Cathy L. Melvin, PhD, MPH Principal Investigator Alexis Moore, MPH Project Director CPCRN Steering Committee Meeting Oc

1. 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 4CNC Overview

2. Organizational Chart Comprehensive Cancer Control Collaborative of North Carolina (4CNC) Jennifer�s slideJennifer�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? YesAlexis� 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

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 yearExpanded 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, EtcAssess awareness of/adherence to screening guidelines? ACS website, USPSTF, Etc

9. 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

10. How widespread is �EBA� use? In 2009 � 21 applicants (95%) In 2010 � 24 applicants (100%) New Insights from Evaluation Data 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. 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 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 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

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 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 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.� 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.� 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 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.� 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.�