Development of a Health Equity Framework for the US Preventive Services Task Force

The US Preventive Services Task Force (USPSTF) is an independent body that makes evidence-based recommendations regarding preventive services to improve health for people nationwide. Here, we summarize current USPSTF methods, describe how methods are evolving to address preventive health equity, and define evidence gaps for future research. We summarize current USPSTF methods as well as ongoing methods development. The USPSTF prioritizes topics on the basis of disease burden, extent of new evidence, and whether the service can be provided in primary care and going forward will increasingly consider health equity. Analytic frameworks specify the key questions and linkages connecting the preventive service to health outcomes. Contextual questions provide information on natural history, current practice, health outcomes in high-risk groups, and health equity. The USPSTF assigns a level of certainty to the estimate of net benefit of a preventive service (high, moderate, or low). The magnitude of net benefit is also judged (substantial, moderate, small, or zero/negative). The USPSTF uses these assessments to assign a letter grade from A (recommend) to D (recommend against). I statements are issued when evidence is insufficient. The USPSTF will continue to evolve its methods for simulation modeling and to use evidence to address conditions for which there are limited data for population groups who bear a disproportionate burden of disease. Additional pilot work is underway to better understand the relations of the social constructs of race, ethnicity, and gender with health outcomes to inform the development of a USPSTF health equity framework.

In 2016, the US Preventive Services Task Force concluded that there was "insufficient" ("I" statement) evidence to support universal primary care screening for autism spectrum disorder. The statement led to controversy among research and clinical communities. Although a number of papers have since been published arguing for the potential benefit of autism spectrum disorder screening, none adequately address the potential harms of autism spectrum disorder screening. This evidence gap may relate to confusion regarding how the US Preventive Services Task Force conceptualizes and evaluates potential harm. In this commentary, we explore how the US Preventive Services Task Force operationalizes harm and discuss how the potential for harm was described in the "I" statement on autism spectrum disorder screening. This information can serve as a guide for investigators working to study the benefits and harms of autism spectrum disorder screening in order to fill the research gaps cited by the US Preventive Services Task Force report. Finally, we recommend future research directions for exploring harms of autism spectrum disorder screening, filling cited research gaps, and ultimately ensuring that the benefits of autism spectrum disorder screening truly outweigh the harms for all children and their families.

Prevalence of preeclampsia risk factors: implications for low-dose aspirin prophylaxis

Colon Cancer Screening Models: Lessons and Challenges

Response to Weinstein’s “Reply of Increased risk of vitamin D deficiency and insufficiency in Black patients with central centrifugal cicatricial alopecia.”

Clinical Preventive Medicine in Primary Care: Background and Practice: 1. Rationale and Current Preventive Practices

News in Brief

Importance: US life expectancy and health outcomes for preventable causes of disease have continued to lag in many populations that experience racism. Objective: To propose iterative changes to US Preventive Services Task Force (USPSTF) processes, methods, and recommendations and enact a commitment to eliminate health inequities for people affected by systemic racism. Design and Evidence: In February 2021, the USPSTF began operational steps in its work to create preventive care recommendations to address the harmful effects of racism. A commissioned methods report was conducted to inform this process. Key findings of the report informed proposed updates to the USPSTF methods to address populations adversely affected by systemic racism and proposed pilots on implementation of the proposed changes. Findings: The USPSTF proposes to consider the opportunity to reduce health inequities when selecting new preventive care topics and prioritizing current topics; seek evidence about the effects of systemic racism and health inequities in all research plans and public comments requested, and integrate available evidence into evidence reviews; and summarize the likely effects of systemic racism and health inequities on clinical preventive services in USPSTF recommendations. The USPSTF will elicit feedback from its partners and experts and proposed changes will be piloted on selected USPSTF topics. Conclusions and Relevance: The USPSTF has developed strategies intended to mitigate the influence of systemic racism in its recommendations. The USPSTF seeks to reduce health inequities and other effects of systemic racism through iterative changes in methods of developing evidence-based recommendations, with partner and public input in the activities to implement the advancements.

ImportanceUS life expectancy and health outcomes for preventable causes of disease have continued to lag in many populations that experience racism.ObjectiveTo propose iterative changes to US Preventive Services Task Force (USPSTF) processes, methods, and recommendations and enact a commitment to eliminate health inequities for people affected by systemic racism.Design and EvidenceIn February 2021, the USPSTF began operational steps in its work to create preventive care recommendations to address the harmful effects of racism. A commissioned methods report was conducted to inform this process. Key findings of the report informed proposed updates to the USPSTF methods to address populations adversely affected by systemic racism and proposed pilots on implementation of the proposed changes.FindingsThe USPSTF proposes to consider the opportunity to reduce health inequities when selecting new preventive care topics and prioritizing current topics; seek evidence about the effects of systemic racism and health inequities in all research plans and public comments requested, and integrate available evidence into evidence reviews; and summarize the likely effects of systemic racism and health inequities on clinical preventive services in USPSTF recommendations. The USPSTF will elicit feedback from its partners and experts and proposed changes will be piloted on selected USPSTF topics.Conclusions and RelevanceThe USPSTF has developed strategies intended to mitigate the influence of systemic racism in its recommendations. The USPSTF seeks to reduce health inequities and other effects of systemic racism through iterative changes in methods of developing evidence-based recommendations, with partner and public input in the activities to implement the advancements.

In this issue of Pediatrics , readers will find the recommendation of the US Preventive Services Task Force (USPSTF) that all newborns be screened for hearing loss1; readers will also find a concise version of the systematic evidence report that was commissioned to help develop this recommendation.2 Over the last several years, Pediatrics has published 5 recommendations relevant to children from the USPSTF3–7 and plans to publish additional recommendations as they are released. Because many pediatricians know very little about the USPSTF,8 we would like to use this commentary to inform readers about this task force: what it is, who is involved, how it works, and what readers can expect from these publications. The USPSTF is an independent panel charged by the US Congress to review the scientific evidence for clinical preventive services and develop evidence-based recommendations for the health care community. It was first convened by the US Public Health Service in 1984 and, since 1998, has been sponsored by the Agency for Healthcare Research and Quality (AHRQ). The USPSTF comprises 16 private-sector experts in prevention and primary care, representing primary care specialties and nursing, who serve for terms of 4 to 6 years. Members of the USPSTF are nominated by federal agencies, partner organizations (such as the American Academy of Pediatrics [AAP]), and individuals in response to an announcement in the Federal Register . Members are chosen for their ability to make rigorous, impartial assessments of the scientific evidence for the effectiveness of a broad range of clinical preventive services, including screening, counseling, and preventive medications, and synthesize these assessments into recommendations. Throughout its existence, the task force has had at least 2 pediatricians, as well as other pediatric health care providers, among its members. Currently, 3 of its 16 … Address correspondence to Virginia A. Moyer, MD, MPH, Baylor College of Medicine, Department of Pediatrics, 6621 Fannin St, #1540, Houston, TX 77030. E-mail: moyer{at}bcm.edu

This is an update of the 2002 US Preventive Services Task Force recommendation on screening for child and adolescent major depressive disorder. The US Preventive Services Task Force weighed the benefits and harms of screening and treatment for major depressive disorder in children and adolescents, incorporating new evidence addressing gaps in the 2002 recommendation statement. Evidence examined included the benefits and harms of screening, the accuracy of primary care-feasible screening tests, and the benefits and risks of treating depression by using psychotherapy and/or medications in patients aged 7 to 18 years. Screen adolescents (12-18 years of age) for major depressive disorder when systems are in place to ensure accurate diagnosis, psychotherapy (cognitive-behavioral or interpersonal), and follow-up (B recommendation). Evidence is insufficient to warrant a recommendation to screen children (7-11 years of age) for major depressive disorder (I statement).

The prevalence of childhood and adolescent overweight has tripled over the past 2 decades, and associations have been identified between dietary patterns, physical activity, sedentary behaviors, and overweight. Some believe that pediatricians can easily recognize an overweight or obese child or adolescent and that there are sufficient therapeutic options to offer these patients and their families.1 However, primary care clinicians face obese and overweight children, adolescents, and parents every day, and most clinicians rarely document overweight. The American Academy of Pediatrics and American Academy of Family Physicians endorse universal screening using body mass index (BMI) and use of BMI growth curves to identify obese and overweight children. Physicians also seem to take high BMI more seriously than weight and height measures2; when documentation of high BMI occurs, screening, counseling, and referral rates for obese and overweight children and adolescents increase.3 Why then, does the US Preventive Services Task Force (USPSTF), in this issue of Pediatrics ,4 find insufficient evidence to recommend for or against formally screening children and adolescents for obesity or overweight in the primary care setting? The answer is: the USPSTF adheres strongly to a policy of making recommendations (either for or against delivery of preventive services) only in the presence of sufficient evidence of adequate quality. The USPSTF cannot make a recommendation for or against screening even for a practice that may be supported by expert consensus or less rigorous evidence. It is important to note that the USPSTF did not recommend that primary care clinicians not weigh and measure children or ignore … Address correspondence to Program Director, USPSTF, Agency for Healthcare Research and Quality, 540 Gaither Rd, Rockville, MD 20850. E-mail: uspstf{at}ahrq.gov

Gaps in evidence regarding iron deficiency anemia in pregnant women and young children: summary of US Preventive Services Task Force recommendations

Optimal gestational weight gain

* Abbreviation: USPSTF — : US Preventive Services Task Force In this issue of Pediatrics , Smith et al1 describe the challenges with implementing the US Preventive Services Task Force (USPSTF) recommendation for obesity screening in children and adolescents and offering or referring patients and families to behavioral interventions to promote weight improvement. The authors posit that effective behavioral interventions are not feasible to routinely deliver, and this challenge further exacerbates existing health inequities. The mission of the USPSTF is to make recommendations about clinical preventive services using a transparent, rigorous, and objective methodology. This approach ensures that clinicians and patients understand the evidence. On the basis of the certainty of the evidence and the magnitude of net benefits (eg, benefits minus harms), the USPSTF issues an A, B, C, or D grade or I statement. For clinicians, A and B grades mean to offer routinely, C means to selectively offer, D means to not routinely offer, and I is insufficient evidence to recommend … Address correspondence to Alex H. Krist, MD, MPH, 3825 Charles Stewart Dr, Fairfax, VA 22033. E-mail: alexander.krist{at}vcuhealth.org, 703-391-2020