May 21, 2020

Publication: "Improving Screening Uptake Among Breast Cancer Survivors and Their First-Degree Relatives at Elevated Risk to Breast Cancer: Results and Implications of a Randomized Study in the State of Georgia"

CPCRN principal investigator Cam Escoffery, PhD, MPH, CHES of Emory University has co-authored a new manuscript titled "Improving screening uptake among breast cancer survivors and their first-degree relatives at elevated risk to breast cancer: Results and implications of a randomized study in the state of Georgia." The article, published in May 2020, can be found in the International Journal of Environmental Research and Public Health.


Women diagnosed with breast cancer at a relatively early age (≤45 years) or with bilateral disease at any age are at elevated risk for additional breast cancer, as are their female first-degree relatives (FDRs). We report on a randomized trial to increase adherence to mammography screening guidelines among survivors and FDRs. From the Georgia Cancer Registry, breast cancer survivors diagnosed during 2000–2009 at six Georgia cancer centers underwent phone interviews about their breast cancer screening behaviors and their FDRs. Nonadherent survivors and FDRs meeting all inclusion criteria were randomized to high-intensity (evidence-based brochure, phone counseling, mailed reminders, and communications with primary care providers) or low-intensity interventions (brochure only). Three and 12-month follow-up questionnaires were completed. Data analyses used standard statistical approaches. Among 1055 survivors and 287 FDRs who were located, contacted, and agreed to participate, 59.5% and 62.7%, respectively, reported breast cancer screening in the past 12 months and were thus ineligible. For survivors enrolled at baseline (N = 95), the proportion reporting adherence to guideline screening by 12 months post-enrollment was similar in the high and low-intensity arms (66.7% vs. 79.2%, p = 0.31). Among FDRs enrolled at baseline (N = 83), screening was significantly higher in the high-intensity arm at 12 months (60.9% vs. 32.4%, p = 0.03). Overall, about 72% of study-eligible survivors (all of whom were screening nonadherent at baseline) reported screening within 12 months of study enrollment. For enrolled FDRs receiving the high-intensity intervention, over 60% reported guideline screening by 12 months. A major conclusion is that using high-quality central cancer registries to identify high-risk breast cancer survivors and then working closely with these survivors to identify their FDRs represents a feasible and effective strategy to promote guideline cancer screening.


Lipscomb, J., Escoffery, C. Gillespie, T., Henley, S.J., Smith, R., Chociemski, T., Almon, L., Jiang, R., Sheng X., Goodman, M., & Ward, K. (2020). Improving screening uptake among breast cancer survivors and their first-degree relatives at elevated risk to breast cancer: Results and implications of a randomized study in the state of Georgia. International Journal of Environmental Research and Public Health17(3): 977. doi:10.3390/ijerph17030977

Link to Full Publication

May 21, 2020

Study Finds Excess Medical Costs Associated with Metastatic Breast Cancer, Especially Among Younger Women (Wheeler, Trogdon)

Trogdon and Wheeler

A study at the University of North Carolina at Chapel Hill has found that metastatic breast cancer is associated with substantial excess health care costs for patients.

Using statistical modeling based on insurance claims data, researchers estimated medical costs for patients with metastatic breast cancer. For comparison, they also estimated costs for patients with earlier-stage breast cancer and with no cancer who were in the same age group, from the same county of residence, and who had the same type of health insurance.

“Our results highlight the tremendous cost burden associated with metastatic breast cancer among working-age women, particularly during the years after initial treatment of metastatic disease as well as at the end of life,” said Stephanie Wheeler, a researcher at the Center for Health Promotion and Disease Prevention (HPDP) at UNC-Chapel Hill and one of the co-authors of the study.

For women with metastatic breast cancer, where the five-year survival rate is only 26.3% compared to 98.8% for localized cancer, treatment continues for longer, and it includes end-of-life care. These factors contribute to the high medical costs associated with metastatic breast cancer, which can be a financial burden for women and their families.

The finding that medical costs are higher for younger and middle age women may reflect their desire for more aggressive treatment and willingness-to-pay for additional months of life, the researchers point out, or it may reflect breakdowns in shared decision-making between patients and practitioners, leading to treatments with minimal financial or health benefits for patients.

“Our results suggest that we spend nearly twice as much in the last year of life for women that die of breast cancer compared to other causes of death,” said Justin Trogdon, a researcher with HPDP and the lead author of the study. “We should work to ensure that end-of-life spending for metastatic breast cancer represents women’s preferences and is of high value.”

By identifying the age groups and phases of care where medical costs are the highest, the results of this study may inform decision-makers about where to invest resources, for example, which groups of patients may be in need of extra financial or psychological support. The study can also inform future research into how to improve metastatic breast cancer treatment for populations or treatment phases that are currently associated with the highest medical costs.

Full text of the paper is available online:

Additional authors: Christopher D. Baggett, Anagha Gogate, Katherine E. Reeder-Hayes, Jason Rotter, Xi Zhou, Donatus U. Ekwueme, and Temeika L. Fairley.

Full citation: Trogdon JG, Baggett CD, Gogate A, et al. Medical costs associated with metastatic breast cancer in younger, midlife, and older women. Breast Cancer Research and Treatment. Published online 2020:1-13. doi:10.1007/s10549-020-05654-x

This publication is a product of a Health Promotion and Disease Prevention Research Center supported by Cooperative Agreement Number (U48DP005017) from the Centers for Disease Control and Prevention. The findings and conclusions in this publication are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

May 20, 2020

Publication: "Future Directions for Implementation Science at the National Cancer Institute: Implementation Science Centers in Cancer Control"

CPCRN federal agency partners of NCI, April Oh, PhD, MPH (left), Cynthia Vinson, PhD, MPA (center), and David Chambers, PhD (right)

CPCRN federal agency partners April Oh, PhD, MPH, Cynthia Vinson, PhD, MPA, and David Chambers, PhD of the National Cancer Institute (NCI) have co-authored a new manuscripttitled "Future Directions for Implementation Science at the National Cancer Institute: Implementation Science Centers in Cancer Control." The article, published in March 2020, can be found in Translational Behavioral Medicine.


The National Cancer Institute (NCI) Cancer Moonshot initiative seeks to accelerate cancer research for the USA. One of the scientific priorities identified by the Moonshot's Blue Ribbon Panel (BRP) of scientific experts was the implementation of evidence-based approaches. In September 2019, the NCI launched the Implementation Science Centers in Cancer Control (ISC3 or "Centers") initiative to advance this Moonshot priority. The vision of the ISC3 is to promote the development of research centers to build capacity and research in high-priority areas of cancer control implementation science (e.g., scale-up and spread, sustainability and adaptation, and precision implementation), build implementation laboratories within community and clinical settings, improve the state of measurement and methods, and improve the adoption, implementation, and sustainment of evidence-based cancer control interventions. This paper highlights the research agenda, vision, and strategic direction for these Centers and encourages transdisciplinary scientists to learn more about opportunities to collaborate with these Centers.


Oh, A., Vinson, C. A., & Chambers, D. A. (2020). Future directions for implementation science at the National Cancer Institute: Implementation science centers in cancer control. Transl Behav Med, ibaa018. doi:10.1093/tbm/ibaa018

Full Article

May 19, 2020

NYU-CUNY CPCRN Investigators Participate in Various Efforts to Address COVID-19

CPCRN investigators from the NYU-CUNY collaborating center have participated in a variety of projects aimed at addressing COVID-19, including interactive and educational resource webinars, an article for an international news source, and a tracking survey to monitor and assess response to the pandemic.

  • The NYU Center for the Study of Asian American Health (CSAAH) partnered with Korean Doctors Against COVID-19 (KDACOVID-19) and Korean Community Services of Metropolitan New York (KCS) to record a COVID-19 resource webinar for Korean New Yorkers. Dr. Hyun Ji Lee, a family practitioner who is the President of the Korean American Physicians Association of New York as well as the pioneer behind the creation of KDACOVID-19, presented a COVID-19 informational overview and answered frequently asked questions by Korean community members. Sara Kim, Director of the KCS Public Health and Research Center, shared critical resources available to Korean community members provided by KCS.
  • Members of the CPCRN investigator team at NYU also contributed to an Al Jazeera article on the impact of COVID in the Bangladeshi community (Nadia Islam, MD Taher, and Mamnunul Haq all contributed to and were featured in this article).
  • CSAAH has initiated a webinar series in response to community partners’ requests for practical health information and prevention tips relating to the COVID19 to support vulnerable and under-reached members of the Asian American community. The first webinar presentation focused on ways that older adults might minimize their risk for COVID19.  Dr. Warren Chin, MD, Executive Director of the Chinese American Medical Society, a member organization of our National Advisory Committee on Research, led the 30-minute live webinar and question-and-answer session broadcast in Cantonese, which was recorded and disseminated via URL link to the community using email list-servs and social media channels. The second live webinar focused on supporting parents of school-aged children, and featured Dr. Eda Chao, MD, Assistant Chief of Pediatrics from the Charles B. Wang Community Health Center, another community partner. This session was presented in Mandarin Chinese, and aimed to support parents with information on safety tips to protect their families. CSAAH worked with community partners to solicit questions in advance from community members and leaders, to be answered during the Q&A portion of the webinars, in response to Chinese community stakeholders’ and project partners’ request for information on the novel coronavirus and practical safety tips or practices to minimize community risk:
  • On May 15, 2020, NYU, in collaboration with the the NYC Cancer Collaborative, launched a standalone website for World No Tobacco Day 2020. This website has a variety of resources for both patients and providers surrounding tobacco use and its effects, including an interactive webinar on COVID-19 and smoking.
  • Researchers from the CUNY SPH and Emerson College are collaborating on an ongoing COVID-19 Tracking Survey to assess how New Yorkers are responding to the pandemic. The weekly survey monitors outcomes such as risk perception, mental health,  job loss, housing, food insecurity, sources of COVID-19 related health information, and compliance with social distancing recommendations. Data emerging from the survey offers weekly snapshots of the pandemic’s impact on the lives of New Yorkers, and is intended to provide policymakers, health professionals, business and community leaders, and the public with a gauge on the adoption of preventive behaviors, and which communication strategies can help individuals and communities prevent the spread of COVID-19. The results of the survey are updated weekly on the CUNY SPH website.
May 19, 2020

Publication: "Rural-Urban Differences in Educational Attainment Among Registered Nurses: Implications for Achieving an 80% BSN Workforce"

CPCRN investigator Whitney Zahnd, PhD has co-authored a new manuscript along with other researchers at the University of South Carolina titled "Rural-Urban Differences in Educational Attainment Among Registered Nurses: Implications for Achieving an 80% BSN Workforce." The article, published in May 2020, can be found in the Journal of Professional Nursing.


BACKGROUND: Multiple professional organizations and institutes recommend the Bachelor of Science in Nursing (BSN) degree as a minimum standard for registered nurse practice. Achieving this standard may be particularly challenging in rural areas, which tend to be more economically disadvantaged and have fewer opportunities for higher educational attainment compared to urban areas.

PURPOSE: Our primary objective was to provide updated information on rural-urban differences in educational attainment. We also examined rural-urban differences in employment type, salary, and demographics among registered nurses in different practice settings.

METHODS: Data were obtained from the 2011–2015 American Community Survey (ACS) Public Use Microdata Sample (PUMS). The sample included registered nurses (RN) between the ages of 18–64 years (n = 34,104) from all 50 states. Chi-square tests, t-tests, and multivariable logistic regression were used to examine the relationship between rurality and BSN preparedness and salary across practice settings.

RESULTS: Urban nurses were more likely to have a BSN degree than rural nurses (57.9% versus 46.1%, respectively; p < 0.0001), and BSN preparedness varied by state. In adjusted analysis, factors in addition to residence associated with BSN preparation included age, race, and region of the country. Differences in wages were experienced by nurses across practice settings with urban nurses generally earning significantly higher salaries across practice settings (p < 0.0001).

CONCLUSIONS: Strategies to advance nursing workforce education are needed in rural areas and may contribute to improved care quality and health outcomes.


Odahowski, C. L., Crouch, E. L., Zahnd, W. E., Probst, J. C., Hunt McKinney, S., & Abshire, D. A. (2020). Rural-urban differences in educational attainment among registered nurses: Implications for achieving an 80% BSN workforce. J Prof Nurs. doi:

Learn More About This Article

May 19, 2020

CPCRN Investigators at University of Iowa Assist the UI PRC With Several COVID-19 Resources

University of Iowa CPCRN investigators have assisted the UI PRC with several COVID-19-related resources, including an informational video series (available in seven languages), and an outdoor social distancing message campaign:

    The Congolese Health Partnership has created a three video series called “Protecting Our Community.” It covers the following topics: (1) What is coronavirus?; (2) How can we prevent coronavirus?; and (3) How do we seek care for coronavirus (specifically for those living in Johnson County, IA)?  The video is currently translated into seven languages: English, Spanish, French, Lingala, Swahili, Kinyarwanda, and Arabic.  Subscribe to their YouTube channel to stay up-to-date on new languages and new videos related to COVID-19.
    These social distancing messaging materials and resources are for use by parks and recreation, community, neighborhood groups or organizations, and others interested in promoting social distancing in outdoors spaces. The messages were developed to provide fun and easy-to follow messaging around social distancing for individuals who are using outdoor spaces during COVID-19.  The images/materials are primarily meant to be used as outdoor signage that can serve as a cue to action for individuals to practice social distancing behaviors when they are using outdoor spaces.  The signage is available in 8.5X11 and 36×24 yard sign sizes. The Implementation Guide features ideas for getting signage posted and where to place it for the best results. You can download the files. 8.5X11 sized signage can be printed on a regular printer, yard signs will likely need to be printed by a professional printer.
May 19, 2020

University of South Carolina Collaborating Center Participates in Various Efforts to Address COVID-19

CPCRN investigators at the University of South Carolina were featured in a podcast and online and print news articles, responding to COVID-19 with insights about implications for cancer patients, as well as rural populations.

  • Jan Eberth, PhD provided an interview to The State,  a newspaper out of South Carolina, highlighting issues regarding the COVID-19 epidemic and rural populations in South Carolina.
  • Swann Arp Adams, PhD was featured in an online news article by the University of South Carolina in which she provided her insight into how cancer patients might be affected by COVID-19,.
May 19, 2020

Investigators from the Emory University Collaborating Center Called Upon to Provide Expertise Surrounding COVID-19 Pandemic

CPCRN investigators at Emory University were called upon to provide COVID-19 expertise pertaining to the spread of disease, business and travel restrictions, and gathering limitations, among other topics, to a wide variety of local and national news media outlets.

May 19, 2020

Publication: "Evaluating and Optimizing the Consolidated Framework for Implementation Research (CFIR) for Use in Low- and Middle-Income Countries: A Systematic Review"

CPCRN investigator Bryan Weiner, PhD has co-authored a new manuscript along with other researchers at the University of Washington titled "Evaluating and Optimizing the Consolidated Framework for Implementation Research (CFIR) for Use in Low- and Middle-Income Countries: A Systematic Review." The article can be found in the March 2020 issue of Implementation Science.


BACKGROUND: The Consolidated Framework for Implementation Research (CFIR) is a determinants framework that may require adaptation or contextualization to fit the needs of implementation scientists in low- and middle-income countries (LMICs). The purpose of this review is to characterize how the CFIR has been applied in LMIC contexts, to evaluate the utility of specific constructs to global implementation science research, and to identify opportunities to refine the CFIR to optimize utility in LMIC settings.

METHODS: A systematic literature review was performed to evaluate the use of the CFIR in LMICs. Citation searches were conducted in Medline, CINAHL, PsycINFO, CINAHL, SCOPUS, and Web of Science. Data abstraction included study location, study design, phase of implementation, manner of implementation (ex., data analysis), domains and constructs used, and justifications for use, among other variables. A standardized questionnaire was sent to the corresponding authors of included studies to determine which CFIR domains and constructs authors found to be compatible with use in LMICs and to solicit feedback regarding ways in which CFIR performance could be improved for use in LMICs.

RESULTS: Our database search yielded 504 articles, of which 34 met final inclusion criteria. The studies took place across 21 countries and focused on 18 different health topics. The studies primarily used qualitative study designs (68%). Over half (59%) of the studies applied the CFIR at study endline, primarily to guide data analysis or to contextualize study findings. Nineteen (59%) of the contacted authors participated in the survey. Authors unanimously identified culture and engaging as compatible with use in global implementation research. Only two constructs, patient needs and resources and individual stages of change were commonly identified as incompatible with use. Author feedback centered on team level influences on implementation, as well as systems characteristics, such as health system architecture. We propose a “Characteristics of Systems” domain and eleven novel constructs be added to the CFIR to increase its compatibility for use in LMICs.

CONCLUSIONS: These additions provide global implementation science practitioners opportunities to account for systems-level determinants operating independently of the implementing organization. Newly proposed constructs require further reliability and validity assessments.


Means, A. R., Kemp, C. G., Gwayi-Chore, M., Gimbel, S., Soi, C., Sherr, K., ... & Weiner, B. J. (2020). Evaluating and optimizing the consolidated framework for implementation research (CFIR) for use in low- and middle-income countries: A systematic review. Implement Sci, 15(17), 1-19. doi:10.1186/s13012-020-0977-0

Link to Full Publication

May 18, 2020

Heather Brandt accepts leadership position at St. Jude Children’s Research Hospital and St. Jude Comprehensive Cancer Center in Memphis, TN

University South Carolina CPCRN investigators design a virtual slide to recognize and celebrate Dr. Brandt

CPCRN co-investigator, Heather Brandt, PhD of the University of South Carolina collaborating center, has accepted a position at the St. Jude Children’s Research Hospital's NCI-designated Comprehensive Cancer Center, in Memphis, Tennessee.

Dr. Brandt has been with the USC CPCRN collaborating center since Cycle 3 of the Network, which commenced in 2009. In her role as co-investigator, Brandt has contributed greatly to various workgroup and center activities, and her research examines, describes, and intervenes to address cancer-related disparities at a community level, with a particular emphasis on dissemination and implementation of evidence-based approaches, HPV vaccination, and colorectal and cervical cancer screening.

Dr. Brandt has been an integral part of CPCRN over the last decade and will be greatly missed!

May 18, 2020

Publication: "Factors Associated With Perceived Job Preparedness Among RNs: Results From a National Survey"

CPCRN co-investigators, Whitney Zahnd, PhD and Jan Eberth, PhD, along with other co-authors at the University of South Carolina, have published a new manuscript titled "Factors Associated With Perceived Job Preparedness Among RNs: Results From a National Survey." The article, published in May 2020, can be found in the Journal of Nursing Administration.


This article examines perceived job preparedness by demographic and professional characteristics among practicing RNs who completed a national survey. Rural and male nurses felt less prepared for nursing practice and may benefit from tailored educational experiences to improve perceptions of being prepared for the workforce.


Zahnd, W. E., Crouch, E. L., Probst, J. C., Hunt McKinney, S., Abshire, D. A., & Eberth, J. M. (2020). Factors associated with perceived job preparedness among RNs: Results from a national survey. JONA, 50(5), 251-253. doi:10.1097/NNA.0000000000000879

Link to Full Publication

May 14, 2020

Jan Eberth Selected for 2020 National Rural Health Association Outstanding Researcher Award

Dr. Eberth selected as National Rural Health Assoc. Outstanding Researcher

CPCRN co-investigator, Jan Eberth, PhD of the University of South Carolina collaborating center, has been honored with the National Rural Health Association's (NRHA) 2020 Outstanding Researcher Award. The Rural Health Awards are given each year to individuals and organizations in the field of rural health who have dedicated their time and talents to improving the health and well-being of others.

The excerpt below was featured in the NRHA's 2020 Rural Health Awards Press Release from May 6th, 2020:

NRHA’s Outstanding Researcher Award winner is Jan Eberth, PhD, who serves as associate professor of epidemiology at the University of South Carolina and director of the Federal Office of Rural Health Policy-funded Rural and Minority Health Research Center. Eberth leads policy-relevant research on rural health issues related to cancer disparities, access to care, and the unique challenges experienced by rural persons of color. “Dr. Eberth’s commitment to rural health research is saliently seen in her service and advocacy for rural health research and in her mentorship of the next generation of rural health researchers,” says Whitney Zahnd, University of South Carolina Rural and Minority Health Research Center research assistant professor.

Learn more about the NRHA 2020 Rural Health Awards here.

May 14, 2020

Publication: "Dietary Pattern Recognition on Twitter: A Case Example of Before, During, and After Four Natural Disasters"

CPCRN  investigator Heather Brandt, PhD has co-authored a new manuscript along with other researchers at the University of South Carolina titled "Dietary Pattern Recognition on Twitter: A Case Example of Before, During, and After Four Natural Disasters." The article, published in May 2020, can be found in the journal Natural Hazards.


Little is known about what foods/beverages (F&B) are common during natural disasters. The goal of this study was to track high-frequency F&B mentions during four hurricanes affecting the coast of South Carolina for quantifying dietary patterns in Twitter. A listing of common F&B (n = 173) was created from the top food sources of energy, fat, protein, and carbohydrate in the USA. A sampling of > 500,000 tweets containing hashtag names (e.g., #HurricaneFlorence) or actual names (e.g., “Hurricane Florence”) of the four hurricanes was collected using Crimson Hexagon. ANOVA was used to examine differences in number of mentions in each food group pre- (6 days before), during (48 h of the hurricane), and post-hurricane (6 days after). Descriptive statistics were used to examine the most frequently mentioned F&B (threshold defined as ≥ 4 mentions/day for each F&B item or 10% of the foods mentioned) and whether F&B were top sources of energy/macronutrients. More than 5000 mentions of F&B were collected in our sample. Grains were the most frequently mentioned food group pre-hurricane, and dairy was most frequently mentioned during the hurricanes. The top five most commonly mentioned F&B overall were milk (n = 517), pizza (n = 511), turkey (n = 425), oranges (n = 384), and waffles (n = 346). Foods mentioned were commonly energy and protein dense. Five foods (pizza, waffles, milk, rolls, and bread) were categorized as a top contributor across energy and all three macronutrients. Social media may be a unique way to detect dietary patterns and help inform public health social media campaigns to advise people about stocking up on healthy, non-perishable foods ahead of natural disasters.


Turner, McGrievy, G., Karami, A., Monroe, C., & Brandt, H. (2020). Dietary pattern recognition on Twitter: A case example of before, during, and after four natural disasters. Nat Hazards. doi:

Link to Full Publication

February 19, 2020

CPCRN-Related Posters and Presentations at the 12th Annual D&I Conference, December 4-6, 2019

The 12th Annual Conference on the Science of Dissemination and Implementation in Health (D&I), co-hosted by the National Institutes of Health (NIH) and AcademyHealth, was held from December 4-6, 2019 at the Renaissance Washington, D.C. Guided by the theme, Raising the Bar on the Rigor, Relevance, and Rapidity of Dissemination and Implementation Science,  a large group of CPCRN members and affiliates convened to address the challenges facing D&I science, present research findings, and identify the next set of research priorities to optimize health and health care by bridging the gap between research, practice, and policy.

Click Here to View the Complete List of CPCRN Posters and Presentations

February 6, 2020

Sarah Birken Co-Edited New Text – Handbook on Implementation Science

Sarah Birken, PhD, MSPH, University of North Carolina

CPCRN co-investigator, Sarah Birken, PhD, MSPH of the University of North Carolina collaborating center, has co-edited a new text, Handbook on Implementation Science. In collaboration with co-editor, Per Nilsen of Linköping University, Sweden, Dr. Birken seeks to advance implementation science through careful consideration of current thinking and recommendations for future directions. The Handbook on Implementation Science provides an overview of the field’s multidisciplinary history, theoretical approaches, key concepts, perspectives, and methods. By drawing on knowledge concerning learning, habits, organizational theory, improvement science and policy research, the handbook offers novel perspectives from a broad group of international experts in the field representing diverse disciplines. Chapters introduce topics, define them, and explain their application in implementation science with examples that resonate with a diverse readership including implementation researchers, instructors, students and practitioners with experience in the field ranging from novices to experienced scholars.

Learn more about the Handbook, which will be available in May 2020, on the Edward Elgar Publishing Website.

February 6, 2020

University of South Carolina Investigators Co-Author Cancer Epidemiology Manuscript – "Cervical Cancer Screening Behaviors and Proximity to Federally Qualified Health Centers in South Carolina"

A team of CPCRN investigators from the University of South Carolina collaborating center co-authored a recent manuscript in Cancer Epidemiology, titled, "Cervical Cancer Screening Behaviors and Proximity to Federally Qualified Health Centers in South Carolina." CPCRN authors, including co-investigators Swann Arp Adams, PhD, Heather Brandt, PhD, Jan Eberth, PhD, and James Hébert, ScD, MSPH, and Principal Investigator, Daniela Friedman, PhD, examined travel distance and cervical cancer screening in Federally Qualified Health Centers (FQHCs).

Introduction: Lack of participation in cervical cancer screening in underserved populations has been attributed to access to care, particularly among women in rural areas. Federally Qualified Health Centers (FQHCs) were created to address this need in medically underserved populations. This study observed proximity to three health centers in relation to cervical cancer screening rates in South Carolina.
Methods: Data were obtained from FQHC patient visits (from 3 centers) between 2007–2010 and were limited to women eligible for cervical cancer screening (n = 24,393). ArcGIS was used to geocode patients addresses and FQHC locations, and distance was calculated. Modified Poisson regression was used to estimate relative risk of obtaining cervical cancer screening within one year or ever, stratified by residential area.
Results: Findings differed markedly by center and urban/rural status. At two health clinics, rural residents living the furthest away from the clinic (∼9 miles difference between quartile 4 and quartile 1) were more likely to be ever screened (RRs = 1.05 and 1.03, p-values < 0.05), while urban residents living the furthest away were less likely to be ever screened (RR = 0.85, p-value < 0.05). At the third center, only urban residents living the furthest away were more likely to be ever screened (RR = 1.02, p-value < 0.05).
Conclusions: Increased travel distance significantly increased the likelihood of cervical cancer screening at two FQHC sites while significantly decreasing the likelihood of screening at the 3rd site. These findings underscore the importance of contextual and environmental factors that impact use of cervical cancer screening services.

Arp Adams, S., Haynes, V. E., Brandt, H. M., Choi, S. K., Young, V., Eberth, J. M., Hébert, J. R., & Friedman, D. B. (2020). Cervical cancer screening behaviors and proximity to federally qualified health centers in South Carolina. Cancer Epidemiology, 65(101681), 1-7. doi: 10.1016/j.canep.2020.101681.

Click here to view the full Article

January 29, 2020

Press Release: With $3.375 Million in Renewed Funding, UNC-Chapel Hill Hosts Kickoff Meeting of Cancer Prevention and Control Research Network

CPCRN researchers at the Jan. 27-28 kickoff meeting in Chapel Hill, N.C.

Fifty-three cancer researchers from eight different academic institutions around the country and their federal agency partners met in Chapel Hill on January 27 and 28 to launch the next five years of the Cancer Prevention and Control Research Network (CPCRN). In September 2019, the Division of Cancer Prevention and Control at the Centers for Disease Control and Prevention (CDC) awarded the University of North Carolina at Chapel Hill $3.375 million over the next five years to continue serving as the CPCRN coordinating center as well as to continue participating in the network as one of its eight collaborating centers.

For the 2019-2024 cycle of funding, two new collaborating centers have joined CPCRN and six centers will rejoin or continue to participate in the network with renewed funding. The centers and their principal investigators are as follows:

  • Emory University: Cam Escoffery, PhD
  • University of Iowa:  Natoshia Askelson, PhD
  • New York University-City University of New York : Chau Trinh-Shevrin, DrPH
  • University of Arizona: Cynthia Thomson, PhD
  • University of South Carolina at Columbia: Daniela Friedman, PhD and James R Hébert, ScD
  • Colorado School of Public Health:  Betsy Risendal, PhD
  • University of North Carolina – Chapel Hill: Jennifer Leeman, DrPH, MDiv and Alison Brenner, PhD
  • University of Washington: Peggy Hannon, PhD and Linda Ko, PhD
  • CPCRN Coordinating Center: Stephanie Wheeler, PhD

Initiated in 2002, CPCRN is the largest and longest-standing thematic research network of the Prevention Research Center (PRC) program, the CDC’s flagship program for preventing and controlling chronic diseases. Eight PRCs from around the country participate in CPCRN, including UNC-Chapel Hill’s PRC, the Center for Health Promotion and Disease Prevention, which also hosts the coordinating center. Researchers from each PRC collaborate within and across their centers to produce research related to the implementation of evidence-based approaches to reduce the burden of cancer, especially in disproportionately affected populations. Since 2004, CPCRN members have produced 1,796 publications and obtained over $669 million in grant funding.

“We are delighted to be in our 16th year of continuous funding as the Coordinating Center for the CDC Prevention Research Centers’ largest thematic research network,” said Stephanie Wheeler, the principal investigator for the CPCRN Coordinating Center. “CPCRN has made a profound impact on the science and practice of cancer prevention and control research translation over the years, and we are excited about the new and returning centers that are part of the network in this current cycle.”

Over the next five years, CPCRN researchers will contribute to cross-center projects to extend research findings across the cancer control continuum into practice. At this week’s meeting, researchers developed consensus around potential thematic areas for the projects, to be coordinated by cross-center workgroups. The proposed areas of focus include cancer survivorship; cancer among rural populations; organization theory in implementation science; applied systems science; a CPCRN scholars trainee program; implementation, quality improvement, and technical assistance; health behaviors; health equity and social determinants of health; and mental health and well-being.

Each center will also complete a five-year core center project that will study the implementation of cancer control interventions directed at one or more levels of the health care context, which may include the patient, a health system, a community, or a wider political or economic context that impacts health outcomes.

For its core project, UNC-Chapel Hill’s collaborating center will study a pilot program to distribute colorectal cancer screening tests in rural areas through pharmacies. People living in rural areas are less likely to be screened for colorectal cancer than urban residents, but distribution of fecal immunochemical test (FIT) kits through pharmacies may improve rural screening rates. In North Carolina, pharmacies are more equally distributed across the state than primary care facilities, and communities with limited access to primary care may have one or more pharmacy which could distribute FIT kits.

“As a CPCRN center, we have the opportunity to develop strategies to prevent and control cancer in North Carolina” said Jennifer Leeman, principal investigator for the UNC-Chapel Hill collaborating center. “Through our partnerships with the other network centers, we also are able to advance the science of what works across diverse populations and settings nationwide.”

To better understand how a pharmacy-based distribution program could work, researchers will interview primary care providers, pharmacy staff, and patients, as well as administer a national survey to pharmacists and pharmacy technicians. After using this information to develop a FIT kit distribution program, they will conduct a small pilot of the program in up to five pharmacies in North Carolina.

“CPCRN collaborating centers are geographically distributed all over the US and work together, leveraging strengths in community-based partnerships, implementation science and population health, to tackle persistent problems in cancer prevention and control and advance health equity,” said Alice Ammerman, director for the UNC Center for Health Promotion and Disease Prevention, UNC-Chapel Hill’s PRC. “We are proud to host the Coordinating Center at the Center for Health Promotion and Disease Prevention and to continue the excellent work of our own collaborating center.”


The Cancer Prevention and Control Research Network (CPCRN) is a national network of academic, public health, and community partners who work together to reduce the burden of cancer, especially among those disproportionately affected. Its members conduct community-based participatory cancer research across its eight network centers, crossing academic affiliations and geographic boundaries. The CPCRN is a thematic research network of the Prevention Research Centers (PRCs), which are CDC’s flagship program for preventing and controlling chronic diseases.

The Cancer Prevention and Control Research Network is supported by Cooperative Agreement Number (U48 DP006400) from the Centers for Disease Control and Prevention. The findings and conclusions are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

January 9, 2020

Investigators at the University of North Carolina CPCRN Collaborating Center Produce Data Brief – Understanding Quality Improvement Collaboratives through an Implementation Science Lens

Jennifer Leeman, DrPH, MDiv (left), Catherine Rohweder, DrPH (center), Mary Wangen, MPH (right)

CPCRN Principal Investigator, Jennifer Leeman, DrPH, MDiv, and Project Directors, Catherine Rohweder, DrPH and Mary Wangen, MPH of the University of North Carolina collaborating center, produce data brief, "Understanding Quality Improvement Collaboratives through an Implementation Science Lens: An evaluation of a quality improvement collaborative designed to improve colorectal cancer screening rates in community health centers."

The Learning Collaborative, hosted by the American Cancer Society (ACS) and the North Carolina Community Health Center Association (NCCHCA), focused on improving colorectal cancer screening rates among Federally Qualified Health Centers (FQHC) using a quality improvement (QI) approach.

Click here to view the full Data Brief

December 18, 2019

Rebecca Williams Named a Tobacco Control 2019 Reviewer of the Year

Rebecca Williams, PhD, MHS, University of North Carolina

Chief Technology Officer and Co-Investigator, Rebecca Williams, PhD, MHS of the University of North Carolina CPCRN Coordinating Center, was named one of Tobacco Control's "2019 Reviewers of the Year." Reviewers are nominated for the honor by one or more members of the senior editorial team for going above and beyond in their contributions to the journal and the field.

In their annual editorial dedicated to the Reviewers of the Year, the senior editorial team highlighted Dr. Williams for her individual contributions, noting:
Rebecca Williams, a researcher at the University of North Carolina Lineberger Comprehensive Cancer Center and Chief Technology Officer of the Cancer Prevention and Control Research Network, is honoured by the senior editorial team for her exquisite skills in providing ‘extensive but useful’ comments both for details and for positioning the work in larger context and pulling out policy implications. Her expertise in the study of online tobacco marketing, a particularly challenging global policy issue, is invaluable.

Click here to read the Full Article

December 16, 2019

Press Release: Cancer Prevention and Control Research Network Produces Supplemental Issue of Preventive Medicine Highlighting Disparities in Cancer Prevention and Control

In 2019, nearly 2 million Americans will receive a cancer diagnosis and more than 600,000 will die of cancer. Cancer diagnoses and deaths are disproportionately high among people who live in rural counties, have a low socioeconomic status, and are members of underserved racial and ethnic groups.

The Cancer Prevention and Control Research Network (CPCRN), a collaborative national network of academic centers engaged in cancer research, has produced a supplemental issue of Preventive Medicine with 12 articles that examine stakeholder-engaged implementation science and population approaches to improve equity in cancer prevention and control. The research findings reported in the supplement investigate factors at the level of the patient, community, health care provider, health care system, and the wider socio-political context.

The supplemental issue represents a diversity of collaborative research products made possible by the research and scientific networking infrastructure enabled by CPCRN, which has been funded by the Centers for Disease Control and Prevention (CDC) and the National Cancer Institute (NCI), part of the National Institutes of Health (NIH), since 2002. CPCRN is a thematic network of the CDC’s Prevention Research Centers (PRCs) in which multiple centers collaborate on research related to the dissemination and implementation of evidence-based approaches to reduce the burden of cancer, especially in disproportionately affected populations. The University of North Carolina at Chapel Hill’s PRC, the Center for Health Promotion and Disease Prevention, hosts the network’s coordinating center.

For the 2014-2019 funding cycle, the CPCRN member centers included cancer investigators at Case Western Reserve University, Oregon Health & Science University, University of Iowa, University of Kentucky, University of North Carolina at Chapel Hill, University of Pennsylvania, University of South Carolina, and University of Washington.

“In this supplemental issue, CPCRN researchers take on two tasks that are essential to reducing disparities in cancer outcomes,” said Jennifer Leeman, a guest editor on the issue and principal investigator of the University of North Carolina CPCRN collaborating center. “First, they examine the multilevel factors that are contributing to cancer disparities, and, second, they identify strategies to speed the implementation of cancer screening interventions across the different levels where factors occur. Taken together, these articles report findings that will aid public health practitioners, policymakers, and others as they design and implement interventions to reduce the burden of cancer in underserved communities.”

The 12 articles included in the supplement illustrate the types of research that are possible within a network of geographically dispersed centers all thematically linked by a common cause — reducing cancer burden in diverse populations. The supplement begins with an article authored by CPCRN federal agency partners at the CDC and NCI that provides an overview of the network and its purpose and history. The supplement ends with an article authored by several network leaders about the potential impact of CPCRN on cancer control and prevention.

In four articles, researchers report findings from their cross-center research on factors that contribute to rural disparities in cancer outcomes and present a conceptual framework to guide future research to reduce rural disparities. In five articles, CPCRN researchers report findings related to interventions to increase colorectal cancer screening rates in underserved populations. In one of these articles, researchers report on a national survey of patient navigators and the barriers they encounter to enabling populations to receive timely colorectal, breast, and cervical cancer screening.

CPCRN facilitates and coordinates timely, high-impact research across the eight collaborating centers. Each center conducts research in its own community and region, as well as collaborates with other centers to conduct multi-state research studies in topic-oriented workgroups. The articles in this issue report on several workgroup initiatives and findings completed during the latest round of network funding between 2014 and 2019.

“Because it leverages geographically dispersed, interdisciplinary teams of investigators, CPCRN is in a unique position to study the individual, geographic, policy, and other multilevel factors that increase the risk for poor cancer outcomes,” said Stephanie Wheeler, the principal investigator for the CPCRN Coordinating Center. “The articles in this supplement highlight the diversity and strength of scientific ideas and leadership that a robust thematic research network like CPCRN can produce, where the network’s contribution to science and practice is clearly greater than the sum of its parts.”

The supplement has been published open access by Elsevier, and the full issue is available for download. Articles included in the supplement can also be individually downloaded by following the links below:

These publications are a product of the Prevention Research Centers Program at the Centers for Disease Control and Prevention. The findings and conclusions in these publications are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or the National Institute of Health. The Cancer Prevention and Control Research Network is funded through Cooperative Agreements [3 U48 DP005013-01S1A3, 3 U48 DP005000-01S2, 3 U48 DP005053-01S1, 3 U48 DP005017-01S8, 3 U48 DP005006-01S3, 3 U48 DP005030-01S5, 3 U48 DP005021-01S4, 3 U48 DP005014-01S2] from the Centers for Disease Control and Prevention and National Cancer Institute.

December 15, 2019

Shannon Watkins Awarded American Cancer Society (ACS) Seed Grant as Part of UI Holden Comprehensive Cancer Center’s ACS Institutional Research Grant

Shannon Watkins, PhD, University of Iowa

CPCRN co-investigator, Shannon Watkins, PhD of the University of Iowa collaborating center, has been awarded a one-year, $30,000 American Cancer Society (ACS) Seed Grant as Part of UI Holden Comprehensive Cancer Center’s ACS Institutional Research Grant. The grant will span from December 15, 2019  to December 14, 2020. More information about the grant can be found below:

The American Cancer Society's (ACS) Institutional Research Grant (IRG) to the Holden Comprehensive Cancer Center, University of Iowa, fosters cancer research to junior faculty members that cannot readily be supported through other available sources. The main purpose of these grants is to serve as "seed" money for junior investigators to permit the initiation of promising new projects or novel ideas to obtain the preliminary results necessary to compete successfully for national research grants. This Institutional Research Grant supports applications from young investigators in all basic biological, medical science and social science departments on the University of Iowa campus.

Poly-tobacco product use among young adults: A qualitative study of social and structural drivers

Young adulthood is a key developmental period during which tobacco product use behaviors often become less experimental and more routine. Prevalence of multiple tobacco product use (herein "poly-tobacco use") is also highest for young adults, who often use different products in response to different social (e.g. anti-smoking norms) and structural (e.g. clean indoor air laws) cues. The introduction of e-cigarettes (also called vapes) and the implicit marketing claims that e-cigarettes can aid cigarette cessation complicate the messages received by and the behavioral patterns of young adults. Understanding the social and structural (e.g. environmental, economic, marketing, policy) context in which poly-tobacco product use occurs, including where young adults learn about and obtain tobacco products, is necessary to identify opportunities for young adult interventions that prevent tobacco initiation and escalation of use, increase early cessation, and ultimately reduce cancer incidence in later adulthood.

Objective: The objective of this work is to identify how social and structural context influences perceptions, appeal, access, and use of different products by young adult poly-tobacco users in Iowa.

Specific Aims:
Aim 1:
Describe key social, environmental, and policy influences on the poly-tobacco product use behaviors of young adults in Iowa.
Aim 2: Compare sources of information (e.g. marketing) and products (e.g. friends, retailers) for young adults in Iowa and California and describe their relationship to poly-tobacco product use behaviors.

Study Design: This study proposes a qualitative investigation of young adult poly-tobacco users in Iowa. Each participant will complete a pre-interview questionnaire to report product use and demographic characteristics and a semi-structured interview that explores details of current tobacco product use, how products are used in their day-to-day lives, and facilitators of and barriers to information and product access. Young adults will be asked to narrate their daily routine, an effective interview tool that provides rich details about the context of product use, including when, where, and why they use each product, and implicit or explicit influence of social norms, marketing messages, and policy.

Transcripts will be analyzed thematically to identify key contextual influences of poly-tobacco product use in Iowa (Aim 1 ). Narratives of young adults in Iowa and California will be compared to identify unique and common sources of information and tobacco products for young adults and to investigate how multiple and competing sources of information play out in young adult poly-tobacco use behaviors (Aim 2).

Cancer Relevance: Tobacco use is the leading cause of preventable death in the United States. Cigarette smoking specifically is the leading cause of lung cancer and contributes to cancers of the bladder, cervix, head and neck, colon/rectum, kidney, liver, pancreas, and stomach. The emergence of e-cigarettes on the US market has the potential to increase the prevalence of nicotine use, increase combusted tobacco product use among young people, and expose users to, as of now, unknown long­term health consequences. By highlighting potential avenues for intervention, understanding the contexts in which multiple tobacco products are used together by young people is crucial to reducing tobacco use and promoting cancer prevention.

December 3, 2019

Investigators at the University of South Carolina CPCRN Collaborating Center Co-Author Manuscripts in "Health Affairs" Special Issue with a Focus on Rural Health

Jan Eberth, PhD & Whitney Zahnd, PhD, University of South Carolina

CPCRN co-investigators Jan Eberth, PhD and Whitney Zahnd, PhD of the University of South Carolina Collaborating Center co-authored several manuscripts in the December 2019 Health Affairs Special Issue on Rural Health. Eberth and Zahnd co-authored two of  32 articles in this issue, which explores the many dimensions of health and health care for the 20 percent of Americans who live in a rural area.

"Structural Urbanism Contributes to Poorer Health Outcomes for Rural America"
ABSTRACT: Rural populations disproportionately suffer from adverse health outcomes, including poorer health and higher age-adjusted mortality. We argue that these disparities are due in part to declining health care provider availability and accessibility in rural communities. Rural challenges are exacerbated by “structural urbanism”—elements of the current public health and health care systems that disadvantage rural communities. We suggest that biases in current models of health care funding, which treat health care as a service for an individual rather than as infrastructure for a population, are innately biased in favor of large populations. Until this bias is recognized, the development of viable models for care across the rural-urban continuum cannot move forward.
Citation: Probst, J., Eberth, J., & Crouch, E. (2019). Structural urbanism contributes to poorer health outcomes for rural America. Health Affairs, 38(12), 1976-1984.

"Declines in Pediatric Mortality Fall Short for Rural US Children"
ABSTRACT: Pediatric mortality rates in the US have declined since 1999, although rates among non-Hispanic black and American Indian/Alaska Native children remain higher than those among non-Hispanic white children. We used mortality data from the Centers for Disease Control and Prevention to ascertain whether children living in rural areas experienced declines in mortality over the period 1999–2017 that paralleled those for the nation as a whole. Throughout the study period and across all age groups, rural children experienced higher mortality rates than their urban peers. Among rural children, non-Hispanic black infants and American Indian/Alaska Native children were particularly at risk. To reduce unnecessary rural pediatric and adolescent deaths, we recommend ongoing surveillance of rural children’s health accompanied by policies targeting the leading causes of death in this population: unintentional injury and suicide.
Citation: Probst, J., Zahnd, W., & Breneman, C. (2019). Declines in pediatric mortality fall short for rural US children. Health Affairs, 38(12), 2069-2076.

Click here to view the full December 2019 Health Affairs Special Issue on Rural Health.

November 19, 2019

Daniela Friedman and Heather Brandt Awarded Funding for Research Project, 'Improving Health Literacy'

Daniela Friedman, PhD (left) & Heather Brandt, PhD (right)

Principal Investigator Daniela Friedman and Co-Investigator Heather Brandt (right) of the University of South Carolina CPCRN collaborating center were one of three projects awarded funding from the Duke Endowment, for a total of $1.8 million in awards. Their project, Improving Health Literacy, will focus on enhancing quality of care through improved health literacy by evaluating patient communication needs across South Carolina, increasing awareness among staff and care team members of health literacy disparities, and encouraging informed and engaging health care-related dialogue to improve patient understanding and active participation in their plan of care.

More information about this and other funded projects can be found at the Arnold School of Public Health website.

August 14, 2019

CPCRN Tobacco/Lung Cancer Screening Workgroup Publication - Addressing Tobacco Cessation at Federally Qualified Health Centers: Current Practices & Resources


This study assesses the current practices of Federally Qualified Health Centers (FQHCs) to address tobacco cessation with patients. A national sample of 112 FQHC medical directors completed the web-based survey. Frequently endorsed barriers to providing tobacco cessation services were: patients lacking insurance coverage (35%), limited transportation (27%), and variance in coverage of cessation services by insurance type (26%). Nearly 50% indicated that two or more tobacco cessation resources met the needs of their patients; 25% had one resource, and the remaining 25% had no resources. There were no differences among resource groups in the use of electronic health record (EHR) best-practice-alerts for tobacco use or in the perceived barriers to providing tobacco cessation assistance. Systems changes to harmonize coverage of tobacco assistance, such as broader accessibility to evidence-based cessation services could have a positive impact on the efforts of FQHCs to provide tobacco cessation assistance to their patients.

Citation: Flocke, S. A. & Vanderpool, R. & Birkby, G. & Gullett, H. & Seaman, E. L. & Land, S. & Zeliadt, S. (2019). Addressing Tobacco Cessation at Federally Qualified Health Centers: Current Practices & Resources. Journal of Health Care for the Poor and Underserved 30(3), 1024-1036. Johns Hopkins University Press. Retrieved August 14, 2019, from Project MUSE database.

Link to article:

July 2, 2019

CPCRN HPV Workgroup Publication - A Multi-Site Case Study of Community-Clinical Linkages for Promoting HPV Vaccination


Human papillomavirus (HPV) vaccination rates in the U.S. are suboptimal, requiring innovative partnerships between community and clinical entities to remedy this issue. A rigorous evaluation of HPV-related community-clinical linkages (CCLs) was conducted to understand their components, processes, and outcomes to increase HPV vaccination. Cancer Prevention and Control Research Network (CPCRN) investigators explored CCLs in their communities employing an iterative, case study approach. Information describing nine CCLs on HPV vaccination was collected from representatives from the community organization and clinical setting. Thematic content analysis was used to analyze and interpret data. Five CCLs included a federally qualified health center as the clinical partner, and five included a non-profit organization as the community partner. Five reflected clinically focused integration wherein engagement occurs in the community but vaccine delivery and follow-up occur in the clinical setting. The main impetus was the need to improve HPV vaccination and a community’s strong interest in preventing cancer. Noted critical components were a designated person to support the CCL and funding. Results will guide HPV vaccination promotion, education, and intervention efforts. CCLs provide an opportunity to study the adaption, integration, and enhancement of evidence-based approaches to increase HPV vaccination.

Citation: Heather M. Brandt, Robin C. Vanderpool, Susan J. Curry, Paige Farris, Jason Daniel-Ulloa, Laura Seegmiller, Lindsay R. Stradtman, Thuy Vu, Victoria Taylor & Maria Zubizarreta (2019): A multi-site case study of community-clinical linkages for promoting HPV vaccination, Human Vaccines & Immunotherapeutics, DOI: 10.1080/21645515.2019.1616501

Link to article:

May 9, 2019

Allison Cole Awarded Supplemental Funding by the NIH

Over $280,000 has been granted to Dr. Allison Cole to improve how the results of scientific research are disseminated and implemented into existing clinical and community settings. Only a small subset of scientific discoveries become actionable changes in the clinic. That means six out of seven breakthroughs never reach patient populations. Those that do make it can take over 15 years to become integrated into healthcare.

“These failures and delays dramatically reduce the potential public health benefit of scientific discoveries,” said Dr. Cole, co-director of ITHS Community Engagement and an expert in Dissemination and Implementation Science. Dissemination and implementation (D&I) science is the study of methods which promote the systematic uptake of research findings and other evidence-based interventions into routine practice in order to improve the quality and effectiveness of health care.

Dr. Cole will use this funding to develop an interactive online tool for identifying gaps and measuring improvement in this area. Having an online mechanism will facilitate consultation and promote meaningful data collection of D&I activities. This tool will play an important role in educating researchers in basic D&I topics to ensure efficient and effective working relationships between D&I experts and investigators. With plans to develop the tool in collaboration with Washington University’s Institute for Clinical and Translational Science, this project represents an exciting cross-CTSA collaboration.

With a shared method among D&I scientists, Dr. Cole hopes to standardize how this crucial step in the translational process is measured across the CTSA program and repeat the successes of the most impactful D&I activities.

This piece was featured in UW's Institute of Translational Health Sciences on September 24, 2018.

May 8, 2019

"Financial Toxicity in Advanced and Metastatic Cancer: Overburdened and Underprepared"

Patients with metastatic or advanced cancer are likely to be particularly susceptible to financial hardship for reasons related both to the characteristics of metastatic disease and to the characteristics of the population living with metastatic disease. First, metastatic cancer is a resource-intensive condition with expensive treatment and consistent, high-intensity monitoring. Second, patients diagnosed with metastatic disease are disproportionately uninsured and low income and from racial or ethnic minority groups. These vulnerable subpopulations have higher cancer related financial burden even in earlier stages of illness, potentially resulting from fewer asset reserves, nonexisting or less generous health insurance benefits, and employment in jobs with less flexibility and fewer employment protections. This combination of high financial need and high financial vulnerability makes those with advanced cancer an important population for additional study. In this article, we summarize why financial toxicity is burdensome for patients with advanced disease; review prior work in the metastatic or advanced settings specifically; and close with implications and recommendations for research, practice, and policy.

Citation: Rotter, J., Spencer, J. C., & Wheeler, S. B. (2019). Financial toxicity in advanced and metastatic cancer: Overburdened and unprepared. Journal of Oncology Practice, 15(4), e300-e307. doi: 10.1200/JOP.18.00518

Link to Full Publication

May 8, 2019

CPCRN Progress Report Executive Summary, April 2019

The Centers for Disease Control and Prevention (CDC)- and National Cancer Institute (NCI)-funded Cancer Prevention and Control Research Network (CPCRN) has been in operation since 2004. Over that time, the Network has had 16 university members, with 8 universities currently housing CPCRN Network Centers. This report demonstrates the impact of the work done by CPCRN’s investigators and summarizes the research and dissemination activities of the CPCRN, its member Centers, and its multicenter Workgroups over three time periods: the past year (through September 2018), the first four years of the current five-year funding cycle, and all network activity dating back to 2004.

Click here to access the full Progress Report Executive Summary

March 28, 2019

Sue Heiney Presented with Ruth and Rallie Seigler Spirit of Giving Award

CPCRN investigator Sue Heiney, PhD, of the University of South Carolina, was awarded the Ruth and Rallie Seigler Spirit of Giving Award on March 21, 2019. The award recognizes those that have played a significant role in advancing the University of South Carolina College of Nursing’s mission in one or more ways through philanthropy, volunteerism and advocacy, significantly increasing the visibility of the nursing profession and the issues of the college.

March 28, 2019

Jan Eberth Featured on American Cancer Society Podcast: ACS Research – TheoryLab

CPCRN investigator Jan Eberth, PhD, of the University of South Carolina made her podcast debut on ACS Research – TheoryLab on March 21, 2019. In this weekly podcast show, American Cancer Society grantees discuss the most critical questions in cancer research. From prevention to treatment, from bench to bedside, from career development and mentoring to outreach and advocacy, the leading experts in the field share their thoughts about the most important issues in the field. In her recent episode, 80% in EVERY Community, Dr. Eberth and colleague Jesse Nodora of the University of California, San Diego, discuss their work toward eliminating cancer disparities and boosting colorectal cancer screening rates.

The podcast can be accessed on iTunesSoundCloudListen Notes, and TheoryLab.

March 28, 2019

Sarah Birken Selected for UNC’s University Award for the Advancement of Women

CPCRN investigator Sarah Birken, PhD, assistant professor of health policy and management at the UNC Gillings School of Global Public Health, has won UNC-Chapel Hill’s University Award for the Advancement of Women.

The annual award recognizes faculty and staff members and graduate and undergraduate students on the UNC-Chapel Hill campus who have elevated the status of women, helped improve campus policies, promoted recruitment, retention and upward mobility of women, and participated in professional development or mentorship for women.

On March 19, Birken and four other awardees were honored at a 1 p.m. ceremony on the UNC campus at the Sonja Haynes Stone Center for Black Culture and History.

Birken, a 2011 alumna of the Gillings School, joined the School’s faculty in 2014. An avid runner, mentor, wife and mother of two, she became active in UNC’s Committee on the Status of Women and began to explore how other women in academia were juggling their many obligations while balancing their work and home lives.

As co-host of a podcast called AcaDames, Birken meets with other women to discuss issues such as salaries, tenure, job security and being a mother in academia. The immediately popular podcast was downloaded more than 1,500 times after only three episodes.

Birken’s AcaDames co-host is Whitney Robinson, PhD, associate professor of epidemiology at the Gillings School.

Fixed-term faculty such as herself are predominantly women, Birken said, often because “the most intense period of an academic’s career coincides with the most intense period of a woman’s life.”

Those who drop out or slow down for personal reasons, as she did, may forgo tenure-track positions, she said. While she has strong support from her department chair, fixed-term faculty in general are vulnerable because they work on short contracts at the will of their department chairs or deans.

“They [may be] more guarded in what they say and what they research because they don’t have the security of tenure,” Birken said.

Other 2019 winners of the Award for the Advancement of Women include DeVetta Holman Copeland, resiliency and student support programs coordinator in Student Wellness and founder of the group, Sister Talk (staff award); Leah Bowers and Jennifer Fulton, graduate students in chemistry and leaders of Allies for Minorities and Women in Science and Engineering (graduate student award); and Grace Langley, senior psychology and sociology major and resident adviser of the Women Engaged in Learning and Leadership Residential Learning Program (undergraduate student award).

The awards are sponsored by the Carolina Women’s Center. Read more about all the awardees in the University Gazette.

This piece was featured in UNC’s Gillings School News on March 15, 2019.

March 17, 2019

CPCRN FQHC Workgroup Publication – Understanding the Processes that Federally Qualified Health Centers Use to Select and Implement Colorectal Cancer Screening Interventions: A Qualitative Study

Colorectal cancer (CRC) screening is highly effective at reducing cancer-related morbidity and mortality, yet screening rates remain suboptimal. Evidence-based interventions can increase screening rates, particularly when they target multiple levels (e.g., patients, providers, health care systems). However, effective interventions remain underutilized. Thus, there is a pressing need to build capacity to select and implement multilevel CRC screening interventions. We report on formative research aimed at understanding how Federally Qualified Health Center (FQHC) staff select and implement CRC screening interventions, which will inform development of capacity-building strategies. We report the qualitative findings from a study that used a mixed methods design, starting with a quantitative survey followed by a qualitative study. In-depth interviews were conducted with 28 staff from 14 FQHCs in 8 states. The Consolidated Framework for Implementation Research (CFIR) guided interview questions and data analysis. Related to the CFIR process domain, few respondents described conducting formal assessments of factors contributing to low screening rates prior to planning their interventions. Many described engaging champions, implementation leaders, and external change agents. Few described a systematic approach to executingimplementation plans beyond conducting plan-do-study-act cycles. Reflection and evaluationconsisted primarily of reviewing Uniform Data System performance measures. Findings also include themes related to factors influencing these implementation processes. Although FQHCs are implementing CRC screening interventions, they are not actively targeting the multilevel factors influencing their CRC screening rates. Our findings on gaps in FQHCs’ implementation processes will inform development of strategies to build capacity to select and implement multilevel CRC screening interventions.

Citation: Leeman, J., Askelson, N., Ko, L. K., Rohweder, C. L., Avelis, J., Best, A., Friedman, D., Glanz, K., Seegmiller, L., Stradtman, L., & Vanderpool, R. C. (2019). Understanding the processes that Federally Qualified Health Centers use to select and implement colorectal cancer screening interventions: A qualitative study. Translational Behavioral Medicine, 1-10.

March 11, 2019

Karen Glanz Served as Keynote Speaker at the Prince Mahidol Award Conference, Thailand, Jan 29 – Feb 1, 2019

CPCRN principal investigator Karen Glanz, PhD of the University of Pennsylvania was a keynote speaker at The Prince Mahidol Award Conference held in Thailand Jan. 29-Feb. 3. The theme of the conference was “The Political Economy of NCDs: A Whole of Society Approach.”

March 7, 2019

Lindsay Stradtman Named University of Kentucky College of Public Health Staff Employee of the Year

Lindsay Stradtman, project director for the University of Kentucky CPCRN Center, was named the University of Kentucky College of Public Health Staff Employee of the Year. Stradtman was chosen by the College of Public Health Staff Council from among a group of individuals nominated by supervisors and peers.  Link to full award details. 

March 7, 2019

Stephanie Wheeler Named Associate Director of UNC Lineberger’s New Office of Community Outreach and Engagement

Stephanie Wheeler, CPCRN Coordinating Center Principal Investigator, has been named associate director of UNC Lineberger’s new Office of Community Outreach and Engagement.

Wheeler will be responsible for gathering community input to assess the needs of North Carolinians related to cancer prevention, early detection, cancer care and survivorship. The new office will set up infrastructure for analysis and implementation that leads to evidenced-based, community participatory service and further research into inequities in the prevention, diagnosis, treatment and outcomes related to cancer.

An alumna of the University of Cape Town, South Africa (Master of Public Health), and of the UNC Gillings School (Doctor of Philosophy in health policy and management), Wheeler has written extensively about cancer prevention and outcomes research, particularly in regard to understanding and reducing health inequities.

She joined the UNC faculty in 2010, and in 2017, was presented with both the Association of Schools and Programs of Public Health’s Early Career Health Research Award and UNC-Chapel Hill’s Philip and Ruth Hettleman Prize for Artistic and Scholarly Achievement by Young Faculty.

“It has been said that cancer is an equal opportunity disease,” said Shelton Earp, MD, director of UNC Lineberger, in announcing the new office and Wheeler’s appointment, “but we know through multiple UNC studies that cancer disproportionately affects some populations, and the burden of cancer falls far more heavily on some communities than others. This is true in our state and throughout the country.”

As North Carolina’s only public National Cancer Institute-designated comprehensive cancer center, UNC Lineberger has a longstanding commitment to understanding the impact of cancer across the state, Earp noted.

UNC researchers, who have conducted population-based studies in breast, prostate and head and neck cancers and developed the groundbreaking use of lay health advisers in community- and faith-based settings, have worked to decrease cancer inequities in North Carolina.

“They have introduced both data and interventions into the national conscience,” Earp said. “Yet, there remains so much more to do, and everyone, from the individual to the community to the policy maker, must be involved if we are to be successful.”

Earp said that UNC Lineberger’s efforts will be made more effective by placing greater institutional focus on the issue of health inequities.

“While the office itself is new,” said Earp, “our commitment to studying how cancer [has an impact upon] minority, rural and urban populations in North Carolina is not. For more than 30 years, together with colleagues at the UNC Gillings School and other health affairs and college faculty members, UNC Lineberger has conducted epidemiologic and prevention/control research to identify at-risk communities and develop and study interventions aimed at reducing cancer disparities.”

Earp said that, despite having defined the problems well, inequities still persist based on race, socio-economic status and the rural/urban divide.

“The establishment of the Office of Community Outreach and Engagement is a crucial next step,” he said, “and it will position us to have greater impact in North Carolina and, very likely, across the country.”

Joining Wheeler in the work of the new office will be Barbara Alvarez Martin, MPH, who will serve as assistant director of Community Outreach and Engagement and Population Science, and Marjory Charlot, MD, MPH, MSc, who will be assistant director of Community Outreach and Engagement for Patient-Centered Research.

This piece was featured in UNC’s Gillings School News on March 8, 2019.

March 7, 2019

Does a Transition to Accountable Care in Medicaid Shift the Modality of Colorectal Cancer Testing?

Background: Health care reform is changing preventive services delivery. This study explored trajectories in colorectal cancer (CRC) testing over a 5-year period that included implementation of 16 Medicaid Accountable Care Organizations (ACOs, 2012) and Medicaid expansion (2014) – two provisions of the Affordable Care Act (ACA) – within the state of Oregon, USA.

Methods: Retrospective analysis of Oregon’s Medicaid claims for enrollee’s eligible for CRC screening (50–64 years) spanning January 2010 through December 2014. Our analysis was conducted and refined April 2016 through June 2018. The analysis assessed the annual probability of patients receiving CRC testing and the modality used (e.g., colonoscopy, fecal testing) relative to a baseline year (2010). We hypothesized that CRC testing would increase following Medicaid ACO formation – called Coordinated Care Organizations (CCOs).

Results: A total of 132,424 unique Medicaid enrollees (representing 255,192 person-years) met inclusion criteria over the 5-year study. Controlling for demographic and regional factors, the predicted probability of CRC testing was significantly higher in 2014 (+ 1.4 percentage points, p < 0.001) compared to the 2010 baseline but not in 2012 or 2013. Increased fecal testing using Fecal Occult Blood Tests (FOBT) or Fecal Immunochemical Tests (FIT) played a prominent role in 2014. The uptick in statewide fecal testing appears driven primarily by a subset of CCOs.

Conclusions: Observed CRC testing did not immediately increase following the transition to CCOs in 2012. However increased testing in 2014, may reflect a delay in implementation of interventions to increase CRC screening and/or a strong desire by newly insured Medicaid CCO members to receive preventive care.

Citation: Davis, M. M., Shafer, P., Renfro, S., Hassmiller Lich, K., Shannon, J., Coronado, G. D., McConnell, K. J., & Wheeler, S. B. (2019). Does a transition to accountable care in Medicaid shift the modality of colorectal cancer testing? BMC Health Services Research, 19(54), 1-8.

Link to Full Publication

March 7, 2019

Correlates of Sun Protection Behaviors in Racially and Ethnically Diverse U.S. Adults

Abstract: Although skin cancer incidence is highest among non-Hispanic Whites, minority populations are often diagnosed with more advanced stage disease and are more likely to experience poor outcomes. Fewer people of color do not practice primary prevention of skin cancer according to recommendations, but public health education and interventions to promote sun protection behaviors have consistently targeted non-Hispanic Whites. This study examines performance of sun protection behaviors in a multiethnic sample and whether demographic, lifestyle and psychosocial predictors of these behaviors differ by race and ethnicity. In this study, a probability-based sample of 1742 adults completed an online survey in 2015. Main outcomes of interest included sunscreen use, wearing a sleeved shirt, and seeking shade. We stratified the sample into racial/ethnic groups (White, Black, Hispanic, Asian) and investigated demographic, lifestyle and psychosocial correlates of these behaviors in each group. Differences in adjusted estimates from each behavior-specific model were tested across strata. Racial/ethnic groups were significantly different in regards to sunscreen use and wearing a sleeved shirt, but similarly engaged in seeking shade. Results from multivariate ordered logistic regression models for each behavior revealed important demographic, lifestyle and psychosocial predictors and the importance of some demographic correlates varied between racial/ethnic groups. This study provides insight into the practice and correlates of skin cancer prevention among a multiethnic sample. Our findings suggest that targeting public health education efforts and interventions to promote sun protection in minority populations may be a beneficial approach to addressing heightened skin cancer morbidity and mortality in these groups.

Citation: Calderón, T. A., Bleakley, A., Jordan, A. B., Lazovich, D., & Glanz, K. Correlates of sun protection behaviors in racially and ethnically diverse U.S. adults. Preventive Medicine Reports, 13, 346-353.

Link to Full Publication

March 7, 2019

Evaluating Centralized Technical Assistance as an Implementation Strategy to Improve Cancer Prevention and Control

Purpose: In 2015–2016, the Comprehensive Cancer Control National Partnership provided technical assistance workshops to support 22 cancer coalitions in increasing human papillomavirus (HPV) vaccination uptake and increasing colorectal cancer (CRC) screening in their local communities. As national efforts continue to invest in providing technical assistance, there is a current gap in understanding its use as a strategy to accelerate implementation of evidence-based interventions (EBIs) for cancer prevention. The objective of this study was to evaluate the impact of technical assistance on the participants’ knowledge, attitudes, and skills for implementing EBIs in their local context and enhancing state team collaboration.

Methods: Data were collected August-November 2017 using web-based questionnaires from 44 HPV workshop participants and 66 CRC workshop participants.

Results: Both HPV vaccination and CRC screening workshop participants reported changes in knowledge, attitudes, and skills related to implementing EBIs in their local state context. Several participants reported increased abilities in communicating and coordinating with partners in their states and utilizing additional implementation strategies to increase HPV vaccination uptake and CRC screening rates.

Conclusions: Findings from this study suggest that providing technical assistance to members of comprehensive cancer control coalitions is useful in promoting collaborations and building capacity for implementing EBIs for cancer prevention and control.

Citation: Moreland-Russell, S., Adsul, P., Nasir, S., Fernandez, M. E., Walker, T. J., Brandt, H. M., Vanderpool, R. C., Pilar, M., Cuccaro, P., Norton, W. E., Vinson, C. A., Chambers, D. A., & Brownson, R. C. (2018). Evaluating centralized technical assistance as an implementation strategy to improve cancer prevention and control. Cancer Causes & Control, 29, 1221-1230.

Link to Full Publication

March 7, 2019

Evaluation of Interventions Intended to Increase Colorectal Cancer Screening Rates in the United States: A Systematic Review and Meta-Analysis

Importance  Colorectal cancer screening (CRC) is recommended by all major US medical organizations but remains underused.

Objective  To identify interventions associated with increasing CRC screening rates and their effect sizes.

Data Sources  PubMed, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, and were searched from January 1, 1996, to August 31, 2017. Key search terms included colorectal cancer and screening.

Study Selection  Randomized clinical trials of US-based interventions in clinical settings designed to improve CRC screening test completion in average-risk adults.

Data Extraction and Synthesis  At least 2 investigators independently extracted data and appraised each study’s risk of bias. Where sufficient data were available, random-effects meta-analysis was used to obtain either a pooled risk ratio (RR) or risk difference (RD) for screening completion for each type of intervention.

Main Outcomes and Measures  The main outcome was completion of CRC screening. Examination included interventions to increase completion of (1) initial CRC screening by any recommended modality, (2) colonoscopy after an abnormal initial screening test result, and (3) continued rounds of annual fecal blood tests (FBTs).

Results  The main review included 73 randomized clinical trials comprising 366 766 patients at low or medium risk of bias. Interventions that were associated with increased CRC screening completion rates compared with usual care included FBT outreach (RR, 2.26; 95% CI, 1.81-2.81; RD, 22%; 95% CI, 17%-27%), patient navigation (RR, 2.01; 95% CI, 1.64-2.46; RD, 18%; 95% CI, 13%-23%), patient education (RR, 1.20; 95% CI, 1.06-1.36; RD, 4%; 95% CI, 1%-6%), patient reminders (RR, 1.20; 95% CI, 1.02-1.41; RD, 3%; 95% CI, 0%-5%), clinician interventions of academic detailing (RD, 10%; 95% CI, 3%-17%), and clinician reminders (RD, 13%; 95% CI, 8%-19%). Combinations of interventions (clinician interventions or navigation added to FBT outreach) were associated with greater increases than single components (RR, 1.18; 95% CI, 1.09-1.29; RD, 7%; 95% CI, 3%-11%). Repeated mailed FBTs with navigation were associated with increased annual FBT completion (RR, 2.09; 95% CI, 1.91-2.29; RD, 39%; 95% CI, 29%-49%). Patient navigation was not associated with colonoscopy completion after an initial abnormal screening test result (RR, 1.21; 95% CI, 0.92-1.60; RD, 14%; 95% CI, 0%-29%).

Conclusions and Relevance  Fecal blood test outreach and patient navigation, particularly in the context of multicomponent interventions, were associated with increased CRC screening rates in US trials. Fecal blood test outreach should be incorporated into population-based screening programs. More research is needed on interventions to increase adherence to continued FBTs, follow-up of abnormal initial screening test results, and cost-effectiveness and other implementation barriers for more intensive interventions, such as navigation.

Citation: Dougherty, M. K., Brenner, A. T., Crockett, S. D., Gupta, S., Wheeler, S. B., Coker-Schwimmer, M., Cubillos, L., Malo, T., & Reuland, D. S. (2018). JAMA Internal Medicine, 178(12), 1645-1658. doi:10.1001/jamainternmed.2018.4637

Link to Full Publication

March 7, 2019

Policy Opportunities to Increase HPV Vaccination in Rural Communities

Abstract: Rural communities experience health disparities, including elevated incidence and mortality of human papillomavirus (HPV)-associated cancers and correspondingly low HPV vaccination rates. There are numerous policy strategies that are available at multiple levels – patient, provider, clinic, community, state, and national – to address geographic, clinical, and communication barriers to HPV vaccination across rural America. Examples include policy development, implementation, and evaluation of healthcare provider and clinic-based assessment and education initiatives; school entry requirements; school, pharmacy, and community-based vaccination programs; evidence-based, community-driven communication efforts; and increased interventional research in rural communities. Strategically implemented policy measures will contribute to reduction in the incidence and mortality from HPV-related cancers through increased access to HPV vaccination in our rural communities.

Citation: Vanderpool, R. C., Stradtman, L. R., & Brandt, H. M. (2019). Policy opportunities to increase HPV vaccination in rural communities. Human Vaccines & Immunotherapeutics, 4, 1-6. doi: 10.1080/21645515.2018.1553475

Link to Full Publication

March 7, 2019

Karen Glanz Named Associate Director for Community Engaged Research and Leader for the Cancer Control Program at Penn Medicine’s Abramson Cancer Center

Abramson Cancer Center director, Robert Vonderheide and deputy director, Katherine Nathanson announced the appointment of Karen Glanz, PhD, MPH as Associate Director for Community Engaged Research and Leader for the Cancer Control Program.

“Dr. Glanz is the George A. Weiss University Professor in the Perelman School of Medicine and the School of Nursing, as one of Penn’s distinguished Penn Integrates Knowledge (PIK) Professors. Dr. Glanz is director of the federally funded UPenn Prevention Research Center. Dr. Glanz is a behavioral scientist with public health expertise. Her basic and translational research in community and healthcare settings focuses on obesity, nutrition, and the built environment; reduction of health disparities; and novel health communication technologies. She has made important and sustained contributions to cancer prevention and control.  With more than 480 publications and designation as a Most Highly-Cited Author over the past 20 years (top 0.5% of authors in the field), Dr. Glanz’s scholarship has been consistently interdisciplinary and highly influential in advancing the science of understanding, predicting, and changing health-related behavior. Dr. Glanz is an elected member of the National Academy of Medicine, served on the US Task Force on Community Preventive Services for 10 years, and is a current member of the NHLBI Advisory Council.  Dr. Glanz has been a valued member of the Cancer Control Program at the ACC since 2009.”

The Cancer Control Program is a transdisciplinary Program composed of members who focus on the identification of the genetic, behavioral, and health care determinants of cancer susceptibility and the development and implementation of strategies to lower risk and improve outcomes.

Dr. Glanz will step into the role previously held by Marilyn Schapira, MD, MPH, Principal Investigator on the UPenn PRC Economic Impact of Clinical Trials for Childhood Cancer Project. Dr. Schapira will continue to work with the Cancer Control Program at Abramson Cancer Center and teach medicine at the Perelman School of Medicine.

This piece was featured in UPenn’s PRC Researchers in the News on November 27, 2018.

March 7, 2019

Erika Trapl Appointed to Serve as Co-Lead of the Cancer Prevention, Control & Population Research Program (CPC) at the Case Comprehensive Cancer Center

The Case Comprehensive Cancer Center is pleased to announce the appointment of Fred Schumacher, PhD, MPH and Erika Trapl, PhD as new co-leaders of the Cancer Prevention, Control and Population Research Program (CPC). Together with current program leader Greg Cooper, MD, Trapl and Schumacher will continue to grow the work of the Prevention Program in the areas of disease-specific genomics, high-risk populations including Barrett’s esophagus, inflammatory bowel disease and colon cancer in young adults, tobacco research, interventions and policy and lung cancer screening, and disparities research in our catchment area as well expansion to rural areas.

Genetic epidemiologist Fred Schumacher is an associate professor in the department of quantitative health sciences. Schumacher is an international leader studying the role of germline genetics in cancer susceptibility and progression and has a researcher interest in cancer, especially prostate cancer. His research findings have enabled the discovery of cancer genetic risk factors, generalizability of genetic effects among non-White populations, and evaluated the utility of genetics in cancer risk prediction. Recent projects include the identification of new prostate cancer loci associated with prostate cancer as well as early onset of cancer. This study increased knowledge of prostate cancer genetic risk factors, allowing the team to create genetic risk scores of developing prostate cancer. The work has also led to a clinical trial to assess the utility of the polygenic risk score in a cohort of men at high-risk for prostate cancer (Schumacher, Nat Genet, 2018). “One of my major priorities for CPC is fostering the development and submission of program project grants to further complement the outstanding research programs of our members,” said Schumacher. He is also prioritizing the development of inter-programmatic collaborations across the cancer center.

Erika Trapl is an associate professor in the department of quantitative health sciences, having trained in epidemiology with a focus on health behavior and statistical methodology. Her research is focused on adolescent health risk behavior, multiple determinants of health and tobacco prevalence and prevention. She is currently the PI of the Ohio Cancer Prevention and Control Research Network funded by the CDC/NCI, Co-I and Associate Director of the CDC-funded Prevention Research Center for Healthy Neighborhoods (PRCHN), and Co-Director of the PRCHN’s Neighborhood Environmental Assessment Project. Trapl has extensive experience in community-based tobacco control research and evaluation, with specific interest in cigar, cigarillo and little cigar use among urban adolescents and young adults (Antognoli, Tob Control, 2019Trapl, Ethn Dis, 2018). One of Trapl’s goals as co-leader is to strengthen the portfolio of primary and secondary prevention research within CPC. “We have great opportunities to partner across clinical and community-based organizations to study expansion of evidence-based interventions to reduce cancer risk,” she said.

Please join us in congratulating Fred and Erika on their new leadership roles!

This piece was featured in Case Comprehensive Cancer Center’s Director’s Message on February 1, 2019.

November 16, 2018

Endocrine Therapy Nonadherence and Discontinuation in Black and White Women

CPCRN principal investigator Stephanie Wheeler of the University of North Carolina was lead author on a new publication in the Journal of the National Cancer Institute, “Endocrine Therapy Nonadherence and Discontinuation in Black and White Women.”

Background: Differential use of endocrine therapy (ET) by race may contribute to breast cancer outcome disparities, but racial differences in ET behaviors are poorly understood. Methods: Women aged 20–74 years with a first primary, stage I–III, hormone receptor–positive (HRþ) breast cancer were in- cluded. At 2 years postdiagnosis, we assessed nonadherence, defined as not taking ET every day or missing more than two pills in the past 14 days, discontinuation, and a composite measure of underuse, defined as either missing pills or discontinu- ing completely. Using logistic regression, we evaluated the relationship between race and nonadherence, discontinuation, and overall underuse in unadjusted, clinically adjusted, and socioeconomically adjusted models. Results: A total of 1280 women were included; 43.2% self-identified as black. Compared to white women, black women more often reported nonadherence (13.7% vs 5.2%) but not discontinuation (10.0% vs 10.7%). Black women also more often reported the following: hot flashes, night sweats, breast sensitivity, and joint pain; believing that their recurrence risk would not change if they stopped ET; forgetting to take ET; and cost-related barriers. In multivariable analysis, black race remained sta- tistically significantly associated with nonadherence after adjusting for clinical characteristics (adjusted odds ratio 1⁄4 2.72, 95% confidence interval 1⁄4 1.75 to 4.24) and after adding socioeconomic to clinical characteristics (adjusted odds ratio 1⁄4 2.44, 95% confidence interval 1⁄4 1.50 to 3.97) but was not independently associated with discontinuation after adjustment. Low re- currence risk perception and lack of a shared decision making were strongly predictive of ET underuse across races.Conclusions: Our results highlight important racial differences in ET-adherence behaviors, perceptions of benefits/harms, and shared decision making that may be targeted with culturally tailored interventions.

Link to Full Publication

Citation: Wheeler, S. B., Spencer, J., Pinheiro, L. C., Murphy, C. C., Earp, J. A., Cary, L., … & Reeder-Hayes, K. E. (2018). Endocrine therapy nonadherence and discontinuation in black and white women. Journal of the National Cancer Institute, 111(5), 1-11. doi: 10.1093/jnci/djy136

November 14, 2018

Cam Escoffery Presented at the CDC National Comprehensive Cancer Control Program’s 20th Anniversary Meeting

CPCRN affiliate Cam Escoffery, PhD, MPH, CHES of Emory University presented “Selecting Evidence-based Interventions (EBIs) for Impact” at the CDC National Comprehensive Cancer Control Program’s (NCCCP) 20th Anniversary Celebration that took place from September 10-11, 2018. On the first day of the conference, NCCCP awardees joined CDC staff and partners in various working sessions to enhance their capacity to implement program work plans, including policy, systems, and environmental interventions, health equity, and communications strategies.

Click here to access the full presentation

November 14, 2018

CPCRN-Related Presentations at the 11th Annual D&I Conference, December 3-5, 2018

The 11th Annual Conference on the Science of Dissemination and Implementation in Health (D&I), co-hosted by the National Institutes of Health (NIH) and AcademyHealth, will be held from December 3-5, 2018 at the Renaissance Washington, D.C. Guided by the theme, Scaling up Effective Health and Healthcare: Advancing the Research Agenda and Necessary Infrastructure, a large group of CPCRN members and affiliates will present on strategies for scaling up effective interventions across communities, health systems, networks and countries, and efforts to build capacity for D&I science, with an emphasis on low-resource settings.

Click here to view the full list of CPCRN-related presentations

November 14, 2018

CPCRN-Related Presentations at the APHA 2018 Annual Meeting & Expo, November 10-14, 2018

APHA’s Annual Meeting and Expo is the largest annual gathering of public health professionals. More than 12,000 people attend, and thousands of new abstracts are presented each year, making APHA 2018 the most influential meeting in public health. This year, members from the University of Iowa and Case Western Reserve University CPCRN centers will be presenting on this year’s theme, “Creating the Healthiest Nation: Health Equity Now.” Presentations by CPCRN members include:

Case Western Reserve University:

University of Iowa:

University of Kentucky:

November 13, 2018

CPCRN Members Contribute to New NCI Implementation Science Text

Several CPCRN members contributed to a new National Cancer Institute (NCI) text, Advancing the Science of Implementation across the Cancer Continuum, published in November 2018. The book is the first text of its kind to focus on the intersection of implementation science and cancer, and provides a broad synthesis of relevant research studies as well as detailed case studies illustrating each topic area.

Description: While many effective interventions have been developed with the potential to significantly reduce morbidity and mortality from cancer, they are of no benefit to the health of populations if they cannot be delivered. In response to this challenge, Advancing the Science of Implementation across the Cancer Continuum provides an overview of research that can improve the delivery of evidence-based interventions in cancer prevention, early detection, treatment, and survivorship. Chapters explore the field of implementation science and its application to practice, a broad synthesis of relevant research and case studies illustrating each cancer-focused topic area, and emerging issues at the intersection of research and practice in cancer. Both comprehensive and accessible, this book is an ideal resource for researchers, clinical and public health practitioners, medical and public health students, and health policymakers.

CPCRN-Affiliated Editors:

Other CPCRN-Affiliated Contributors:

Chapters with CPCRN-Affiliated Contributors:

Ch 2. Evidence-Based Cancer Practices, Programs, and Interventions Maria E. Fernandez, Patricia Dolan Mullen, Jennifer Leeman, Timothy J. Walker, and Cam Escoffery

Ch 4. Measures and Outcomes in Implementation Science Cara C. Lewis, Kayne D. Mettert, Caitlin N. Dorsey, and Bryan J. Weiner

Ch 6. Implementation Strategies Byron J. Powell, Krystal G. Garcia, and Maria E. Fernandez

Case Study 7A: Implementation Strategies for Increasing Rates of Human Papillomavirus Vaccination Robin C. VanderpoolHeather M. Brandt, and Meagan R. Pilar

Case Study 7D: Dissemination and Implementation Science in Retail Tobacco Control Policy Todd B. Combs, Laura Brossart, Kurt M. Ribisl, and Douglas A. Luke

Ch 10. Organization- and System-Level Factors Influencing Implementation: Overview of Case Studies Stephanie B. Wheeler

Case Study 11C: The Challenge of Implementing Survivorship Care Plans  Sarah A. Birken, Erin E. Hahn, Yan Yu, Emily Haines, Deborah K. Mayer, and Brian Mittman

November 13, 2018

Beliefs About Behavioral Determinants of Obesity in Appalachia, 2011-2014

CPCRN principal investigator Robin Vanderpool of the University of Kentucky co-authored a new publication in Public Health Reports, “Beliefs About Behavioral Determinants of Obesity in Appalachia, 2011-2014.”

AbstractThe populations of many Appalachian communities have high rates of unhealthy body weight. This study aimed to identify differences in beliefs about obesity between Appalachians and non-Appalachians. Our analyses explored health beliefs and behaviors among US adults aged 18 (n 1⁄4 14 451) who responded to the Health Information National Trends Survey (2011-2014), of whom 1015 (8%) resided within the 420 counties recognized as Appalachian by the Appalachian RegionalCommission. Using weighted regression analyses and controlling for sociodemographic characteristics and general health, we determined that self-reported body mass index was higher among Appalachians than among non-Appalachians (B 1⁄4 0.75, P 1⁄4 .03, 95% confidence interval, 0.08-1.47) and that Appalachians were less likely than non-Appalachians to believe that lifestyle factors were related to obesity (B 1⁄4 –0.37, P 1⁄4 .03, 95% confidence interval, –0.04 to  0.71). Results suggest that Appalachians may regard behavioral prevention differently from non-Appalachians, perhaps with less confidence in the effectiveness of certain behaviors to reduce obesity risk. Future research may determine whether such beliefs could complicate efforts to encourage healthy lifestyles throughout the region.

Link to Full Publication

Citation: Rice, E. L., Patel, M., Serrano, K. J., Thai, C. L., Blake, K. D., & Vanderpool, R. C. (2018). Beliefs about behavioral determinants of obesity in Appalachia, 2011-2014. Public Health Reports, 133(4), 379-384. doi: 10.1177/0033354918774064

November 13, 2018

Jennifer Leeman Co-Authored New NCI Resource, Qualitative Methods in Implementation Science

In 2015, the National Cancer Institute’s (NCI’s) Implementation Science Team convened a group of experts in implementation science and/or qualitative research, to develop guidance for the use of qualitative methods in implementation science. Jennifer Leeman, DrPH, MDIV, PI of 4CNC, was invited to join The Qualitative Research in Implementation Science (QUALRIS) group which produced a white paper titled “QUALITATIVE METHODS IN IMPLEMENTATION SCIENCE.”  This resource: (1) describes the role of qualitative research in health-related implementation science; (2) offers guidelines for conducting qualitative research in implementation science; (3) identifies areas of need and opportunities for the development of innovative qualitative methods; and (4) provides resources for those wishing to employ or learn more about qualitative methods in implementation science.

Click here to access the full resource

November 13, 2018

Cancer Epidemiology, Biomarkers & Prevention–Special Issue: Rural Cancer Control Focus

In November 2018, Cancer Epidemiology, Biomarkers & Prevention (CEBP) released a special issue: Rural Cancer Control Focus. The issue featured multiple articles authored by CPCRN members, including principal investigator Robin Vanderpool of the University of Kentucky, and c0-investigator Whitney Zahnd of the University of South Carolina. CEBP presented the Rural Cancer Control Focus Issue following a recently held NCI-sponsored conference assessing the current state of rural cancer control research. The following articles feature CPCRN authors:

Robin Vanderpool, DrPH, CHES

Whitney, Zahnd, PhD

Click here to access the full special issue

October 26, 2018

Interactive Map Features CPCRN Areas of Expertise

Presentation that you can view by selecting the tree of knowledge below, displaying in a network diagram, all of our members, their areas of expertise, and connections between them. You can search for specific people or areas of expertise (to identify people with those areas of expertise) via the search box at the top of the map. You can also use the Meet Our Experts page to search for experts in particular areas or from particular CPCRN Collaborating Centers, see their areas of expertise, bios, and contact information.

September 10, 2018

CPCRN Cervical Cancer Workgroup Publication – Reducing Overuse of Cervical Cancer Screening: A Systematic Review

The CPCRN Cervical Cancer Workgroup recently published an article, “Reducing Overuse of Cervical Cancer Screening: A Systematic Review,” in the American Journal of Preventive Medicine.

ABSTRACT  Overuse of clinical preventive services increases healthcare costs and may deprive underserved patients of necessary care. Up to 45% of cervical cancer screening is overuse. We conducted a systematic review of correlates of overuse of cervical cancer screening and interventions to reduce overuse. The search identified 25 studies (20 observational; 5 intervention). Correlates varied by the type of overuse measured (i.e., too frequent, before/after recommended age to start or stop screening, after hysterectomy), the most common correlates of overuse related to patient age (n = 7), OBGYN practice or provider (n = 5), location (n = 4), and marital status (n = 4). Six observational studies reported a decrease in overuse over time. Screening overuse decreased in all intervention studies, which used before-after designs with no control or comparison groups. Observational studies suggest potential targets for de-escalating overuse. Randomized clinical trials are needed to establish best practices for reducing overuse.

Link to Full Publication

Citation: Alber, J. M., Brewer, N. T., Melvin, C., Yackle, A., Smith, J. S., Ko, L. K., Crawford, A., & Glanz, K. Reducing overuse of cervical cancer screening: A systematic review. American Journal of Preventive Medicine, 116, 51-59.

Acknowledgements: Amber Cohen, Jade Avelis, Meagan Robichaud, Matt Kearney, Ryan Quinn, Jenny Spencer, Dana Burshell.

August 13, 2018

Coverage of Op-Ed “Sunscreens save lives, have limited impact on coral reefs,” co-authored by Karen Glanz

Hawaii proposed and subsequently passed a bill banning sunscreens containing oxybenzone and octinoxate in order to “preserve marine ecosystems.” CPCRN principal investigator, Karen Glanz of the University of Pennsylvania, co-authored an op-ed for the Honolulu Star-Advertiser titled, Suncreens save lives, have limited impact on coral reefs. While on sabbatical for the first part of 2018 as a Visiting Professor at the University of Hawaii Cancer Center, Glanz teamed up with Kevin Cassel, president of the Hawaii Skin Cancer Coalition, on this piece published, March 29, 2018.

Their article caught the attention of the local media and they called on Glanz to present her views on the impact this decision could have on those at risk for skin cancer. She mentions that the higher price for sunscreens that don’t contain those ingredients could prevent people from purchasing those products. “The cost of these so-called reef-friendly products for sunscreen ranges anywhere from two times to as much as six to eight times as much as what is on the shelves now.” She points out that it isn’t just beachgoers that are affected, there are a number of jobs in Hawaii requiring people to work outside and they could be the most at risk.

Click here to continue reading and watch full interviews of Glanz on the topic

August 9, 2018

University of North Carolina CPCRN Team Presented the CPCRN Curriculum to the North Region of the American Cancer Society

On July 16th, 4CNC team members Jennifer Leeman, Catherine Rohweder and Mary Wangen and Emory faculty, Cam Escoffery, traveled to Bloomington, MN, to provide a day-long training to over 30 American Cancer Society (ACS) North Region staff in the hospital and healthcare systems verticals. They delivered a version of the CPCRN’s “Putting Public Health Evidence into Action” curriculum that is adapted for a more clinically oriented audience. Pre- and post-training evaluation data demonstrate increases in self-reported confidence to meet all 20 learning objectives from the six training modules. The results will be used to refine the curriculum for future trainings. The team is currently exploring ways to deliver the training to more ACS regions and in alternative formats, such as a webinar series. One ACS participant noted, “Loved the process maps and all the tools to find EBIs [evidence-based interventions]… Evaluation is essential and the tools shared will help!”

Click here to view the full curriculum

August 3, 2018

Carmen Guerra Co-Authored New American Cancer Society Guidelines, Recommending Earlier Colorectal Cancer Screening

New guidelines developed by the American Cancer Society recommend that screening for colorectal cancer for average-risk adults begin at age 45, five years earlier than the previous recommendation. Co-authored by CPCRN investigator Carmen Guerra, MD, MS of the University of Pennsylvania, the recommendations are based in part on research that found an increased incidence of colorectal cancer in younger adults. The Guideline Committee also developed new materials to facilitate conversations between clinicians and patients to help patients decide which test is best for them.

Click here for more information

Link to Full Publication

Citation: Wolf AMD, Fontham ETH, Church TR, Flowers CR, Guerra CE, LaMonte SJ, Etzioni R, McKenna MT, Oeffinger KC, Shih YT, Walter LC, Andrews KS, Brawley OW, Brooks D, Fedewa SA, Manassaram-Baptiste D, Siegel RL, Wender RC, Smith RA. Colorectal cancer screening for average-risk adults: 2018 guideline update from the American Cancer Society. CA: A Cancer Journal for Clinicians. 2018 May 30. DOI:10.3322/caac.21457.

June 26, 2018

Modeling EBI Impact Workgroup Colorectal Cancer Simulation Model Resource Brief, April 2018

In April 2018, CPCRN’s Modeling Evidence-Based Intervention (EBI) Impact Workgroup published their Colorectal Cancer (CRC) Simulation Model Resource Brief to reflect upon recent efforts to model CRC risk, screening, treatment, and cancer outcomes. Study coordinator Sarah Drier and principal investigator Stephanie Wheeler, both of UNC-Chapel Hill, led the effort alongside fellow workgroup members.

The Model:The microsimulation model was designed to simulate colorectal cancer (CRC) risk, screening behaviors, treatment, and cancer outcomes under a variety of scenarios. The model supports stakeholder learning and decision-making by comparing the costs, resource implications (e.g., increased colonoscopy demand), population health impacts, and efficiency of competing intervention and policy approaches designed to improve CRC screening implementation. Model application in specific settings can help address CRC screening and outcome disparities at state, local, and sub-population levels.

Primary Objectives:

  • To determine the most effective and efficient approaches for closing gaps in CRC screening and outcomes in specific settings and sub- populations (e.g., rural, minority, low-income, uninsured/under-insured) and understand how impacts vary based on the local context
  • To identify how healthcare systems, screening intervention, and implementation strategies can be optimized to ensure that people receive CRC screening at the lowest cost
  • To gain greater insight into uncertainties, capacity implications, and unintended consequences of specific CRC screening interventions on diverse populations

Link to Full Resource Brief

June 14, 2018

Data-Powered Participatory Decision Making: Leveraging Systems Thinking and Simulation to Guide Selection and Implementation of Evidence-Based Colorectal Cancer Screening Interventions

A robust evidence base supports the effectiveness of timely colorectal cancer (CRC) screening, follow-up of abnormal results, and referral to care in reducing CRC morbidity and mortality. However, only two-thirds of the US population is current with recommended screening, and rates are much lower for those who are vulnerable because of their race/ethnicity, insurance status, or rural location. Multiple, multilevel factors contribute to observed disparities, and these factors vary across different populations and contexts. As highlighted by the Cancer Moonshot Blue Ribbon Panel working groups focused on Prevention and Early Detection and Implementation Science inadequate CRC screening and follow-up represent an enormous missed opportunity in cancer prevention and control. To measurably reduce CRC morbidity and mortality, the evidence base must be strengthened to guide the identification of (1) multilevel factors that influence screening across different populations and contexts, (2) multilevel interventions and implementation strategies that will be most effective at targeting those factors, and (3) combinations of strategies that interact synergistically to improve outcomes. Systems thinking and simulation modeling (systems science) provide a set of approaches and techniques to aid decision makers in using the best available data and research evidence to guide implementation planning in the context of such complexity. This commentary summarizes current challenges in CRC prevention and control, discusses the status of the evidence base to guide the selection and implementation of multilevel CRC screening interventions, and describes a multi-institution project to showcase how systems science can be leveraged to optimize selection and implementation of CRC screening interventions in diverse populations and contexts.

Link to Full Publication

Citation: Wheeler SB, Leeman J, Hassmiller Lich K, Tangka FKL, Davis MM, Richardson LC. Data-Powered Participatory Decision Making: Leveraging Systems Thinking and Simulation to Guide Selection and Implementation of Evidence-Based Colorectal Cancer Screening Interventions. The Cancer Journal. 24(3):132-139. May 2018. DOI: 10.1097/PPO.0000000000000317.

June 1, 2018

Use of Evidence-Based Interventions and Implementation Strategies to Increase Colorectal Cancer Screening in Federally Qualified Health Centers

While colorectal cancer (CRC) screening rates have been increasing in the general population, rates are considerably lower in Federally Qualified Health Centers (FQHCs), which serve a large proportion of uninsured and medically vulnerable patients. Efforts to screen eligible patients must be accelerated if we are to reach the national screening goal of 80% by 2018 and beyond. To inform this work, we conducted a survey of key informants at FQHCs in eight states to determine which evidence-based interventions (EBIs) to promote CRC screening are currently being used, and which implementation strategies are being employed to ensure that the interventions are executed as intended. One hundred and forty-eight FQHCs were invited to participate in the study, and 56 completed surveys were received for a response rate of 38%. Results demonstrated that provider reminder and recall systems were the most commonly used EBIs (44.6%) while the most commonly used implementation strategy was the identification of barriers (84.0%). The mean number of EBIs that were fully implemented at the centers was 2.4 (range 0–7) out of seven. Almost one-quarter of respondents indicated that their FQHCs were not using any EBIs to increase CRC screening. Full implementation of EBIs was correlated with higher CRC screening rates. These findings identify gaps as well as the preferences and needs of FQHCs in selecting and implementing EBIs for CRC screening.

Link to Full Publication

Citation: Adams SA, Rohweder CL, Leeman J, Friedman DB, Gizlice Z, Vanderpool RC, Askelson N, Best A, Flocke SA, Glanz K, Ko LK, Kegler M. Use of Evidence-based Interventions and Implementation Strategies to Increase Colorectal Cancer Screening in Federally Qualified Health Centers. Journal of Community Health. DOI: 10.1007/s10900-018-0520-2.

May 31, 2018

Edith Parker Named New Dean of the University of Iowa College of Public Health

CPCRN investigator, Edith Parker, DrPH of the University of Iowa, has been named dean of the University of Iowa College of Public Health. She will begin on June 1.

Parker has been professor and chair of the Department of Community and Behavioral Health since joining the University of Iowa faculty in 2010. She also has a faculty appointment with the UI Public Policy Center. In her new role, Parker will be the third dean of the College of Public Health, which was founded in 1999. She succeeds Keith Mueller, Gerhard Hartman Professor of Health Management and Policy, who served as interim dean since April 2017.

Click here to read more.

May 31, 2018

Robin Vanderpool Serves as Chair of the Accelerating Rural Cancer Control (ARCC) Research Meeting, 2018

CPCRN Principal Investigator, Robin Vanderpool, DrPH of the University of Kentucky, was selected as chair of the 2018 Accelerating Rural Cancer Control (ARCC) Research Meeting, scheduled to take place May 30-31, 2018 at the NIH Natcher Conference Center in Bethesda, Maryland. Dr. Vanderpool will lead a Fireside Chat on Rural Cancer Control Research, and will be accompanied by various other CPCRN attendees, including presenters Gloria Coronado, UW, Stephanie Wheeler, UNC, and David Chambers of NCI.

Click here for more information on the ARCC Research Meeting.

May 18, 2018

Impact of the Cancer Prevention and Control Research Network: Progress Report Executive Summary, April 2018

The Centers for Disease Control and Prevention (CDC)- and National Cancer Institute (NCI)-funded Cancer Prevention and Control Research Network (CPCRN) has been in operation since 2004. Over that time, the Network has had 16 university members, with 8 universities currently housing CPCRN Network Centers. This report demonstrates the impact of the work done by CPCRN’s investigators and summarizes the research and dissemination activities of the CPCRN, its member Centers, and its multicenter Workgroups over three time periods: the past year (through September 2017), the first three years of the current five-year funding cycle, and all network activity dating back to 2004.

Click here to access the full Progress Report Executive Summary

May 14, 2018

A Systematic Review of Clinic and Community Intervention to Increase Fecal Testing for Colorectal Cancer in Rural and Low-Income Populations in the United States – How, What and When?

Background: Interventions to improve fecal testing for colorectal cancer (CRC) exist, but are not yet routine practice. We conducted this systematic review to determine how implementation strategies and contextual factors influenced the uptake of interventions to increase Fecal Immunochemical Tests (FIT) and Fecal Occult Blood Testing (FOBT) for CRC in rural and low-income populations in the United States.

Methods: We searched Medline and the Cochrane Library from January 1998 through July 2016, and Scopus and through March 2015, for original articles of interventions to increase fecal testing for CRC. Two reviewers independently screened abstracts, reviewed full-text articles, extracted data and performed quality assessments. A qualitative synthesis described the relationship between changes in fecal testing rates for CRC, intervention components, implementation strategies, and contextual factors. A technical expert panel of primary care professionals, health system leaders, and academicians guided this work.

Results: Of 4218 citations initially identified, 27 unique studies reported in 29 publications met inclusion criteria. Studies were conducted in primary care (n = 20, 74.1%), community (n = 5, 18.5%), or both (n = 2, 7.4%) settings. All studies (n = 27, 100.0%) described multicomponent interventions. In clinic based studies, components that occurred most frequently among the highly effective/effective study arms were provision of kits by direct mail, use of a pre-addressed stamped envelope, client reminders, and provider ordered in-clinic distribution. Interventions were delivered by clinic staff/community members (n = 10, 37.0%), research staff (n = 6, 22.2%), both (n = 10, 37.0%), or it was unclear (n = 1, 3.7%). Over half of the studies lacked information on training or monitoring intervention fidelity (n = 15, 55.6%).

Link to Full Publication

Citation: Davis, M.M., Freeman, M., Shannon, J., Coronado, G.D. Stange, K.C., Guise, J., Wheeler, S.B., & Buckley, D.I. (2018). A systematic review of clinic and community intervention to increase fecal testing for colorectal cancer in rural and low-income populations in the United States – How, what and when? BMC Cancer, 18(1), 40. DOI 10.1186/s12885-017-3813-4.

May 14, 2018

A Social-Ecological Review of Cancer Disparities in Kentucky

Cancer continuously ranks among the top 10 leading causes of death in the United States. The burden of cancer is particularly ele- vated in the Commonwealth of Kentucky and its 54-county Appala- chian region, where cancer is the leading cause of death. Kentucky’s high rates of cancer have been attributed to a wide range of socioeco- nomic, behavioral, environmental, and policy influences, resulting in numerous disparities. The present review specifically evaluates the burden of lung, colorectal, cervical, and head and neck cancers in Kentucky, along with resultant cancer control research and community outreach efforts conducted by the state’s only National Cancer Institute–designated can- cer center using an adapted version of McLeroy’s Social-Ecological Model. Here, we categorize disparities and identify relevant interven- tion approaches based on their level of influence (ie, individual, com- munity, and policy).

Link to Full Publication

Citation: Rodriguez, S.D., Vanderford, N.L., Huang, B., & Vanderpool, R.C. (2018). A social-ecological review of cancer disparities in Kentucky. Southern Medical Journal, 111(4), 213-219. DOI: 10.14423/SMJ.0000000000000794.

May 10, 2018

Financial Impact of Breast Cancer in Black Versus White Women

PurposeRacial variation in the financial impact of cancer may contribute to observed differences in the use of guideline-recommended treatments. We describe racial differences with regard to the financial impact of breast cancer in a large population-based prospective cohort study.

MethodsThe Carolina Breast Cancer Study oversampled black women and women younger than age 50 years with incident breast cancer in North Carolina from 2008 to 2013. Participants provided medical records and data regarding demographics, socioeconomic status, and financial impact of cancer at 5 and 25 months postdiagnosis. We report unadjusted and adjusted financial impact at 25 months postdiagnosis by race.

ResultsThe sample included 2,494 women who completed follow-up surveys (49% black, 51% white). Since diagnosis, 58% of black women reported any adverse financial impact of cancer (v 39% of white women; P , .001). In models adjusted for age, stage at diagnosis, and treatment received, black women were more likely to report adverse financial impact attributable to cancer (adjusted risk difference [aRD], +14 percentage points; P , .001), including income loss (aRD, +10 percentage points; P , .001), health care-related financial barriers (aRD, +10 percentage points; P , .001), health care-related transportation barriers (aRD, +10 percentage points; P , .001), job loss (aRD, 6 percentage points; P , .001), and loss of health insurance (aRD, +3 percentage points; P , .001). The effect of race was attenuated when socioeconomic factors were included but remained significant for job loss, transportation barriers, income loss, and overall financial impact.

ConclusionCompared with white women, black women with breast cancer experience a significantly worse financial impact. Disproportionate financial strain may contribute to higher stress, lower treatment compliance, and worse outcomes by race. Policies that help to limit the effect of cancer-related financial strain are needed.

Link to Full Publication

Citation: Wheeler, S.B., Spencer, J.C., Pinheiro, L.C., Carey, L.A., Olshan, A.F., & Reeder-Hayes, K.E. (2018). Financial impact of breast cancer in black versus white women. Journal of Clinical Oncology. doi: 10.1200/JCO.2017.77.6310.

March 5, 2018

Applying a Community Engaged Model to Community-Clinic Linkages: Trial and Error in a Small Rural Town

Jason Daniel-Ulloa presented a poster related to his CPCRN work on community-clinical linkages and HPV vaccination at the inaugural Advancing the Science of Cancer in Latinos Conference that took place in San Antonio, Texas on Feb 21-23, 2018. The presentation was called Applying a Community Engaged Model to Community-Clinic Linkages: Trial and Error in a Small Rural Town.


Latinas have the second highest incidence and mortality of cervical cancer compared to other racial/ethnic groups in the United States. The HPV vaccine prevents most cervical cancer cases but immunization rates remain low. In 2016, up-to-date HPV vaccinations for Latinx adolescents in the US was 49.9% (55.3% of females and 44.6% of males), well below the ideal 80%.

These national statistics may be obscuring rural rates, especially in areas with higher than average proportions of foreign-born Latinos/as, and below average rates of educational attainment and health insurance; all factors that contribute to lower odds of vaccination status. For small rural towns, these factors may be exacerbated by economic, geographic and social barriers to vaccine access.

This project is a description of the process used by our research group to build partnerships, identify major barriers to access based on community input, and to implement a project to link community education and clinic resources to increase access to the HPV vaccine in a rural Latinx population.

Link to Full Presentation

Citation: Daniel-Ulloa, J., Seegmiller, L., Duarte, A., Baquero, B., Moreno, E., & Reyes, J. (February 21-23, 2018). Applying a community engaged model to community-clinic linkages: Trial and error in a small rural town. Advancing the Science of Cancer in Latinos Conference.

March 5, 2018

Rise Up, Get Tested, and Live: an Arts-Based Colorectal Cancer Educational Program in a Faith-Based Setting

Engaging community members in efforts to reduce cancer-related health disparities through community mini-grant programs has been shown to have meaningful impact. A predominantly African-American church in South Carolina was awarded a community mini-grant to increase awareness about colorectal cancer (CRC) screening among disproportionally high-risk African-American communities through culturally appropriate arts-based cancer education. The church’s pastor, health and wellness ministry, and drama ministry created a theatrical production called Rise Up, Get Tested, and Live. Over 100 attendees viewed the play. A pre/ post-test evaluation design assessed the effectiveness of the production in increasing participants’ knowledge about CRC and examined their intentions to be screened. Results showed increased knowledge about CRC, increased awareness and under- standing about the importance of CRC screening, and favorable intentions about CRC screening. Findings suggest that arts-based cancer education may be an effective tool for the dissemination of information about CRC screening.

Link to Full Publication

Citation: Friedman, D.B., Adams, S.A., Brandt, H.M., Heiney, S.P., Hébert, J.R., Ureda, J.R., Seel, J.S., Schrock, C.S., Mathias, W., Clark-Armstead, V., Reverend Dees, V., & Reverend Oliver, P. (2018). Rise up, get tested, and live: An arts-based colorectal cancer education program in a faith-based setting. Journal of Cancer Education, 1-6.

March 2, 2018

Challenges Implementing Lung Cancer Screening in Federally Qualified Health Centers

In 2016, the Society of Behavioral Medicine highlighted that disparities endemic to lung cancer will remain and may be exacerbated by gaps in implementation of high-quality screening among high-risk populations. This is because a disproportionate burden of lung cancer incidence and mortality largely tracks disparities associated with higher tobacco use among individuals with fewer socioeconomic resources; some racial/ethnic minority groups; individuals residing in rural areas; the lesbian, gay, bisexual, transgender, and questioning community; and individuals with psychiatric comorbidity. They emphasized the importance of targeting efforts to reach underserved populations and provided a specific recommendation to expand the resource capacity for lung cancer screening within Federally Qualified Health Centers (FQHCs). FQHCs are safety-net clinics, often located in rural areas, whose underserved populations have a high burden of tobacco use. FQHCs comprise about 90% of the Community Health Centers program, which cared for more than 24 million low-income patients in the U.S. in 2015. Although FQHCs are mandated to provide preventive services, they may face substantial challenges to implementing lung cancer screening, given their unique patient population of underinsured and uninsured individuals. Recognizing the need for guidance about implementing screening in high-risk, underserved populations, this study surveyed a national sample of FQHC medical directors to explore potential barriers that impact screening access, uptake, and adherence in FQHC populations.

Link to Publication

Citation: Zeliadt, S.B., Hoffman, R.M., Birkby, G., Eberth, J.M., Brenner, A.T., Reuland, D.S., & Flocke, S.A. (2018). Challenges implementing lung cancer screening in federally qualified health centers. American Journal of Preventive Medicine, 1-8.

February 20, 2018

Cancer Epidemiologic Research in Understudied Populations Webinar Series: Cancer Prevention and Control Research in Appalachian Kentucky

The NCI webinar with Dr. Robin Vanderpool, PI of the Unviersity of Kentucky CPCRN center, took place on January 17, 2018 from 2-3pm ET. As part of the Cancer Epidemiologic Research in Understudied Populations Webinar Series, Dr. Vanderpool’s presentation entitled Cancer Prevention and Control Research in Appalachian Kentucky, discussed best practices and lessons learned from the Appalachian Center for Cancer Education, Screening, and Support (ACCESS) and the UK Rural Cancer Prevention Center (RCPC) projects.  Continue Reading

Watch Full Webinar

December 14, 2017

University of Kentucky’s Appalachian Center for Cancer Education, Screening, and Support (ACCESS) Featured on RHIhub

The Appalachian Center for Cancer Education, Screening, and Support (ACCESS) at the University of Kentucky and the Proactive Office Encounter (POE) are now a featured under the “model and innovations” database on the Rural Health Information Hub (RHIhub) website. RHIhub serves a national information center for rural health issues in the United States, and is funded by the Federal Office of Rural Health Policy.

To learn more about RHIhub, click here.

RHIhub’s section on ACCESS and the POE framework can be found here.

December 13, 2017

Talking About Your Prostate: Perspectives from Providers and Community Members

Prostate cancer (PrCA) screening is controversial, especially for African-American (AA) men who have higher PrCA incidence and mortality than other racial/ethnic groups. Patient-provider communication is important for the PrCA screening decision process. The study purpose was to better understand the current dialogue between primary care providers (PCPs—physicians and nurse practitioners) and AA men about PrCA prevention and screening. An online survey with 46 PCPs, education sessions (including pre/post surveys) with 56 AA men, and a forum with 5 panelists and 38 AA men for open dialogue were held to examine both provider and community perspectives on PrCA communication needs and practices. PCPs’ perceptions of PrCA screening were varied and they used different PrCA screening guidelines in their practices. PCPs and AA men had different experiences with PrCA communication. PCPs reported that they have discussions about PrCA screening and prostate health with AA patients; few AA men reported these same experiences. About 38.0% of PCPs reported that they remain neutral about PSA testing during discussions; however, only 10.7% of AA men reported that their doctor remained neutral. Prostate health knowledge among AA men increased significantly following participation in the education sessions (p<0.001). AA community members reported high satisfaction regarding the education session and forum. Different recommendations from PCPs may hinder AA men’s decisions about PrCA screening. The forum used in this study could be a model for others to help improve patient-provider communication and increase engagement in dialogue about this common cancer.

Link to Publication.

Citation: Choi, S. K., Seel, J. S., Steck, S. E., Payne, J., McCormick, D., Schrock, C. S., & Friedman, D. B. (2017). Talking about your prostate: Perspectives from providers and community members. Journal of Cancer Education, 1-9. DOI: 10.1007/s13187-017-1205-8.

Acknowledgements: This study was funded by the South Carolina Cancer Alliance. Friedman and Seel are partially supported by the South Carolina Cancer Prevention and Control Research Network under Cooperative Agreement Number U48/DP005000-01S2 from the Centers for Disease Control and Prevention (Prevention Research Centers) and the National Cancer Institute.

December 13, 2017

CPCRN Data Brief – Use of Evidence-based Interventions and Implementation Strategies for Colorectal Cancer Screening in Federally Qualified Health Centers

Issue: In recent years, colorectal cancer (CRC) screening rates have been increasing in Federally Qualified Health Centers (FQHCs), which serve a large proportion of medically underserved patients. While this trend is promising, there is still work to be done in order to reach the national goal of 80% by 2018.

Methods: A survey of FQHCs in eight states was conducted to determine which evidence-based CRC screening interventions (EBIs) are currently being used and which implementation strategies are being employed to ensure that the interventions are executed as intended. Web-based surveys were sent to 148 FQHCs, and 56 were completed for a response rate of 38%.

Results: Among participating FQHCs, the average CRC screening rate was 38% (UDS, 2016). Provider reminder and recall systems were the most commonly implemented EBIs (45%) while the most commonly employed implementation strategy was identification of barriers to implementing EBIs (84%). Full implementation of EBIs was associated with higher CRC screening rates.

Link to Full Data Brief

December 13, 2017

Heather Brandt Appointed to the Editorial Board of the American Journal of Public Health (AJPH)

Heather Brandt, associate professor of health promotion, education, and behavior (HPEB), has been appointed to serve on the editorial board of the American Public Health Association’s (APHA) American Journal of Public Health (AJPH). The journal aims to advance public health research, policy, practice and education. Brandt’s three-year term begins following the Annual Meeting of the American Public Health Association in Atlanta this November.

As a board member, Brandt will help develop and review the Journal’s strategic plan and policy issues and provide direction and advice to the Journal’s editors and staff. The board also serves as a link to APHA members and readers, representing their interests by ensuring their viewpoints are shared. Every year, the Board provides a report to the Association’s Executive Board/Governing Council to share progress and setbacks, allowing a transparent assessment of the Journal’s performance.

Brandt has been an active member of the Association since 1998. She presents original research on an array of topics at the organization’s annual meetings and has held a variety of service roles, including Chair and Secretary of the Public Health Education and Health Promotion Section, Chair of the Women’s Caucus, and Chair of the Committee on Women’s Rights. She has served as an ad hoc reviewer for more than 30 peer-reviewed journals and as an editorial board member for five journals.

At the University of South Carolina, Brandt serves on various committees within her department, across the Arnold School, and throughout the university—particularly through her role as associate dean of professional development for the Graduate School. Recent honors include the Judith R. Miller Award for Service (American Public Health Association), Norman J. Arnold Alumni Medal and James A. Keith Excellence in Teaching Award (Arnold School of Public Health), Crescent Award (South Carolina Coalition for Healthy Families), Tribute to Women in Industry Award (Palmetto Center for Women), and Early Career Award (American Public Health Association).

This piece was featured in the Arnold School of Public Health’s 2017 News Archive on November 15th, 2017.

December 13, 2017

Accelerating Research Collaborations Between Academia and Federally Qualified Health Centers: Suggestions Shaped by History

Collaborations between community health centers (CHCs), including federally qualified health centers (FQHCs), and academic partners can provide opportunities to conduct research designed to help vulnerable populations. Despite the potential to deepen understanding of health disparities and to develop means to ameliorate them, barriers to successful research collaboration exist. Barriers to collaboration include financial limitations for conducting research, a lack of experience in working together, minimal collaborative research infrastructure, CHC partners’ unfamiliarity with research methods, and incomplete knowledge about the CHC environment and academia’s mandate to address communities’ perceived needs. Guided by historical context, this commentary offers suggestions to academic researchers for a more participatory approach for conducting research in collaboration with CHCs.

Link to Publication

Citation: Hébert, J. R., Adams, S. A., Ureda, J. R., Young, V. M., Brandt, H. M., Heiney, S. P., Seel, J. S., & Friedman, D. B. (2017). Accelerating research collaborations between academia and federally qualified health centers: Suggestions shaped by history. Public Health Reports, 1-7. DOI: 10.1177/0033354917742127

Acknowledgements: The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the South Carolina Cancer Prevention and Control Research Network under cooperative agreement U48/ DP005000-01S2 from the Centers for Disease Control and Prevention (Prevention Research Centers) and the National Cancer Institute.

December 13, 2017

Scaling Up and Tailoring the “Putting Public Health in Action” Training Curriculum

Despite access to a growing menu of evidence-based interventions, public health practitioners continue to underuse them, in part because practitioners may require new knowledge, skills, and resources to do so. Numerous foundations, universities, governmental agencies, and consultants are providing trainings to address the gaps in practitioners’ capacity. To most significantly affect population health, these trainings need to reach practitioners who may have limited access to on-site trainings. Despite the number of organizations offering trainings, little is known about how to scale up trainings to efficiently extend their reach or how to tailor trainings to the needs of different intervention. The Cancer Prevention and Control Research Network and its collaborating centers have developed a training curriculum and delivered it in both in-person and distance formats to a range of audiences. The purpose of this article is to describe the training curriculum and findings from the Network’s evaluation of approaches used to scale up delivery of the “Putting Public Health Evidence in Action” curriculum and tailor content for specific evidence-based interventions.

Link to Publication

Citation: Mainor, A. G., Decosimo, K., Escoffery, C., Farris, P., Shannon, J., Winters-Stone, K., Williams, B., & Leeman, J. (2017). Scaling up and tailoring the “Putting Public Health in Action” training curriculum. Health Promotion Practice, 1-9. DOI: 10.1177/1524839917741486.

Acknowledgements: This publication was supported by Cooperative Agreement Number U48-DP005017 from the Centers for Disease Control and Prevention’s Prevention Research Centers Program and the National Cancer Institute. The findings and conclusions in this publication are those of the author(s) and do not necessarily represent the official position of the funders. Address correspondence to Avia G. Mainor, Training and Workforce Development Specialist, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Campus Box #8165, Rosenau Hall, Suite 004, Chapel Hill, NC 27599, USA; e-mail:

November 17, 2017

Implementation strategies can help create public health policies to counter tobacco marketing at point of sale

Jennifer Leeman, DrPH

Research recently published from the University of North Carolina at Chapel Hill has identified strategies and resources that can be successful in creating health policy to counteract tobacco point of sale (POS) marketing and be used in other public health arenas.  The article appeared in the journal Translational and Behavioral Medicine in September.

The tobacco industry spends $8.2 billion each year on POS marketing, which includes in-store displays and discounts to encourage purchases.  Evidence-based policy interventions can reduce exposure to POS marketing, but little is known about the best way to implement those interventions to be successful in communities. Counter Tools, currently led by Interim Executive Director Nina Baltierra, is a non-profit spinoff founded by researchers at the University of North Carolina at Chapel Hill that provides resources and trainings to community partners focused on reducing exposure to POS marketing of tobacco products. Drs. Kurt Ribisl and Allison Myers launched Counter Tools in 2012. Today Counter Tools has public health partnerships in 19 US states.

The Comprehensive Cancer Control Collaborative of NC (4CNC) analyzed data from one year for evidence-based police interventions (EBPIs) implemented by 30 community partnerships in one southern state. The researchers at 4CNC partnered with Counter Tools in order to study EBPI implementation by coordinators and partnerships, who were equipped with the resources and trainings provided by the non-profit.

The study was co-led by Jennifer Leeman, DrPH, the director of 4CNC, and Allison Myers, PhD, who is currently serving as an RWJF Health Policy Fellow at the National Academies of Medicine. The 4CNC project is a Special Interest Project funded by the Centers of Disease Control and Prevention through the Prevention Research Center (PRC) program as part of its eight center Cancer Prevention and Control Research Network (CPCRN). UNC-Chapel Hill is also home to CPCRN’s Coordinating Center.

Leeman, Myers, and their colleagues found that the coordinators of the community partnerships had greater confidence to lead efforts to counter tobacco marketing and that the partnerships increased their efforts to engage strategic partners and to document and raise awareness of the tobacco marketing problem.

“Changes to local policy are essential to creating community environments that support healthy behaviors,” said Leeman. “Working with Counter Tools(c) provides 4CNC with the opportunity to better understand the types of training, tools, and other supports needed to promote successful policy change.”

The 4CNC researchers found that community coordinators’ self-efficacy—their individual performance—overall increased from the beginning to the end of the study. The coordinators were able to describe store environment effects on tobacco use and identify retailers using POS marketing, as well as present data to their partnerships and describe how to raise community awareness.

Alison Myers, PhD

The partnerships themselves also completed many tasks important in the process of EBPI implementation, including completing store audits to document the POS marketing occurring in their communities in addition to meeting to engage partnerships and holding events to raise community awareness of the marketing practice.

Because the study only lasted one year, coordinators were unable to enact new EBPIs at the time. However, partnerships were already well on their way towards EBPI enactment, and it is likely with more time that policy changes could be implemented in the participating communities. In the future, it would be crucial for these partnerships to continue their role in promoting EBPI implementation.

“We envision continuing this work in other areas of public health policy beyond tobacco,” said Myers. “4CNC and Counter Tools are well positioned to offer leading edge implementation strategies to support health promotion policy enactment in healthy food access, alcohol retailer density, and other place-based determinants of health.”

By Clara To, UNC Center for Health Promotion and Disease Prevention, the UNC-Chapel Hill Prevention Research Center

November 16, 2017

Natoshia Askelson Appointed Principal Investigator of the University of Iowa CPCRN Collaborating Center

Natoshia M. Askelson, MPH, PhD, assistant professor in the Department of Community and Behavioral Health at the UI College of Public Health, has been named Principal Investigator of the Cancer Prevention and Control Research Network (CPCRN) collaborating center at the University of Iowa. The CPCRN is a national network of academic, public health, and community partners who work together to reduce the burden of cancer, especially among those disproportionately affected. The Iowa collaborating center, affiliated with the College of Public Health’s Prevention Research Center, and is funded by the Centers for Disease Control and Prevention and the National Cancer Institute. The University of Iowa joined the CPCRN in 2014, and is one of eight institutions that participate as collaborating centers nationally.“We are very pleased to have someone with Dr. Askelson’s experience in cancer prevention and control as the PI of the CPCRN collaborating center at Iowa,” says Edith Parker, professor and head of community and behavioral health and director of the Prevention Research Center. “Her expertise in research and applied evaluation in issues related to cancer prevention and control will benefit our investigators as well as our community partnerships.”

The University of Iowa collaborates with other CPCRN centers to investigate areas of research interest, including initiatives to increase Human Papillomavirus (HPV) vaccination rates and colorectal cancer screening rates. Currently, CPCRN investigator Jason Daniel-Ulloa, PhD clinical assistant professor in the Department of Community and Behavioral Health, is working in the community of West Liberty, Iowa, to establish sustainable community-clinical partnerships aimed at increasing HPV vaccination rates in Latinos. Askelson and Edith Parker, DrPH professor and head of the Department of Community and Behavioral Health, contribute to a collaborative workgroup that is examining the use of evidence-based colorectal cancer screening interventions in Federally Qualified Health Centers.

More information about the University of Iowa CPCRN is available at Information on the national network of CPCRN collaborating centers is available at .

This pice was featured in the University of Iowa College of Public Health News on June 28, 2017.

November 15, 2017

Former CPCRN Coordinating Center PI Kurt Ribisl Named Chair of the UNC Gillings School of Global Public Health Department of Health Behavior

Kurt M. Ribisl, PhD, professor of health behavior at the UNC Gillings School of Global Public Health and program leader for cancer prevention and control at UNC Lineberger Comprehensive Cancer Center, was named chair of the Gillings School’s Department of Health Behavior, effective July 1.

A member of the School’s faculty since 1999, Ribisl is a nationally recognized tobacco control researcher who has had a significant impact on tobacco policies at the local, state, and national levels.

His work has focused on the regulation of the sales and marketing of tobacco products, including cigarettes, e-cigarettes and little cigars. He helped pioneer policies that set a minimum price for tobacco products and recently worked with New York City on their landmark minimum price regulation.

Ribisl also documented high rates of tax evasion and sales to minors online for both cigarettes and e-cigarettes. This work helped lead to federal policies banning internet tobacco sales to minors.

He has been extremely well-funded as a principal investigator from the National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC) and Robert Wood Johnson Foundation, among other organizations, and has authored more than 150 articles for publication in top public health and medical journals.

He completed his undergraduate training at Wake Forest University, his doctoral training at Michigan State University, and his postdoctoral training at Stanford University School of Medicine.

“I have great confidence in Dr. Ribisl,” said Barbara K. Rimer, DrPH, dean and Alumni Distinguished Professor at the Gillings School. “He is an innovative thinker, and an outstanding classroom teacher, adviser and mentor to our students with an excellent track record in this domain. He is committed to enhancing diversity and inclusion in the department and Gillings School.”

Rimer noted Ribisl’s impressive level of service at all levels — from department, to university, to advising key government agencies, including the N.C. DHHS, U.S. Department of Justice, Food and Drug Administration, CDC and NIH — and praised his commitment to working collaboratively with faculty and staff members and students in striving for academic excellence.

“His leadership will continue to move the outstanding health behavior department forward,” Rimer said, “and he will be a stellar senior leader at the Gillings School during a period in which we are making exciting changes Schoolwide to our academic programs.”

Ribisl succeeds Leslie Lytle, PhD, who has served as department chair since 2012. Lytle will continue on the faculty as professor of health behavior and of nutrition.

This piece was featured in the UNC Gillings School of Global Public Health News on August 11, 2017.

Kurt Ribisl served as principal investigator of the CPCRN Coordinating Center from 2004-2013.

November 15, 2017

University of North Carolina Investigators Awarded New CDC Funding to Study the Economic Burden of Metastatic Breast Cancer

Stephanie Wheeler and Justin Trogdon of the University of North Carolina were awarded CDC funding for SIP 17-004, Assessing the Lifetime Economic Burden in Younger, Midlife, and Older Women with Metastatic Breast Cancer. The economic cost data produced by this study will help decision makers allocate scarce public health resources more effectively for the prevention and treatment of mestastics breast cancer (mBC). For example, the cost projections can highlight cost drivers for women with mBC and motivate population-level prevention, early detection, and timely treatment activities. This study will also identify cost-effective treatment pathways to improve quantity and quality of life among women of all ages with mBC to ensure that women with mBC receive high-quality care while minimizing the economic impact on patients and payers. In addition, findings can be used to support value-based pathway driven treatment decisions and inform policymaking.

November 15, 2017

CPCRN-Related Presentations at the 10th Annual Conference on the Science of Dissemination and Implementation in Health, December 4-6, 2017

A list of all CPCRN-related presentations at the 10th Annual Conference on the Science of Dissemination and Implementation in Health in Arlington, Virginia on December 4-6, 2017 can be found here.

November 15, 2017

Putting Public Health Evidence in Action Training Curriculum Updated

The Putting Public Health Evidence in Action training curriculum was updated in November 2017. This interactive training curriculum was created by the CPCRN to support community program planners and health educators in developing skills in using evidence-based approaches and learning about new tools for planning and evaluating community health interventions. The curriculum can be accessed at

November 10, 2017

CPCRN Team from UPenn Network Center Presents at the Advancing the Science of Community-Engaged Research Conference, September 2017

A team of CPCRN members from the University of Pennsylvania network center presented a poster at the Advancing the Science of Community-Engaged Research Conference in Washington, D.C. in mid-September. The poster, titled “Community Scholars-in-Residence Program for Graduate Students and Postdoctoral Fellows: Hands-On Community-Engaged Research,” was the result of a collaborative effort between the UPenn CPCRN center and the Community Engagement Core of their Clinical and Translational Science Awards (CTSA) Program. Authors were Karen Glanz, Sarah Green, Jill McDonald, and Alyssa Yackle.

More information about the conference can be found here.

November 10, 2017

CPCRN Members Present at the 4th Biennial Society for Implementation Research Collaboration Conference (SIRC 2017)

CPCRN principal investigator Jennifer Leeman, DrPH presented alongside Kathleen Knocke, MPH and Allison Myers, PhD, MPH at the 2017 SIRC conference in early September. They presented their work on “Adapting the Stages of Implementation Completion Measure as a Model for Health Policy Interventions” during the breakout session Connecting Research to Policy for Enhanced Implementation. The presentation, meticulously selected based on its high quality and unique content, was handpicked by SIRC members from a record number of 195 submissions.

Link to presentation.

Click here for more information on the SIRC conference.

November 10, 2017

University of Kentucky Pilot Project on HPV Vaccination Featured in The Kentucky Pharmacist

The Kentucky Pharmacist recently featured University of Kentucky’s work “Increasing HPV Vaccination through Community Pharmacy Partnerships: Lessons Learned from a Pilot Project”.

link to article

November 10, 2017

CPCRN Data Brief – Tobacco and Lung Cancer Screening in Federally Qualified Health Centers: A National Survey

While prevalence of tobacco use has declined over the past decade, rates have remained steady and haveeven increased among some socially and economically disadvantaged populations. Studies have also shownthat lower-income cigarette smokers suffer from more diseases, such as lung cancer, than smokers withhigher incomes. In August 2016, the Cancer Prevention Research & Control Research Network (CPCRN)—anetwork of academic, public health, and community partners—conducted a national survey of FederallyQualified Health Centers (FQHCs) to better understand their tobacco cessation and lung cancer screeningpractices. Of 258 invited, a total of 112 FQHCs completed the survey, representing 48 states.

link to full data brief

November 10, 2017

P30 HPV Supplement Grants Awarded to CPCRN Investigators at the University of Iowa and Oregon Health and Science University

University of Iowa and the The Oregon Health and Science University Knight Cancer Institute have both been awarded P30 HPV Supplement Grants for NCI-Designated Cancer Centers.

Iowa’s year-long project will investigate HPV vaccination disparities in rural Iowa counties. They’ll conduct an environmental scan looking at community, clinic and organizational factors related to uptake of the HPV vaccine in rural areas. Rural counties with large discrepancies between the rates of HPV vaccination and rates of adolescents who are up-to-date on other vaccinations (Hepatitis B, Meningococcal, MMR, Tdap/Td, and Varicella) will be a priority in the scan. Research team members include CPCRN members Natoshia Askelson and Laura Seegmiller.

OHSU’s catchment area is inclusive of the state of Oregon; a largely rural state with approximately 36% of residents living in areas designated as rural or frontier. They’ll conduct environmental scans – collecting data from each level on the socioecological model – in seven rural counties that reflect dyads or triads of geographically similar counties and which have very divergent HPV immunization coverage. By scanning areas of both highest and lowest uptake, they’ll identify both barriers and facilitators to full vaccination among adolescents and ideally approaches to improvement that may be most easily shared across rural regions. Research team members include CPCRN members Jackilen Shannon, Paige Farris and Advisory Team members Michelle Berlin and Robin Vanderpool.

November 10, 2017

Beyond “Implementation Strategies”: Classifying the Full Range of Strategies Used in Implementation Science and Practice

Background: Strategies are central to the National Institutes of Health’s definition of implementation research as “the study of strategies to integrate evidence-based interventions into specific settings.” Multiple scholars have proposed lists of the strategies used in implementation research and practice, which they increasingly are classifying under the single term “implementation strategies.” We contend that classifying all strategies under a single term leads to confusion, impedes synthesis across studies, and limits advancement of the full range of strategies of importance to implementation. To address this concern, we offer a system for classifying implementation strategies that builds on Proctor and colleagues’ (2013) reporting guidelines, which recommend that authors not only name and define their implementation strategies but also specify who enacted the strategy (i.e., the actor) and the level and determinants that were targeted (i.e., the action targets).

Main body: We build on Wandersman and colleagues’ Interactive Systems Framework to distinguish strategies based on whether they are enacted by actors functioning as part of a Delivery, Support, or Synthesis and Translation System. We build on Damschroder and colleague’s Consolidated Framework for Implementation Research to distinguish the levels that strategies target (intervention, inner setting, outer setting, individual, and process). We then draw on numerous resources to identify determinants, which are conceptualized as modifiable factors that prevent or enable the adoption and implementation of evidence-based interventions. Identifying actors and targets resulted in five conceptually distinct classes of implementation strategies: dissemination, implementation process, integration, capacity-building, and scale-up. In our descriptions of each class, we identify the level of the Interactive System Framework at which the strategy is enacted (actors), level and determinants targeted (action targets), and outcomes used to assess strategy effectiveness. We illustrate how each class would apply to efforts to improve colorectal cancer screening rates in Federally Qualified Health Centers.

Conclusions: Structuring strategies into classes will aid reporting of implementation research findings, alignment of strategies with relevant theories, synthesis of findings across studies, and identification of potential gaps in current strategy listings. Organizing strategies into classes also will assist users in locating the strategies that best match their needs.

Link to publication.

Citation: Leeman, J., Birken, S. A., Powell, B. J., Rohweder, C., & Shea, C. M. (2017). Beyond “implementation strategies”: Classifying the full range of strategies used in implementation science and practice. Implementation Science, 12(125). doi: 10.1186/s13012-017-0657-x

Acknowledgements: Appreciation is expressed to Jennifer Scott who also read and edited a near final version of the manuscript.

November 10, 2017

“Taking the Bull by the Horns”: Four Principles to Align Public Health, Primary Care, and Community Efforts to Improve Rural Cancer Control

To urban city dwellers, rural life can seem idyllic—a slower pace, easy-to-access outdoor recreation, and close ties to family, friends, and the community. What may not be as obvious is the extent to which persistent health disparities plague rural populations. For example, recurring evidence suggests that rural Americans face greater mortality risks from multiple diseases, including cancer, cardiovascular disease, and drug-related injuries. In addition, rural Americans are more likely than urban Americans to have low incomes, to have no more than a high school education, to be unemployed, and to be uninsured. Such data may compel stakeholders to seek to “save rural” by simply extending services and opportunities that exist and work well in urban environments. However, we argue that rural settings are fundamentally different in ways that require more creative thinking in order to optimize health outcomes. In this commentary, we summarize current trends in cancer prevention and control in rural areas and argue that 4 key considerations are needed when working in rural settings to address cancer disparities.

Link to publication.

Citation: Wheeler S. B., & Davis M. M. (2017). “Taking the bull by the horns”: Four principles to align public health, primary care, and community efforts to improve rural cancer control. The Journal of Rural Health, 33, 345-349. doi: 10.1111/jrh.12263

Acknowledgements: We are grateful for the support of our community partners in this work. Eliana Sullivan provided helpful edits on early versions of this commentary.

November 9, 2017

Funding Opportunities Aligned with Cancer Moonshot

In response to recommendations provided in the Blue Ribbon Panel (BRP) report, NCI established implementation teams to consider multiple ways to fund Cancer Moonshot-related research. These funding opportunities are now available.

Open Funding Opportunity Announcements (FOAs) can be found here.

Closed Funding Opportunity Announcements (FOAs) can be found here.

Cancer Moonshot Funding Opportunities Resources℠ and Cancer Moonshot℠-Funding Opportunities were originally published by the National Cancer Institute.

November 9, 2017

Stephanie Wheeler, CPCRN Coordinating Center PI, Awarded UNC’s Hettleman Prize for Artistic and Scholarly Achievement

Stephanie Wheeler, PhD,  associate professor of health policy and management at UNC’s Gillings School of Global Public, has been awarded UNC’s Philip and Ruth Hettleman Prize for Artistic and Scholarly Achievement by Young Faculty.

Wheeler and three other awardees were recognized at the Sept. 8 meeting of the UNC-Chapel Hill Faculty Council.

An alumnus of the Gillings School, Wheeler joined its faculty in 2010. Since then, her research has focused upon the use of mathematical modeling and systems thinking to address complex health services and policy questions. She examines links between “big data” and analytics, and studies cancer care quality and outcomes, health disparities, social epidemiology, medical decision making and reproductive health.

“I have mentored and collaborated with many talented and successful junior investigators during my 38 years as a faculty member,” said Morris Weinberger, PhD, Vergil N. Slee Distinguished Professor of Healthcare Quality Management and chair of the Gillings School’s Department of Health Policy and Management. “Dr. Wheeler’s record to date is the single most accomplished of them at this stage of their careers. Her strong passion for conducting policy-relevant public health research to reduce disparities among patients with cancer is palpable. Her research has spanned the cancer care continuum from screening to treatment and survivorship. Moreover, her research will be transformative as she moves beyond simply documenting problems in health care to developing evidence-based, pragmatic interventions that providers, decision makers, and policy makers can use to make a difference in patients’ lives.”

Wheeler continues a long tradition of Hettleman Prize winners at the Gillings School. Wizdom Powell, PhD, former faculty member and now adjunct associate professor of health policy and management, and Jason Surratt, PhD, associate professor of environmental sciences and engineering, won in 2015. In 2014, Mark Holmes, PhD, associate professor of health policy and management, was an awardee. Noel Brewer, PhD, professor of health behavior, was a 2011 recipient. Others won in prior years.

“I feel incredibly honored and humbled to be among those selected for the Hettleman Prize,” Wheeler said. “It is a testament, not to my own successes, but rather to the unparalleled mentorship and outstanding intellectual and material support I’ve received at Carolina over the years, both as a student and as a faculty member. There is truly no better place to grow an academic career in public health.”

Other 2017 Hettleman Prize winners are Mara Buchbinder, PhD, associate professor of social medicine, and Spencer Smith, PhD, associate professor of cell biology and physiology, both in the UNC School of Medicine; and James Cahoon, PhD, associate professor of chemistry in the UNC College of Arts and Sciences.

The award, which includes a $5,000 stipend, was established in 1986 by the late Phillip Hettleman, a New York investment banker and member of the UNC class of 1921, to recognize the achievements of outstanding junior tenure-track faculty or recently tenured faculty. A stipulation of the award is that the recipients will deliver a lecture during the academic year.

As a student at Carolina, Hettleman was business manager of The Daily Tar Heel when Thomas Wolfe was editor. In 1946, Hettleman bought a portrait of the then-famous author, and for years it hung in his office in New York City. One of his earliest gifts to the University, the portrait hangs in the Wolfe Room of Wilson Library’s North Carolina Collection.

Hettleman died in 1986.

This piece was featured in the UNC Gillings School of Global Public Health News on October 3rd, 2017.

November 9, 2017

Julia Alber Appointed Assistant Professor at California Polytechnic State University, San Luis Obispo

Julia Alber, University of Pennsylvania Postdoc 2015-2017 who has worked with the Cervical Cancer Screening Working Group, has begun a new position as Assistant Professor at Cal Poly San Luis Obispo. Alber will be teaching in the Department of Kinesiology.

Eleven new faculty and 15 new staff members joined the college this fall and during the past year. Read Julia Alber and other faculty bios here.

November 9, 2017

Karen Glanz Appointed to the Editorial Board for the American Journal of Preventive Medicine

Karen Glanz was recently appointed to the Editorial Board for the American Journal of Preventive Medicine. “Members of the AJPM editorial board perform myriad services for the journal including peer reviewing, recommending reviewers in their areas of expertise, serving as guest editors for supplements and themes, and acting as ambassadors for the journal. Our editorial board members are key to helping AJPM stay at the forefront of preventive medicine and public health.” Read more from the AJPM in their recent newsletter here.

This piece was featured in the University of Pennsylvania Prevention Research Center’s PRC Researchers in the News on October 19th, 2017.

August 13, 2017

CPCRN-Related Presentations at the CDC National Cancer Conference 2017

Several CPCRN workgroup projects and center projects were presented at the CDC Cancer Conference held in Atlanta, Georgia on August 14-16, 2017.  Click the presentation title to view the presentation. A list of all CPCRN-related presentations can be found here.

Partnering for Prevention: The Cancer Prevention and Control Research Network’s Collaborations Research with Federally Qualified Health Center (pdf) (ppt here)Session Moderator: Karen Glanz, PhD, MPH, University of PennsylvaniaThe Cancer Prevention and Control Research Network (CPCRN) is a national network of academic, community-engaged researchers working to accelerate the adoption of evidence-based cancer prevention and control in communities through effective dissemination and implementation strategies, including among federally qualified health centers. This session discusses the outcomes of this partnership to reduce health disparities in disadvantaged populations.

  1. Federally Qualified Health Centers As a Key Partner in Community-Clinical Linkages to Support HPV Vaccination Robin Vanderpool, DrPH, University of Kentucky; Heather M. Brandt, PhD, University of South Carolina Arnold School of Public Health; Laura Seegmiller, MPH, University of Iowa; Lindsay Stradtman, University of Kentucky College; Jason Daniel-Ulloa, PhD, MPH, University of Iowa; Thuy Vu, MPH, University of Washington; Vicky Taylor, MD, Fred Hutchinson Cancer Research Center; Paige Farris, MSW, Oregon Health and Science University; Susan J. Curry, PhD, University of Iowa
  2. Implementation of Lung Cancer Screening Among Federally Qualified Health Centers (FQHCs) in the U.S. Susan A. Flocke, PhD, Case Western Reserve University; Robin Vanderpool, DrPH, University of Kentucky; Jan Eberth, University of South Carolina; Richard Hoffman, MD, University of Iowa; Daniel Reuland, MD, MPH, University of North Carolina School of Medicine; Genevieve Birkby, PhD, Case Western Reserve University; Steven Zeliadt, PhD, University of Washington
  3. Partnering for Prevention: The Cancer Prevention and Control Research Network’s Collaborations with Federally Qualified Health Centers Catherine Lois Rohweder, DrPH, University of North Carolina, Chapel Hill; Daniela Friedman, Arnold School of Public Health; Jennifer Leeman, DrPH, MDiv, University of North Carolina School of Nursing; Linda Ko, PhD, Fred Hutchinson Cancer Research Center; Karen Glanz, PhD, MPH, University of Pennsylvania

Harnessing the Power of Big Data and Simulation to Improve Colorectal Cancer ScreeningSession Moderator: Cynthia A. Vinson, PhD, MA, National Cancer InstituteLocal and national decision makers are interested in increasing colorectal cancer screening while simultaneously addressing disparities. This session will discuss how simulation modeling can enhance the decision-making process for implementation planning for colorectal cancer screening.

  1. Technical Considerations: The Past, Present, and Future of Simulation Modeling of Colorectal Cancer Siddhartha Nambiar, MS, North Carolina State University; Maria E. Mayorga, PhD, North Carolina State University, Rachel Townsley, MIE, North Carolina State University; Kristen Hassmiller Lich, PhD, MHSA, University of North Carolina at Chapel Hill; Stephanie B. Wheeler, PhD, MPH, University of North Carolina at Chapel Hill
  2. Using Individual-Based Simulation Modeling to Integrate Big Data and Intervention Evidence to Inform Intervention Selection, Adaptation, and Evaluation: An Example on Colorectal Cancer Screening  Kristen Hassmiller Lich, PhD, MHSA, University of North Carolina at Chapel Hill; Maria E. Mayorga, PhD, North Carolina State University; Rachel Townsley, MIE, North Carolina State University, Stephanie B. Wheeler, PhD, MPH, University of North Carolina at Chapel Hill; Leah Frerichs, PhD, University of North Carolina at Chapel Hill
  3. Relationships, Data, and Quality Improvement: Critical Factors When Accountable Care Organizations and Primary Care Practices Collaborate to Increase Colorectal Cancer Screening in Medicaid Members  Melinda Davis, PhD, Oregon Health & Science University; Rose Gunn, MA, Oregon Health & Science University; Robyn Pham, Oregon Health & Science University; Kristen Hassmiller Lich, PhD, MHSA, University of North Carolina at Chapel Hill; Stephanie B. Wheeler, PhD, MPH, University of North Carolina at Chapel Hill
  4. Data-Powered Decision Making: One State’s Approach to Improving Colorectal Cancer Screening in Underserved Populations  Stephanie B. Wheeler, PhD, MPH, University of North Carolina at Chapel Hill; Maria E. Mayorga, PhD, North Carolina State University; Melinda Davis, PhD, Oregon Health & Science University; Leah Frerichs, PhD, University of North Carolina at Chapel Hill; Michael Pignone, MD, MPH, University of Texas, Austin; Florence Tangka, PhD, CDC;Lisa C. Richardson, MD, MPH, CDC; Kristen Hassmiller Lich, PhD, MHSA, University of North Carolina at Chapel Hill

Any Questions? Asking the Right Ones for Program Implementation and EvaluationSession Moderator: Toye Williams, MSPH, CDCNeeds assessments and program evaluation are essential to public health programs, including ones for colorectal cancer screening. This session will provide an overview of recent evaluations of implemented methods and materials used to improve colorectal cancer screening and outcomes for medically underserved populations.

  1. Adoption, Implementation, and Maintenance of Evidence-Based Colorectal Cancer Screening Interventions among CRCCP Grantees Peggy Hannon, PhD, MPH, University of Washington; Annette Maxwell, DrPH, University of California at Los Angeles; Cam Escoffery, PhD, Rollins School of Public Health; Thuy Vu, MPH, University of Washington; Marlana Kohn, University of Washington; Laurel Dillon-Sumner, MA, University of Washington; Caitlin Mason, PhD, University of Washington
  2. Factors Relating to Use and Non-Use of Direct-Mail Fecal Immunochemical Tests (FIT): Interview Findings from a Diverse FQHC Patient Population Thuy Vu, MPH, University of Washington; Allison M. Cole, MD, MPH, University of Washington Department of Family Medicine; Peggy Hannon, PhD, MPH, University of Washington; Kathryn E. Kemper, HealthPoint Community Health Center; Jennifer Moon, A.T. Still University; Gloria Coronado, PhD, Kaiser Permanente Northwest; Casey Eastman, MPH, Washington State Department of Health; Roxane Waldron, Washington State Department of Health
  3. Mixed Methods Study of the Role of Partnerships in Advancing Screening Promotion in the Colorectal Cancer Control Program (CRCCP) Cam Escoffery, PhD, Rollins School of Public Health; Michelle Carvalho, MPH, Rollins School of Public Health; Anamika Satsangi, MPH, CDC; Grace Miskin, MPH, NIH, Rollins Scholl of Public Health; Shade Owolabi, MS, Rollins Schools of Public Health; Peggy Hannon, PhD, MPH, University of Washington; Thuy Vu, MPH, University of Washington; Annette Maxwell, DrPH, University of California, Los Angeles; Caitlin Mason, PhD, University of Washington
November 10, 2016

National HPV Vaccination Roundtable Pilot Project: Pharmacy-Located HPV Vaccination

CPCRN investigators from the University of Iowa, University of Kentucky, and Oregon Health & Science University collaborated on a National HPV Vaccination Roundtable pilot project to document the front-line experiences during the implementation of a planned pharmacy-clinic linkage protocol. This report describes the experiences across three states with diverse populations, settings, and partnerships. Participation in this important initiative provides valuable information for continued efforts to achieve national goals for initiation and completion of the HPV vaccination series.

Link to full report: ACS CPCRN HPV Final Report 2016