Despite the many accomplishments of public health, a greater attention to evidence-based approaches is warranted. This article reviews the concepts of evidence-based public health (EBPH), on which formal discourse originated about a decade ago. Key components of EBPH include making decisions on the basis of the best available scientific evidence, using data and information systems systematically, applying program-planning frameworks, engaging the community in decision making, conducting sound evaluation, and disseminating what is learned. Three types of evidence have been presented on the causes of diseases and the magnitude of risk factors, the relative impact of specific interventions, and how and under which contextual conditions interventions were implemented. Analytic tools (e.g., systematic reviews, economic evaluation) can be useful in accelerating the uptake of EBPH. Challenges and opportunities (e.g., political issues, training needs) for disseminating EBPH are reviewed. The concepts of EBPH outlined in this article hold promise to better bridge evidence and practice. 175

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The authors examined the independent associations of educational attainment and ethnicity with behavioral risk factors for cardiovascular disease using data from the 1989 baseline survey for the New York State Healthy Heart Program. This telephone survey used the Centers for Disease Control Behavioral Risk Factor Survey interview instrument and was conducted in eight communities (total population, approximately 1.24 million people) in New York State. The response rate was 65.5% (n = 4,179); 3,606 subjects aged 20-64 years with self-described ethnicity of white (n = 1,935), black (n = 1,035), or Hispanic (n = 636) and of known educational status were retained in the analysis. After adjustment for age, sex, and ethnicity, significant associations were found between educational attainment and smoking, lack of regular exercise, overweight, diet atherogenicity, and knowledge about blood pressure and cholesterol. After adjustment for age, sex, and educational attainment, associations were found between ethnicity and most of these same variables. Blacks and Hispanics generally had less favorable risk factor profiles. These data indicate that the differences in cardiovascular disease risk profiles between whites and blacks or Hispanics cannot be fully explained by underlying differences in educational attainment. The differing patterns of risk factor distribution by educational attainment within ethnic groups have implications for the segmentation of risk reduction programs.

The prevalence of current asthma was significantly higher among Puerto Ricans, who had higher symptomatic frequency and greater diagnosis rates. Although all children with asthma in the East Harlem study appear to be sensitive to selected indoor environmental risk factors, only Puerto Rican children with asthma appear to be sensitive to the presence of rodents in their buildings. However, their higher school absence rate suggests problems with routine asthma management that could be addressed by improved medical management, programs to help parents manage their children's asthma, or school staff assistance with medications.