Use of Evidence-Based Practices and Resources Among Comprehensive Cancer Control Programs.

CONTEXT: While efforts to promote use of evidence-based practices (EBPs) for cancer control have increased, questions remain whether this will result in widespread adoption of EBPs (eg, Guide to Community Preventive Services interventions) by comprehensive cancer control (CCC) programs. OBJECTIVE: To examine use of EBPs among CCC programs to develop cancer control plans and select interventions. DESIGN: Conducted Web-based surveys of and telephone interviews with CCC program staff between March and July 2012. SETTING: CCC programs funded by the Centers for Disease Control and Prevention's National Comprehensive Cancer Control Program (NCCCP). PARTICIPANTS: Sixty-one CCC program directors. MAIN OUTCOME MEASURES: 1) Use of and knowledge/attitudes about EBPs and related resources and 2) EBP-related technical assistance needs. RESULTS: Seventy-five percent of eligible program directors reported use of EBPs to a moderate or great extent to address program objectives. Benefits of using EBPS included their effectiveness has been proven, they are an efficient use of resources, and they lend credibility to an intervention. Challenges to using EBPs included resource limitations, lack of culturally appropriate interventions, and limited skills adapting EBPs for local use. Most respondents had heard of and used Web sites for The Guide to Community Preventive Services (95% and 91%, respectively) and Cancer Control P.L.A.N.E.T. (98% and 75%, respectively). Training needs included how to adapt an EBP and its materials for cultural appropriateness (state 78%, tribe 86%, territory 80%) and how to maintain the fidelity of an EBP (state 75%, tribe 86%, territory 60%). CONCLUSIONS: While awareness, knowledge, and use of EBPs and related resources are high, respondents identified numerous challenges and training needs. The findings from this study may be used to enhance technical assistance provided to NCCCP grantees related to selecting and implementing EBPs.

A captive audience: bringing the WISEWOMAN program to South Dakota prisoners.

PURPOSE: This analysis compares the baseline heart disease risk profile of WISEWOMAN participants screened in the South Dakota Women's Prison with the general WISEWOMAN population in South Dakota and explores the potential benefits of lifestyle intervention programs to reduce heart disease risk factors among women during incarceration. METHODS: Using baseline data for WISEWOMAN participants in South Dakota, we compared participants who were enrolled in prison (n = 261) with nonincarcerated participants enrolled throughout the state (n = 1,427). Using regression analysis and adjusting for demographics, we assessed differences in baseline prevalence of risk factors (hypertension, high cholesterol, smoking, and obesity), awareness and treatment of hypertension and high cholesterol, and attendance at lifestyle intervention sessions. RESULTS: Incarcerated participants had significantly lower (p < .01) total cholesterol (183 mg/dL) than nonincarcerated participants (199 mg/dL). However, a significantly higher (p < .03) percentage of incarcerated women (85%) than nonincarcerated women (54%) with high cholesterol were unaware of their condition. Despite the smoke-free status of the prison, 24% of incarcerated participants reported smoking. Attendance at lifestyle intervention sessions was significantly higher among incarcerated participants than among nonincarcerated participants with intervention take-up rates of 53% among incarcerated versus 23% among nonincarcerated women (p < .01) and intervention completion rates of 43% and 4% (p < .01). CONCLUSIONS: The results illustrate the need for screening and education programs in prisons. WISEWOMAN screenings helped identify undiagnosed cases of abnormal blood pressure and cholesterol, and educational interventions provided women with opportunities to improve their health. Such programs may also improve discharge planning and linkages between released women and community health providers.

Health promotion interventions for disadvantaged women: overview of the WISEWOMAN projects.

BACKGROUND: The Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) program aims to remove racial and ethnic disparities in health by addressing the screening and intervention needs of midlife uninsured women. This paper describes the WISEWOMAN program requirements, the design of the 12 projects funded in 2002, the use of a standardized data reporting and analysis system, risk factors among participants, effective behavioral strategies, and plans for the future. METHODS: The WISEWOMAN demonstration projects are examining the feasibility and effectiveness of adding a cardiovascular disease (CVD) prevention component to the early detection of breast and cervical cancer. Women aged 40-64 are eligible if they are enrolled in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) in selected U. S. states and are financially disadvantaged and lack health insurance. The primary outcome measures are blood pressure, lipid levels, and tobacco use. Intermediate measures include self-reported diet and physical activity, measures of readiness for change, and barriers to behavior change. RESULTS: During 2002, the 10 projects that were fully operational screened 8164 financially disadvantaged women and developed culturally and regionally appropriate nutrition and physical activity interventions for a variety of racial and ethnic backgrounds. Twenty-three percent of the women screened had high total cholesterol, with 48% of these being newly diagnosed. Thirty-eight percent of the women had high blood pressure, with 24% being newly diagnosed. Approximately, 75% of participants were either overweight or obese, and in some sites up to 42% were smokers. CONCLUSIONS: The WISEWOMAN demonstration projects have been successful at reaching financially disadvantaged and minority women who are at high risk for chronic diseases. These projects face challenges because they are generally implemented by safety net providers who have limited resources and staff to conduct research and evaluation. On the other hand, the findings from these projects will be especially informative in reducing health disparities because they are conducted in those settings where the most socially and medically vulnerable women receive care.