Cathy L. Melvin, PhD, MPH Principal Investigator Alexis Moore, MPH Project Director

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. 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 Investigator: Bill Carpenter Health Policy & Management Investigator: Jennifer Leeman School of Nursing Investigator: Noel Brewer Health Behavior & Health Education Program Assistant: Xavier McCutcheon Training/TA Director: Monair Hamilton McGregor

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. 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

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?

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

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

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

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.