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pdfATTACHMENT 8
PREVENTION RESEARCH CENTERS
PRC INFORMATION SYSTEM - DATA ENTRY FRAMES
(0920-0650)
Form Approved OMB NO.: 0920-0650
Expiration Date: 11/30/2007
Public reporting burden of this collection of information is estimated to average 4.23 hours per
response, including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information. An agency
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burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia
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Prevention Research Centers
PRC Information System
Center Information
Section
CDC Prevention Research Centers: MyPRC - Home
Page 1 of3
~
*
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My PRC
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Required
Performance Indicator
Texas Prevention Research Center
University of Texas Health Science Center at Houston
• Center Information
• Projects
Edit General Information
·~QQJLC~
• Log Out
Office mailing
address
Address line 1*
7000 Fannin
General Information
Address line 2
UCT 2630
5-Year Goals
City*, State*,
ZIP*
Houston
Overnight
Annual Work Plan
mailing
TX
77225
Center Staff
Community
Committees
address
Same as office mailing address?*
@ Yes
0 No
National
Community
Committee (NCg
Representatives
Address line 1 7000 Fannin
Address line 2 UCT 2630
Partners
TX
City, State, ZIP Houston
77225
PartneLG.cC!nts_eJlld
Contracts
Evaluation Plan
Telephone*
Fax 800
800
555
555
1212
Ext.
135
Re~nition
1200
Media Highlights
Students Trained or
Mentorec!
Web site http://www.sph.uth.tme.edu/chppr/
NCC Region*
Southeast
NCC Regional
Director*
Awards
Mary Smith
Mission*
Briefly state the center's mission.
To promote health during child and adolescent years, and
to prevent diseases of adulthood that have their origins
in childhood and youth.
Organizational
Chart*
To upload a copy of the center organizational chart
enter the entire path of the file or click the 'Browse' button.
Enter path and file name
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.htm
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Date organizational
chart last revised
Can the organizational
Yes
No
0
o
Page 2 of3
(mm/ddNYYY)
chart be shared with other PRCs?
Organizational Chart Files
Name
Size
Revised
Share
Qrgc:::h9Jtl,QQc
70K
03/28/2004
Yes
OrgChart 2 .doc 35K
03/28/2004
Yes
Delete
Physical Space and Staff Support
Does the PRC have designated physical space in which to operate that is
within, or in close proximity to, the university or school campus?*+
C) Yes, on campus () Yes, off campus () No
Does the PRC have designated physical space in which to operate that is
within, or in close proximity to, the partnering community? *+
() Yes
No
0
Which of the following does every PRC staff person have?*+
An individual office or cubicle
o
o An individual
o
computer
An individual telephone
What type of indirect rate does your academic institution
core funding award? *+
On campus
Off campus
Other (specify below)
use for the PRC
o
o
o
Does the PRC's academic institution provide in-kind financial support,
other than indirect rate recovery, for any PRC faculty or staff? * +
Yes
No
o
0
If yes, enter the number of faculty or staff that are financially supported
in-kind (outside of indirect rate recovery)
Does the PRC's academic institution provide financial support through
indirect rate recovery for any PRC faculty or staff?*+
Yes
No
o
0
If yes, enter the number of faculty or staff that are financially
with indirect rate funds
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United States Department of Health and Human Services
Centen;JorPiseaseCQlltCol
andPcevention
National Center for Chronic Disease Prevention and Health Promotion
Division of Adult and Community Health
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PREVENTION
System RESEARCH CENTERS
PRC Information
@
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+ Performance Indicator
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2005-2006
State University of New York at Albany
Prevention Research Center
S-Year Goals
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• ErQjS!cts
• Products
*
Evaluation Goals
Add Goal
General Informatio_n
5-Year Goals
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.bQ.g-Out
Collaboration and Partnership Goals
CeDteLStaff
Community
C~Qmmittees
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Goals
Add Goal
National Commuolty
Committee (NCC)
Representatives
Partners
Infrastructure
Health Priorities
Goals
Add Goal
Research Aqenc;Ja
E:Vi'lILJCltion
Plan
Training and Education Goals
Add Goal
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Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion
Division of Adult and Community Health
http:// qa.nccd.cdc. gOYImy PRCAdmin/CenterInfol
5Y earGoals _ List.aspx
8/21/2006
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SAF'CR
~t1ItALTH1E'R. PI:OPLC: u.•
Page 1 of 1
PREVENTION RESEARCH CENTERS
PRC
Information System
*
Required
+ Performance Indicator
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PRC IS
My PRC
• Center Information
State University of New York at Albany
Prevention Research Center
2005-2006
Add 5-Year Goal·
• E!:Qject~
• F'r9c1u<:ts
• Required Reports
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Program Component
General Information
Evaluation
5-Year Goals
Goal Statement
Annual Work Plan
Briefly describe one of the center's 5-year goals. *
C:E!DtE!L$taff
Community
C:ommittE!E!s
--
Status*
National Community
Committee (NCe)
Representatives
F'.ar.:tllE!rS
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.Health Priorities
Research Aqenda
!:Yi:lJuationpli:ln
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PRC Home I News I Contact Us
CDC Home I Search I Health Topics A-Z
This page was last reviewed on 10/17/2005
Quality Assurance Build
Un itE!cIStatesQe partmelltof
HE!i:lltha ndHuman Services
Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion·
Diyjsiollof .A,cJultandC:Qrnmunity Health
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earGoals _ Edit.aspx?action=addgoal&typecode=EG
... 8/21/2006
PRC IS: Center - Add 5-Year Goal
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*
-
Required
+ Performance Indicator
Help
('
PRC IS
My PRC
• Center Information
State University of New York at Albany
Prevention Research Center
Add 5-Year Goal
• PrQjS!~~
• Prod ucts
• Require(;LR~p...9rts
LQg-Out
Program Component
Collaboration and Partnership
2005-2006
General Information
5-Year Goals
Goal Statement
Annual Work Plan
Briefly describe one of the center's 5-year goals. *
<:::eoteL5taff
Community
CommIttees
-Status*
National CommulJ.illt
Committee (NCC)
Representatives
f>gr1:Jlers
Select one
.Health Priorities
Research Aqenda
EyalugtioO. f>lan
\._-----~)
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PRC Home I News I Contgct Us
CDC Home I Search I Health Topics A-Z
This page was last reviewed on 10/17/2005
Quality Assurance Build
United StgtesDepartment
of Healthand Human Services
Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion'
DiyisiQoof Adult and Community Health
http://Qa.nccd.cdc.gov/mvPRCAdminiCenterInfo/5Y
earGoals Edit.aspx?action=addgoal&typecode=CP
... 8/21/2006
PRC IS: Center - Add 5-Year Goal
Page 1 of 1
* Required
+ Performance Indicator
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PRC IS
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• Center Information
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2005-2006
State University of New York at Albany
Prevention Research Center
Add 5-Year Goal
• PsojecJ!;
• Products
• Required Report~
!"Qg-Out
Program Component
Communication and Dissemination
General Information
5-Year Goals
Goal Statement
Annual Work Plan
Briefly describe one of the center's 5-year goals. *
c:gnteL$tgff
Community
C:QmmLttees
--
Status*
National Community
Committee (NCC)
Representatives
j:>goners
Select one
Health Prioritie!i
Research Aqenda
I':valuatiQn Plan
'-.
oj
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PRC Home I News I Contact Us
CDC Home I Search I Health Topics A-Z
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Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion.
Division of Adult and CommunityJjealth
http://qa.nccd.cdc.gov/myPRCAdmin/CenterInfo/5Y
earGoals _Edit.aspx?action=addgoal&typecode=C
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8/21/2006
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Nationa! CenteT for Chronic Disease Prevention and HeiJlth P,omotion
PREVENTION
PRC Informntion System RESEARCH CENTERS@}
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State University of New York at Albany
Prevention Research Center
PRC IS
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• Center Information
Add 5-Year Goal
• PJ:9j~c;J;?
• Prod ucts
Program Component
• Required RE;Pill"-f:!;
~-Out
I nfrastructu re
*
-
Required
+ Performance Indicator
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2005-2006
General Information
5-Year Goals
Goal Statement
Annual Work Plan
Briefly describe one of the center's 5-year goals. *
c:~nt~LStaff
Community
C()mmiJtegs
National Community
Committee (NCC)
R~presentatives
-Status*
pgr:tn~rs
Select one
Health Priorities
Research Aqenda
Ey:gluClti()n Plan
'--...
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Priva~y Policy I Accessibilitv
PRC Home I News I Contact Us
CDC Home I Search I Health Topics A-Z
This page was last reviewed on 10/17/2005
Quality Assurance Build
United States Department Of H~althandHuman
Services
Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion.
Divisionof Adult and Community Health
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Yearly amount
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partners
Outcomes &
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Prostucts
'\.
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PRC Home
I News I Contact
C::Q.cJ:fo~meI Search
I Health
Us
Topics A-Z
This page was last reviewed on 10/17/2005
Quality Assurance Build
United States Department of Health and Human Services
Centers_foC Qise!,!seControICln<:tPreyeDtion
National Center for Chronic Disease Prevention and Health Promotion
Qlvlslo.D..QfAdult and CommunityJjgalth
http://
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PREVENTION RESEARCH CENTERS fC) = J5 Printer-friendly
PRC_Hom~ I ~ew~ I Cont<3~~
I LQg Out
---=* Required
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MyPRC
• ~enter
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Indicator
Texas Prevention Research Center
University of Texas Health Science Center at Houston
Information
Diffusion of CATCH in Texas Elementary Schools
Edit Focus Areas
General
Information
Contacts
Health or Behavioral Focus
Funding
Which health or behavioral topic is a focus of the project?*+
Goals & Objectives
Focus Areas
[J
behavioral
topic
D
Vision
Nutrition
No
specific
and
hearing
focus
adiseases
health
Medical
product
safety
Access to health care
[J Tobacco
Injury
Physical
Reproductive
School
Sexually
Substance
Maternal,
Respiratory
or
health
fitness
use
transmitted
violence
infant
use
diseases
prevention
health
prevention
or
oron
prevention
activity
child
or
health
or or
~
Occupational
Obesity
or
overweight
safety
or
health.
Oral
Health
control
disabilities
infectious
alternative
medicineVirus
chronic
back conditions
conditions diseases
(HIV)
or
AIDS
Immunodeficiency
Environmental
Diabetes
health
uman
eart
disease
stroke
D Other
Birth
Cancer
Immunization
defects
(specify
oror
below)
Aging
health
Adolescent
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Family
Food
Global
safety
health
planning
oror
health
secondary
Chronic
kidney
disease D
Arthritis,
osteoporosis,
or
D
Mental
health
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Complementary or
Population
Studied
Keywords
Community
Committee
Partners
Outcomes
Advances
&
Products
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Research Focus
Which research topic is a focus of the project?*+
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o
o
o
o
o
o
Community-based
participatory research
Determinant
research
Dissemination
Epidemiological
research
research
Evaluation research
Formative research
Page 2 of3
o Guidelines or procedures
o Intervention research
~
Methods development
o Models or theories
o Psychometrics (measures,
scales, or instruments)
o No specific focus on a research
topic
o Other (specify below)
Public Health Focus
Which public health topic is a focus of the project?*+
o
or
collaborations
assessment
involvement
capacity
changes
making
programs
management
building
strateg
ies
promotion
amily
ommunity-based
ehavioral
participation
change
or
tervention
planning
Communication
Health
communication
disparities
education
skills
or or~
Data analysis or
o skills
Advocacy
o
health
topic
(including
bioterrorism)
mapping
~ Training
Program
evaluation
Organizational
Social
Surveillance
Other
Leadership
Life
Policy
Public
Risk
No
specific
skills
assessment
(specify
determinants
health
marketing
planning
focus
ordevelopment
infrastructure
preparedness
management
below)
development
onora assets
public
Needs
assessment
Professional
Community
or
coalition
Environmental
Health
care
delivery
factors
Financial
Evidence-based
planning
decision
or or
Cultural
competence
Community
partnerships
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National Center for Chronic Disease Prevention and Health Promotion
Division of Adult and Community Health
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tProj ectF ocus.htm
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PREVENTION
RESEARCH CENTERS
PRC Home I News I Contact Us I l,Q9 Out
MyPRC
@ .=*
=t
.
Texas Prevention Research Center
University of Texas Health Science Center at Houston
• Cgnter Information
• PrQj~ts
Diffusion of CATCH in Texas Elementary Schools
• Products
-
Required
Performance Indicator
General Information
Edit Population Studied
Contacts
Population Studied
Which of the following
of the project?
Funding
best charaterizes the population
of interest
Goals & Objectives
Data Sources &
Focus Areas
Ethnicity*+
o Hispanic
D Not
Population Studied
o Unknown
or Latino
Hispanic or Latino
D
at this time
No specific focus on ethnicity
CommuDJ1Y
Committee
Partners
Race*+
RJ African American or Black
G2J
K§ywords
American Indian or Alaska
Native
D Asian
o Pacific
Native Hawaiian
Islander
D
or Other
Outcomes &
Advances
Products
White
\.'-
D
~.1
Unknown at this time
o No specific
focus on race
Age group*+
D 0-11
RJ 12-23
G2J
months
months
2-3 years
o 4-11
years
D
12-13 years
D
14-18 years
o
D 20-22
years
o 23-49
years
D
50-64 years
o 65 years and older
o Unknown at this time
o No specific focus on age
group
19 years
o Other
(specify below)
Sex*+
RJ Boys or men
G2J
Girls or women
o Unknown
D
No specific focus on sex
o Other
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1 /'J') /'Jnn7
CDC Prevention Research Centers: MyPRC - Home
Page 20[2
Other Population Characteristics*
o Cultural
ethnicity),
group (not race or
specify below
o Deaf or Hard-of-Hearing
o Gay, lesbian, bisexual,
transgender,
or questioning
(GLBTQ)
o Migrant,
immigrant,
0 Non-English
speaking group,
specify below
o Poverty or low socioeconomic group
o No specific focus on other
population characteristics
o other
or
refugee
Setting or Site* +
o Child care center
o City
o County or parish
(specify below)
o Medical or clinical site
o Neighborhood or community
o School or school district
o Senior residence or center
o State
o Tribal nation or area
o University or college
o Urban area
o Work site
o Place of worship
o Rural area
o Unknown at this time
o site
No specific focus on setting
o Home
~
Jail or prison
or
Other (specify below)
I
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National Center for Chronic Disease Prevention and Health Promotion
Division of Adult and Communit~alth
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ectPopulation.htm
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rruJeCIS - ACC K.eywords
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National (enter for Chronic. Diseasf' Prevention and Health Pmmot>on
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PRC IS
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2005-2006
State University of New York at Albany
Prevention Research Center
• Center Information
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Educational Resources Video Project
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GerH=rgLInformation
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To search for CDC keywords, enter three or more letters of a
word and click 'Search' button.
Fundinq
Search phrase*
Population Studied
Data Sources &
Focus Areas
Keywords
Cqmm.u.l1lty
CommJttS:!es
f>artO~I.s
Outcomes ~
A,dyaJ1<:es
Products
\..
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C~.!lte[~.l9L[)J$e9.$!!~9ntnII. CI!1d!'feYeoti90
National Center forChrooic Di~easeprevention
and Health Promotion
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Edi t.aspx
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PREVENTION
RESEARCH CENTERS
PRC Home I News I Contact Us I Loq Out
MyPRC
•
C_~flt~r.JnforlDjJtjoo
•
Projects
•
Prod ucts
=
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=* Required
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Indicator
ABC Prevention Research Center
University of XYZ
~.'
Project Title
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General
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Information
Contacts
Funding
OTHER LINKS
• CDC PRC Home
Select from committees
Goals & Objectives
Select one
Data Sources
Focus Areas
• PRC Web Board
-ORIf not in the list, enter a new committee
below.
&
~words
Community
Committee
Committee
name*
Partners
When did the community committee
together on this project?*
Select one
and the center start working
Outcomes
Advances
&
Products
'--
(yyyy)
J
Number of members*+
Committee Composition
What constituencies, organizations,
committee members represent?*+
o Academia
o Advocate of health issue
o Business sector
o Community coalition
o Community health center or
clinic
o Community resident
o Community-based
organization
o County or local government
agency
o County or local health
department
o Cultural organization
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or perspectives do the
0 Labor
unions
0 Managed
0 Media
care
0
o Neighborhood
National nonprofit
organization
association
o Parent
o Politician or political staff
o Public health practitioner
o Research center, institute,
network
o School or school-based
ectCommittee.htm
or
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organization
D
Environmental
D
D
Faith-based organization
D
D
Foundation
o
o State
agency
Federal government
State, county, or local
nonprofit organization
agency
Health care or medical
professional organization
D
education department
D State government agency
D State health department
D Training center or
ogranization
Health care provider
o Hospital
D Indian Health Service (IHS)
D Judicial system (law, police,
jails)
o Tribal government agency
o Tribal health department
o Youth
o Youth agency
o Other (specify below)
Activities
In which project activities
is the community
committee
o
Conceptualizing
D
Selecting the project
o
Providing or obtaining funding for the project
D
Establishing project goals or objectives
o
Developing or planning the project
D
D
D
D
D
D
D
o
involved?*+
the project
Conducting or implementing
project activities
Evaluating the project
Facilitating collaboration between the center and the
partnering community or other partners
Data analysis or interpretation
Communicating
resu Its
or educating about project activities and
.
Developing or disseminating
project materials or products
Providing space
Other (specify)
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=*
MyPRC
•
C~n_te_U_nfoImation
•
Projects
•
Products
Required
=t Performance
ABC Prevention Research Center
University of XYZ
Project Title
General
Add Partner
Indicator
Information
Contacts
Funding
OTHER LINKS
• C~D~C
PRC Home
Select from partners from the list
Goals & Objectives
Select one
Data Sources
Focus Areas
• PRC Web Board
-OR-
@ulation
If not in the list, enter a new partner below.
&
Studied
KIDtwords
Community
Committee
Partner type*
If organization,
0 Individual
0 Organization
Partners
Outcomes
enter name
&
~~tvanc_es
Products
When did the partner and center start working together on this
project?*
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What constituencies, organizations,
partner represent?*+
o
coalition
center
issue or clinic
resident
organization
government
Advocate agency
of health
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health department
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Activities
In which project activities
D
o
o
o
D
o
o
D
o
o
o
o
o
Conceptualizing
is the partner involved?*+
the project
Selecting the project
Providing or obtaining funding for the project
Establishing project goals or objectives
Developing or planning the project
Conducting or implementing
project activities
Evaluating the project
Facilitating collaboration between the center and the
partnering community or other partners
Data analysis or interpretation
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resu Its
or educating about project activities and
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project materials or products
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that is specific to this project (e.g., memorandum
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For the intervention
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that is part of this project, what
level of effectiveness?*+
Goals & Objectives
Focus Areas
Select one
Population
Has the intervention been recommended
national agency or organization?*+
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Outputs &
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Environmental
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'--
~J
If yes, enter the name of the publication or Web
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found+
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Has the PRC made the intervention available for
dissemination?*+
() Yes Cj No
If yes, what methods were used to disseminate
the intervention?+
o
o
Web site (free access)
Web site (fee)
o
Partner organization
D
Distributed
D
Other (specify below)
through external company
Is there a system in place to track dissemination
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the intervention?*+
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was the
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unknown
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Cultural
Environmental
Federal
Healthcare
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CommunityCounty
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agency
If yes,
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Other
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organization
Tribal
State
Youth
School
State,
Neighborhood
National
Parent
Politician
Public
Research
Managed
education
government
health
government
health
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resident
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clinic
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medical
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organization
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Has the intervention been adopted by any
organizations, agencies, or communities?*+
Yes
No
0
o
If yes, how many organizations, agencies, or
communities adopted the intervention?+
o
or Dof Tribal
Youth
department
Academia
Business
Cultural
Environmental
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organization
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D
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D
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o
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ja ils)
o
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D
D Youth
agency
D Organization
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unknown
o Other
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Project Title
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Information
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Name of environmental
or policy change*+
Funding
OTHER LINKS
Goals & Objectives
• CDC PRC Home
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Type of change*+
0 Environmental 0 Policy
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Population
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Keywords
Level or setting of the environmental
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subdivision
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City-,
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Nutrition
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Individual or group education or behavior
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D
D
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Summer food service program
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Physical Activity
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Availability
prog ra ms
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programs (including walking and biking trails)
D
D
Economic incentives
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Individual or group education or behavior
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D
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Support for incidental activity indoors
Support for personal transportation
biking)
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Reproductive Health
D
D
Access to reproductive
D
D
Maternal nutrition
health services
Individual or group education or behavior
change programs
Other (specify below)
Safety
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o
o
o
o
o
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Bike lane design
Crime reduction
Helmet use
Lighting
Sidewalk design and repair
Other (specify below)
Tobacco
o
o
o
o
o
o
o
o
o
o
o
o
Elimination of exposure to environmental
tobacco smoke
Individual or group education or behavior
change programs
Prevention of initiation
Product litigation
Product warning labels
Promotion of cessation
Reducing cessation costs
Restricting advertising
Restricting youth access
Smoking and pregnancy
Taxes and pricing
Other (specify below)
Other environmental
below)
or policy topic area (specify
How was the PRC involved in the environmental
policy change?*+
o
Assisted in securing funds
D
Coordinated or facilitated
o
o
o
o
o
o
o
or
meetings
Drafted legislation
Funded activities related to the environmental
or policy change
Mobilized communities
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used to create policy
Provided testimony
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• f:[odu_ct~
PROJECT
General Information
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Title
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CATCH in
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Families and
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Primary
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*
Type + Book
Languages
Keywords
Title *+
Nutrition and physical activity knowledge
and behaviors of elementary school children
in after-school programs
Related project*
Diffusion of CATCH in Texas Elementary Schools
Related training*
Peer
reviewed*+
Publication
name+
Sample
Not related to a training
0 Yes 0 No 0 Not applicable
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Date published, completed,
June
2002
Reference information
or presented*+
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In press
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o
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on
..••
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Focus
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Access to health
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Adolescent health
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research
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Public Health Focus
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~ Advocacy
skills
o
o
Behavioral change
D
Life skills
Communication
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Community-based
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Organizational development
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CATCH: A Team
Approach to
Physical Activity
and Nutrition in
;:ichools
[)j??~mjIJC:lt.iQIJQf
CATCH in Texas
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Focus Areas
ImpierneotClti90
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PRC IS: Reports
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2005-2006
PRCIS
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ReQ.9J:!;
Annual Report
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Interim
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Step
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1. Review 2005-2006
Activities Prog ress
Center Objectives &
2. Review 2005-2006
Activities Prog ress
Project Objectives &
3. View, Finalize and Print Report
Finalized
12/29/2006:
FINALIZED On 12/29/2006
Center and Core Project
SIP 3-2004 SIP 4-2004 SIP 7-2004 SIP 11-2004 SIP 16-2004 SIP
18-2004 SIP 19-2004 SIP 21-2004 SIP 23-2004 SIP 15-2005 SIP
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Finalized
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Center and Core Project
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18-2004 SIP 19-2004 SIP 21-2004 SIP 23-2004 SIP 15-2005 SIP
17-2005 SIP 18-2005 SIP 11-2005 All SIPs
Finalized
12/29/2006 :
Center and Core Project
SIP 3-2004 SIP 4-2004 SIP 7-2004 SIP 1£2904 SIP 16-2004 SIP
18-2004 SIP 19-2004 SIP 21-2004 SIP 23-2004 SIP 15-2005 SIP
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| File Created | 2007-01-23 |