1

NCI Center to Reduce Cancer Health Disparities

Community Networks Cancer Health Disparities Summit 2005

Bethesda, MDJuly 18–20, 2005

2

CDC’s Programs and Research Addressing Cancer Disparities

Ralph J. Coates, PhD

Division of Cancer Prevention and ControlCenters for Disease Control and Prevention

3

CDC goals in common with Community Networks Program

To reduce cancer disparities throughprograms (including education, training)and researchwith community partnersto bring research into practice

Discuss today some programs developed to address those goals

4

CDC Program Examples

Comprehensive Cancer ControlGuide to Community Preventive ServicesRacial and Ethnic Approaches to Community HealthSteps to a Healthier USNational Tobacco Control ProgramNutrition and Physical Activity ProgramNational Program of Cancer RegistriesNational Breast and Cervical Cancer Early

Detection ProgramColorectal Cancer InitiativesPrevention Research CentersCancer Prevention and Control Research Network

5

6

Status of CDC Comprehensive Cancer Control Funding

FY05

Republic of Palau

CA

ID

WA

MT

WY

UTCO

NM

TX

OK

KS

NE

SD

ND

MNWI

IA

IL OHIN

KYVA

NC

GA

FL

ALMS

MO

AR

LA

NV

MI

PANJ

NYCTMA

VTNH

ME

TN

SC

MDDE

RI

AZ

AK

OR

American Samoa, Commonwealth of Northern Mariana Islands, Federated States of Micronesia, Guam, and Republic of the Marshall Islands are funded through a cooperative agreement with the University of Hawaii

WV

DC

Alaska Native Tribal Health Consortium

South Puget Intertribal Planning Agency

Northwest Portland Area Indian Health Board

Cherokee Nation

Fond Du Lac Reservation

HI

Aberdeen Area Tribal

$ 95,000-$338,000$339,000-$724,999$725,000-$1M>$1M

7

Comprehensive Cancer Control

State, tribe, and territory CCC coalitions include health departments, cancer centers, ACS regional offices, NCI-CIS, health plans, health care providers, cancer advocacy groups, researchers, academics.

CCC national partners include NCI, ACS, C-Change, ACoS, ICC, others

8

Comprehensive Cancer Control (CCC)

Increase coordination, collaboration, and synergies across agencies/organizations at national, state, and local levels

Coordinate across cancer sites and interventions from primary prevention through survivorship

Address the range of activities from surveillance through preventive and clinical services to workforce development

Reduce gap between research/evidence-based interventions and practice.

9

Comprehensive Cancer Control

Local CCC coalitions develop and implement plans with priority activities for cancer control in their communities

Plans propose a number of initiatives, including policy (e.g., regulations on insurance coverage & access)

Focus on underservedInclude public education and outreach

10

CCC Information

More information, including contacts with states, tribes, territoriescdc.gov/cancer/nccp/

CCC national partners provide leadership, funding, training, and resources.

Excellent example of collaborative support to CCC partners:Cancer Control Planetcancercontrolplanet.cancer.gov/

11

Opportunities for CNP Grantees With CCC

Access and utilize resources, e.g, at Cancer Control Planet

Coordinate with other local efforts addressing disparities

Collaborate with CCC coalition partnersCNP Maryland grantee works with the Maryland CCC coalition

12

13

The Guide to Community Preventive Services

The “Community Guide” provides evidence-based recommendations on the effectiveness of community interventions to promote health and prevent disease, disability, and premature death,including cancer

14

Community Guide Reviews & Recommendations Related to Cancer

Community interventions to Reduce tobacco useIncrease cancer screening useIncrease physical activityReduce obesityImprove nutritionReduce alcohol abuseIncrease vaccine coverage

15

Community Guide

Similar to USPSTF Guide to Clinical Preventive Services

DHHS initiative / CDC coordinationNumerous partners (including NIH)

Systematic literature reviewsWhat’s effective, needs research

Referenced in reports by National Cancer Policy Board (IOM)

16

Non-Federal Leadership of the Community GuideTask Force Member Affiliations

Lineberger Comprehensive Cancer Center UCLA School of MedicineUT Texas – Houston School of Public HealthMidwest Business Group on HealthMerck & Company, Inc. Health Partners (managed care) MinnesotaGroup Health Cooperative of Puget SoundU.S. Cochrane Center, Brown UniversityRhode Island Department of HealthL. A. County Department of Health

17

Users of the Community Guide

People who plan, fund, or implement services and policies for health care systems, communities, and states

Public health departmentsHealth care delivery systemsPurchasers of health careGovernment and foundationsCommunity organizationsCCC coalitions

P r e v e n t i v e S e r v i c e sP r e v e n t i v e S e r v i c e sP r e v e n t i v e S e r v i c e sP r e v e n t i v e S e r v i c e s

18

Examples of Community GuideRecommended interventions

Tobacco control: Increased price (taxes)Smoking bans

Physical activity: Creation or enhancedaccess to places for PA

Mammography: Patient tracking andreminder systems

19

Community Guide Consistency With AHRQ Evidence Reviews

AHRQ Evidence Report: Number 90Strategies for Improving Minority Healthcare

QualityOverall, there is excellent evidence

supporting the use of tracking/reminder systems by health care providers of racial/ethnic minority patients

(Evidence Grade A).

20

Community Guide Applicability for Underserved CNP Communities

Reviews examine evidence on the populations and communities included in the intervention studies, e.g., by race/ethnicity and SES.

Recommendations identify groups to whom recommendations are likely to apply and gaps in research

21

CNP Grantee Use of theCommunity Guide?

Training and education: ID interventions shown to work in similar communities/populations

Research: ID gaps in knowledge about applicability of interventions with certain populations and communities

CDC use CNP grantee research: include CNP publications in Community Guide reviews to help provide guidance to CDC and partners

22

www.thecommunityguide.org

SYSTEMATIC REVIEWS AND EVIDENCE-BASED RECOMMENDATIONSP r e v e n t i v e S e r v i c e sP r e v e n t i v e S e r v i c e s

SYSTEMATIC REVIEWS AND EVIDENCE-BASED RECOMMENDATIONSP r e v e n t i v e S e r v i c e sP r e v e n t i v e S e r v i c e s

Cancer Control PlanetLink to the Community Guide and

Research Tested Intervention Programscancercontrol.cancer.gov/rtips

24

Racial and Ethnic Approaches to Community Health (REACH) 2010

REACH 2010 A cornerstones of CDC’s efforts to

eliminate racial and ethnic disparities in health

2004-5: 40 projects, $34.5 million fundingSupports community coalitions in

designing, implementing, and evaluating community-driven strategies to improve health

25

REACH 2010Breast and Cervical Cancer Screening

Access Community Health Network (IL) Albuquerque Area Indian Health Board (NM) Boston Public Health Commission (MA) Special Services for Groups, Inc. (CA)University of California, San Francisco (CA) University of Alabama, Birmingham (AL)

REACHInformation: cdc.gov/reach2010/

27

Overview of Steps Cooperative Agreement

Program

28

Steps to a Healthier US

Help Americans take steps to Be physically active each dayEat a nutritious dietGet preventive screeningMake healthy choices

Funds community partnerships, useevidence-based strategies

2005 funding: $45.6 million

29

Steps Awardees Representing 40 Communities

State-coordinatedSmall Cities/RuralCommunities

WA – 4 countiesAZ – 3 countiesCO – 4 countiesNY – 4 counties

AL– 2 areasMN – 4 areasPA – 3 counties

Tribes/Tribal EntitlesIntertribal Council of Michigan

Cherokee Nation Health Services Group (Oklahoma)

Southeast Alaska Regional Consortium

Large Cities/Urban CommunitiesSeattle-King county, WASalinas-Monterey county, CAAustin-Travis county, TXNew Orleans, LASt. Petersburg-Pinellas county, FLBoston, MA

Philadelphia, PASan Antonio, TXCleveland, OHSanta Clara county, CADekalb county, GAHillsborough county, FL

CA

ID

MT

WY

UTCO

NM

TX

OK

KS

NE

SD

ND

MN

WI

IA

IL OHIN

KYVA

NC

GA

FL

ALMS

MO

AR

LA

NV

MI

PANJ

NYCTMA

VTNH

ME

TN

SCAZ

AK

WV

HI

MDDE

RI

DC

WA

OR

30

Steps information…..

Contact: e-mail addressnccdodsteps@cdc.gov

On-line brochure:http://healthierus.gov/steps/grantees/2004/

StepsCoopAgrmn.pdf

31

CDC National Tobacco Control Program

Comprehensive, science-based program funds, training, & assistance

Goals: prevention of initiationcessation among smokerselimination of 2nd hand smokeelimination of disparities

32

CDC National Tobacco Control Program

50 states, DC, 7 U.S. Territories 7 national networks to address tobacco control

in populations defined by race, ethnicity, gender, sexual preference, SES, and age

7 Tribal Support Centers Additionally:

11 states to identify and eliminate disparities

33

CDC Tobacco Control Programs

General:

cdc.gov/tobacco

State Tobacco Activities Tracking and Evaluation System cdc.gov/tobacco/STATESystem

34

CDC Funded States for Nutrition & Physical Activity

to Prevent Obesity and Other Chronic Diseases

Basic ImplementationCapacity Building

http://www.cdc.gov/nccdphp/dnpa/obesity/state_programs/index.htm

35

Nutrition/Physical Activity Change Efforts

25%

45%

20%

45%

35%

45%

0

10

20

30

40

50

60

70

80

90

100

Policies Legislation Environmental Changes

Initiated Planned

Percentage of States Reporting Environmental Change Efforts

Note: These data are based on progress reports from the 20 state Obesity Prevention Programs in January 2004.21

36

CDC Nutrition Program Information General:

cdc.gov/nccdphp/dnpa/

State-Based Nutrition and Physical Activity Program to Prevent Obesity and Other Chronic Diseases cdc.gov/nccdphp/dnpa/obesity/state_programs/

37

38

Public Law 102-515, October, 1992

Population-based cancer registries in all statesuniform, timely, high-quality datacancer reporting by those who treat itannual registry reporting

For CNP grantees: data on populations not previously served by a registry

39

National Program of Cancer Registries (NPCR)

CA

ID

WA

MT

WY

UTCO

NM

TX

OK

KS

NE

SD

ND

MN

WI

IA

IL OHIN

KYVA

NC

GA

FL

ALMS

MO

AR

LA

NV

MI

PANJ

NYCTMA

VTNH

ME

TN

SC

HAWAII

AZ

AK

OR

WV

Basic Implementation ProgramsREPUBLIC OF PALAU

VIRGIN ISLANDS

PUERTO RICOCapacity Building ProgramsSEER Programs

MDDE

RI

DC

40

National and State-Specific Cancer IncidenceJoint Publication by CDC and NCI

41

CDC Surveillance Information

National Program of Cancer Registriescdc.gov/cancer/npcr

Additional data available for CNP communities:Behavioral Risk Factor Surveillance System

Risk factors and use of preventive servicesin your communities

cdc.gov/cancer/brfss

NPCR & BRFSS at State Cancer Profilesstatecancerprofiles.cancer.gov

43

44

Key Elements of NBCCEDP

Provides breast and cervical cancer screening to underserved womenlow income (<250% of poverty), uninsured

Program activities include:Coalitions and partnerships to reach

underserved womenPublic education and outreachProfessional educationScreening, follow-up, case managementQuality assurance and surveillance

Treatment is provided through Medicaid

45

The National Breast and Cervical Cancer Early Detection Program

June 30, 2005

American Indian Initiative:

Arctic Slope Native Assn, Ltd – North Slope Borough, Barrow, AKCherokee Nation – Tahlequah, OKCheyenne River Sioux Tribe – Eagle Butte, SD

Kaw Nation – Kaw City, OK

Native American Rehabilitation Assn of the Northwest, Inc

Poarch Band of Creek Indians – Atmore, ALSouth Puget Intertribal Planning Agency – Shelton, WA

Hopi Tribe – Kykotsmovi, AZ

Navajo Nation – Window Rock, AZ

Yukon-Kuskokwim Health Corp – Bethel, AKMississippi Band of Choctaw – Philadelphia, MS

HI

Southeast Alaska Regional Health Consortium – Sitka, AKSouthcentral Foundation – Anchorage, AK

CA

ID

OR

WA

MT

WY

UTCO

NM

TX

OK

KS

NE

SD

NDMN

WI

IA

IL OHIN

KY

WVVA

NC

GA

FL

ALMS

MO

AR

LA

NV

MI

PA

NJ

NY CTMA

VTNH

ME

TN

SC

RI

AZ

REPUBLIC of PALAUAMERICAN SAMOAGUAM

AK

DCDEMD

PUERTO RICO

HI

Basic Implementation

46

Number of Women Screened for Fiscal Years 1991-2004

Total number of women ever screened = 2,316,632

Source: Minimum Data Elements through 06/30/2004 paid with NBCCEDP funds, National Breast & Cervical Cancer Early Detection Program

134,724

177,144

239,907

300,737

343,950 334,610353,896

383,367405,276

446,197

585,562

439,979

54,687

0

50,000

100,000

150,000

200,000

250,000

300,000

350,000

400,000

450,000

500,000

550,000

600,000

FY91/92 FY93 FY94 FY95 FY96 FY97 FY98 FY99 FY00 FY01 FY02 FY03 FY04(thru06/04)

47

Distribution of Women Receiving Papanicolaou Tests, by Race/Ethnicity, 1991-2004

(N=1,589,723)

* Includes Hispanics of any raceSource: Minimum Data Elements through 06/30/2004 paid with NBCCEDP funds, National Breast & Cervical Cancer Early Detection Program

Multiracial 0.2%

White 51.4%Black 14.3%

Hispanic 21.3%*

American Indian 6.5%

Asian/Pacific Islander 4.2%

Other/Unknown 2.2%

48

Colorectal Cancer Initiatives

Screen for Life CampaignStudy of Endoscopic CapacityNational Colorectal Cancer RoundtableSupport for state interventionsSurveillance of screening practicesPatterns of Care ResearchIntervention Research

49

Prevention Research Centers

CDC’s PRC programconducts research to improve health

promotion and disease preventionfocuses on high-priority public health

issues promotes application of scientific

knowledge in public health practiceenhances cooperation between academic

institutions and state and local health

50

Prevention Research CentersFunded in FY 2005

University of Washington at Seattle

University of California

at Berkeley

University of California

at Los AngelesUniversity of

ArizonaUniversity of New Mexico

University of Colorado

University of TexasHouston HealthScience Center

Universityof Oklahoma

St. LouisUniversity

TulaneUniversity

University of Minnesota University

of Illinoisat Chicago

University of Alabama atBirmingham

University of Kentucky

University of South Florida

MorehouseSchool of Medicine

University ofMichigan

West Virginia University

University of North Carolina at Chapel Hill

University of South Carolina

Harvard University

Yale University

Columbia University

The Johns HopkinsUniversity

State University ofNew York at Albany

Universityof Iowa

Boston University

University of Pittsburgh

Oregon Healthand Sciences

University

San DiegoState University

Texas A&MUniversity

Emory University

University ofRochester

AK

HAWAII

51

Prevention Research Centers

2005 Core Funding: $29.7 millionAdditional funding from other parts of CDC for

specific studies, including cancerOpportunity for CNP grantees to collaborate

with PRCsExamples of PRC projects:Improving health in California’s Korean-

American community Reducing health disparities in rural southwest

Georgia

52

Prevention Research Centers: information

General Information:cdc.gov/prc/

Grantee Center profiles:cdc.gov/prc/centers/

e-mail contact Barbara Gray:BGray@cdc.gov

53

Prevention Research Centers:Cancer Prevention and Control Network

Collaboration between CDC and NCIIncrease expertise in community-based

intervention research in cancer prevention and control

Facilitate translation of effective interventions into practice

54

Primary Objectives of the CPCRN

Research on how to disseminate into communities cancer-related community interventions recommended by the Guide to Community Preventive Services

Research on effectiveness of community interventions for which new evidence can change a Community Guide finding of insufficient evidence into a recommendation.

55

Primary Objectives of the CPCRN

Research replicating Community Guide-recommended interventions in populations and communities in which they have not yet been evaluated, particularly underserved populations

Research on interventions commonly used by community groups and health departments and for which there is insufficient evidence for a Community Guide recommendation

56

CPCRN Network Center Map

CA

WA

TX

NC

GA

MO

University of Washington

University of California at Los Angeles

University of Texas

Emory UniversityMorehouse School of Medicine

University of North Carolina

Harvard University

Saint LouisUniversity

57

CPCRN Principal Investigators

Kurt Ribisl, PhDUNC-Chapel Hill Coordinating Center

Karen Glanz, PhDEmory University

Jeffrey Harris, MD, MPH, MBAUniversity of Washington

Maria Fernandez, PhDUniversity of Texas Health Science Center at Houston

Cathy Melvin, PhDUniversity of North Carolina at Chapel Hill

Roshan Bastani, PhDUniversity of California, Los Angeles

Matthew Kreuter, PhDSaint Louis University

Dan Blumenthal, MD, MPHMorehouse School of Medicine

Glorian Sorensen, PhDHarvard University

Principal InvestigatorMember Center

Information on the CPCRNwww.cpcrn.org/

59

Information about CDC’s Division of Cancer

Prevention & Controlwww.cdc.gov/cancer