4CNC promotes the use of evidence-based interventions to prevent cancer, detect cancer at earlier stages, and improve treatment outcomes in communities across North Carolina.  We are dedicated to:

  • Providing training, technical assistance, and tools to support the adoption and implementation of proven cancer prevention and control interventions;
  • Conducting research to understand factors that contribute to the effective implementation of evidence-based cancer prevention and control strategies.

Topic area(s): Technical Assistance and Training, Dissemination, Implementation, Health Equity; Colorectal and Cervical Cancer Screening, HPV vaccination, Tobacco Prevention and Control.   

Purpose

The 4CNC vision includes health care providers, community members, and researchers working together to reduce the burden of cancer, especially among those who are disproportionately affected. Our purpose is to conduct community-based cancer prevention and control research that:

  • Identifies effective clinical and public health cancer prevention and control interventions and supports decision making related to intervention impact across different contexts;
  • Applies implementation strategies to integrate effective cancer prevention and control interventions into a wide range of clinical and community settings;
  • Develops and evaluates training, technical assistance, and tools to increase community and clinical partners’ capacity to select, adapt, implement, and sustain evidence-based interventions.

4CNC Core Projects

Partnership with Counter Tools©

Dr. Jennifer Leeman partners with Counter Tools, a 501(c)(3) non-profit created by Drs. Kurt Ribisl and Allison Myers, to provide training, tools, and other strategies to support community efforts to enact policies to reduce exposure to tobacco marketing in the retail environment. 4CNC’s partnership with Counter Tools aims to develop intermediate outcome measures for use in policy implementation research.

Putting Public Health Evidence into Action Curriculum

Under the leadership of Dr. Jennifer Leeman, 4CNC continues to partner with Dr. Cam Escoffery at Emory University to disseminate and provide training on Putting Public Health Evidence in Action, an interactive curriculum to support community program planners and health educators in developing skills in using evidence-based interventions and learning about new tools for planning and evaluating community health interventions. The latest curriculum is posted on the Cancer Prevention and Control Research Network website.

Colorectal Cancer Screening in Federally Qualified Health Centers (FQHCs)

The research team includes four members with expertise in colorectal cancer screening (Wheeler, Reuland, Brenner, and Rohweder). 4CNC provides an opportunity for these researchers to collaborate and benefit from other team members’ expertise. In addition to writing proposals for external funding, a workgroup has been developed to adapt the CPCRN’s “Putting Public Health Evidence Into Action” for colorectal cancer screening.  Under the leadership of Drs. Jennifer Leeman and Catherine Rohweder, the workgroup builds upon the Federally Qualified Health Centers (FQHC) Signature Project to develop a curriculum for practice facilitators that incorporates quality improvement techniques to increase colorectal cancer screening initiatives in community health centers and primary care associations.

Increasing HPV Vaccination

4CNC researchers Drs. Noel Brewer and Jennifer Leeman collaborate on interventions to enhance the CDC’s AFIX intervention with the goal of increasing HPV vaccination coverage among adolescents. Following completion of a three year RWJF-grant, team members received funding for a CDC-grant to continue and extend their work. In addition, Dr. Brewer is chairing The National HPV Vaccination Roundtable, a national coalition of public, private, and voluntary organizations with expertise relevant to increasing HPV vaccination coverage in the U.S. as a way to reduce the incidence of and mortality from HPV-associated cancers, through coordinated leadership, strategic planning and advocacy. Approximately 70 organizations participate on the Roundtable based on their involvement in HPV vaccination activities or prevention of HPV-associated cancers, their ability to deliver education or vaccination, or their expertise related to expanding HPV vaccination.

  • Source: Centers for Disease Control and Prevention (CDC) PRC Special Interest Projects and the National Cancer Institute (NCI)
  • Dates of funding: September 30, 2005 – September 29, 2014

Cross-Center Projects

Federally Qualified Health Centers (FQHC) Signature Project

Dr. Catherine Rohweder co-leads this CPCRN cross-center project, which has the goal of strengthening and evaluating existing colorectal cancer (CRC) screening initiatives at the patient, clinic, and community level in order to increase CRC screening rates among the patient populations served by FQHCs.

The study aims to answer the following questions:

  • What evidence-based interventions (e.g., client reminders, provider assessment and feedback) are FQHCs currently using to increase CRC screening rates?
  • What evidence-based implementation strategies (e.g., patient navigation, practice facilitation) are FQHCs currently using to put CRC screening interventions into practice?
  • What types of implementation supports (tools / training / technical assistance / other resources) are FQHCs currently accessing and what is their experience with those supports?
  • How ready are FQHCs to implement and evaluate multi-level interventions to increase CRC screening rates?
  • How are FQHCs using the tools, trainings, and technical assistance developed for study activities?

Findings from surveys and interviews will inform subsequent training and technical assistance around implementing multi-level interventions in community health centers.  Drs. Leeman and Brenner also serve on this working group.

Cervical Cancer Workgroup

Recent studies indicate that adherence to new (2009, 2012) Cervical Cancer Screening guidelines is low and patients and providers are reluctant to lengthen screening intervals. Dr. Noel Brewer participates in this workgroup’s systematic review of interventions to “de-escalate” guidelines that are no longer evidence-based.

Modeling Evidence-Based Intervention (EBI) Impact Workgroup

Dr. Stephanie Wheeler serves as chair of the Modeling EBI Impact workgroup which includes collaborations with investigators at Oregon Health and Sciences University and North Carolina State University.  Her work through this group is focused on:

  • Understanding regional and sub-population specific trends and predictors of CRC screening and outcomes to inform mathematical modeling estimates of the burden of CRC in specific regions and populations
  • Developing decision support models to engage stakeholders in optimizing CRC screening rates in specific settings by quantifying anticipated cost and health impact of EBIs
  • Using mathematical models to project effects of specific policies (e.g., Medicaid expansion) on CRC screening and outcomes
  • Quantifying uncertainty in decision making

Tobacco and Lung Cancer Workgroup

Drs. Dan Reuland and Alison Brenner collaborate on this cross-center initiative which aims to understand barriers and facilitators faced by community health centers related to implementing both: 1) tobacco assessment and cessation assistance/referral (USPSTF grade A recommendation); and 2) low dose computed tomographic (LDCT) scan for lung cancer screening (the USPSTF grade B recommendation). A survey was developed and conducted to assess current practices, resources and potential barriers to these preventive services.

Funders

  • 4CNC is funded by Cooperative Agreement Number 3 U48 DP005017-01S8 from the Centers for Disease Control and Prevention’s Prevention Research Centers Program and the National Cancer Institute.
  • Funding cycle is September 30, 2014 – September 29, 2019

Key Contacts

Principal Investigator: Jennifer Leeman, DrPH, MDiv

Telephone: (919) 966-3648

Email: jleeman@email.unc.edu

Project Director: Catherine Rohweder, DrPH

Telephone: (919) 923-0784

Email: rohweder@email.unc.edu

4cnc faculty and staff

Our team includes UNC faculty and staff from the School of Nursing, Gillings School of Global Public Health, the Cecil G. Sheps Center for Health Services Research, the Center for Health Promotion and Disease Prevention, and Lineberger Comprehensive Cancer Center.

Co-Investigators:

Alison Brenner, PhD, MPH                Email: alison.brenner@unc.edu

Noel Brewer, PhD, MS                     Email: ntb@unc.edu

Daniel Reuland, MD, MPH                Email: dreuland@med.unc.edu

Stephanie Wheeler, PhD, MPH          Email: stephanie_wheeler@unc.edu

Graduate Research Assistant:

Kathleen Knocke                             Email: kathleenknocke@unc.edu

Research Associate:

Mary Wangen                                  Email: wange062@live.unc.edu

Partners