In It for the Long Haul: Making Changes One Population at a Time

Policy, Systems, and Environmental Changes for Cancer Prevention and Control: Lessons Learned from a Demonstration Program among National Comprehensive Cancer Control Program Grantees

Authors:

Angela Moore (Presenter)
Centers for Disease Control and Prevention

John Rose, Battelle
Eilzabeth Rohan, Centers for Disease Control and Prevention
Julie Townsend, Centers for Disease Control and Prevention
Monique Young, Centers for Disease Control and Prevention
Gary Chovnick, Battelle
Jarrod Olson, Battelle Memorial Institute
Annette Gardner, Centers for Disease Control and Prevention
Anne Major, Centers for Disease Control and Prevention
Adrienne Cocci, Battelle Memorial Institute

Public Health Statement: Policy, systems, and environmental (PSE) changes are essential to comprehensive efforts to reduce cancer morbidity and mortality. For many National Comprehensive Cancer Control Program (NCCCP) grantees, developing and informing the evidence for effective PSE change strategies in their jurisdictions requires new sets of skills, resources, strategies, and partnerships.

Purpose: To enhance their capacity to develop and inform PSE change strategies, 13 NCCCP grantees participated in a demonstration program that provided additional funding and technical assistance (TA)/trainings, and asked grantees to—

1. Hire a dedicated policy analyst;
2. Convene a PSE workgroup;
3. Develop and implement a PSE agenda and media plan.

This project presents the evaluation results from that demonstration project.

Methods/Approach: A longitudinal, mixed-methods evaluation of the demonstration program included case studies, surveys, and secondary data.

Results: Staff and partner skills increased through TA/training and peer-to-peer communication. Grantees enhanced collaboration infrastructure by forming workgroups with coalition members and other strategic stakeholders (both traditional and non-traditional partners). Implementation activities included decision-maker education; outreach, and media for increased public awareness. Grantees reported improvements in awareness of and support for PSE strategies, and achieved several PSE change goals.

Conclusions/Implications: Developing and informing PSE change strategies is a long-term process requiring workforce development, collaboration and partnership-building, careful planning and preparation, and agility to respond to opportunities. Dedicated financial and technical support enhanced grantee capacity to engage in that process, and to achieve PSE change with anticipated long-term, population-level impacts. These evaluation results provide guidance for wider adaptation and development of PSE change strategies in all NCCCP grantees.

Evaluation of a Public Health Policy to Decrease Indoor Tanning in Young Adults

Author:

Michelle Strangis (Presenter)
Minnesota Department of Health

Public Health Statement: Evaluation of public health policies is critical to determine impact of the policy, to understand gaps and unintended consequences, and to maintain credibility with policy makers.

Purpose: The purpose of this evaluation was to assess whether indoor tanning facilities posted a sign consistent with state law announcing that minors are prohibited from tanning and whether a business mailing list of tanning facilities was complete.

Methods/Approach: Two MPH students visited 179 tanning facilities in 8 geographic regions of the state in the spring of 2016. A business mailing list was used to identify tanning facilities because the State of Minnesota does not license or register tanning facilities. MPH students supplemented the business mailing list of tanning facilities with internet searches and lists from three cities that license tanning facilities. The students interviewed the tanning facility operator using a script, and then provided the operator a letter about the law and a laminated sign for posting in the facility that met the requirements of the law. The students recorded information from the interview and from their observations at the facility. This data was compiled in a spreadsheet.

Results: More than half of the facilities visited did not have a sign conspicuously posted at the point of purchase, as required by law. Furthermore, more than a third of the facilities did not have any sign posted. Only 61% of indoor tanning facilities were on the business mailing list. Indoor tanning services were most commonly available at tanning salons for both urban (52%) and rural (43%) areas. The second most common location in urban areas was health clubs (23%) and in rural areas was beauty salons (32%). Health clubs had the poorest results in our evaluation: 78% did not have any sign posted. One of the unexpected findings was that an estimated 87% of health clubs did not have an operator present at all times that tanning facilities were accessible to health club members.

Conclusions/Implications: This study provided critical information about indoor tanning facilties in Minnesota and points to the need for better complliance with the consumer protection mechanisms in the law. In the absence of state licensure or registration, we do not know who is offering indoor tanning services and whether they have knowledge of changes in state law regulating this potentially dangerous activity. Failure to have a tanning bed operator present at health clubs is a violation of state law and increases the risk of harm from these devices.

Expanding Physical Activity Access Through Active Transportation (AT) Infrastructure for All Utahans: Utah’s New Road Respect Community Program (RRC)

Authors:

Kendra Babitz (Presenter)
Utah Comprehensive Cancer Control Program

Brad Belnap, Utah Comprehensive Cancer Control Program

Public Health Statement: Expanding the Utah Department of Transportation’s (UDOT) RRC to include walking, cycling, health impact assessment (HIA) criteria, and alignment with national designations decreases barriers to physical activity.

Purpose: Most of Utah is rural or frontier with increased rates of obesity and physical inactivity due to barriers to physical activity resources. Expanding RRC is a sustainable systems change to increase physical activity access through partnerships with the Utah Comprehensive Cancer Control Program (CCC), the DP13 1305 grant program (1305), and UDOT.

Methods/Approach: For three years, CCC offered mini-grants to rural communities to implement RRC, but grantees were required to meet separate objectives for project requirements for the CCC and 1305. RRC only required planning for cycling; CCC and 1305 required planning for walking as well as HIA criteria. After receiving grantee feedback, CCC helped UDOT streamline RRC to incorporate CCC and 1305 criteria as well as add requirements for national recognition from groups like League of American Cyclists. RRC is now the designated AT program for Utah.

Results: Through these efforts, Utah now has a statewide AT program, and multiple rural and frontier communities have committed to adopting it.

Conclusions/Implications: RRC is the required program all communities in Utah must use when working with UDOT on AT, so all future RRC communities will incorporate cycling and walking, work with local health departments on HIAs, and increase national designations for bikeable and walkable communities the state receives.

Reducing Alcohol-Related Cancer: What Can Public Health Advocates, Policy Makers, and Cancer Charities Do?

Authors:

Marcia Bassier-Paltoo (Presenter)
Cancer Care Ontario

Norman Giesbrecht, Centre for Addiction and Mental Health
Rebecca Truscott, Cancer Care Ontario

Public Health Statement: Alcohol causes cancers of the oral cavity, pharynx, larynx, esophagus, colon and rectum, female breast, liver, and possibly pancreas. Despite the health and social consequences, alcohol is still being consumed in quantities that increase the risk for disease.

Purpose: This presentation will discuss alcohol and cancer, the low public awareness of this carcinogen and programs and policies that can address this growing public health burden.

Methods/Approach: Based on four main sources—

1. Meta-analyses, systematic reviews and seminal high quality recent studies – alcohol policy, programs, evidence for cancer;
2. Surveys of public perception of alcohol as a carcinogen;
3. Documentation of emerging programs and policies to reduce alcohol-related cancer risk;
4. Cancer charities with a strong alcohol policy perspective.

Results: Alcohol use and cancer evidence is extensive. However, surveys of general populations show that only a third, or less, are aware of alcohol as a carcinogen. The session will discuss evidence-based population health programs and policies that seek to address alcohol as a risk factor for cancer, including—

1. Minimum alcohol pricing.
2. Controlling alcohol availability.
3. Curtailing marketing and promotion.
4. Increasing access to brief counselling interventions.

Participants will highlight their own initiatives and experience in leveraging support and influence in advocating for interventions to reduce alcohol-related cancer risk especially for public health practitioners, policy makers and cancer prevention charities.

Conclusions/Implications: To reduce the harm from alcohol, including cancer risk, a combination of individual and population level interventions are needed. Public health advocates, governments and NGOs, including cancer prevention charities, have critical roles to play in a coordinated response.