"The magic is in the mix": lessons from research capacity building in the Canadian tobacco control community, 2000-2010.

Riley, Barbara L. ; Viehbeck, Sarah M. ; Cohen, Joanna E. 等

Tobacco use persists as a global public health issue. While smoking prevalence has reduced substantially in many developed countries, global tobacco use is increasing. (1) Tobacco control initiatives, including the international Framework Convention on Tobacco Control (FCTC), need to be informed by best available evidence and evaluated using rigorous research approaches. To that end, an important input is sufficient capacity for research in tobacco control. The same needs and logic apply to other issues in population-based chronic disease prevention such as obesity prevention and alcohol use. Illustrative examples of research capacity-building (RCB) approaches include the Prevention Research Centers in the US, (2) and the Population Health Intervention Research Initiative for Canada. (3)

The general goals of RCB are to increase the ability to undertake and sustain relevant and high-quality research. Cooke (4) puts forward six principles for RCB: to develop skills and confidence, to support linkages and partnerships, to ensure the research is "close to practice", to develop appropriate dissemination, to invest in infrastructure, and to build elements of sustainability and continuity. Similar principles are apparent in a RCB pyramid described by Riley and colleagues (ref. 5, adapted from ref. 6), whose focus was specific to solution-oriented research and to population-based chronic disease prevention. Despite the importance of RCB, evidence for how to create relevant capacities

is limited.

RCB for tobacco control in Canada offers a relevant and informative experience from which to learn. Canada is a recognized leader in the early implementation of innovative and comprehensive tobacco control policies, conducting meaningful tobacco control research (7) and developing a research training agenda. (8) Over the past 10 years in Canada, tobacco control RCB received substantial investment, especially with impetus from and through the former Canadian Tobacco Control Research Initiative (CTCRI). (9) Disbanded in March 2009, the CTCRI was a partnership of research, government and not-for-profit organizations with a mandate to provide strategic leadership in Canada and internationally to catalyze, coordinate and sustain research that has a direct impact on programs and policies aimed at reducing tobacco abuse and nicotine addiction.

On January 22-23, 2009, CTCRI facilitated an invitational workshop as a systematic process to discern lessons from RCB initiatives in tobacco control, with a goal of informing future RCB efforts. The process involved advance data collection and on-site discussion/analysis from 25 leaders and partners of key RCB initiatives, representatives from the Canadian Institutes of Health Research, the Lung Association, and the (former) National Cancer Institute of Canada (now the Canadian Cancer Society Research Institute), the Canadian Council for Tobacco Control, and the Principal Investigators and related staff leads from each of the seven tobacco control RCB initiatives described in Table 1.

The description of initiatives and lessons that follow are informed by workshop proceedings, (9) and further synthesis and specification by the authors, with a focus on linking the experience with relevant literature and the Canadian context for tobacco control and RCB.

Tobacco control research capacity-building initiatives in Canada: 2000-2010

Table 1 describes seven major tobacco control RCB initiatives in Canada from 2000 to 2010. All were intended to build capacity for policy-/practice-relevant tobacco control research (from biomedical to population studies) and six were national in scope.

The seven RCB initiatives were funded independently, however, many individuals and organizations made the decision to collaborate to reduce duplication and maximize reach and impact. For example, an Annual Symposium brought together trainees and mentors from all of the initiatives, and a graduate course Tobacco and Health: From Cells to Society was a common foundational training resource to which trainees were referred. Further, many common approaches were used to build RCB across the initiatives, such as seed grants to researchers and awards/stipends for trainees and/or junior researchers.

Evaluations varied across the initiatives and captured outputs and short-term data collections based primarily on requirements from the respective funding agencies. Outcome evaluations were limited.

Lessons learned

Based on the Canadian experience described in this paper, we cannot offer definitive guidelines for RCB. Evaluation data were extremely limited, and few of the RCB activities have been sustained in their original form, although cuts, shifts in responsibility in tobacco control spending, and a reduced focus on tobacco as a single issue may explain limited continuation of RCB initiatives following initial funding periods. Five main lessons are described.

1. Take an Organic Approach to RCB

What emerged from the documentation and especially the workshop (9) was a narrative that more closely resembles social change; an organic process fueled by a dynamic interplay of people, events and circumstance. (10)

Consistent with this organic process, the initiatives described in this paper were not started as a deliberately complementary set of RCB investments for tobacco control. There was an evolution over time to be more intentional in creating synergy and minimizing duplication across initiatives. This evolution was facilitated by a history of working relationships among the initiative leads; shared overarching goals for initiatives; and a commitment to investing in joint RCB activities to minimize duplication.

A social change process may optimize commitment from individuals and organizations, and implementation. Sustainability, however, may require applying a social change process within an intentional, long-term plan for RCB with goals that are aligned with major policy and practice needs. (11)

2. Target and Sustain Investments in a Mix of RCB Activities CTCRI and CIHR provided complementary funding specific to RCB in tobacco control. Notably unique at the time was multi-year funding opportunities that were large enough to attract leading researchers in tobacco control, and had sufficient flexibility to stimulate creative approaches to RCB (e.g., Interdisciplinary Capacity Enhancement or "ICE" grants, and Strategic Training Initiative in Health Research or "STIHR" grants). Across all RCB investments, a continuum of funding opportunities supported relevant and collaborative projects by researchers through the "life course" of their careers from students to principal investigators. This continuum of support was accomplished by a mix of RCB activities, including incentives for trainees and established researchers, small project and seed grants, a graduate course, and an annual symposium.

Although the initiatives as a whole were not evaluated systematically, they contributed to enhancements in prevention research in tobacco control, as documented by the Canadian Cancer Research Alliance. (12) The RCB initiatives also closely resemble what the Robert Wood Johnson Foundation refers to as "field building", with encouraging results in the area of active living research. (13) Field building generally refers to the development of a critical mass of effort, energy and capacity to achieve desired outcomes (e.g., to offset forces that promote tobacco use, physical inactivity, excess weight). Moreover, a similar mix of RCB activities has been applied in a next generation of RCB initiatives, such as those offered by

The Institute for Global Tobacco Control in the US, (14) and a pan-Canadian strategic training initiative in population intervention for chronic disease prevention (see http://www.propel.uwaterloo.ca/index.cfm?section=29&page=417).

3. Support a Vision and Collaborative Leadership at Organizational and Initiative Levels

Vision and collaborative leadership were essential to advance RCB and they came in different forms. For example, early and visionary leadership was provided by the Canadian Cancer Society and partner organizations (Health Canada, CIHR, The Lung Association) through their joint funding partnership in the CTCRI and also through direct involvement in many of the initiatives.

Vision and leadership also came from the initiative leads. It was critical to have senior researchers and tobacco control champions as leads for the RCB initiatives, all of whom shared a strong commitment to the field, understood the interdependence of their efforts, and had some history of collaboration and trust. These are well-known ingredients for strong working relationships and effective collective action. (15)

Importantly, it was not necessary for all to share a common vision. It was necessary, however, to have a small core of people who could co-create a vision and work within their mandates and networks to build commitment to, and work towards realizing it. The idea of a small strategic team providing leadership is consistent with experiences elsewhere, including the Robert Wood Johnson Foundation. (13)

4. Build Community

Community building emerged as one of the essential ingredients (as a process and an outcome) of tobacco control RCB in Canada. Consistent with trends internationally, (11) the community was multidisciplinary, including the full spectrum from basic to population health scientists, and included leaders in tobacco control policy and practice. The graduate course "Tobacco and Health: From Cells to Society", offered by the Ontario Tobacco Research Unit, supported community building by providing foundational training in the full scope of tobacco control. The main contributor to community building was an annual symposium, which grew to be a magnet event for bringing together leading tobacco control investigators, their trainees and relevant decision-makers. The face-to-face interactions, which were enabled through invitation and travel funds, were considered critical success factors to facilitate linkages among researchers, trainees, policy-makers, tobacco control advocates, and research funders.

5. Build in Initiative and Cross-initiative Evaluations

Evaluation data are limited from the RCB initiatives, especially to evaluate contributions from the mix of investments over the 10-year time period. This is not surprising given limited resources for this purpose, and the early stage of development of research on RCB. While some conceptual frameworks and indicators of RCB exist, (4,5) RCB is not a robust focus of research and little evidence exists for effective approaches.

The shared experiences in RCB in Canadian tobacco control raise many questions that can form the basis of a RCB research agenda. For example: How do you know when sufficient capacity has been built? Does existing capacity dissipate without sustained funding or can initial catalytic investments be leveraged to successfully access other funding sources? Do shared research agendas need to be set and then revitalized on a regular basis? How can well-positioned champions be identified who can legitimize, advance and sustain RCB for tobacco control and other issue areas?

CONCLUSION

Ten years of RCB for tobacco control in Canada reinforces RCB principles and experiences reported by others. (4) It also provides examples of how to translate concepts into practical strategies and how independent investments can be linked to create a coherent approach. Looking ahead, promising directions may include positioning RCB within a broader context of "field building", focusing on practical approaches to sustainability, and enhancing research on RCB.

Acknowledgements: Contributions from Dr. Riley were supported by the Canadian Cancer Society (grant #2011-701019). Dr. Cohen's time was supported by the Ontario Tobacco Research Unit, which receives funding from the Ontario Ministry of Health and Long-Term Care. Thanks to all participants in the CTCRI-sponsored workshop and to Paula Stanghetta for preparing a workshop summary report.

Thanks also to the many individuals and organizations that contributed to the seven tobacco control research capacity-building initiatives. Special thanks to the initiative leads: Roy Cameron, Paul Clarke, Roberta Ferrence, Chris Lovato, Paul McDonald, Cheryl Moyer, Jennifer O'Loughlin, and Peter Selby. The authors acknowledge Mari Alice Jolin and Dana Zummach for administrative support in the preparation of this manuscript.

Conflict of Interest: All authors were funded, employed, or affiliated with one or more of the tobacco control research capacity-building initiatives during the period of time described in this article.

REFERENCES

(1.) Eriksen M, Mackay J, Ross H. The Tobacco Atlas, 4th edition. Atlanta, GA: The American Cancer Society, 2012;1-132.

(2.) Green LW. The prevention research centers as models of practice-based evidence two decades on. Am J Prev Med 2007;33(Suppl. 1):S6-S8.

(3.) Sullivan L. Introduction to the Population Health Intervention Research Initiative for Canada. Can J Public Health 2009;100(1):i5-i6.

(4.) Cooke J. A framework to evaluate research capacity building in health care. BMC Family Practice 2005;6:44.

(5.) Riley B, Stachenko S, Wilson E, Harvey D, Cameron R, Farquharson J, et al. Can the Canadian Heart Health Initiative inform the Population Health Intervention Research Initiative for Canada? Can J Public Health 2009;100(1):i20 i26.

(6.) Potter C, Brough R. Systemic capacity building: A hierarchy of needs. Health Policy Plan 2004;19(5):336-45.

(7.) Canadian Tobacco Control Research Initiative. Towards a Coordinated Research Agenda to Reduce Tobacco-related Problems in Canada: Report on the Canadian Tobacco Control Research Summit. Ottawa, ON: CTCRI, 2002;1-84.

(8.) Leatherdale S, Viehbeck S, Murphy C, Norman C, Schultz A. The tobacco control community of tomorrow: A vision for training. Can J Public Health 2008;98(1):30-32.

(9.) Canadian Tobacco Control Research Initiative. "The Magic Is in the Mix": Capacity Building in Tobacco Control Research. Summary of a workshop convened by the Canadian Tobacco Control Research Initiative. 2009;1-74.

(10.) Westley F, Zimmerman B, Patton MQ. Getting to Maybe: How the World is Changed. Toronto, ON: Random House, 2006.

(11.) National Cancer Institute. Greater Than the Sum: Systems Thinking in Tobacco Control. Tobacco Control Monograph No. 18. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, National Cancer Institute. NIH Pub. No. 06-6085, April 2007.

(12.) Canadian Cancer Research Alliance. Cancer Research Investment in Canada, 2008: The Canadian Cancer Research Alliance's Survey of Government and Voluntary Sector Investment in Cancer Research in 2008. Toronto, ON: CCRA, 2011; 1-52.

(13.) Ottoson JM, Green LW, Beery WL, Senter SK, Cahill CL, Pearson DC, et al. Policy-contribution assessment and field-building analysis of the Robert Wood Johnson Foundation's Active Living Research Program. Am J Prev Med 2009; 36(2S):S34-S43.

(14.) Stillman F, Yang G, Figeriredo V, Hernandez-Avila M, Samet J. Building capacity for tobacco control research and policy. Tob ControL 2006;15(Suppl. 1): i18-i23.

(15.) Provan KG, Fish A, Sydow J. Interorganizational networks at the network level: A review of the empirical literature on whole networks. J Management 2007;33:479-516.

Received: August 3, 2012

Accepted: February 15, 2013

Barbara L. Riley, PhD, [1] Sarah M. Viehbeck, PhD, [2] Joanna E. Cohen, PhD, [3] Marie C. Chia, PhD [4]

Author Affiliations

[1.] Propel Centre for Population Health Impact, University of Waterloo, Waterloo, ON

[2.] University of Ottawa, Ottawa, ON

[3.] Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

4. Public Health Agency of Canada, Ottawa, ON

Correspondence: Barbara Riley, Propel Centre for Population Health Impact, University of Waterloo, Lyle Hallman Institute North, Room 1727, 200 University Ave. West, Waterloo, ON N2L 3G1, Tel: 519-888-4567, ext. 37562, Fax: 519-886-6424, E-mail: [email protected]

Table 1. Description of Seven Major Tobacco
Control RCB Investments in Canada, 2000-2010

Name of             Time Period     Total Investment
Initiative          of Investment   and Funding
and Lead                            Source(s)

CTCRI               1997-2009       $7M (from 2003-08)
Lead:                               Canadian Cancer
Ms. Cheryl Moyer/                   Society, Canadian
Dr. Marie Chia                      Institutes of
                                    Health Research,
                                    and Health Canada

Ontario Tobacco     1993-present    $1.4M (2004-10)
Research Unit                       Funded primarily
(OTRU)                              by the Ontario
Lead:                               Ministry of
Dr. Roberta                         Health Promotion
Ferrence                            and Sport/Ontario
                                    Ministry of Health
                                    and Long-Term Care

CIHR-Strategic      2002-2009       $2.4M
Training Program                    CIHR
in Tobacco
Research (STPTR)
Lead:
Dr. Roy Cameron

CIHR-Strategic      2003-2008       $1.4M
Training Program                    CIHR
in Tobacco Use
in Special
Populations
(TUSP)
Lead: Dr. Peter
Selby

Interdiscipli-      2004-2010       $1.5M
nary Capacity                       CIHR
Enhancement (ICE)
program - Pan-
Canadian Resource
Network for
Tobacco Control
Research, Policy,
and Practice
Lead:
Dr. Paul McDonald

ICE program -       2004-2010       $1.5M
Strengthening                       CIHR
the Links Bet-
ween Research,
Practice, and
Public Policy
to Reduce the
Burden of Tobacco
Lead:
Dr. Jennifer
O'Loughlin

ICE program -       2004-2009       $1.5M
Nicotine Addic-                     CIHR
tion: Behavioural
and Brain Mecha-
nisms from
Rodents to Humans
Lead:
Dr. Paul Clarke

Name of             Brief Description of RCB Activities
Initiative
and Lead

CTCRI               Innovative research grant-funding programs, inclu-
Lead:               ding grants for policy research, innovative ideas,
Ms. Cheryl Moyer/   knowledge synthesis, student research, travel and
Dr. Marie Chia      workshops.

Ontario Tobacco     Studentships for graduate students conducting re-
Research Unit       search in tobacco control, small project grants for
(OTRU)              new investigators, a graduate course (Tobacco and
Lead:               Health: From Cells to Society) offered across
Dr. Roberta         Canada through video-conferencing and webcasting, a
Ferrence            web-based course on tobacco control for public
                    health professionals, student mentoring and super-
                    vision opportunities, student poster awards given
                    for outstanding poster presentations at relevant
                    conferences, and collaboration with other training
                    programs to identify the needs of trainees and
                    sponsor training and networking events.

CIHR-Strategic      The STPTR and TUSP programs shared the goal of fun-
Training Program    ding graduate students and fellows through stipends
in Tobacco          and transdisciplinary training opportunities with a
Research (STPTR)    strong emphasis on linking research, policy, and
Lead:               practice. STPTR initiated an annual meeting in 2002
Dr. Roy Cameron     and this evolved into a large annual event for
                    trainees, mentors, and decision-makers that was co-
CIHR-Strategic      sponsored by the capacity-building initiatives des-
Training Program    cribed in this section. The purpose of the annual
in Tobacco Use      meeting was to build a tobacco control community
in Special          spanning research, policy and practice.
Populations
(TUSP)
Lead: Dr. Peter
Selby

Interdiscipli-      Focused on building research capacity to produce
nary Capacity       relevant, rigorous and timely evidence to inform
Enhancement (ICE)   tobacco control policies and programs. Activities
program - Pan-      were primarily targeted to geographic areas with
Canadian Resource   limited research capacity, and included: seed
Network for         grants, summer learning forums, a population health
Tobacco Control     data repository to enable access to research data,
Research, Policy,   a skills enhancement learning opportunities
and Practice        program, a newsletter and special project grants.
Lead:
Dr. Paul McDonald

ICE program -       Facilitated two-way knowledge exchange to foster
Strengthening       the development of research that reflects practi-
the Links Bet-      tioner needs, and translation of research results
ween Research,      into relevant preventive and clinical practice and
Practice, and       policy. The project activities focused on team
Public Policy       building, mentoring and knowledge translation to
to Reduce the       increase research capacity and involved researchers
Burden of Tobacco   and practitioners, students and trainers, and the
Lead:               Institut national de sante publique du Quebec
Dr. Jennifer        (INSPQ).
O'Loughlin

ICE program -       Focused on training graduate students and postdoc-
Nicotine Addic-     toral fellows to undertake lab-based research with
tion: Behavioural   an aim to advance the basic science underlying
and Brain Mecha-    nicotine/tobacco addiction. The project activities
nisms from          included five interconnected research initiatives,
Rodents to Humans   with a primary focus on the development of novel
Lead:               methods for studying the reinforcing effects of
Dr. Paul Clarke     nicotine.