title: Development of a guide to applying precaution in local public health.
abstract: OBJECTIVE
  The precautionary principle (PP) urges actions to prevent harm even in the face of scientific uncertainty. Members of Toronto Public Health (TPH) sought guidance on applying precaution.
  
  
  METHODS
  We searched five bibliographic databases (yield 60 articles from 1996 to 2009 and 8 from 2009 to 2011) and Google (yield 11 gray literature sources) for material relevant to local public health. From these sources, we extracted questions until saturation was reached (n =55). We applied these questions retrospectively to eight case studies where TPH felt precaution was applied. We ranked questions for their importance in applying precaution.
  
  
  RESULTS
  Our final guide included 35 questions in five domains: context, assessment, alternative interventions, implementation, and monitoring and evaluation. Importance rankings varied across cases, but the role of stakeholders in driving precautionary action was consistent. Monitoring and evaluation components could have been strengthened across cases.
  
  
  CONCLUSIONS
  The TPH guide can assist municipal environmental health practitioners in applying precaution in a more transparent manner.
authors.forename: Monica
authors.initials: M
authors.lastname: Hau
authors.forename: Donald
authors.initials: D
authors.lastname: Cole
authors.forename: Loren
authors.initials: L
authors.lastname: Vanderlinden
authors.forename: Ronald
authors.initials: R
authors.lastname: MacFarlane
authors.forename: Carol
authors.initials: C
authors.lastname: Mee
authors.forename: Josephine
authors.initials: J
authors.lastname: Archbold
authors.forename: Monica
authors.initials: M
authors.lastname: Campbell
mesh_terms: D002170:Canada; D004781:Environmental Exposure / Q000517:prevention & control; D004784:Environmental Monitoring / Q000592:standards; D017408:Guidelines as Topic; D006801:Humans; D009111:Local Government; D015980:Public Health Practice / Q000592:standards*
keywords: Decision support systems,; Environmental impacts,; Environmental policy,; Local government,; Precautionary principle,; Risk management