Capacity Building for and Implementation of Policy, Systems, and Environmental Change: Results from a Survey of the National Comprehensive Cancer Control Program

Still Lost in Transition? Perspectives of Ongoing Cancer Survivorship Care Needs from Comprehensive Cancer Control Programs, Survivors, and Health Care Providers

Public health agencies have played a critical role in addressing the complex health and mental health needs of cancer survivors. We conducted a mixed-methods evaluation via a Web-based survey (n = 51) and focus groups (n = 11) with National Comprehensive Cancer Control Program (NCCCP) recipients and interviews (n = 9) with survivors, health care providers (HCPs), and patient navigators to explore these audiences’ cancer survivorship information needs and strategies to improve resource dissemination. Participants revealed a need for tailored resources and support for survivors on healthy lifestyle, post-treatment survivorship concerns, psychosocial health, and navigating the health system. HCP needs included education on survivorship care plans and care coordination to facilitate the transition between oncology and primary care. HCPs were survivors’ most trusted source for information; however, participants noted difficulties engaging HCPs in survivorship care. These findings can help public health practitioners focus their efforts to better meet the needs of cancer survivors and their HCPs.

Strengthening Resilience and Adaptive Capacity to Disasters in Cancer Control Plans: Lessons Learned from Puerto Rico

Patients with cancer are among the most vulnerable populations in the aftermath of a disaster. They are at higher risk of medical complications and death due to the collapse of or disruptions in the health care system, the community infrastructure, and the complexity of cancer care. The United Nations' Sendai Framework for Disaster Reduction states that people with life-threatening and chronic diseases should be considered in disaster plans to manage their risks. With extreme weather or disasters becoming more intense and frequent and with the high burden of cancer in the United States and its territories, it is important to develop region-specific plans to mitigate the impact of these events on the cancer patient population. After Hurricanes Irma and Maria hit Puerto Rico and the U.S. Virgin Islands in 2017, the need to develop and implement such plans for patients with cancer was evident. We describe ongoing efforts and opportunities for disseminating and implementing emergency response plans to maintain adequate cancer care for patients during and after disasters. While plans for patients with cancer should be housed within the emergency support function infrastructure of each jurisdiction, the Centers for Disease Control and Prevention's Comprehensive Cancer Control Plans provide excellent community-centered mechanisms to support these efforts.

Leveraging the strength of comprehensive cancer control coalitions to support policy, systems, and environmental change

Strategies that facilitate change to policy, systems, and environmental (PSE) changes can enable behaviors and practices that lead to cancer risk reduction, early detection, treatment access, and improved quality of life among survivors. Comprehensive cancer control is a coordinated collaborative approach to reduce cancer burden and operationalizes PSE change strategies for this purpose. Efforts to support these actions occur at the national, state, and local levels. Resources integral to bolstering strategies for sustainable cancer control include coordination and support from national organizations committed to addressing the burden of cancer, strong partnerships at the state and local levels, funding and resources, an evidence-based framework and program guidance, and technical assistance and training opportunities to build capacity. The purpose of this paper is to describe the impact of public policy, public health programming, and technical assistance and training on the use of PSE change interventions in cancer control. It also describes the foundations for and examples of successes achieved by comprehensive cancer control programs and coalitions using PSE strategies.

Promoting congregant health in faith-based organizations across Los Angeles County, 2013-2016

The Los Angeles County Department of Public Health (DPH) launched the Nutrition Education and Obesity Prevention (NEOP) Project in fall 2013. As the local arm of the Supplemental Nutrition Assistance Program Education (SNAP-Ed), this project partnered with faith-based organizations (FBOs) in Los Angeles County to implement policy, systems, and environmental change interventions (PSEs) at selected church sites, alongside the usual delivery of health education.

A 2-part programmatic assessment was conducted to better understand how the NEOP Faith Based Project at one of the FBOs was implemented during the 2013–2016 SNAP-Ed funding cycle. A qualitative component (key informant interviews) sought to understand and describe the PSE implementation process at each of the participating church sites, whereas the quantitative component (surveys) focused on assessing congregant perceptions about their awareness of the PSEs, their knowledge and beliefs about health, and their self-reported health behaviors after exposure to onsite changes.

Among congregants who participated in the survey, 52% expressed desire for more health education classes. However, only 37% reported being aware of them at church sites that hosted them. When asked to compare their behaviors for “today” versus 6 months ago, more than half reported greater interest in eating more fruits and vegetables (66%), choosing water over soda (69%), and becoming more physically active (59%).

Results from the NEOP Project have implications for how local health departments could partner with FBOs to outreach and promote health among congregants, particularly for those who are at high-risk of diet-related diseases due to poor nutrition and obesity.