Cathy L. Melvin, PhD, MPHPrincipal InvestigatorAlexis Moore, MPH
Project Director
CPCRN Steering Committee MeetingOctober 19-20, 2010
University of North CarolinaChapel 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
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