CPCRN: Your Partner in Cancer Control

1. CPCRN: Your Partner in Cancer Control Kurt M. Ribisl, PhD University of North Carolina at Chapel Hill CPCRN Coordinating Center CDC, Atlanta, GA May 24, 2010

2. CPCRN Mission To accelerate the adoption of evidence-based cancer prevention and control in communities.

3. Organization • One of five Thematic Research Networks in the Prevention Research Centers (PRCs) • Only Thematic Network focused on dissemination and translation • Collaboration with two Federal Agencies • CDC – Division of Cancer Prevention and Control • NCI – Division of Cancer Control and Population Sciences • Ten Network Centers at major research institutions

4. PI’s Michelle Kegler, DrPH Jennifer Allen, ScD, MPH, RN Marcia Ory, PhD, MPH Betsy Risendahl, PhD Roshan Bastani, PhD James Hebert, ScD, MSPH Cathy Melvin, PhD Kurt Ribisl, PhD (Coord Ctr) Maria Fernandez, PhD Vicky Taylor, MD, MPH Matthew Kreuter, PhD, MPH

5. Network Center Map

6. Selected Projects • 2-1-1 to Reduce Disparities • HPV Vaccination • Use of Evidence-Based Practice • Cancer Registry Data • BCCEDP • CRC Control Programs • FQHC Research

7. 240 active systems • 46 states, DC, Puerto Rico • 80% of U.S. population • 14.3 million calls in 2008

8. Survey administered in four 2-1-1 systems Goal (~300 surveys/Center)

9. Assessing six cancer control actions Mammography Pap testing Colonoscopy HPV vaccination Smoking Smoke-free home policies

10. 2-1-1 callers vs. U.S. population - 2-1-1 callers (n = 1,413)- 2008 BRFSS (n = 415,194)

11. Unmet Needs Cancer needs of 2-1-1 callers (n=1,413) - Need at least one action 72%- Need two or more 42%- Need three or more 17%

12. Risk Factors 2-1-1 Callers vs. BRFSS * Adjusted for gender and age

13. Information and Referral… Mammograms Pap smears Colonoscopies HPV vaccination Smoking cessation Smoke-free home policy girls 9-17 women 18-26 Merck Patient Assistance Program

14. HPV Projects • HPV Policy Analysis • Started in 2008 • Participants from UCLA, UNC, UT, UW, & CDC • Produced a detailed database of state legislative bills nationwide re: vax from 1/06-6/08 • Will help guide development of future policies • Manuscript in preparation

15. HPV Projects • HPV Measures Review • Started in 2007, let by Jennifer Allen (Harvard) • Participants from Harvard, Emory, Morehouse, UCLA, UNC, UT, UW, & CDC • Conducted a lit review of surveys re: knowledge, attitudes, behaviors related to HPV vaccination • Provided important info re: quality of existing measures • Manuscript in press at Vaccine

16. HPV Projects • HPV Cognitive Testing • Participants from UNC, Harvard, UCLA, UT, UW, WU, NCI, & CDC • 57 cognitive interviews conducted to cog test 20 survey items for parents/caregivers of vax-eligible girls • 13 items revised based on findings • Produced a set of validated survey items for use in CPCRN HPV survey and others • Led by Alice Richman/Noel Brewer (UNC-CH)

17. HPV Projects • HPV Latino Survey • Participants from UCLA, Harvard, UT, UW, WU, & CDC • Bilingual survey with 24 core items targeted @ parents/ caregivers of vax-eligible girls (9-17) • Administered in multiple settings • Builds on lessons learned from Measures and Cog Testing projects

18. Promoting Evidence-Based Practice • National and Statewide Trainings • Research and Partnerships with Cancer Control Planners

19. Designing Prevention Programs that Work

20. History of Trainings(Coming June 2010 to This Center)

21. CPCRN Partners’ Awareness & Use of EBPs and EBP Resources: EBP Resource Inventory Partner Survey Peggy Hannon et al. (U Washington)

22. Purpose • Funders increasingly seek evidence-based approaches and programs (EBPs) • Many program planners have limited training for finding and using EBPs • CPCRN seeks to create a training framework and interactive tool to facilitate cancer control planners’ use of EBPs

23. Key Questions • Do community-based cancer control planners use EBPs? • Do planners want to use EBPs? • What resources are available to support EBP use? • Are planners aware of and using these resources? • What training and support is needed to enhance use of EBPs?

24. EBP Resources Inventory • Web-based resources • Cancer Control P.L.A.N.E.T • Guide to Community Preventive Services • Research-Tested Intervention Programs • In-person training program • Using What Works

25. Pilot Survey: CDC Cancer Conference, 2007 • 63 participated in interactive survey w/ hand-held devices • Use of resources varies • 35% (R-TIPs) – 72% (P.L.A.N.E.T.) • Most find using EBPs challenging • 32% agree EBPs easy to find & obtain • 24% agree EBPs easy to adapt

26. Partner Survey • Each CPCRN Center surveyed > 30 partners • Key survey domains • Source of their programs • Perceptions of EBPs • Use of EBP resources • Perceived EBP training needs • 240 respondents included in analyses

27. Partners’ Program Sources

28. Awareness & Use of EBP Resources Note. 80-85% of those who had ever used these resources rated them as somewhat or very useful

29. EBP Resource Use & EBP Beliefs Note. * indicates p < .01

30. Partners’ Training Needs

31. Conclusion • Cancer control planners know and like “evidence based” • Majority are not using EBP resources • Majority report significant training needs to support EBP use Hannon PA, Fernandez ME, Williams R et al. Cancer control planners’ perceptions and use of evidence-based programs. J Public Health Manag Pract, in press.

32. Novel use of Registry Data in SC Hebert JR, Daguise VG, Hurley DM, Wilkerson RC, Mosley C, Adams SA, Puett R, Burch JB, Steck SE, Bolick-Aldrich Sl. Mapping cancer mortality-to-incidence ratios to illustrate racial and gender disparities in a high-risk population. Cancer 2009;115:2539-52.

33. PrCA Incidence in Relation to Soil Metal Concentration: Unique Use of Combining SCCCR & Environmental Data Selenium Zinc Wagner SE, Burch JB, Hussey J, Temples T, Bolick-Aldrich S, Mosley C, Liu Y, Hebert JR. Soil zinc content, groundwater usage, and prostate cancer incidence in South Carolina. Cancer Causes Control 2009;20:345-53.

34. Texas Cancer Information • Texas Cancer Information can connect patients, caregivers, the general public, health care policy planners, physicians and other health professionals with reliable online cancer information. • Dr. Fernandez is on the advisory committee. • Dr. Fernandez is working with Lewis Foxhall on developing a logic model for the TCI.

35. Promoting Screening • All Centers have projects • Promoting cancer screening • Have linkages with the Comprehensive Cancer Program • Promotion of screening through kiosks • Washington University (Matt Kreuter et al.) • Survey of BCCEDP • Emory University (Escoffery and CPCRN)

37. Reach and specificityCriteria for prioritizing among settings Highest reach Laundromats • Health centers • Lowest specificity Highest specificity Public libraries • Social services • • Churches • Beauty salons Lowest reach Source: Kreuter et al.

38. Using technology to connect rarely and never screened women to mammography • kiosks equipped with telephones and wireless technology • placed in Laundromats and public libraries to reach high volumes of rarely or never screened women • kiosk-administered survey identifies women needing mammograms • instant connection to nearby, free mammography programs directly from the kiosk

39. Inventory and Assessment of National Breast and Cervical Cancer Early Detection Program • PI: Cam Escoffery, PhD (Emory) • CPCRN Participating Centers-Advisory Committee: • Emory (Glanz, Kegler) • Harvard (Sorenson) • Morehouse (Blumenthal) • SLU/Washington University (Kreuter) • UCLA (Bastani) • UNC (Porterfield) • UT (Fernandez, Mullen) • UW (Harris, Taylor) • Funder: CDC

40. Purpose of Study • Inventory NBCCEDP interventions used to recruit women for screening and interventions used for the professional development of program staff and healthcare providers • Assess the recruitment and professional development interventions used based on their application of evidence-based cancer prevention practices • Disseminate the findings to encourage effective, evidence-based interventions for recruiting women and the professional development of healthcare providers

41. ResearchQuestions What is the use of evidence-based resources for increasing cancer screening by NBCCEDP grantees (i.e., Community Guide, RTIPS)? To what extent do the recruitment and professional development activities match evidence-based interventions to increase breast and cervical cancer screening? To what extent do NBCCEDP grantees implement process steps or core elements from evidence-based interventions for their recruitment and professional development activities? (intervention fidelity) What are interventions perceived to be effective by the NBCCEDP? (practice-based evidence)

42. Promoting CRC Screening

43. Goal Help community organizations create effective information resources for populations they serve Approach Make it easy to design and customize high quality, audience tested information resources

44. `

46. St. Louis Kansas City El Paso Lower Rio Grande Valley

47. Calls to 1-800-4-CANCER (group*time interaction, F=8.6, p=.004) - St. Louis - LRGV Calls to CIS - Kansas City - El Paso Pre-MIYO MIYO

48. About CRCCP • 80% screening by 2014 • Using EBIs from the Guide • client reminders • small media • reducing structural barriers • provider assessment/feedback • provider reminders • 26 states & tribal orgs

50. Survey of NCCCP grantees 1. Do you have CRC resources targeted to… - patients? - spouses/partners? - children of eligible adults? - health care providers? - community health centers? - community organizations?2. How satisfied are you with… - the number of resources you have? - the quality of resources you have?