Communities of Texas Cancer ● Activity ● Research ● Education ● Support CDC Site Visit May...

Communities of TexasCancer●Activity●Research●Education●S

upport

CDC Site Visit May 12, 2010

Educational programs of the Texas AgriLife Extension Service are open to all people without regard to race, color, sex, disability, religion, age, or national origin. The Texas A&M University System, U.S. Department of Agriculture, and the County Commissioners Courts of Texas Cooperating.

Center for Community Health Development

Principal Investigator: Kenneth R. McLeroy, Ph.D.

Co-PI and Director: James N. Burdine, Dr.P.H.Co-Director: Monica L. Wendel, Dr.P.H., M.A.

Mission Statement:To work collaboratively with communities and other partners to translate, evaluate, and disseminate effective individual, organizational, community and regional strategies for addressing critical public health and health-related issues in rural and underserved populations.

Organizational Structure

Six Central Components:

Administration

Community Collaboration

Research

Evaluation

Training

Communication

Successes

Increased collaboration across academic units within and outside of SRPH

Engagement of multidisciplinary faculty

Development of diverse range of strong research focus areas

Generation of new research—e.g., SIPs

Assets Strong relationships with partner

communities and organizations

History of collaboration

Established infrastructure and operational processes

Diverse expertise

Visibility/dissemination of products

Texas A&M School of Rural Public Health

14 Full Tenure Track & Non-Tenure Track Faculty

Located in College Station and McAllen, Texas

Nearly all address research of relevance to cancer prevention

Department of Social & Behavioral Health

Texas A&M School of Rural Public Health

SRPH philosophical approach to public health:Practical “real world” applications of

research.Translation into public health interventions

that affect population health.

Texas A&M School of Rural Public Health

Faculty Foci:Smoking Cessation in Adolescents (Colwell)Physical activity promotion (Ory, Dowdy)Nutritional risk factors (Sharkey, Dean)Obesity prevention (Tai-Seale, Ory)Health Disparities in Minorities (McLeroy; Mier)

Texas A&M School of Rural Public Health

Faculty Foci:Environmental exposures in migrant

workers (Millard)Cancer risk behaviors (Smith)Survivorship issues (Ory)Community engagement (Burdine, Wendel)

Example: Youth Cessation

Can we expand Cognitive-Behavioral Therapy for use with groups in community settings?

Can paraprofessionals with limited training effectively implement a theory-based intervention?

Are the measures of success of proximal, intermediate and distal determinants of tobacco use salient to program evaluation?

Do we get anything of value doing this in community settings?

60 clinics 9+ hospitals 220,000+ member health plan Cancer Institute (treatment, research, drug

development)

Electronic Medical Record system

Mason

ErathHood

Somervell

Johnson

HillBosque

Hamilton

Mills

San Saba

Llano

Hays

Blanco

McLennan

CoryellLeon

Robertson

Falls

Bell

Burnet

Travis

Williamson

Caldwell

Milam

Bastrop

Lee

Burleson

Brazos

Madison

Walker

Grimes

Washington

Austin

Waller

Lampasas

Hospital

Clinic

Specialty Clinics

TomGreen

ConchoMcCulloch

Translation and Dissemination:

System change to improve hepatitis screening in GI

Analyses to identify areas of need.

Consequences of mammography screening without additional primary care.

Treatment and genetic counseling patterns for women with and without family history of breast cancer.

Extension, hand-in-hand with the Texas A&M System, partners with the following entities: the state legislature county commissioners courts Extension serves Texans through educational

programming designed to address identified needs.

Extension strives to meet Texans’ needs with programs supported by: a network of Extension

offices 616 Extension agents 343 subject-matter

specialists

Texas County offices

CDC Vision and Priorities

Doctors’ Show & Tell: Colon Cancer Screening

Workshop based on Screen for Life

Demonstration materials:

FOBT/FIT Test Materials

Physician demonstration of simulated sigmoidoscopy and colonoscopy.

Participant interaction with simulator “games” using procedure tools.

RE-AIMDomain

Evaluation Examples

Reach

Number invited

Number attending a workshop

Percent representing target groups

Effectiveness

Change in self-reported likelihood of adherence to screening guidelines

Change in perceptions of cancer threat and screening benefits

Adoption

Number of physicians that lead one or more workshops

Requests from additional physicians, departments, clinics to be actively involved

Implementation

Percent of workshops covering all sections of the agenda

MaintenanceEstimated cost of continuing the program after funding period

Expressed interest of leaders, physicians to continue program

Goal: To reduce skin cancer morbidity and mortality through education.

Strategy:TABS utilizes cosmetologists to deliver Evidence-based skin cancer prevention and early detection techniques with their clients.

Implications for Dissemination/Translation:

•TABS disseminates evidence-based health promotion through cosmetologists.

•Cosmetologists are “natural helpers”.

•Cosmetologists often have a long-standing relationship with their clients.

Texas Survivorship Assessment

Goals: To document survivorship practices in the Brazos Valley including:

Receipt of survivorship care plansUse of online resources and supportPhysical activity practicesParticipation in cancer clinical trials

Strategy: Surveying cancer survivors in the Brazos Valley at County Relay for Life Events.

Texas Survivorship Assessment

Implications for dissemination/translation:

Enable CTxCARE to implement and test strategies for enhancing the dissemination of recommended survivorship practices.

Project STAR:Survivors Thriving After

RecoveryGoals: To increase physical activity and provide social support to breast cancer survivors.

Strategies:Address survivorship by applying an evidence-based program to increase physical activity.

Examine how to embed programs through wrap-around strategies:

• Walk Across Texas• Internet-based support

Project STAR:Survivors Thriving After

Recovery

Implications for dissemination/translation:

Disseminate an evidence-program (Active Living) in a survivor population.

CTxCARE will consider CPRIT reviewers feedback and examine other funding sources.

SOAR: Breast & Cervical Cancer -Screening, Outreach, Access & Referral

Goals: To increase the number of low income women in the Brazos Valley.

Target Population: Low income women in Brazos Valley:Age 40 and older receiving mammogramsAge 20 and older receiving pap tests

SOAR: Breast & Cervical Cancer -Screening, Outreach, Access & Referral

Strategy:CTxCARES will partner with St. Joseph’s to

provide community outreach that will connect women to Screening and Referral services for Breast and Cervical Cancer.

Addresses problem of low screening rates.

SOAR: Breast & Cervical Cancer -Screening, Outreach, Access & Referral

Implications for dissemination/translation:

This program will utilize Community Guide recommended client oriented screening interventions:• Client reminders• Small media• One-on-one education

SOAR: Breast & Cervical Cancer -Screening, Outreach, Access & Referral

Implications for dissemination/translation:

Will also utilize evidence-based practices for promoting other healthy behaviors.

Link patient navigator to community resources.

Clinical Trial Accrual & Assessment

Goals: To test evidence-based strategies for increasing both provider and patient recruitment and retention.

Strategy:Opportunity to work with CtNET (CPRIT funding).Patient accrual for cancer clinical trials is suboptimal for rural and underserved populations.

Clinical Trial Accrual & Assessment

Implications for dissemination/translation:

Will work on as part of our A&M Center for Clinical Sciences & Translational Research

How can we go from knowing barriers to identifying solutions?

Draw on community engagement and recruitment literature

Clinical Trial Accrual & Assessment

Implications for dissemination/translation:

Start with a few sites and disseminate more broadly through Texas.

Share with others facing similar issues throughout nation.

Release RFAs in May, making funding decisions in August

Fund up to 8 programs

Utilize Emory University’s experience and input from community connections

Mini-grants

Are narrowing the topics:• Development and promotion of walking trails

• Evaluation and modification on exercise patterns

• Body & Soul program in churches

• Treatwell 5-a-day program in worksites

• Worksite internet nutrition

Considering adding more/less to our menu

Mini-grants

Other questions for discussion:How adaptable are the programs?

• Example: Can a Hispanic church have success adapting program designed for an African American church?

What should our primary focus be?• Example: Emory has a focus on fidelity

What can we expect to gain from the evaluation data that will be provided?

Mini-grants

CTxCARES Involvement in Recent SIPS

Will serve as a consultant to:

• Emory for the Health Fair SIP

• University of Colorado for the survivorship care planning SIP

Follow-up from Steering Committee meeting

CTxCARES will be involved in cross-site projects.

The survivorship workgroup will move forward.

Other activities to be determined at the CDC site visit.