Jennifer Leeman

Comprehensive Cancer Control
Collaborative of North Carolina
This presentation was supported by Cooperative Agreement Number 1U48DP005017 from the Centers for Disease Control and Prevention. The findings and
conclusions in this presentation are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
4CNC Team
Jennifer Leeman - School of Nursing
Noel Brewer - Health Behavior, School of Public Health
Seth Noar - School of Journalism
Kurt Ribisl - Health Behavior, School of Public Health
Catherine Rohweder - Consortium for Implementation
Science, School of Public Health
Stephanie Wheeler - Health Policy & Management,
School of Public Health
Project Directors: Alexis Moore & Nancy Aycock
North Carolinians Who Experience
Cancer Disparities
• Rural dwelling – 40%
• African American – 22%
• Below poverty level – 17%
Rural and Urban Counties
Presentation Objectives
Tell you about…
• 4CNC’s research focus - Advance the science of
what strategies most effectively support practitioners
as they plan and implement evidence-based
approaches (EBAs)
• Capacity Building Technical Assistance and Training
Workgroup (CBTAT, 2009-2014)
• 4CNC’s proposed project
• Opportunities for cross-center collaboration
4CNC’s Focus – Advance Science of
Prevention Support
Wandersman et al., 2008; Fernandez et al., 2014
4CNC’s Focus – Prevention Support for
Community Environment EBAs
• Advance science of how to provide support
(training, tools and technical assistance) to promote
EBA planning and implementation
• Develop a comprehensive approach that applies to
a wide range of community environment EBAs
• Start with focus on EBAs related to
– Tobacco marketing and sales
– Nutrition and physical activity
Community Environment EBAs
• Smoke free policies
• Retailer licensing and zoning
• Increasing price of tobacco products
Nutrition/Physical Activity
• Joint use agreements
• Walking trails
• Access to healthy foods &
Community Environment EBAs Require
New Approaches to Prevention Support
• Few standardized, replicable EBAs
• Change processes are
– Complex and emergent
– Multi-sector
– Multi-level
– Potentially polarizing
Leeman, Myers, Ribisl, & Ammerman, 2014
Build on CBTAT Workgroup’s Training
• Putting Evidence into Action curriculum
and Facilitator’s Guide
– 7 modules on how to assess
contexts and select, adapt,
implement, and evaluate EBAs
– Delivered curriculum in 14
workshops to 600+ practitioners
– Soon to be posted to CPCRN website
Led by Cam Escoffery at Emory (2009-2014)
Build on CBTAT’s Systematic Review
• Guided by Evidence-Based System of Innovation
Support (EBSIS, Wandersman et al., 2012)
• Reviewed studies of community-based prevention
support interventions to identify
– strategies used
– variations in their format
– evidence for effectiveness
• 42 publications reporting findings from 29 studies
Leeman et al., under review
Systematic Review Findings
Prevention Support Interventions
Systematic Review Findings
• Of 29 studies, 12 were group randomized trials
– 12 assessed effects on adoption/implementation
– 3 assessed effects on capacity
– 2 assessed effects on planning behaviors
– 4 compared effectiveness of different designs
4CNC’s Core Project
Partner with community coalitions/teams to test and refine a
prevention support intervention
CBTAT Curriculum
Developed by UNC or other CPCRN’s
Technical Assistance (TA)
New – TA After Training
• Walk teams/coalitions through a structured
planning model as they
– Engage cross-sector partners
– Assess local environments
– Collectively formulate an evidence-informed
– Develop and execute an
advocacy/implementation plan
– Evaluate processes and outcomes
TA Coupled with Tools
Center for Training and Research Translation (
– Ammerman/Leeman PIs
– CDC-funded 2004-2014
– Nutrition and physical activity
Counter Tobacco (
– Ribisl PI
– CDC-funded 2009-2016
– Tobacco marketing at
the Point of Sale
Tools that Practitioners Can Use
at Each Step in the Process
• Tools to
– Engage stakeholders
– Collect local data
– Raise awareness of problems and solutions
– Develop and implement action plans
– Evaluate processes and outcomes
Leeman, Myers, Ribisl, & Ammerman, 2014
Assess Intervention Effectiveness
• Assess effects on
– Practitioner capacity (measure under
development with CTSA funding)
– Team/coalition planning behaviors
– EBA adoption and implementation
– EBA’s target outcomes
Opportunities for Cross-Center
1. Compare the effectiveness of prevention support
formats (webinar vs in-person)
Partnering CPCRN centers would
Recruit two or more active coalitions
Assist with intervention delivery
Collect data
Collaborate on interpreting findings, refining
interventions and study measures, writing for
• Collaborate on proposal for external funding
Opportunities for Cross-Center
2. Adapt the prevention support intervention and apply it
to other community environment EBAs
- Partnering centers would
• Write site-specific findings
• Contribute to cross-center paper on use of model
across different focus areas
3. Shift focus to supporting systems change EBAs (e.g.,
HPV vaccination, Cancer Screening,
Community/Clinical Linkages)
In Summary
• Improving community environments is central
to supporting healthy behaviors and reducing
cancer risk
• Yet, practitioners often lack skills, tools and
support to change community environments
• CPCRN offers a unique platform for testing and
strengthening the effectiveness of prevention
support interventions

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