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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.