TFW policy adoption, specialized provider training to treat tobacco use, and nicotine replacement therapy (NRT) within HSAs. Pre- and post-implementation interviews with providers and managers (n = 13) pursued adapting interventions to specific HSAs and assessed the program success, respectively. The organizational readiness for change theory framed the data content analysis, yielding three categories: change commitment, change efficacy and contextual factors. Pre- to post-implementation, increasing challenges impacted the organizational capacity and providers\' attitudes, wherein previously enabling factors were reframed as inhibiting, resulting in limited implementation despite resource provision. These findings indicate that low-resourced HSAs require additional support and guidance to overcome infrastructure challenges and build the capacity needed to implement a TFW program. This study\'s findings can guide future TFW program interventions, enable identification of agencies that are well-positioned to adopt such programs, and facilitate capacity-building efforts to ensure their successful participation.

Strengthening systems for chronic disease prevention is essential. Leadership for systems change is an important key to strengthening systems. Leadership in prevention research for supporting systems change remains a relatively abstract concept and there is limited empirical information about the leadership practices of prevention research teams when viewed through a complexity lens. In this paper we examine and describe some systems leadership practices for creating change through prevention research, as identified in a series of six case studies.
A qualitative approach incorporating semi-structured interviews, participant observation, and document review was used to facilitate an in-depth investigation of the research topic.
Several researcher practices for enhancing research impact in the prevention of chronic disease were distilled from the data pertaining to how they sought to create change. These included persuasive communication, compassion and deep listening, reflective practice, and embedding themselves within the systems they sought to change.
The findings provide insights that may assist prevention researchers and other practitioners dedicated to creating change in chronic disease prevention.

We can learn a great deal about the research questions being addressed in a field by examining the study designs used in that field. This manuscript examines the research questions being addressed in prevention research by characterizing the distribution and trends of study designs included in primary and secondary prevention research supported by the National Institutes of Health through grants and cooperative agreements, together with the types of prevention research, populations, rationales, exposures, and outcomes associated with each type of design. The Office of Disease Prevention developed a taxonomy to classify new extramural NIH-funded research projects and created a database with a representative sample of 14,523 research projects for fiscal years 2012-2019. The data were weighted to represent the entirety of the extramural research portfolio. Leveraging this dataset, the Office of Disease Prevention characterized the study designs proposed in NIH-funded primary and secondary prevention research applications. The most common study designs proposed in new NIH-supported prevention research applications during FY12-19 were observational designs (63.3%, 95% CI 61.5%-65.0%), analysis of existing data (44.5%, 95% CI: 42.7-46.3), methods research (23.9%, 95% CI: 22.3-25.6), and randomized interventions (17.2%, 95% CI: 16.1%-18.4%). Observational study designs dominated primary prevention research, while intervention designs were more common in secondary prevention research. Observational designs were more common for exposures that would be difficult to manipulate (e.g., genetics, chemical toxin, and infectious disease (not pneumonia/influenza or HIV/AIDS)), while intervention designs were more common for exposures that would be easier to manipulate (e.g., education/counseling, medication/device, diet/nutrition, and healthcare delivery). Intervention designs were not common for outcomes that are rare or have a long latency (e.g., cancer, neurological disease, Alzheimer\'s disease) and more common for outcomes that are more common or where effects would be expected earlier (e.g., healthcare delivery, health related quality of life, substance use, and medication/device). Observational designs and analyses of existing data dominated, suggesting that much of the prevention research funded by NIH continues to focus on questions of association and on questions of identification of risk and protective factors. Randomized and non-randomized intervention designs were included far less often, suggesting that a much smaller fraction of the NIH prevention research portfolio is focused on questions of whether interventions can be used to modify risk or protective factors or to change some other health-related biomedical or behavioral outcome. The much heavier focus on observational studies is surprising given how much we know already about the leading risk factors for death and disability in the USA, because those risk factors account for 74% of the county-level mortality in the USA, and because they play such a vital role in the development of clinical and public health guidelines, whose developers often weigh results from randomized trials much more heavily than results from observational studies. Improvements in death and disability nationwide are more likely to derive from guidelines based on intervention research to address the leading risk factors than from additional observational studies.

The United States drug overdose epidemic has reached an all-time high, with 2020 provisional mortality data indicating that over 90,000 lives were lost to drug overdose in the 12-months ending in December 2020. The overdose epidemic has evolved over time with respect to the substances involved in overdose deaths and also with respect to the geographic distribution and epidemiology of deaths involving specific substances. Thus, a nimble approach to addressing the epidemic and preventing future overdoses is needed. CDC\'s response to the overdose epidemic supports implementation efforts at the state and local levels, where partners can better detect and respond to the evolving drug overdose landscape and implement prevention measures that meet their needs. CDC\'s framework for responding to the overdose epidemic focuses on five areas: (1) conducting surveillance and research; (2) building state, local and tribal capacity; (3) supporting providers, health systems and payers; (4) partnering with public safety; and (5) empowering consumers to make safe choices. Central to informing the implementation of evidence-based strategies to prevent drug overdose is rigorous research that undergirds the evidence. This Commentary describes recent investments in overdose prevention research and outlines opportunities for ensuring that future research efforts allow for the flexibility necessary to effectively respond to the continually evolving epidemic.

Open Science practices bear great promise for making research in general more reproducible and transparent, and these goals are very important for preventive intervention research. From my perspective as a program co-developer, I note potential concerns and issues of how open science practices can be used in intervention research. Key issues considered are in the realms of pre-registration (making pre-registration a living document; providing rewards for hypothesis-generating research, in addition to hypothesis-testing research), data archiving (resources for data archiving of large datasets; ethical issues related to need for strong de-identification), and research materials (intervention manuals and materials, and characteristics, training and supervision of intervention staff). The paper focuses on easier-to-address and considerably harder-to-address issues and concerns in these three areas.

OBJECTIVE: To effectively confront the type 2 diabetes (T2D) epidemic, policymakers and the public need to problematize T2D less as a medical and more as a social problem. An award-winning T2D prevention campaign was harnessed to determine the most successful ways of framing ads on Facebook.
OBJECTIVE: We will observe variation in the effectiveness of ad message-frames within audience-segments.
METHODS: Six parallel quasi-experiments (participants N = 203,156) were conducted with 6 disparate audience-segments defined through the Facebook ads-manager tool. Across all audiences, we exposed Facebook users to values-based ad-frames (10-15-word appeals), assigning 7 of 11 possible frames to participants within each audience in a quasi-experimental fashion (using Facebook users\' birth-month). Engagement was measured by rates of ad video-views, unique-link-clicks and donations to the campaign.
RESULTS: Contrary to our hypothesis, we observed remarkable consistency across target audiences. Ad-frames that ranked highly with most audience-segments included Entertainment and Emotional Appeal; Defiance Against Authority Appeal; Second-Hand Smoke/Environmental Appeal; and to a lesser extent, Common-Enemy/War-Metaphor Appeal. Conclusion and Practice-Implications: Across disparate segments of society, there appears to be a set of common values that public health communication initiatives can tap into to catalyze a more inclusive movement to confront the T2D epidemic through policy, systems and environmental approaches.

Health care providers are in a unique position to address patients\' health behaviors and social determinants of health, factors like income and social support that can significantly impact health. There is a need to better understand the risk behaviors of a population that providers may counsel (i.e., those who are insured and have a provider.) Using the 2015 and 2016 CDC\'s Behavioral Risk Factor Surveillance System, we examine the prevalence of health behaviors and the existence of disparities in health behaviors based on social determinants among American adults. Our sample included noninstitutionalized adults aged 18 to 64 years, in the U.S. (N > 300,000). We used multivariate logistic regression analysis to assess the independent effects of income, education, sex, race, and metropolitan status on nine key health behaviors. Among adults with insurance and a provider (n > 200,000): 1) rates of engaging in poor health behaviors ranged from 6.4% (heavy drinking) to 68.1% (being overweight or obese), 2) rural residence, lower income, and lower education were associated with decreased clinical preventive services, 3) lower income and lower education were associated with lifestyle-related risks, and 4) being black was associated with receiving more cancer screenings, no influenza vaccination, inadequate physical activity, and being overweight or obese. Insured adults, with a provider, are not meeting recommended guidelines for health behaviors. Significant disparities in health behaviors related to social factors exist among this group. Health care providers and organizations may find it helpful to consider these poor health behaviors and disparities when determining strategies to address SDOH.

The Good Participatory Practice (GPP): Guidelines for Biomedical HIV Prevention Trials, second edition (2011) were developed to provide clinical trial sponsors and implementers with a formal stakeholder engagement framework. As one of the largest African research institutes, Wits Reproductive Health and HIV Institute (Wits RHI) became an early adopter of GPP by implementing its principles within large-scale national and regional clinical trials. This article examines Wits RHI\'s lessons learned from implementing GPP, its ongoing efforts to institutionalize GPP, and the yet to be realized potential in creating fully sustainable structures for meaningful stakeholder engagement in HIV prevention research, implementation science and beyond.
For the past seven years, Wits RHI has undertaken both centralized leadership roles in implementing GPP across multi-party regional research consortia as well as overseeing GPP for smaller investigator-driven trials. Through this iterative roll-out of GPP, key lessons have emerged. Obtaining upfront funding to support GPP activities throughout and between the research life cycle, and a trained multi-disciplinary team of GPP practitioners have helped facilitate an enabling environment for GPP implementation. We further recommend formally integrating stakeholder engagement into study documents, including monitoring and evaluation plans with indicators and performance metrics, to assist teams to track and refine their GPP strategies. Finally, institutionalizing resources and supporting organization-wide GPP along with ongoing support can help build efficiencies and maximize economies of scale toward a pragmatic and innovative application of the GPP Guidelines.
Thanks to a growing global network of GPP practitioners and a burgeoning GPP Community of Practice, there has been substantive progress in making GPP an integral component of clinical HIV prevention research. The Wits RHI experience highlights the possibilities and the challenges to translating the GPP principles into concrete practices within specific clinical trials and across a research institute. Realizing the full potential of GPP, including direct and indirect - \'collateral benefits\' will require the collective buy-in and support from sponsors, implementers and community stakeholders across the research field. As the HIV prevention research field expands, however, a more conscious and systematic implementation of GPP is timely.