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Reducing the Burden of Tobacco-Associated Cancers in Florida Florida Cancer Data System,

Reducing the Burden of Tobacco-Associated Cancers in Florida Florida Cancer Data System, Sylvester Comprehensive Cancer Center Department of Epidemiology and Public Health Department of Surgery, Division of Surgical Oncology Florida Department of Health, Bureau of Epidemiology.

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Reducing the Burden of Tobacco-Associated Cancers in Florida Florida Cancer Data System,

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  1. Reducing the Burden of Tobacco-Associated Cancers in Florida Florida Cancer Data System, Sylvester Comprehensive Cancer Center Department of Epidemiology and Public Health Department of Surgery, Division of Surgical Oncology Florida Department of Health, Bureau of Epidemiology

  2. Team Science Program Grant Program • Awarded to multidisciplinary, multi-investigator and multi-project programs at larger research institutions • Goal is to assist them in building a research infrastructure • One million dollars over a 24 month period

  3. 2006-7 Funded Team Science Programs • University of Florida- (PI Paul Davenport): The Role of Nicotine in the Neural Control of Respiratory and Cardiovascular Systems ($949,404) • Mayo Clinic- (PI Alan Fields): Oncogenic PKC iota in Smoking-Related Lung Cancer , $950,000 • University of Miami- (PI David Lee): Reducing the Burden of Tobacco-Associated Cancers in Florida , $949,974

  4. Project Aims: • Identify areas of Florida in greatest need of primary prevention by mapping county-level smoking prevalence data • Identify areas of Florida in greatest need of secondary and tertiary prevention by using spatial analysis methods that will illustrate tobacco-associated cancer clusters • Identify areas in Florida in need of secondary and tertiary prevention by using data from FCDS and from the Florida Agency for Health Care Administration to map late-stage presentation of tobacco-associated cancers and to evaluate access to state-of-the-art medical care for tobacco-related cancers.

  5. Outreach, Education and Dissemination Core • (Dr. Lee PI; Ms. Parker, Co-PI; Dr. Kobetz Co-I) • Will be responsible for laying the groundwork for communication of the knowledge acquired in Projects 1, 2 and 3 to the professional and lay community via the development of a website. • Will also be instrumental in bringing together key stakeholders and community leaders into the Year 2 activities leading up to the development of the NCI Program Project application. • Will also begin the process of identifying community assets and barriers in preparation for the P01 intervention project.

  6. Biostatistics and Data Management Core • (Dr. Anello PI; Dr. MacKinnon, Co-PI) • Provides data management and statistical analytic support for the three projects including the development of a web-based query system for the Website. • Will work in consultation with Dr. Kuldorff, a spatial statistician and creator of the time/space scan statistical package (SaTScan), to apply this methodology to identify areas in Florida in need of primary, secondary, and tertiary tobacco-associated cancer prevention. Will also examine other small area estimation techniques.

  7. Project 1 • (Dr. Huang PI; Dr. Voti Co-PI; Dr. Dietz Co-I) • Collect data on tobacco use related behaviors among middle & high school students in Florida as part of the 2006 FYTS. Conduct in 2007 a combined BRFSS and FLATS survey with enhanced sample size. • Explore various statistical methodologies to analyze the adult and youth tobacco data, estimate the prevalence of youth and adult tobacco use related behaviors in sub-groups of interest (e.g., gender, race-ethnicity) at the county-level and below.

  8. Project 1 • (Dr. Huang PI; Dr. Voti Co-PI; Dr. Dietz Co-I) • Provide area- and county-specific data to Project 2 and to the Outreach, Education, and Dissemination Core to inform the design of primary prevention interventions for the future NCI Program Project.

  9. 2002 County-Level Smoking Prevalence Quartiles

  10. Project 2 • (Dr. Fleming PI; Dr. Mackinnon Co-PI) • To utilize the cancer cluster software program SaTScan to analyze Florida’s tobacco-related cancer incidence and mortality data identify geographic areas (i.e. census block groups) with higher than expected tobacco-related cancer rates • Using US Census SES indicators and Project 1 smoking rates, assign an SES category and a smoking prevalence rate category to each block group in Florida for analyses designed to examine factors related to excess cancer incidence and mortalityrates.

  11. Project 2 • (Dr. Fleming PI; Dr. Mackinnon Co-PI) • Provide state incidence and mortality information to Project 3, and state incidence and mortality maps to the Outreach, Education, and Dissemination Core on all subgroups of interest (e.g., age, gender, race/ethnic, etc.) to inform to the design of the future NCI Program Project.

  12. SatScan • SaTScan employs a spatial scan statistic which can be used to identify the location of cancer clusters • Modeling approach permits adjustment for covariates and interaction terms

  13. Project 3 • (Dr. Franceschi PI; Dr. Koniaris Co-PI; Dr. McCollister, Co-I) • Use SaTScan to identify regions within Florida which have a higher than expected incidence of late stage tobacco-associated cancer. • Utilizing Agency for Health Care Administration (ACHA) data sets, identify patient- and treatment-level factors associated with outcome for tobacco associated cancers.

  14. In collaboration with the Outreach Education and Dissemination Core, create the framework to provide educational opportunities directed at primary and secondary health care providers in areas of need to make them aware of problems of late diagnosis, and options to improve early detection and cancer treatment outcomes.

  15. Treatment Center Volume Improves Outcomes for Pancreatic Cancer Care • Group I treated > 30 patients/year (n = 9 centers) • Group II treated between 10 and 30 patients/year (n = 61 centers) • Group III treated less than 10 patients per year (n = 177 centers)

  16. Overall Survival – Surgical Patients

  17. Long-Term Objectives: • Draw upon expertise to reduce tobacco-associated cancer incidence and mortality in high risk regions in Florida. • This effort will be organized around the three levels of prevention: • Primary • Secondary • Tertiary • Seek funding from the NCI/ACS to pursue these studies via a series of R01s and/or thru a P01-type mechanism

  18. Our Roadmap: • Quarterly meetings with the IAC; also quarterly conference calls with the EAC plus an EAC annual meeting (first is scheduled for the end of October). • Development of intervention-focused R01s or P01 for submission in October, 2007 (fallback February, 2008?).

  19. Thank You

  20. Biostatistics and Data Management Core (Co-PI C. Anello and J. MacKinnon)

  21. BiostatisticsCore (BC) Outline • LevelofSupport • Purpose of BC • Action Plan

  22. Level of Support • PI is 10% effort • 1 Biostatistician FTE at 10% effort • 1 Statistical research associate at 20 % effort. No cost

  23. Purpose of BC • Provide statistical expertise to support the aims of the 3 identified projects • Work with (Youjie Huang and Lydia Voti) on methodological issues related to BRFSS, FLATS, and FYTS surveys analysis, as needed • Work with Drs Fleming and MacKinnon on alternative methods to the current spatial statistical methodology, allowing for incorporation of other data • Work with Drs. Franceschi and Koniaris on comparing treatment and outcomes in relation to geographic regions and medical facility volume. Taking into account potential confounders such as co-morbidity

  24. Action Plan • Work on statistical aspects of small area estimation: Using data from 2000 BRFSS survey to investigate various approaches to estimating county level data. • Examine the role of hierarchical modeling as an analyses tool in combining information from various sources. • Examine assumptions of the various models used in the analyses in relation to available data • Cluster analysis- SaTScan/Dr. Kulldorff • Small sample estimation • Survival analyses and long rank tests

  25. Action Plan(cont.) 4. Review analysis and validity, when possible 5. Review inferences from analysis

  26. Some Special Statistical Issues • Comparison of small area estimations methodology • Role of hierarchical modeling • Analysis of outcome in relation to medical facility volume taking into account potential confounders such as co-morbidity

  27. Data Management Assemble, merge, manipulate, and make various databases available to Team Science Researchers

  28. Data Bases • FCDS ‘Commercial File’ • Tobacco related sites • AHCA • Merged with FCDS data • Assignment of co-morbid conditions • BRFSS • FLATS • FYTS Raw and Aggregated Data

  29. Data Access • Team Science web site • Public access • Tabular data • Maps • Publications • Password protected access • Team Science research team members only

  30. Thank You

  31. Outreach, Education and Dissemination Core (OEDC) David Lee, PI Dorothy Parker, Co-PI Erin Kobetz, Co-I Communication with professional and lay audiences to promote and develop tobacco-control research aimed at reducing morbidity and mortality.

  32. OEDC Goals • Disseminate findings from Projects 1, 2 and 3 to researchers, health care providers, and the general public. • Help develop future studies in areas identified as high risk with input from key stakeholders and community leaders in those areas.

  33. Research & Health Care Audience • FTRG researchers • Access to raw data for analyses (internal web page) • Other researchers – internal & external • Build interdisciplinary research team • Medical & public health professionals • Increasing awareness of high risk areas • Data for planning and evaluating interventions • 1°, 2 ° & 3° prevention • Statewide cancer control groups & programs • CCRAB, FCC, FDOC, Regional Collaboratives, etc.

  34. Public/Lay Audiences • Advocacy groups and CBOs interested in tobacco issues • Local community groups and organizations in high risk areas interested in education and cessation • among all age groups • The media (TV, radio, newspapers) • State and local government & elected officials

  35. http://tobaccoinfo.med.miami.edu

  36. Input for Future Research • Feedback on web page • Ongoing changes to make it useful and user-friendly for public and researchers • Input from high risk communities • Public forums, focus groups, on-line surveys • Appropriateness and acceptability of proposed interventions

  37. Role in Future Research • Population Research Core and other shared resources at SCCC • Disparities • Multicultural communities • Community-based participatory research

  38. Thank You

  39. Project 1 (Dr. Huang PI; Dr. Voti Co-PI; Dr. Dietz Co-I)

  40. Project 1 Objectives • Complete in 2007 a county-level Behavioral Risk Factor Surveillance System (BRFSS) survey with expanded tobacco-related questions. • Collect data on tobacco use related behaviors among middle school and high school students in Florida as part of the 2006 FYTS. • Analyze data from the BRFSS, FLATS and FYTS to identify areas with high rates of tobacco use.

  41. Background: BRFSS • A population-based, random telephone survey, following CDC survey protocol. • Sample stratified by size of county population and over-sampled for minorities • Monitors behavioral risk factors and chronic diseases among residents 18 years and older. • Conducted annually since 1986. • Sample size was approximately 9,000 in 2006 • Supported by CDC.

  42. Background: BRFSS Questions • Health Status • Health-Related Quality of Life • Health Care Access • Demographics • Exercise • Diabetes • Hypertension Awareness • Cholesterol Awareness • Cardiovascular Disease • Asthma • Immunization • Tobacco Use • Alcohol Consumption • Disability • Arthritis Burden • Fruits & Vegetables • Diabetes • Actions to Control High Blood Pressure • Women’s Health • Prostate Cancer Screening • Colorectal Cancer Screening

  43. Background: Adult Tobacco Survey (ATS) • A random telephone survey of adults for monitoring smoking and tobacco-related health behaviors • Sponsored by the Centers for Disease Control and Prevention (CDC) • Has been administered annually in Florida since 2003 • More than 100 questions • Sample size: 2,600-4,000

  44. Background: ATS Questions • Demographics • Tobacco use: cigarettes, smokeless tobacco, and cigars • Cessation • Exposure to second-hand smoke • Risk Perception and social Influences • Health and social influences • State-added questions

  45. Plan of BRFSS Survey • To increase sample size to 26,000 for estimating county level prevalence of smoking • To increase sample size by 6,000 using the grant funding in 2007 • To combine BRFSS and ATS survey by adding 4,000 sample size in 2007 • To combine 2006 BRFSS data that adds 9,000 sample size

  46. Progress of BRFSS Survey • DOH plans a county-level BRFSS survey in 2007 • Total sample size >38,5000 • At least 500 completed interviews per county • Approximately 150 questions • 5 counties added county-specific question • 11 counties increased sample size • The questionnaire is finalized • Currently working with CDC and survey company to implement the plan • Data will be available in April 2008

  47. Progress of Adult Tobacco Survey • To best use the resource from the grant: • Plan A: To increase sample size and over sample Hispanic population • To obtain unique data among Hispanics • Plan B: To increase sample size and over sample areas with high prevalence of smoking and/or smoking attributable cancer • To study areas at greater risk • Plan C: To conduct a follow-up survey using the County BRFSS information • Cost effective

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