Abstract
Objectives
The Community Preventive Services Task Force (CPSTF) makes evidence-based recommendations about preventive services, programs, and policies in community settings to improve public health. CPSTF recommendations are based on systematic evidence reviews. This study examined the sponsors (ie, sources of financial, material, or intellectual support) for publications included in systematic reviews used by the CPSTF to make recommendations during a 9-year period.
Methods
We examined systematic evidence reviews (effectiveness reviews and economic reviews) for CPSTF findings issued from January 1, 2010, through December 31, 2018. We assessed study publications used in these reviews for sources of support; we classified sources as government, nonprofit, industry, or no identified support. We also identified country of origin for each sponsor and the most frequently mentioned sponsors.
Results
The CPSTF issued findings based on 144 systematic reviews (106 effectiveness reviews and 38 economic reviews). These reviews included 3846 publications: 3363 publications in effectiveness reviews and 483 publications in economic reviews. Government agencies supported 57.1% (n = 1919) of publications in effectiveness reviews and 59.2% (n = 286) in economic reviews. More than 1500 study sponsors from 36 countries provided support. The National Institutes of Health was the leading sponsor for effectiveness reviews (21.3%; 718 of 3363) and economic reviews (16.2%; 78 of 480), followed by the Centers for Disease Control and Prevention (7.0%; 234 of 3363 effectiveness reviews and 14.8%; 71 of 480 economic reviews).
Conclusions
The evidence base used by the CPSTF was supported by an array of sponsors, with government agencies providing the most support. Study findings highlight the need for sponsorship transparency and the role of government as a leading supporter of studies that underpin CPSTF recommendations for improving public health.
Keywords: public health, systematic review, recommendation, funding bias, Community Preventive Services Task Force (CPSTF)
Decision makers from health departments, government agencies, schools, businesses, and community organizations seek guidance on effective population-based interventions that can prevent disease and promote well-being.1,2 To address this need, the Community Preventive Services Task Force (CPSTF)—an independent, nonfederal panel of public health and prevention experts—publishes findings and recommendations about community preventive services, programs, and policies (ie, interventions) based on systematic reviews of their effectiveness and economic benefit.2,3 CPSTF recommendations, and the systematic reviews on which they are based, are published in The Community Guide (www.thecommunityguide.org). The systematic reviews used by the CPSTF include relevant research and evaluation studies from various sources (eg, published articles, technical reports, unpublished dissertations/theses, abstracts/presentations, books/book chapters).4 When drawing conclusions about an intervention’s effectiveness, the CPSTF considers the evidence that is assessed in the systematic effectiveness review5 and issues 1 of 3 findings: (1) recommend (strong or sufficient evidence that the intervention is effective), (2) recommend against (strong or sufficient evidence that the intervention is harmful or not effective), or (3) insufficient evidence (inadequate evidence for determining whether the intervention is, or is not, effective).5 For interventions determined to be effective, the CPSTF often considers evidence from a separate systematic review of the economics of the intervention, and it publishes findings about key features, such as the intervention’s costs, benefits, costs averted, and cost-effectiveness.6
Decision makers who use, or are considering using, CPSTF recommendations need credible information based on unbiased research. Although the scientific literature does not cite specific concerns about bias in CPSTF recommendations, previous work showed that many clinicians and other experts may have misgivings about research generally because of the widespread presence of industry-funded studies7 (eg, studies funded by companies or corporations that are involved in the development and production of drugs and devices and that may reap financial or other benefits). Some studies may lack clarity in the reporting of study sponsors,7 and some studies may be biased in design, outcome, and reporting7 to show a favorable outcome that benefits a study’s sponsor.8
Calls are increasing for more transparency in identifying sponsors that provide support for health research.9 The area of sponsorship that typically draws the most attention is financial support, which involves providing funds for a study or compensation for study researchers (eg, grants, salaries, speaking fees). Yet sponsorship can also include material or intellectual support. Material support involves providing supplies and equipment needed to conduct a study (eg, medications, software, computers). Intellectual support involves the provision of professional services, or scholarly advice or analysis, to advance a study. To date, a comprehensive assessment of sponsors (ie, sources of financial, material, or intellectual support) that have contributed to studies and evaluations included in the systematic reviews that serve as the evidence base for CPSTF recommendations has not been undertaken. The primary objective of this study was to fill that need and to increase the transparency of CPSTF findings and recommendations. A second objective was to describe the extent to which federal agencies support studies that inform CPSTF recommendations and help identify insufficient evidence. These baseline data can inform future cross-agency collaborations to address topic-specific research gaps.
Methods
We used The Community Guide to identify all CPSTF findings issued from January 1, 2010, through December 31, 2018.10 We chose this period to be contemporaneous with a related study of funding sources for publications included in US Preventive Services Task Force (USPSTF) systematic reviews11 and to maximize the availability of publications (almost all publications could be found online or in The Community Guide’s electronic storage systems). For each CPSTF finding, we obtained the accompanying systematic reviews—effectiveness review and/or economic review—and lists of the included publications for each review (available on The Community Guide website). We located electronic copies of all publications included in these reviews by using PubMed, Google Scholar, and the search services of the National Institutes of Health (NIH) Library, or with assistance from staff members of The Community Guide at the Centers for Disease Control and Prevention (CDC).
One primary coder (E.N.) examined each publication for its acknowledged sources of support (ie, financial, material, or intellectual). As was done in the USPSTF study,11 the coder classified sources of support into the following categories according to the type of organization that was acknowledged as providing support: (1) government (ie, federal, state, or local agencies and offices); (2) nonprofit (ie, charitable foundations and nonprofit organizations, health systems, hospitals, and postsecondary academic institutions); (3) industry (ie, pharmaceutical, technology, diagnostic, health insurance and consulting companies, for-profit medical groups, and other businesses); and (4) no identified support (ie, the publication did not list any sources of support).
The same coder also categorized publications into the following types of publications: journal articles, technical reports, dissertations or theses, abstracts or presentations, or books or book chapters. In addition, the coder coded sources of support by country of origin based on the location of the organization’s headquarters. We consulted the World Bank website to determine which of the sponsors were headquartered in high-income countries.12 The coder did not classify types of support (ie, financial, material, or intellectual) because this level of detail was often not provided in publications. We used Microsoft Excel to capture and summarize the coded information. For a randomly selected 10% of publications, a second coder (an NIH project support administrator, K.K.) verified the categorization of sources of support; intercoder reliability was 98%.
When a publication listed >1 category of support (eg, government and nonprofit), the coder classified the publication in both categories; therefore, totals for individual categories may sum to >100%. We counted publications in 2 ways: the number of unique publications and the total number of publications. For the number of unique publications, we counted each publication only once, regardless of whether it was used in >1 systematic review. A portion of the unique publications was used in >1 systematic review. For the total number of publications, we counted a publication each time it was used in a review. We tabulated study results based on the total number of publications, rather than on the number of unique publications, to enable a comprehensive description of the sources of support by CPSTF health topic. We organized results separately for effectiveness reviews and economic reviews and organized each by CPSTF health topic.
This study entailed a secondary analysis of documents; as such, we obtained no identifiable private information about patients. The senior author determined that the study was exempt from institutional review board approval under 45 CFR 46.104.
Results
From 2010 through 2018, The Community Guide posted 144 systematic reviews (106 effectiveness reviews and 38 economic reviews). CPSTF used these reviews to make 116 recommendations (115 recommended interventions; 1 recommended against) and 28 insufficient evidence determinations. The reviews covered 16 broad health topics (eg, physical activity) and 106 subtopics addressing interventions within broad health topics (eg, school-based physical education—to improve physical activity).
Number of Unique Publications
The 144 systematic reviews comprised 3123 unique publications—90.0% (n = 2810) were journal articles, 6.5% (n = 204) were technical reports, 2.2% (n = 70) were dissertations and theses, 0.9% (n = 27) were abstracts or presentations, and 0.2% (n = 5) were books or book chapters. Of these unique publications, 76.0% (n = 2373) listed >1 source of support, 23.2% (n = 726) did not identify a source of support, and 0.7% (n = 24) could not be located or were not in English.
Total Number of Publications
Twelve percent (n = 363) of the unique publications were used in >1 systematic review. The citation of a publication in >1 review occurred most often when both effectiveness reviews and economic reviews were conducted for the same intervention or when a study assessed >1 intervention strategy and the strategies were evaluated in >1 review. Counting publications each time they appeared in a review resulted in a total of 3846 publications (average per review, 27; median, 16; interquartile range, 7-31): 3363 publications were in effectiveness reviews, and 483 publications were in economic reviews.
Total Number of Publications Included in Effectiveness Reviews
Of the 3363 publications included in The Community Guide effectiveness reviews, 57.1% (n = 1919) were supported by a government agency, 34.2% (n = 1151) by a nonprofit entity, and 7.0% (n = 235) by industry; 23.3% (n = 783) had no identified support, and 0.7% (n = 25) could not be located or were not in English (Table 1). The top 5 study sponsors, each of which supported ≥40 publications, were the NIH (21.3%; n = 718), CDC (7.0%; n = 234), the Robert Wood Johnson Foundation (RWJF) (3.3%; n = 111), the US Department of Education (1.6%; n = 53), and the Agency for Healthcare Research and Quality (AHRQ) (1.4%; n = 47). NIH support was primarily provided for the topic areas of cancer, tobacco, cardiovascular disease, physical activity, obesity, and mental health (Table 2). Although CDC predominantly provided support for studies on vaccination, the agency also supported publications on cancer, tobacco, and diabetes. RWJF primarily provided support for publications on tobacco, vaccination, obesity, and mental health. The US Department of Education supported publications on educational interventions that were included in health equity reviews, whereas AHRQ primarily supported publications on vaccination and cardiovascular disease.
Table 1.
Sources of support for publications included in CPSTF effectiveness reviews for findings published from January 1, 2010, to December 31, 2018
| Health topic | No. of effectiveness reviews | No. of publicationsa | Type of organization providing support for publications, no. (%)b | |||
|---|---|---|---|---|---|---|
| Government | Nonprofit | Industry | Unknownc | |||
| Cancer | 22 | 445 | 282 (63.4) | 175 (39.3) | 30 (6.7) | 60 (14.2) |
| Cardiovascular disease | 8 | 256 | 127 (49.6) | 76 (29.7) | 52 (20.3) | 46 (18.0) |
| Diabetes | 7 | 189 | 111 (58.7) | 97 (51.3) | 38 (20.1) | 15 (7.9) |
| Emergency preparedness | 1 | 67 | 39 (58.2) | 7 (10.4) | 1 (1.5) | 29 (43.3) |
| Excessive alcohol consumption | 5 | 68 | 49 (72.1) | 17 (25.0) | 2 (2.9) | 12 (17.6) |
| Health communication and health information technology | 3 | 67 | 40 (59.7) | 28 (41.8) | 7 (10.4) | 10 (14.9) |
| Health equity | 10 | 516 | 246 (47.7) | 159 (30.8) | 11 (2.1) | 201 (39.0) |
| Mental health | 2 | 100 | 66 (66.0) | 41 (41.0) | 11 (11.0) | 15 (15.0) |
| Motor vehicle injury | 2 | 102 | 51 (50.0) | 20 (19.6) | 1 (1.0) | 35 (34.3) |
| Nutrition | 1 | 14 | 6 (42.9) | 9 (64.3) | 2 (14.3) | 3 (21.4) |
| Obesity | 9 | 174 | 127 (73.0) | 83 (47.7) | 9 (5.2) | 19 (10.9) |
| Oral health | 5 | 183 | 84 (45.9) | 43 (23.5) | 9 (4.9) | 73 (39.9) |
| Physical activity | 6 | 203 | 137 (67.5) | 80 (39.4) | 11 (5.4) | 40 (19.7) |
| Tobacco | 8 | 531 | 312 (58.8) | 203 (38.2) | 26 (4.9) | 109 (20.5) |
| Vaccination | 16 | 421 | 218 (51.8) | 102 (24.2) | 23 (5.5) | 140 (33.3) |
| Violence | 1 | 27 | 24 (88.9) | 11 (40.7) | 2 (7.4) | 1 (3.7) |
| Total | 106 | 3363 | 1919 (57.1) | 1151 (34.2) | 235 (7.0) | 808 (24.0) |
Abbreviation: CPSTF, Community Preventive Services Task Force.
aPublications may be cited more than once within and across health topics.
bPublications may be supported by >1 category of sponsor; therefore, sums may be >100%.
cIncludes publications with no identified support, publications that could not be located, and non–English-language studies.
Table 2.
Organizations supporting at least 40 publications included in CPSTF effectiveness reviews for findings published from January 1, 2010, to December 31, 2018
| Health topic | No. of publicationsa | Organization providing support for publications, no. (%)b | ||||
|---|---|---|---|---|---|---|
| NIH | CDC | RWJF | ED | AHRQ | ||
| Cancer | 445 | 204 (45.8) | 49 (11.0) | 2 (0.4) | 0 | 7 (1.6) |
| Cardiovascular disease | 256 | 57 (22.3) | 2 (0.8) | 7 (2.7) | 1 (0.4) | 13 (5.1) |
| Diabetes | 189 | 40 (21.2) | 13 (6.9) | 0 | 0 | 0 |
| Emergency preparedness | 67 | 14 (20.9) | 9 (13.4) | 1 (1.5) | 0 | 0 |
| Excessive alcohol consumption | 68 | 31 (45.6) | 2 (2.9) | 1 (1.5) | 1 (1.5) | 0 |
| Health communication and health information technology | 67 | 12 (17.9) | 7 (10.4) | 1 (1.5) | 0 | 0 |
| Health equity | 516 | 20 (3.9) | 3 (0.6) | 8 (1.6) | 49 (9.5) | 1 (0.2) |
| Mental health | 100 | 45 (45.0) | 1 (1.0) | 13 (13.0) | 0 | 4 (4.0) |
| Motor vehicle injury | 102 | 3 (2.9) | 2 (2.0) | 0 | 0 | 1 (1.0) |
| Nutrition | 14 | 1 (7.1) | 0 | 1 (7.1) | 0 | 0 |
| Obesity | 174 | 48 (27.6) | 4 (2.3) | 13 (7.5) | 0 | 0 |
| Oral health | 183 | 18 (9.8) | 1 (0.5) | 1 (0.5) | 0 | 0 |
| Physical activity | 203 | 50 (24.6) | 4 (2.0) | 1 (0.5) | 0 | 0 |
| Tobacco | 531 | 138 (26.0) | 23 (4.3) | 43 (8.1) | 0 | 3 (0.6) |
| Vaccination | 421 | 29 (6.9) | 106 (25.2) | 17 (4.0) | 0 | 18 (4.3) |
| Violence | 27 | 8 (29.6) | 8 (29.6) | 2 (7.4) | 2 (7.4) | 0 |
| Total | 3363 | 718 (21.3) | 234 (7.0) | 111 (3.3) | 53 (1.6) | 47 (1.4) |
Abbreviations: AHRQ, Agency for Healthcare Research and Quality; CDC, Centers for Disease Control and Prevention; CPSTF, Community Preventive Services Task Force; ED, US Department of Education; NIH, National Institutes of Health; RWJF, Robert Wood Johnson Foundation.
aPublications may be cited more than once within and across health topics.
bPublications may be supported by >1 category of sponsor; therefore, sums may be >100%.
Total Number of Publications Included in Economic Reviews
Of the 483 publications included in economic reviews from The Community Guide, 59.2% (n = 286) were supported by government agencies, 28.4% (n = 137) by nonprofit entities, and 11.4% (n = 55) by industry; 19.5% (n = 94) had no identified support, and 0.6% (n = 3) could not be located or were not in English (Table 3). The top 5 study sponsors, each of which supported ≥10 of 480 publications, were the NIH (16.2%; n = 78), CDC (14.8%; n = 71), RWJF (3.8%; n = 18), AHRQ (2.5%; n = 12), and the US Department of Veterans Affairs (2.1%; n = 10) (Table 4). In economic reviews, the NIH largely supported studies on mental health, tobacco, cardiovascular disease, and diabetes, whereas CDC primarily supported publications on vaccination. Most RWJF-sponsored publications concerned tobacco, AHRQ primarily supported publications on cardiovascular disease, and the US Department of Veterans Affairs primarily supported publications on cardiovascular disease and mental health.
Table 3.
Sources of support for publications included in the CPSTF economic reviews for findings published from January 1, 2010, to December 31, 2018
| Health topic | No. of economic reviews | No. of publicationsa | Type of organization providing support for publications, no. (%)b | |||
|---|---|---|---|---|---|---|
| Government | Nonprofit | Industry | Unknownc | |||
| Cardiovascular disease | 4 | 63 | 29 (46.0) | 24 (38.1) | 18 (28.6) | 7 (11.1) |
| Diabetes | 2 | 43 | 25 (58.1) | 16 (37.2) | 10 (23.3) | 7 (16.3) |
| Emergency preparedness | 1 | 20 | 13 (65.0) | 0 | 0 | 8 (40.0) |
| Excessive alcohol consumption | 1 | 3 | 3 (100.0) | 0 | 0 | 0 |
| Health communication and health information technology | 1 | 16 | 12 (75.0) | 3 (18.8) | 0 | 2 (12.5) |
| Health equity | 2 | 34 | 13 (38.2) | 13 (38.2) | 0 | 10 (29.4) |
| Mental health | 2 | 37 | 22 (59.5) | 13 (35.1) | 2 (5.4) | 10 (27.0) |
| Motor vehicle injury | 2 | 33 | 20 (60.6) | 6 (18.2) | 0 | 8 (24.2) |
| Obesity | 3 | 17 | 14 (82.4) | 3 (17.6) | 5 (29.4) | 2 (11.8) |
| Oral health | 1 | 10 | 7 (70.0) | 1 (10.0) | 0 | 3 (30.0) |
| Physical activity | 1 | 12 | 8 (66.7) | 7 (58.3) | 0 | 1 (8.3) |
| Tobacco | 6 | 92 | 55 (59.8) | 29 (31.5) | 11 (12.0) | 12 (13.0) |
| Vaccination | 12 | 103 | 65 (63.1) | 22 (21.4) | 9 (8.7) | 27 (26.2) |
| Total | 38 | 483 | 286 (59.2) | 137 (28.4) | 55 (11.4) | 97 (20.1) |
Abbreviation: CPSTF, Community Preventive Services Task Force.
aPublications may be cited more than once within and across health topics.
bPublications may be supported by >1 category of sponsor; therefore, sums may be >100%.
cIncludes publications with no identified support, publications that could not be located, and non–English-language studies.
Table 4.
Organizations supporting at least 10 publications included in CPSTF economic reviews for findings published from January 1, 2010, to December 31, 2018
| Health topic | No. of publicationsa | Support for publications, no. (%)b | ||||
|---|---|---|---|---|---|---|
| NIH | CDC | RWJF | AHRQ | VA | ||
| Cardiovascular disease | 63 | 12 (19.0) | 0 | 3 (4.8) | 6 (9.5) | 5 (7.9) |
| Diabetes | 43 | 11 (25.6) | 9 (20.9) | 0 | 0 | 1 (2.3) |
| Emergency preparedness | 20 | 5 (25.0) | 5 (25.0) | 0 | 0 | 0 |
| Health communication and health information technology | 16 | 2 (12.5) | 5 (31.3) | 0 | 0 | 0 |
| Health equity | 34 | 1 (2.9) | 0 | 1 (2.9) | 0 | 0 |
| Mental health | 37 | 19 (51.4) | 1 (2.7) | 3 (8.1) | 2 (5.4) | 4 (10.8) |
| Motor vehicle injury | 33 | 2 (6.1) | 3 (9.1) | 0 | 1 (3.0) | 0 |
| Obesity | 17 | 1 (5.9) | 3 (17.6) | 1 (5.9) | 0 | 0 |
| Oral health | 10 | 1 (10.0) | 3 (30.0) | 0 | 0 | 0 |
| Physical activity | 12 | 1 (8.3) | 1 (8.3) | 0 | 0 | 0 |
| Tobacco | 92 | 14 (15.2) | 6 (6.5) | 9 (9.8) | 0 | 0 |
| Vaccination | 103 | 9 (8.7) | 35 (34.0) | 1 (1.0) | 3 (2.9) | 0 |
| Total | 480 | 78 (16.2) | 71 (14.8) | 18 (3.8) | 12 (2.5) | 10 (2.1) |
Abbreviations: AHRQ, Agency for Healthcare Research and Quality; CDC, Centers for Disease Control and Prevention; CPSTF, Community Preventive Services Task Force; NIH, National Institutes of Health; RWJF, Robert Wood Johnson Foundation; VA, US Department of Veterans Affairs.
aPublications may be cited more than once within and across health topics.
bPublications may be supported by >1 category of sponsor; therefore, sums may be >100%.
Country of Origin of Sponsors
We identified 1539 unique study sponsors in 36 countries in the 3846 publications. Although most publications (79.5%; n = 3056) were supported by a US sponsor only, 20.5% (n = 790) reported international support (Figure). Of the 36 countries sponsoring studies, all but 6 (Argentina, Brazil, Kenya, Malaysia, Mexico, and Thailand) were listed as high income by the World Bank. Among the 790 internationally supported publications included in CPSTF systematic reviews, the top 3 sponsoring countries were Australia (18.5%, n = 146), the United Kingdom (18.1%, n = 143), and Canada (16.3%, n = 129). The top organizational study sponsors in these countries were Australia’s National Health and Medical Research Council, the United Kingdom’s Medical Research Council, and the Canadian Institutes of Health Research.
Figure.
Top 20 non-US countries that supported publications in Community Preventive Services Task Force systematic reviews from January 1, 2010, to December 31, 2018.
Discussion
This study examined the numbers and types of sponsors of publications that were included in systematic evidence reviews that provided the basis for recommendations issued by the CPSTF during a 9-year period. The evidence base (3846 publications) represented in these reviews was supported by a broad array of study sponsors, with government agencies providing most of the support for publications included in effectiveness reviews (57.1%) and economic reviews (59.2%), and the NIH and CDC serving as lead sponsors in both categories. In contrast, nonprofit organizations supported 34.0% of effectiveness reviews and 28.4% of economic reviews, and industry sponsored relatively few publications (7.0% of effectiveness reviews and 11.4% of economic reviews). About one-fifth of publications were supported by a sponsor located outside the United States; nearly all study sponsors were in high-income countries, resulting in study populations socioeconomically similar to the United States.
Results highlight the lead role that government agencies continue to play in supporting public health research and evaluation studies. Producing high-quality, independent science is a valuable government function, and this independence is critical to the issue of trust.13 Government sponsors have helped develop the preponderance of the evidence base used by the CPSTF, which may instill additional confidence in task force recommendations and encourage data-driven changes in practice despite a research milieu that is increasingly seen as biased by industry.7 For example, the Institute of Medicine (IOM) Committee on Standards for Developing Trustworthy Clinical Practice Guidelines noted that approximately 75% of clinical trials published in The Lancet, The New England Journal of Medicine, and The Journal of the American Medical Association are industry-sponsored.7 Furthermore, even high-quality, industry-sponsored research is “5.3 times more likely to endorse their sponsors’ products than non-commercially funded studies of identical products.”7 Therefore, it is noteworthy that CPSTF recommendations―which focus on community-based rather than clinical interventions―have comparatively little industry support. Research indicates that some physicians perceive NIH-funded trials as having more credibility than industry-supported studies14 and that government-supported recommendation developers (eg, CPSTF, USPSTF) are valued for their objectivity.15
Our study adds to a small but growing body of literature on funders of health research. A study by Villani et al11 in 2018 characterized the sources of support for the scientific evidence base used by the USPSTF, a parallel expert group to the CPSTF that uses effectiveness reviews to make recommendations about clinical preventive services in primary care, such as screenings, preventive medications, and counseling services.16 A comparison of findings from the USPSTF study11 with the findings of our study shows a similar distribution of sponsors for effectiveness reviews. Despite the IOM findings of industry’s dominance in health research, the proportions of publications in USPSTF and CPSTF effectiveness reviews that were supported by government agencies (56% USPSTF, 57% CPSTF) were high and nearly identical. Moreover, several government sponsors (eg, NIH, Australia’s National Health and Medical Research Council, and the United Kingdom’s Medical Research Council) supported research used by both task forces. These sponsors were also noted in a 2016 study of the top global funders of health research.17
We found a difference between the CPSTF and the USPSTF in the extent to which industry provided support for publications included in the effectiveness reviews used to make recommendations (on average, 7% for the CPSTF vs 17% for the USPSTF). This difference may be related to the difference in types of interventions evaluated by the 2 task forces. The USPSTF evaluates clinical interventions (eg, screening tests, medications), which are more often funded by industry than are the community-based, public health interventions considered by the CPSTF. For a few CPSTF topics, the percentage of industry support was higher than the 7% average across topics in this study (eg, cardiovascular disease [20.3%], diabetes [20.1%]). The higher proportion of industry support in these topic areas could be related to studies evaluating the use of computer-based decision support systems and efforts to promote medication adherence.18-32
We noted a modest difference between the 2 task forces among effectiveness review publications that had no identified source of support (21%, USPSTF; 23%, CPSTF). This difference may be due to differences in inclusion criteria for the systematic reviews used by the USPSTF and the CPSTF. The USPSTF includes only peer-reviewed articles in its systematic reviews, whereas the CPSTF also considers technical reports, unpublished theses, presentations, and books to identify studies relevant to the topic under consideration. The latter types of publications may be less likely than the former types to acknowledge sources of support.
Although the NIH and CDC were the top 2 sponsors of research underpinning CPSTF recommendations, several other federal agencies and offices sponsored studies that were included in CPSTF systematic reviews. Nine agencies in the US Department of Health and Human Services and an additional 13 federal agencies or offices provided support for the evidence base used by the CPSTF (Box). By understanding the extent to which federal agencies and offices provide support for evidence generation, coordinated efforts can be taken to strengthen collaboration, initiate new partnerships, and leverage resources to promote the efficient use of federal research and evaluation dollars. Murray et al33 described several reasons for coordinating the activities of the USPSTF, the AHRQ (which provides scientific, administrative, and dissemination support to the USPSTF),16 and the NIH. Coordination among these partners can promote identification of evidence gaps and increase awareness and efforts to fill these gaps among scientists and funders; increase development of and access to high-quality evidence; and ensure that evidence is understood and appropriately used to improve the health of the nation.33 These compelling reasons for federal agency coordination are also applicable to the CPSTF, CDC, the NIH, and other federal agencies that have official liaison status with the CPSTF.34
Box.
Federal sponsors of studies included in Community Preventive Services Task Force systematic reviews published from January 1, 2010, to December 31, 2018
| US Department of Health and Human Services |
|---|
| Administration for Children and Families |
| Agency for Healthcare Research and Quality |
| Centers for Disease Control and Prevention |
| Centers for Medicare & Medicaid Services |
| Health Resources and Services Administration |
| US Department of Health and Human Services (several offices) |
| Indian Health Service |
| National Institutes of Health |
| Substance Abuse and Mental Health Services Administration |
| Other federal sponsors |
| Congressional Budget Office |
| Department of Agriculture |
| Department of Defense |
| Department of Education |
| Department of Energy |
| Department of Homeland Security |
| Department of Justice |
| Department of Labor |
| Department of Transportation |
| Department of Veterans Affairs |
| Environmental Protection Agency |
| Government Accountability Office |
| Office of Personnel Management |
Limitations
This study had several limitations. First, the study was limited by the number (n = 726; 23%) of unique publications that did not note a source of support. This limitation may be partly attributable to the fact that many of the publications included in The Community Guide systematic reviews were published before the International Committee of Medical Journal Editors established guidelines for journal manuscripts in 1993.35-37 These guidelines indicate that authors should acknowledge financial and material support for their studies, as well as any financial relationship that could pose a conflict of interest.38 In 1995, approximately 75% of biomedical journals required these disclosures; by 2005, the percentage was 94%.39 Approximately 15% of unique publications from our study were from 1995 or earlier. Although some publications from The Community Guide systematic reviews were published in educational, law, and criminology journals, most studies were published in biomedical journals, to which requirements for disclosure of sponsorship increasingly apply. This study’s conclusions could be distorted because of missing data on the sources of publication support.
Second, our study was limited by a 9-year review period. Analyses of systematic reviews covering other periods might include other subtopics among the >100 additional subtopics included in The Community Guide to date and result in a different research sponsor profile.40 Third, although our study documented sources of support, it did not assess perceptions of study sponsors among users of The Community Guide. Evaluation of the extent to which users of CPSTF recommendations perceive various study sponsors as credible and unbiased would enhance understanding of guideline uptake and be an important topic for future investigation. Fourth, nonprofit organizations may have substantial industry relationships that introduce pro-industry biases. Our study did not explore possible industry biases in the nonprofit sector.
Conclusions
Evidence-based recommendations from expert panels that interpret results from systematic evidence reviews, such as the CPSTF, can help public health professionals and other stakeholders implement more effective population-based programs, leading to improved health outcomes.41 This study characterized the sponsors of publications that were included in systematic evidence reviews that provided the basis for recommendations issued by the CPSTF during a 9-year period. It showed that CPSTF effectiveness and economic systematic review publications were heavily supported by government agencies, particularly the NIH and CDC, and a low proportion of publications were sponsored by industry. Although our study adds to the body of literature on sponsors of health research, an ongoing need remains to identify and assess supporters of research and for investigators to provide greater transparency in reporting their sponsors.
Acknowledgments
The authors thank Anil Thota, MD, MPH, and Robert A. Hahn, PhD, MPH, of the Centers for Disease Control and Prevention (CDC) and staff members of the National Institutes of Health (NIH) Library for their assistance in locating publications; Kathryn Koczot of the NIH Office of Disease Prevention for data collection and participating in data audits; and Kathy Rarer, BA, for reviewing this article. The findings and conclusions in this article are those of the authors and do not necessarily represent the official position of the NIH or CDC.
Footnotes
Authors’ Note: A list of health topics and subtopics covered by Community Preventive Services Task Force systematic reviews for findings published from January 1, 2010, through December 31, 2018, is available upon request from the corresponding author.
Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding: The authors received no financial support with respect to the research, authorship, and/or publication of this article.
ORCID iD
Elizabeth Neilson, PhD, MPH, MSN https://orcid.org/0000-0001-5197-9093
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