Promising practices for the prevention of liver cancer: a review of the literature and cancer plan activities in the National Comprehensive Cancer Control Program.

INTRODUCTION: Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are risk factors for hepatocellular carcinoma, a type of primary liver cancer, and are most prevalent in people born 1945-1965. Relatively little information is available for liver cancer prevention, compared to other cancers. In this review, we provide a summary of current promising public health practices for liver cancer prevention from the literature, as well as liver cancer-related initiatives in the National Comprehensive Cancer Control Program (NCCCP). METHODS: Two types of source materials were analyzed for this review: published literature (2005-present), and current cancer plans from the NCCCP (2005-2022). A search strategy was developed to include a review of several scientific databases. Of the 73 articles identified as potentially eligible, 20 articles were eligible for inclusion in the review. Eligible articles were abstracted using a data abstraction tool. Three independent keyword searches on 65 NCCCP plans were conducted. Keyword searches within each of the plans to identify activities related to liver cancer were conducted. Relevant information was abstracted from the plans and saved in a data table. RESULTS: Of the 20 eligible articles, 15 articles provided information on interventions related to liver cancer and hepatitis B or hepatitis C prevention. All 15 of the intervention articles were related to hepatitis; 13 were hepatitis B-focused, two were hepatitis C-focused, and 14 focused on Asian/Pacific Islander American populations. The independent keyword search of NCCCP plans produced 46 results for liver, 27 results for hepatitis, and 52 results for alcohol. Two plans included activities related to liver cancer. Twenty-four plans included activities related to hepatitis. DISCUSSION: A majority of the intervention articles published focused on HBV infection in Asian/Pacific Islander American populations, and a small percentage of NCCCP plans included liver-related content. The findings from this review will inform the development of an Action Plan on liver cancer prevention for the NCCCP, which will assist programs with the adoption and uptake of promising practices for the prevention of liver cancer.

Collaborative drug therapy management: case studies of three community-based models of care.

Collaborative drug therapy management agreements are a strategy for expanding the role of pharmacists in team-based care with other providers. However, these agreements have not been widely implemented. This study describes the features of existing provider-pharmacist collaborative drug therapy management practices and identifies the facilitators and barriers to implementing such services in community settings. We conducted in-depth, qualitative interviews in 2012 in a federally qualified health center, an independent pharmacy, and a retail pharmacy chain. Facilitators included 1) ensuring pharmacists were adequately trained; 2) obtaining stakeholder (eg, physician) buy-in; and 3) leveraging academic partners. Barriers included 1) lack of pharmacist compensation; 2) hesitation among providers to trust pharmacists; 3) lack of time and resources; and 4) existing informal collaborations that resulted in reduced interest in formal agreements. The models described in this study could be used to strengthen clinical-community linkages through team-based care, particularly for chronic disease prevention and management.

Mammography adherence: a qualitative study.

BACKGROUND: Regular mammography accounts for half of the recent declines in breast cancer mortality. Mammography use declined significantly in 2008. Given the success of regular breast cancer screening, understanding why mammography use decreased is important. We undertook a focus group study to explore reasons women who were previously adherent with regular mammography no longer were screened. METHODS: We conducted 20 focus groups with white non-Hispanic, black non-Hispanic, Hispanic, Japanese American, and American Indian/Alaska Native women, and segmented the groups by age, race/ethnicity, and health insurance status. A conceptual framework, based on existing research, informed the development of the focus group guide. Discussion topics included previous mammography experiences, perceptions of personal breast cancer risk, barriers to mammography, and risks and benefits associated with undergoing mammography. Atlas.ti was used to facilitate data analysis. RESULTS: All focus groups (n=128 women) were completed in 2009 in five cities across the United States. Half of the groups were held with white non-Hispanic women and the remainder with other racial/ethnic groups. Major barriers to routine mammography included (1) concerns about test efficacy, (2) personal concerns about the procedure, (3) access to screening services, (4) psychosocial issues, and (5) cultural factors. For uninsured women, lack of health insurance was the primary barrier to mammography. CONCLUSIONS: Multilevel interventions at the health-care provider and system levels are needed to address barriers women experience to undergoing regular mammography screening. Ultimately, breast cancer screening with mammography is an individual behavior; therefore, individual behavioral change strategies will continue to be needed.

Contribution of the school environment to physical fitness in children and youth.

BACKGROUND: This study analyzed the effect of school practices regarding the provision of physical education (PE) on the physical fitness of children and youth. METHODS: Using an untapped sample of approximately 5000 5th and 7th graders from 93 schools in Georgia in 2006, individual-level and merged school-level data on physical education were analyzed. Multivariate regression analyses were conducted to estimate the potential influence of the school environment on measured health outcomes. Controls were included for grade, gender, race/ethnicity, urbanicity, and county of residence. RESULTS: Variables measuring 8 school-level practices pertaining to physical education were found to have significant effects on cardiovascular fitness as measured by the FitnessGram, with signs in the expected direction. These variables, combined with demographic variables, explained 29.73% of the variation in the Progressive Aerobic Cardiovascular Endurance Run but only 4.53% of the variation in the body mass index. CONCLUSIONS: School-level variables pertaining to PE practices were collectively strong predictors of physical fitness, particularly cardiovascular fitness. Schools that adopt these policies will likely encourage favorable physical activity habits that may last into adulthood. Future research should examine the causal relationships among physical education practices, physical activity, and health outcomes.

Community capacity building in CDC's Community Coalition Partnership Programs for the Prevention of Teen Pregnancy.

PURPOSE: To describe lessons learned from the Centers for Disease Control and Prevention's Community Coalition Partnership Program (CCPP) about building a community's capacity to prevent teen pregnancy through strengthening of partnerships, mobilization of community resources, and changes in the number and quality of community programs. METHODS: A multi-component post-test-only evaluation. In-person interviews (n = 364) were conducted with a sample of CCPP project staff, evaluators, and community and agency members from each of the 13 CCPP communities. RESULTS: All partnerships reported that new groups worked together to address teen pregnancy prevention; however, more time, effort, and resources than anticipated were spent engaging these groups and strengthening their partnerships. Respondents reported increases in community awareness of the problem of teen pregnancy and the willingness to discuss the issue. As a result of partnerships' activities, knowledge and skills related to addressing teen pregnancy improved among partnership members, but respondents were concerned that the broader community did not share these gains. To a lesser extent, respondents reported that partners worked together to reduce duplication and fill gaps in services either through increased collaboration and/or differentiation of activities. Respondents from most of the partnerships also reported new programs were developed as a result of the project; however, in several partnerships, only a few programs were developed in their community. Many respondents doubted whether the limited mobilization of resources during the program would translate into increased agency and community capacity. CONCLUSIONS: Overall, increased partner skills, program improvements, and new programs did not appear to be sufficient to affect community capacity. Research is needed to identify the pathways between changes in community capacity and in individual-level behavior that might result in the avoidance or reduction of teen pregnancy.

Coalition models: lessons learned from the CDC's Community Coalition Partnership Programs for the Prevention of Teen Pregnancy.

PURPOSE: To describe the models created by the 13 communities in the Centers for Disease Control and Prevention's Community Coalition Partnership Program (CCPP), and the relationship between key organizational features of the coalitions and the perception by coalition members of interim and community-wide outcomes. METHODS: This study relied on three sources of data: interviews conducted on site with a sample of coalition staff, evaluators, and members (n = 364); a written survey administered after the site visit to those interviewed (n = 216) asking about perceived outcomes and changes between the beginning and end of the project; and a coalition member survey mailed to all coalition members at all sites (n = 341) focusing on perceptions of coalition functioning, outcomes, and satisfaction. RESULTS: A variety of coalition models were developed. Respondents were positive in their assessments of how their coalitions operated even though few were sustained. The coalitions for which members perceived more positive outcomes were better established at the outset of the grant, led by paid staff, and had an area-wide focus, a steering committee, and a hub that was not a community-based organization. Coalitions composed primarily of neighborhood members were difficult to maintain. CONCLUSIONS: Despite members' high ratings, by the end of the funding period most coalitions were no longer functioning. It may be that coalitions are useful but not as permanent structures in communities. Grassroots and individual members not affiliated with an agency may require meaningful incentives to sustain participation. Because maturity of the coalition at the start of the project was a good predictor of sustainability, time should be spent verifying the stage of coalition development before funding.