Cathy L. Melvin, PhD, MPHPrincipal InvestigatorAlexis Moore, MPH

Project DirectorCPCRN Steering Committee Meeting

October 19-20, 2010University of North Carolina

Chapel Hill

4CNC Overview

Organizational ChartComprehensive Cancer Control Collaborative of North Carolina (4CNC)

4CNC Advisory Group

•Alice Ammerman•Marci Campbell•Karen Glanz•Laura Linnan

•Sally Malek•Deb Mayer•Michael O’Malley•Mike Pignone

•Barbara Rimer•Pam Silberman•Walter Shepherd

Principal Investigator: Cathy Melvin Co-Principal Investigator: Kurt Ribisl

Investigator:Jennifer LeemanSchool of Nursing

Investigator:Bill CarpenterHealth Policy & Management

Investigator:Noel BrewerHealth Behavior & Health Education

Project Director: Alexis Moore

Program Assistant:Xavier McCutcheon

Training/TA Director: Monair Hamilton McGregor

Research Themes Evaluating Policy, Training and Technical Assistance to

Build Capacity to Implement EBA Testing Approaches to Implementing USPSTF, Community

Guide and Other Recommendations– Breast cancer screening– Colorectal cancer screening– HPV vaccine uptake

Research on Tobacco Sales and Marketing: Implications for Program Implementation– Outdoor Point of Sale (POS) Ad Study– Internet Sales Surveillance

Prevention Support System Increasingly, academic/community partnerships

are operating as Prevention Support Systems– E.g., PRCs, CTSAs, PBRNs, CNPs, and CPCRN

One focus is building capacity to implement evidence-based interventions by providing– Evidence– Training– Technical assistance

Adapted from work by Jennifer Leeman, UNC.

• General capacity building• Innovation-specific capacity building

Prevention Support System

Increasing Adoption of EBA: Evaluating Policy, TA, and Training

Evaluation Team– Nadine Barrett, Susan G. Komen Race for the Cure– Ashley Leighton, 4CNC Graduate Research Assistant– Alexis Moore

UNC Faculty Advisors– Jennifer Leeman, School of Nursing – Allan Steckler, Department of Health Behavior and Health

Education, Gillings School of Global Public Health

AimsUnderstand consequences of a policy change

requiring grantees to use EBI/EBA–Do applications differ by • Attendance at training?• Receipt of individual consultation?

Determine vocabulary that community organizations use to describe evidence

Policy Change

Community partner: Komen-Triangle Affiliate– Modified its Community Grants Program to

require EBI/EBA use– Partners with 4CNC to give grant applicants• Brief training on EBI/EBA selection and adaptation• Consultation and TA during proposal development

Project Goal: Increase funding for successful implementation of EBI/EBA

Methods Sample: Narrative text from all Community Health Grant

applications with a focus on breast cancer screening – 26 applications in2009 and 24 in 2010

Content analysis:– Are proposed intervention strategies evidence-based?

• How are they cited? What words are used to define them? – What are differences by

• Year of application: pre- and post-policy change?• Training attendance?• Receipt of consultation?• Funding status?

New Insights from Evaluation Data

Total # Applications

Cited The Community Guide

Used Language from The Community Guide

Used Language from RTIPS

2009 22 1 0 0

2010 24 10 6 1-maybe 2

We reviewed all applications from 2009 and 2010 that described breast cancer screening promotion activities

We extracted “data” about any use of evidence-based strategies in proposed program plans. How did we determine use of “evidence”? Applications described EBA and sources used to identify EBA Sometimes we inferred from specific words and context

How widespread is “EBA” use? In 2009 – 21 applicants (95%) In 2010 – 24 applicants (100%)

New Insights from Evaluation Data

Triangle Affiliate Community Health Grants

200922 applicationsn (%)

201024 applicationsn (%)

Reducing out of pocket costs 17 (77%) 20 (83%)

Reducing structural barriers 17 (77%) 21 (88%)

Client reminders 6 (27%) 11 (46%)

One-on-one education 7 (32%) 15 (63%)

Next Steps

Cross-code– Challenge: Identify and accurately code specific

intervention components in community grants. Can we achieve agreement across coders?

Finish analysis– Policy, training and TA probably influenced applicant

grant-writing behavior. Did it also influence funding decisions?

Develop research questions and a proposal in collaboration with our community partners

Implementing EBA to Reduce Disparities in Colorectal Cancer

Carolina Community Network Center to Reduce Cancer Health Disparities (CCN II)– U54, Paul Godley, MD, PI

CCN II Intervention Research Project– Cathy Melvin, PhD, MPH, PI– Michael Pignone, MD, co-I

Purpose

To close gaps in colorectal cancer screening and survival rates among uninsured and African American individuals in Guilford County, NC by implementing Community Guide and USPSTF recommendations and testing a small media intervention

Pilot Project Benefits of Community Engagement

Formative work in pilot project with community providers and community groups allowed us to:– Adapt study design and implementation to local

needs and resources– Develop screening materials based on user input– Demonstrate our ability to recruit low income

participants for both a CRC screening program based on FIT and a randomized trial

– Work out a referral process for providing diagnostic follow-up evaluation and treatment

Pilot Project FindingsFIT Return Rate

– Overall FIT return rates were higher than expected based on the literature

– African Americans returned FIT tests at lower rate (58.2%) than Whites (77.6%)

– African Americans were more likely to return re-packaged (71.6%) than usual (61.8%) FIT Kit but difference was not statistically significant

Aims 1. Estimate potential demand for both primary screening and

diagnostic colonoscopy services in a guideline compliant program based on FIT, including estimates of the number of individuals requiring colonoscopy services at low or no cost.

2. Increase participation of African Americans in CRC screening thereby decreasing their risk of CRC cancer related mortality and morbidity.

3. Inform construction of a county, region and/or statewide approach to CRC screening in NC based on FIT

Community Partners

Three Major Health Care Systems– LeBauer HealthCare– Moses Cone Health System• HealthServe Community Clinic• Internal Medicine Clinic

– High Point Regional Health System– Adult Clinic– Community Clinic

Outdoor POS Ads StudyKurt Ribisl (UNC) & Doug Luke (Wash U)

Examine how the 2009 Family Smoking Prevention and Tobacco Control Act (FSPTCA) rules banning outdoor tobacco advertising near schools and playgrounds would affect over 20,000 tobacco retailers in two states, New York and Missouri

Estimate the differential impact of advertising ban distances ranging from 350 to 1000 feet under consideration by FDA

Recommendation

FDA should retain the 1000 feet buffer in all areas.

Action

Findings submitted to US FDA via Docket, to Campaign for Tobacco Free Kids, and NY Tobacco

Control Program.