1. 4CNC Overview Cathy L. Melvin, PhD, MPH Principal Investigator
Alexis Moore, MPH
Project Director
CPCRN Steering Committee Meeting
October 19-20, 2010
University of North Carolina
Chapel Hill

2. Comprehensive Cancer Control Collaborative of North Carolina (4CNC)
Organizational Chart
Comprehensive 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
Project Director: Alexis Moore
Program Assistant:
Xavier McCutcheon
Training/TA Director:
Monair Hamilton McGregor
Investigator:
Jennifer Leeman
School of Nursing
Bill Carpenter
Health Policy & Management
Noel Brewer
Health Behavior & Health Education
Jennifer’s slide

3. 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

4. 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.
Alexis’ version. I think we should examine whether PSS is the right or only role for A/C partnerships. It seems like we need to be able to advance the science so we can create PSSs (i.e., build community capacity to fill the PSS role) that know what to do and how to do it. Also, Academic/Community Partnerships are part of the other to boxes too….
Ultimately, don’t we want Academic/Community partnerhsip activities to occur in all the boxes and in the arrows? Yes – but our focus (me, you Randahl, Monair) is the PSS for right now and for this talk.
We are proposing to do research on factors (still tbd) in the middle box and the arrows extending from it. Right? Yes
Prevention Support System
General capacity building
Innovation-specific capacity building

5. 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

6. Aims
Understand 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

7. 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
Expanded to 19 counties this year

8. 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?
Assess awareness of/adherence to screening guidelines?
ACS website, USPSTF, Etc

9. New Insights from Evaluation Data
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
Total # Applications
Cited
The Community Guide
Used Language from The
Community Guide
Used Language from RTIPS
2009 22 1
2010 24 10 6
1-maybe 2

10. New Insights from Evaluation Data
How widespread is “EBA” use?
In 2009 – 21 applicants (95%)
In 2010 – 24 applicants (100%)
Triangle Affiliate Community Health Grants
2009
22 applications
n (%)
2010
24 applications
Reducing out of pocket costs
17 (77%)
20 (83%)
Reducing structural barriers
21 (88%)
Client reminders
6 (27%)
11 (46%)
One-on-one education
7 (32%)
15 (63%)
Other EBA mentioned but not described in sufficient detail to determine if they could be categorized as EBA: small media, mass media in combination with other approaches, provider assessment and feedback and provider reminders.
Interesting point: number of grants that specifically described approaches to that have insufficient evidence also increased (e.g., group education & client incentives)
Agencies weren’t told to only use EBA. Only that they had to use EBA as well as other approaches. They were encouraged to more clearly specify their approaches, offer an explanation for non-EBA, and cite evidence for some of their approaches.

11. Next Steps Cross-code Finish analysis
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

12. 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

13. 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

14. 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

15. Pilot Project Findings FIT 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

16. Aims
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.
Increase participation of African Americans in CRC screening thereby decreasing their risk of CRC cancer related mortality and morbidity.
Inform construction of a county, region and/or statewide approach to CRC screening in NC based on FIT

17. 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

18. Outdoor POS Ads Study Kurt 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
studying how a proposed FDA ban on outdoor tobacco advertising near schools and playgrounds would affect over 20,000 retailers in MO and NYRecommendation: Tailored 500 Ft buffer in urban; 1,000 Ft buffer in non-urban
Outdoor POS Ads Study
studying how a proposed FDA ban on outdoor tobacco advertising near schools and playgrounds would affect over 20,000 retailers in MO and NYTo examine how the 2009 Family Smoking Prevention and Tobacco Control Act (FSPTCA) rules banning outdoor tobacco advertising near schools and playgrounds would affect tobacco retailers in two states, New York and Missouri.
FDA is considering advertising ban distances ranging from 350 to 1000 feet, and the differential impact of these is estimated.
For the state areas, buffer zones of 1,000 feet around all local parks and schools were constructed and for the two urban areas, buffer zones of 350, 500, and 1,000 feet were constructed. 

19. studying how a proposed FDA ban on outdoor tobacco advertising near schools and playgrounds would affect over 20,000 retailers in MO and NYRecommendation: Tailored 500 Ft buffer in urban; 1,000 Ft buffer in non-urban
Outdoor POS Ads Study
studying how a proposed FDA ban on outdoor tobacco advertising near schools and playgrounds would affect over 20,000 retailers in MO and NYTo examine how the 2009 Family Smoking Prevention and Tobacco Control Act (FSPTCA) rules banning outdoor tobacco advertising near schools and playgrounds would affect tobacco retailers in two states, New York and Missouri.
FDA is considering advertising ban distances ranging from 350 to 1000 feet, and the differential impact of these is estimated.
For the state areas, buffer zones of 1,000 feet around all local parks and schools were constructed and for the two urban areas, buffer zones of 350, 500, and 1,000 feet were constructed. 

20. Recommendation Action
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.
studying how a proposed FDA ban on outdoor tobacco advertising near schools and playgrounds would affect over 20,000 retailers in MO and NYRecommendation: Tailored 500 Ft buffer in urban; 1,000 Ft buffer in non-urban
Outdoor POS Ads Study
studying how a proposed FDA ban on outdoor tobacco advertising near schools and playgrounds would affect over 20,000 retailers in MO and NYTo examine how the 2009 Family Smoking Prevention and Tobacco Control Act (FSPTCA) rules banning outdoor tobacco advertising near schools and playgrounds would affect tobacco retailers in two states, New York and Missouri.
FDA is considering advertising ban distances ranging from 350 to 1000 feet, and the differential impact of these is estimated.
For the state areas, buffer zones of 1,000 feet around all local parks and schools were constructed and for the two urban areas, buffer zones of 350, 500, and 1,000 feet were constructed.