2: No. 1, January 2005
COMMUNITY CASE STUDY
The Cancer Prevention and Control Research Network
Jeffrey R. Harris, MD, MPH, MBA, Pamela K. Brown, MPA, Steven Coughlin, PhD, Maria E. Fernandez, PhD, James R. Hebert,
ScD, Jon Kerner, PhD, Marianne Prout, MD, MPH, Randy Schwartz, MSPH, Eduardo
J. Simoes, MD, MSc, MPH, Carol White, MPH, Katherine Wilson, PhD
Suggested citation for this article: Harris JR, Brown PK, Coughlin
S, Fernandez ME, Hebert JR, Kerner J, et al. The Cancer Prevention and Control
Research Network. Prev Chronic Dis [serial online] 2005 Jan [date
cited]. Available from: URL:
The Cancer Prevention and Control Research Network is a national network
recently established to focus on developing new
interventions and disseminating and translating proven interventions into
practice to reduce cancer burden and disparities, especially among minority
and medically underserved populations. Jointly funded by the Centers for
Disease Control and Prevention and the National Cancer Institute, the Cancer
Prevention and Control Research Network consists of sites administered through
Prevention Research Centers funded by the Centers for Disease Control and
Prevention. The five sites are located in Kentucky, Massachusetts, South Carolina, Texas,
Washington State, and West Virginia. The Cancer Prevention and Control
Research Network’s intervention areas include primary prevention of cancer
through healthy eating, physical activity, sun avoidance, tobacco control,
and early detection of cancer through screening. The Cancer Prevention
and Control Research Network uses the methods of community-based participatory
research and seeks to build on the cancer-relevant systematic reviews of the
Guide to Community Preventive Services. Initial foci for the Cancer
Prevention and Control Research Network’s research work groups include
projects to increase screening for breast, cervical, and colorectal cancers;
to promote informed decision making for prostate cancer screening; and to
validate educational materials developed for low-literacy populations.
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The Cancer Prevention and Control Research Network (CPCRN) is a federally
funded, national network of academic, public health, and community
partnerships that work together to reduce the burden of cancer, especially
among those disproportionately affected. The CPCRN was initiated in October
2002, with funding from the Centers for Disease Control and Prevention (CDC)
and the National Cancer Institute (NCI) as part of their effort to more
effectively translate research into practice. The five CPCRN sites were
selected through a competition among the CDC-funded Prevention Research
Centers (PRCs). Three sites are operated by individual universities: the
Universities of South Carolina, Texas-Houston, and Washington. Two sites are
operated jointly by pairs of universities: Boston and Harvard Universities;
and the University of Kentucky and West Virginia University. This paper
introduces the CPCRN; outlines the context for its creation, along with its
goals, structure, and operations; and summarizes progress to date.
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Although the CPCRN sites carry out most of
their work locally, the CPCRN is a national network and was developed in a
national context. The CPCRN is a further step in efforts by two federal
agencies, the CDC and the NCI, to translate research into practice with
potential for reducing the cancer burden in the United States, especially
among populations that are disproportionately affected. The context for the CPCRN, discussed in detail below, consists of four factors. First, the cancer
burden in the United States remains high, and disparities in incidence and
mortality persist. Second, one of the best opportunities to reduce these
disparities is through community-based participatory research. Third, recently
published syntheses of research, such as the CDC’s Guide to
Community Preventive Services (Community Guide) (1), suggest
specific areas where carefully evaluated dissemination research is
needed. Finally, the CDC’s PRC Program (2), with its focus on community-based
participatory research (CBPR) and translation, provides a unique combination
of trained, experienced investigators and infrastructure to support a network
like the CPCRN.
Cancer burden in the United States
The creation of the CPCRN is, in part, a response to the growing magnitude
of and persistent disparities in cancer burden. Cancer is the second leading
cause of death in the United States as well as a leading cause of morbidity.
Cancer accounts for one of every four deaths (3), and, in 2004, 563,700 people
are expected to die of cancer. In 2004, 1,368,030 new cancer cases are
expected to be diagnosed in the United States (3), not including carcinoma in
situ or basal and squamous cell skin cancers. The top four cancer sites (with
expected numbers of cases) are prostate (230,110), breast (217,440), lung
(173,770), and colorectal (150,950). In addition, more than 1 million cases of
basal and squamous cell skin cancer are expected to be diagnosed in 2004.
Disparities in cancer incidence and mortality persist. For example, the
incidence of cervical cancer is four times as high among Vietnamese women as
it is among other Asian American and Pacific Islander women (3). Overall, cancer
mortality among African American men is 1.4 times higher than among whites,
and cancer mortality among African American women is 1.2 times higher than
among whites (4). Additional disparities in cancer
incidence and mortality rates across major racial and ethnic groups in the
United States are highlighted in recent reports (3,5) and below in
descriptions of the CPCRN sites.
Those disparities are the result of a complex array of economic, social,
and cultural factors, and these factors are also reflected in disparities in
preventive behaviors. For example, smoking prevalence is now highest among
American Indian (38.6%) and Alaska Native (27.4%) men and women (3,5).
Screening prevalence for colorectal cancer is the lowest among Hispanics and
Latinos (3,5). To optimize the effect of cancer prevention efforts relative to
expenditure, we need to be clear about 1) the efficiency of intervening on
known risk factors early in the natural history of the carcinogenic process
(e.g., reducing use of tobacco products, improving access to fresh fruits and
vegetables), 2) the utility of various preventive services (e.g., screening),
and 3) the willingness of communities to be engaged in cancer prevention and
The importance of community-based participatory research
The CPCRN embraces the principles of CBPR (6) as core values. Research and
evaluation developed with communities in a participatory way are more likely
to reflect the needs, interests, and values of the community. Also, after
research funding has ended, the results from such research and evaluation are
more likely to be widely disseminated and the interventions to be sustained
(7). The CPCRN has made a commitment in each of its sites to implement
activities in a manner that is community-based and participatory to strengthen
local resources and to build the capacity of community organizations to
conduct and translate research. The CPCRN’s commitment to CBPR is consistent
with the strong and growing commitment of funding agencies to support this
type of research partnership (8).
The need for research dissemination and translation
The need for the CPCRN is highlighted by recent reports of both progress
against cancer and remaining challenges in disseminating and translating
knowledge gained from efficacy and effectiveness research. During the late
1990s, death rates from the four leading cancers — lung, colorectal, breast,
and prostate — declined nationally and in most states (5). Two important
prevention strategies have contributed to this decline but remain underused:
1) primary prevention by reducing risk behaviors and 2) early detection by
increasing the use of screening services (3).
Both the NCI and the CDC have given high priority to bridging the dissemination
gap. The NCI’s Translating Research into Improved Outcomes program has identified
the dearth of dissemination research as a key impediment to the adoption of
evidence-based cancer control intervention. The program has also identified
the need to expand research/practice partnerships as critical to both the
adoption and evaluation of evidence-based interventions in public health and
clinical practice settings (9).
The Community Guide, developed under the aegis of an independent,
nonfederal Task Force on Community Preventive Services and maintained at the
CDC, has provided a partial summary of the state of the art of community-based
cancer prevention and control. Based on a systematic review of the literature,
the Community Guide currently recommends 14 interventions aimed at
increasing physical activity, reducing exposure to and use of tobacco, and
reducing exposure to ultraviolet light (Table 1) (10-13). In addition to these
recommendations, the Task Force has recently completed recommendations for
increasing informed decision making regarding cancer screening (14) and plans
to publish its reviews of interventions to increase cancer screening in 2005.
The CDC has a ready dissemination outlet for proven intervention strategies
through its state-based cancer prevention and control programs: the National
Breast and Cervical Cancer Early Detection Program and the Comprehensive
Cancer Control Program.
The CDC Prevention Research Centers program
The prior investment of the CDC in its PRC program facilitated the creation
of the CPCRN by providing a well-established administrative home for each of
the five sites. In 1984, Congress created the PRC program at the CDC by
authorizing the funding of academic health centers for innovative research and
demonstration projects to prevent chronic disease. In 1986, the CDC
established three PRCs for two years. Since then, the funding period has
increased to five years, and the number of centers has grown to 28, which are located in
Three aspects of the PRC program strengthen the ability of the
participating CPCRN sites to design, implement, and evaluate cancer prevention
research with immediate application to public health practice. First, the PRC
peer-review mechanism involves researchers experienced with CBPR. The peer
review process provides assurance that applications are scientifically sound and that
the research conducted is of practical use to communities. Second, the
program’s focus on CBPR enhances the likelihood that the PRCs will evaluate
acceptable and sustainable community-based interventions. Partnerships and
collaborations of PRCs with various entities (e.g., businesses, community
coalitions, grassroots organizations, private health care providers, state and
local public health agencies, voluntary health organizations) increase the
likelihood that PRCs will produce evaluations of interventions that are likely
to be translated and sustained. Third, research conducted among the most
disadvantaged and underserved populations in the nation provides the PRCs with
the opportunity to evaluate the external validity of interventions among
diverse populations, including the rural poor of Appalachia, African Americans
in South Carolina, public housing residents in Boston, residents of the
U.S.-Mexico border, and loggers and pulp-mill workers in Washington State.
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The overall goal for the CPCRN is to conduct community-based cancer
prevention and control intervention and dissemination research that extends
the knowledge base, addresses critical gaps, and leads to adoption,
replication, implementation, and dissemination of successful programs in
The CPCRN addresses gaps and builds on recommendations in the Community
Guide by conducting site-specific and multisite intervention and
dissemination research. The four specific research areas include 1) research
on the effectiveness of community-based interventions for which evidence is
insufficient to justify a Community Guide recommendation; 2) research
replicating Community Guide-recommended interventions in populations
and settings where they have not been adequately evaluated; 3) research on how
to disseminate and implement Community Guide-recommended interventions
into communities by public health and community-based organizations; and 4)
evaluation of community programs to determine their effectiveness.
The initial funding of the CPCRN for a two-year period supported the
development of both local network centers and the larger national network of
the CPCRN sites. At both levels, expected outcomes are evidence of the
networks’ existence and viability, including mission and vision statements,
short- and long-term objectives, and active working groups. Of special
emphasis in the research arena are efforts to develop strong partnerships with
communities bearing the greatest burden from cancer, where community-based
participatory research projects are likely to contribute to the reduction
and/or the elimination of disparities in cancer burden.
Cancer Prevention and Control Research Network structure and operations
The CPCRN is a national network of five
sites, each of which is a local network of academic, community, and
other organizations with an interest in cancer prevention and research. The
work of the CPCRN is led by a Coordinating Center that organizes, among other
things, cross-site work groups on research topics of mutual interest to the
sites, the CDC, and the NCI. The six sections that follow describe the work of
the Coordinating Center and of each of the five local sites.
Cancer Prevention and Control Research Network Coordinating Center
The University of Kentucky and West Virginia University share the
coordinating center role for the CPCRN. The Coordinating Center guides
discussions on developing research tools for community interventions in cancer
prevention and control, organizes collaborative activities with CPCRN members
and their partners, fosters relationships among CPCRN members and
national/state/local partners to ensure that CPCRN objectives are being
achieved, and provides leadership in developing and managing the CPCRN
Specific activities include 1) developing and implementing a plan and
system for effective communication among CPCRN centers; 2) implementing a
collaborative planning process resulting in a seven-year plan for CPCRN
research, dissemination, and evaluation; 3) implementing processes and
procedures for encouraging PRCs to develop collaborative cancer prevention and
control research projects; and 4) ensuring that external evaluation is
conducted and is focused on the Coordinating Center's performance.
Alliance for Reducing Cancer, Northwest
The site based at the University of Washington is the Alliance for Reducing
Cancer, Northwest (ARC NW; available from: URL: http://www.arcnw.org*). The mission of the ARC NW is to
increase primary-preventive and early-detection behaviors to prevent and
control cancer in the Puget Sound region, Washington State, and the Pacific
Northwest. ARC NW is a collaborative effort among the University of Washington PRC, the American Cancer Society Great West Division; Fred Hutchinson Cancer
Research Center; Group Health Cooperative of Puget Sound, a health maintenance
organization; Public Health Seattle and King County, a local health
department; the Puget Sound Neighborhood Health Centers, an organization of
several community health centers in the region; Qualis Health, the Medicare
quality improvement organization for Alaska, Idaho, and Washington State; the
Washington State Department of Health; and the Weyerhaeuser Company, a large timber
Data from the Washington State Behavioral Risk Factor Surveillance System
reveal underuse of primary-preventive and early-detection behaviors. In 2002,
21% of Washingtonians aged 18 or older smoked, 15% were physically
inactive during leisure time, 76% ate inadequate quantities of fruits and
vegetables, and 60% were overweight or obese. Also in 2002, among appropriate
age groups, 45% had never received a flexible sigmoidoscopy or colonoscopy,
40% had never received a fecal occult blood test, 26% had not received a
mammogram within two years, and 13% had not received a Papanicolaou (Pap) test
within three years (15).
One important factor in the underuse of these behaviors is the lack of
support for prevention at the worksite and in employer-based health insurance.
At the worksite, employers of all sizes reported in a 2001 national
survey the following offerings: 11% offered fitness services and 5% offered
tobacco-cessation services (personal communication, Maris Bondi, Partnership
for Prevention, November 2003). Employers of all
sizes nationwide reported in the same survey the following health insurance offerings: 80%
covered mammograms, 79% covered Pap smears, 68% covered colorectal cancer
screening, and 10% covered smoking cessation treatment that included both
prescription medications and counseling.
The ARC NW focuses on employed populations and on underserved communities.
Five current activities include 1) a pilot test, involving the Weyerhaeuser
Company, of a policy intervention to promote primary prevention and early
detection via the worksite and employment-based health insurance; 2)
development of a work site-based, team-oriented intervention to promote
primary prevention and early detection of cancer; 3) a pilot test of a tool to
increase informed decision making regarding prostate cancer screening; 4)
assistance to the Washington State Department of Health in designing and
evaluating its colorectal and prostate cancer screening programs; and 5) a
review of the literature regarding the quality of life after treatment of
Appalachian Cancer Research Consortium
The site based at the University of Kentucky and West Virginia University
is the Appalachian Cancer Research Consortium (ACRC). The target population of
the ACRC includes the poor, medically underserved, and primarily rural residents of
West Virginia and the 51 counties in Appalachian Kentucky. The two
universities have a long history of collaboration, with extensive
experience in working with communities throughout Appalachia on critical
The U.S. Department of Health and Human Services considers the rural
residents of Appalachia a “special population” (16). These residents tend to
be older, poorer, less educated, and more likely to be uninsured than urban
Americans. Rural communities have higher rates of chronic illness and
disability and report poorer overall health status than urban communities
(16). Residents of rural areas generally have fewer visits with physicians and
lower levels of preventive care. In addition to factors related to rural
health status and practices, there are systemic factors related to rural life
that may contribute to less than optimal preventive care (17).
These factors include lack of public transportation, lack of health care providers, and
lower levels of community services.
As a result, West Virginia and the Appalachian regions of Kentucky have
higher total cancer mortality rates than the national average (18,19). Both
states rank among the top 10 U.S. states for total, male, and female cancer
mortality. Lung cancer is a significant problem for residents, accounting for
approximately 30% of all cancer deaths in West Virginia and Kentucky and
resulting in a higher lung cancer mortality rate than the U.S. rate. Kentucky and West Virginia have invasive cervical cancer
incidence and mortality rates that are significantly higher than the U.S.
rates. West Virginia and Appalachian Kentucky also have higher colorectal
cancer mortality rates than the United States and Appalachia as a whole.
Breast cancer mortality rates are similar to national rates, but breast cancer
mortality in several rural counties exceeds the national rate by more than
The ACRC focuses its efforts primarily on four cancer sites — lung, cervix,
colorectal, and breast — with high disease burden, high behavioral risks, and
high importance to community members in the region. Current activities of the
ACRC include 1) developing a standardized assessment tool to evaluate
readability, format, illustrations, and content of cancer prevention and
control materials; 2) developing a protocol for colorectal cancer intervention
for men and women aged 50 and older; and 3) conducting work site focus
groups to identify barriers to colorectal screening for public employees aged
50 and older.
Latinos in a Network for Cancer Control
The site based at the University of Texas (UT) is Latinos in a Network for
Cancer Control (LINCC; available from: URL: http://www.sph.uth.tmc.edu/research/lincc*). The mission of the LINCC
is to reduce cancer-related health disparities among Hispanics/Latinos through
community-based intervention, replication, and dissemination research. LINCC is a collaboration among 1) academic researchers at the UT School of
Public Health, the UT M.D. Anderson Cancer Center, and the Baylor College of
Medicine; 2) cancer control organizations, including the American Cancer
Society, Cancer Information Service, Sanchez Cancer Center, Texas Cancer
Council, Texas Comprehensive Cancer Coalition, and the Texas Department of
Health; and 3) community-based organizations, including the Center for Border
Health Research, Hispanic Health Coalition, Migrant Health Promotion, the
National Center for Farmworker Health, and the Racial and Ethnic Approaches to
Community Health coalition.
Hispanics/Latinos in Texas account for approximately 25% of the total U.S.
Hispanic population and 32% of the total Texas population (20). Along the
U.S.-Mexico border where LINCC has focused its initial research efforts,
Hispanics comprise roughly 80% of the population (21). Many border residents
experience high rates of poverty and live in colonias, unincorporated
areas where environmental pollution, inadequate wastewater systems, and
inadequate access to public drinking water compound socioeconomic influences
on health behavior.
Hispanics in the United States experience higher incidence rates of
cervical cancer per 100,000 (16.3) compared with non-Hispanics (7.8) and higher rates of mortality
per 100,000 (3.7 compared with 2.6)
(22). Along the U.S.-Mexico border, the disparity is even greater: the
incidence rate of cervical cancer per 100,000 among Hispanics (18.7) is higher
than the rate among non-Hispanics (8.2), and the mortality rate
among Hispanics (6.2) is higher than the rate among non-Hispanics
(3.4) (23). In addition, Hispanics have lower rates of cancer
screening. Only 27% of the older Hispanic adults in Texas reported having a
recent fecal occult blood test for colorectal cancer (compared with 34% among
non-Hispanic whites), and only 50% reported regular mammography use (compared
with 60% for non-Hispanic whites) (24). Use of Pap tests for cervical cancer
screening among Hispanics (83%) was also lower compared with non-Hispanic
whites (87%) (22).
Current LINCC activities include 1) new research on factors influencing
colorectal cancer screening among Hispanics and the development of a
community-based intervention to increase this screening; 2) research on
informed decision making for prostate and colorectal cancer screening; 3) an
evidence review and new research on lay health-worker- (promotora-)
based interventions for increasing cancer screening; and 4) research on the
effectiveness of small media interventions to increase cancer screening.
Another major focus of LINNC is to identify important factors and
effective strategies for replicating and disseminating effective cancer
control interventions in Hispanic communities. To this end, LINCC is
conducting research on the replication and dissemination of an evidence-based,
effective breast and cervical cancer screening intervention for Hispanic
women: Cultivando la Salud (Cultivating Health) (25).
Massachusetts Cancer Prevention Community Research Network
The site based at Boston and Harvard Universities is the Massachusetts
Cancer Prevention Community Research Network (MCPCRN). The MCPCRN’s mission is
to foster a network of partnerships among cancer prevention researchers and
community collaborators to support CBPR and to reduce social disparities in
cancer risk. The MCPCRN is a collaboration of the Dana-Farber/Harvard Cancer
Center Risk Reduction Program, the Harvard Prevention Research Center (HPRC),
and the Boston University Prevention Research Center, with participation from
the American Cancer Society’s New England Division and the Massachusetts
Cancer Control Coalition.
Massachusetts has 6.5 million residents, 82% of whom are non-Hispanic white
(26). In Boston, however, because of recent immigration, non-Hispanic whites
are no longer in the majority (27). The total cancer incidence rate per
Massachusetts (501.2) is higher than the national rate (468.9) in the Surveillance, Epidemiology, and End Results Program, and so
are the incidence rates for prostate, breast, lung, and colorectal cancers
(4,28). The total cancer mortality rate per 100,000 in Massachusetts (211.3)
is just slightly higher than the U.S. rate (206.0) (4,28); and
colorectal and breast cancers are the major contributors with higher mortality
rates. Smoking rates have fallen to less than 19%; 20.8% of the population
is sedentary, and 54.4% is overweight or obese (15).
To reduce these risks, the MCPCRN is approaching four priority community
sectors: 1) schools and youth, 2) work sites and labor unions, 3) health care
providers, 4) and low-income housing. Among schools and youth, the HPRC
faculty direct a range of school and community-based research to improve youth nutrition and physical activity. Work sites and union
partners include the Massachusetts AFL-CIO (American Federation of
Labor-Congress of Industrial Organizations), the Massachusetts Coalition on
Occupational Safety and Health, and individual local unions. Approximately 50
community health centers, many with strong ties to MCPCRN partners, facilitate
access to health care providers in Massachusetts. The cost of housing in
Massachusetts ranks third nationally; MCPCRN collaborators have identified
more than 100 housing developments in Boston, Cambridge, and Somerville as
The MCPCRN’s current objectives are to strengthen ties with communities and to
conduct pilot and developmental studies as a foundation for future research.
An upcoming conference on CBPR will emphasize engaging community organizations
in cancer prevention research opportunities. Collaborative community efforts
support Health Ambassadors for African American and African immigrant women in
Boston and train tobacco advocates in housing developments. Developmental
research includes a work site protocol to increase informed decision making for
prostate cancer screening; materials to promote timely follow-up for abnormal
mammograms among low-income, ethnic minority women; and methods to improve
decision making on colorectal cancer screening. Pilot studies include an
intervention aimed at weight reduction and increased physical activity through
the Young Men’s Christian Association and data collection in low-income
South Carolina Cancer Prevention and Control Research Network
The site based at the University of South Carolina is the South Carolina
Cancer Prevention and Control Research Network (SCCRN). The SCCRN was created
to address the large and growing cancer burden among African Americans living
in South Carolina. Its aim is to serve the entire state, with a population of
just more than 4 million people, comprising an area of 31,000 square miles, and
ranging from a long, broad coastal plain to the Piedmont region of southern
Appalachia. The SCCRN builds on a strong network of existing programs that
have coalesced recently in the South Carolina Cancer Alliance (SCCA), which
consists of more than 750 institutional and individual members. The
constituent bodies of the SCCA include the South Carolina Department of Health
and Environmental Control and numerous grassroots organizations in addition to all
academic, clinical care, and nongovernmental organizations with
South Carolina is a relatively rural state, with very high (>40%) African
American representation in rural areas. It is also a poor state, where the
average personal income is about 81% of the national average (29). Cancer
rates of African Americans, who represent 31% of South Carolina’s total
population, diverge from the U.S. average, in many instances markedly (4,30).
For example, prostate cancer incidence among African American men in South
Carolina is more than 70% higher than in white men, whereas the difference is
55% nationally (30). Nearly all cancers have higher mortality in South
Carolina than in the United States as a whole (4). Illustrative of the pattern
of increased mortality, breast cancer incidence in South Carolinian African
American women is 18% lower than the incidence in white women (as opposed to
being 15% lower nationally), but mortality is 47% higher (vs the national
differential of 32%) (4,30).
Research at the SCCRN focuses on investigating ways to implement programs
that complement existing cancer prevention and control infrastructure and
through which we can anticipate risk reduction based on changes in individual
and organizational behavior. The SCCRN focuses on breast, cervix, colorectal,
oropharyngeal, prostate, and thoracic cancers. Ongoing projects include 1)
investigation of small media approaches to increase breast and cervical cancer
screening in low-income, rural women at highest risk of aggressive forms of
these cancers, 2) research on informed decision making for prostate cancer
screening and treatment, and 3) identification of geographical determinants of
prostate cancer. Formative work includes 1) exploration of a community-based,
statewide program of research in oral cancer precancerous lesions, 2)
development of a mammography registry to understand patterns of use in
low-income, predominantly African American populations, and 3) a church-based
participatory intervention of lay health advocate-delivered cancer education
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In its first year of operation, the CPCRN has focused on a strategic
planning process. From the beginning, community partners from each of the five
sites have played strong and active roles in these processes. The strategic
planning process produced vision and mission statements; a set of operating
structures, principles, and plans; and four research work groups (see below).
Communities and researchers working together to reduce the burden of
cancer, especially among those disproportionately affected.
The mission of the CPCRN is to conduct cancer prevention and control
research that extends the knowledge base, addresses critical gaps, and leads
to adoption, replication, implementation, diffusion, and evaluation of
successful programs in communities.
Operating structure, principles, and plans
The CPCRN has developed a governing structure with a steering committee,
guiding principles, and a seven-year strategic plan. Further information on
each of these documents is available from: URL:
Research work groups
The strategic planning process also suggested the development of work
groups to initiate and carry out CPCRN research. The CPCRN currently has work
groups focusing on 1) screening for breast and cervical cancers; 2) screening
for colorectal cancer; 3) informed decision making and quality-of-life issues
for prostate cancer screening and treatment; and 4) validating low-literacy
educational and media materials. The work groups involve cross-site
collaboration among scientists from the network centers and have established
research goals (Table 2).
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The CPCRN represents a new and innovative approach for addressing the
challenge of identifying effective interventions and promoting dissemination
and adoption of these interventions into communities. The CPCRN sites are
geographically distributed across the nation, enhancing opportunities to
develop community partnerships and to conduct community-based assessments,
evaluation, and research with populations that represent nearly all types of
medically underserved racial and ethnic groups in the continental United
States. A strong commitment to CBPR increases the likelihood that CPCRN
research will benefit the underserved communities in greatest need. The CPCRN
also provides an opportunity for the sites to collaborate in addressing
research gaps, including dissemination research and research translation, and
to build on recommendations provided in the Community Guide. Finally,
the location of the CPCRN within the CDC’s PRC program enables its research
findings to be easily translated, both nationally and locally, through
long-existing partnerships with other prevention organizations.
Fostering the optimal results from the CPCRN will require that its members
maintain a delicate balance between coordinated, centralized efforts and
retaining and enhancing the critical, locally responsive nature of its
individual members. Within the tension between centralization and
decentralization lies the exciting opportunity to create new strategies for
successfully reducing the burden of cancer, especially among those
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Corresponding author: Jeffrey R. Harris, MD, MPH, MBA, Health Promotion
Research Center, University of Washington Health Promotion Research Center,
1107 NE 45th St, Suite 200, Seattle, WA 98105. Telephone:
206-616-8113. Email: firstname.lastname@example.org.
Author affiliations: Pamela K. Brown, MPA, Mary Babb Randolph Cancer
Center, West Virginia University, Morgantown, WV; Steven Coughlin, PhD, and Katherine Wilson,
PhD, Division of Cancer
Prevention and Control, National Center for Chronic Disease Prevention and
Health Promotion (NCCDPHP), Centers for Disease Control and Prevention (CDC),
Maria E. Fernandez, PhD, Center for Health Promotion and Prevention Research,
University of Texas Health Science Center at Houston School of Public Health,
James R. Hebert, ScD, University of South Carolina, Columbia, the
Hollings Cancer Center at the Medical University of South Carolina, and the
Palmetto Health South Carolina Cancer Center, Columbia, SC; Jon Kerner, PhD,
Division of Cancer Control and Population Sciences, National Cancer Institute,
Marianne Prout, MD, MPH, Department of Epidemiology, Boston University School
of Public Health, Boston, Mass; Randy Schwartz, MSPH, New England Division, American Cancer
Society, Boston, Mass; Eduardo J. Simoes, MD, MSc, MPH, Division of Adult and Community
Health, NCCDPHP, CDC, Atlanta, Ga; Carol White, MPH, University
of Kentucky Center for Prevention Research, Lexington, Ky.
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Table 1. Cancer Prevention Interventions Recommended by the Guide to
Community Preventive Services (10-12)
|Increasing Physical Activity
||Reducing Tobacco Use and Exposure to Environmental
||Reducing Exposure to Ultraviolet Light
|Behavioral and social approaches
- Individually adapted programs
- School-based physical education
- Group programs that foster social support
Environmental and policy approaches
- Enhanced access to facilities, with informational outreach
- Stair-use reminders
- Community-wide campaigns
- Stair-use reminders
- Increasing the price of tobacco products
- Mass media campaigns
- Provider reminders
- Reducing treatment out-of-pocket costs
- Telephone quit lines
Reducing exposure to environmental tobacco smoke
- Smoking bans and restrictions
- Increasing the price of tobacco products
- Mass media campaigns
- Primary schools: education and policies
- Recreation/tourism: education and policies
Table 2. The Cancer Prevention and Control Research Network (CPCRN)
Research Work Groups and Their Goalsa
- Develop a protocol for a community-based intervention trial to
increase colorectal cancer screening and promote informed decision
making for colorectal cancer screening among Hispanics.
- Develop a protocol for implementing an intervention to increase
colorectal cancer screening among men and women aged 50 and older.
|Breast and cervical cancers
- Design a small-media community-intervention trial to increase the
use and awareness of the CDC’s National Breast and Cervical Cancer Early
Detection Program among program-eligible African American women.
- Replicate small-media interventions to increase breast and cervical
cancer screening among Hispanics (both farm-working and non-farm-working
populations) living in the Texas-Mexico border area.
- Develop and pretest a work site intervention protocol to increase
informed decision making for prostate cancer screening among men aged 50
- Develop an interactive and innovative decision-making tool to
promote informed decision making for prostate cancer screening among men
aged 40 to 70.
- Conduct and write a review of available literature regarding the
effect of treatment on health-related quality of life among prostate
cancer survivors, with an emphasis on African American men.
- Identify a care provider network that serves African American men
and supports informed and shared decision making for prostate cancer
screening; assess the network’s acceptance and perception of the
usefulness and relevance of NCI materials for informed decision making,
and field test these materials with African American men.
|Low-literacy materials validation
- Provide CPCRN sites and others with an extensive collection of
tested materials for individuals who are among several minority and
ethnic populations and have limited reading skills, and develop tools
the CPCRN sites can use to validate materials.
- Conduct a review of existing materials that address the need for
timely follow-up of mammographic abnormalities among low-income ethnic
minority women and, where needed, adapt materials to better meet the
needs of these women.
aCDC indicates the Centers for Disease Control and Prevention; NCI
indicates National Cancer Institute.
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