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[...] Balas and Boren found that it takes about 17 years to turn 14% of original research to the benefit of patient care.10 Similarly, the National Research Council concluded that, even when effective interventions have been developed, there often is a gap between scientific knowledge and clinical practice.11 In addition, minorities and underserved communities usually gain access to effective interventions more slowly than do other populations.12 Thus, the idea that research would progress from efficacy trials to effectiveness trials to widespread dissemination has not become a reality for a number of reasons, not the least of which is the time and cost involved in this stepwise progress of research to practice.6 As a result of the failure of this model, practitioners are often unable to determine if a given study's findings apply to their local setting, population staffing, or resources.6 Reviews indicate that reporting on external validity is provided far less often than is reporting on other methodological issues.13 However, there are several reasons for the lack of information on external validity being an important contributor to the failure to translate research into public health practice.14 Policy and administrative decisionmakers are unable to determine the generalizability or breadth of applicability of research findings. THE JOURNAL ENDORSES A GREATER EMPHASIS ON EXTERNAL VALIDITY Although the Journal has long recognized the importance of external validity in articles it has published, the relatively recent CONSORT and TREND reports, as well as the recent emphasis on the RE-AIM model, has strengthened the recognition by the Journal editors and editorial board of the need to formally emphasize external validity and to collect information on appropriate manuscripts that enhances both inference and potential generalizability.6,15-18 Recently, two members of the the Journal editorial board and editors represented the Journal in a meeting with 12 other leading health journals and representatives from the National Institutes of Health, the Centers for Disease Control and Prevention, and the Robert Wood Johnson Foundation.

Efforts to change policies and the environments in which people live, work, and play have gained increasing attention over the past several decades. Yet health promotion frameworks that illustrate the complex processes that produce health-enhancing structural changes are limited. Building on the experiences of health educators, community activists, and community-based researchers described in this supplement and elsewhere, as well as several political, social, and behavioral science theories, we propose a new framework to organize our thinking about producing policy, environmental, and other structural changes. We build on the social ecological model, a framework widely employed in public health research and practice, by turning it inside out, placing health-related and other social policies and environments at the center, and conceptualizing the ways in which individuals, their social networks, and organized groups produce a community context that fosters healthy policy and environmental development. We conclude by describing how health promotion practitioners and researchers can foster structural change by (1) conveying the health and social relevance of policy and environmental change initiatives, (2) building partnerships to support them, and (3) promoting more equitable distributions of the resources necessary for people to meet their daily needs, control their lives, and freely participate in the public sphere.

Objectives. We sought a better understanding of how nonprofit hospitals are fulfilling the community health needs assessment (CHNA) provision of the 2010 Patient Protection and Affordable Care Act to conduct CHNAs and develop CHNA and implementation strategies reports. Methods. Through an Internet search of an estimated 179 nonprofit hospitals in Texas conducted between December 1, 2013, and January 5, 2014, we identified and reviewed 95 CHNA and implementation strategies reports. We evaluated and scored reports with specific criteria. We analyzed hospital-related and other report characteristics to understand relationships with report quality. Results. There was wide-ranging diversity in CHNA approaches and report quality. Consultant-led CHNA processes and collaboration with local health departments were associated with higher-quality reports. Conclusions. At the time of this study, the Internal Revenue Service had not yet issued the final regulations for the CHNA requirement. This provides an opportunity to strengthen the CHNA guidance for the final regulations, clarify the purpose of the assessment and planning process and reports, and better align assessment and planning activities through a public health framework.

This article is based on a presentation that was made at the 2014 annual meeting of the editorial board of Health Education & Behavior. The article addresses critical issues related to standards of scientific reporting in journals, including concerns about external and internal validity and reporting bias. It reviews current reporting guidelines, effects of adopting guidelines, and offers suggestions for improving reporting. The evidence about the effects of guideline adoption and implementation is briefly reviewed. Recommendations for adoption and implementation of appropriate guidelines, including considerations for journals, are provided.

This Office of Adolescent Health and the AJPH supplement on adolescent pregnancy prevention illustrates the implications and practical lessons that behavioral scientists and health educators face in large-scale replication of evidence-based adolescent pregnancy prevention programs.Of the program models replicated during the 2010 to 2015 initiative, a variety of approaches- abstinence, sexual health education, youth development, and programs for clinical settings and specific populations-were represented. Throughout these evaluations, the focus on replication was largely aimed at assuring program fidelity, which was measured using facilitator's self-reported adherence to program models and observations by independent observers. Findings from the research presented in this theme issue suggest there is valuable information to be gained through replication studies. Information provided by this first cohort of adolescent pregnancy prevention grantees can inform the evidence base and provide insight into what is needed for program replication in other fields.

Widespread recognition of the need to improve the science of published research, as well as the moral and ethical reasons for adequately reporting study results, has spurred recent interest in strengthening journal research reporting through the use of reporting guidelines. Reporting guidelines also provide information for readers to judge study quality. American Journal of Public Health previously adopted the Consolidated Standards of Reporting Trials and Transparent Reporting of Evaluations With Nonrandomized Designs guidelines and recently endorsed the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. In adopting these guidelines, the journal aims to support authors, reviewers, and editors in reporting and evaluating systematic reviews of public health policy and practice priorities.

Nonprofit hospitals are exempt from paying taxes. To maintain this status, they must provide benefit to the community they serve. In an attempt to improve accountability to these communities and the federal government, the Patient Protection and Affordable Care Act of 2010 includes a provision that requires all nonprofit hospitals to conduct a community health needs assessment (CHNA) and implement strategies to address identified health priorities every 3 years. This Act's provision, operationalized by a regulation developed and enforced by the Internal Revenue Service, mandates the involvement of public health agencies and other community stakeholders in the completion of the CHNA. To better understand community participation in nonprofit hospital-directed community health assessment and health improvement planning activities. Using a 2-phased, mixed-methods study design, we (1) conducted content analysis of 95 CHNA/implementation plan reports and (2) interviewed hospital and health system key informants, consultants, and community stakeholders involved in CHNA and planning processes. Community participation was assessed in terms of types of stakeholders involved and the depth of their involvement. Our findings suggest that many hospitals engaged and involved community stakeholders in certain aspects of the assessment process, but very few engaged a broad array of community stakeholder and community members in meaningful participation throughout the CHNA and health improvement planning process. Vast improvements in community participation and collaborative assessment and planning can be made in future CHNAs. On the basis of the findings, recommendations are made for further research. Practice implications include expanding community engagement and participation by stakeholder and activity type and using a common community health improvement model that better aligns hospital CHNA processes and implementation strategies with other organizations and agencies.

Community health assessment and community health improvement planning are continuous, systematic processes for assessing and addressing health needs in a community. Since there are different models to guide assessment and planning, as well as a variety of organizations and agencies that carry out these activities, there may be confusion in choosing among approaches. By examining the various components of the different assessment and planning models, we are able to identify areas for coordination, ways to maximize collaboration, and strategies to further improve community health. We identified 11 common assessment and planning components across 18 models and requirements, with a particular focus on health department, health system, and hospital models and requirements. These common components included preplanning; developing partnerships; developing vision and scope; collecting, analyzing, and interpreting data; identifying community assets; identifying priorities; developing and implementing an intervention plan; developing and implementing an evaluation plan; communicating and receiving feedback on the assessment findings and/or the plan; planning for sustainability; and celebrating success. Within several of these components, we discuss characteristics that are critical to improving community health. Practice implications include better understanding of different models and requirements by health departments, hospitals, and others involved in assessment and planning to improve cross-sector collaboration, collective impact, and community health. In addition, federal and state policy and accreditation requirements may be revised or implemented to better facilitate assessment and planning collaboration between health departments, hospitals, and others for the purpose of improving community health.

McLeroy et al examine the four categories of community-based projects: community as setting, community as target, community as agent, and community as resource. The goal of community-based programs is to carefully work with naturally occurring units of solution as our units of practice. This necessitates a careful assessment of community structures and processes of any intervention.

Historically, public health has been viewed through a variety of lenses. Of particular importance for public health professionals interested in rural health is that lens through which one sees an important part of the history of public health's development as oscillation between a focus on health issues facing populations defined by their demographic characteristics and health issues in populations defined by their geographic location.