QLCER_Partnership Study_SSA_080711

The Centers for Disease Control and Prevention (CDC) requests OMB approval to collect information for the Study of Comprehensive Cancer Control and Tobacco Control Program Partnerships. This is a new Information Collection Request. This qualitative project will allow CDC to obtain and disseminate information about the current level of communication and collaboration between Comprehensive Cancer Control programs and Tobacco Control Programs in selected states. Approval is requested for one year.

The partnership study is one component of a larger Comparative Effectiveness Research (CER) study that also includes a promotion/cessation component. The promotion/cessation study will be described in a separate Information Collection Request.

A. Justification

A.1 Circumstances Making the Collection of Information Necessary

Background

This is a new Information Collection Request. The Centers for Chronic Disease Prevention and Health Promotion (NCCDPHP), Centers for Disease Control and Prevention (CDC), requests approval from the Office of Management and Budget (OMB) to collect information associated with a study to qualitatively document an exemplar of strategies conducted by seven state Comprehensive Cancer Control (CCC) Programs and Tobacco Control Programs (TCP) that promote cross-collaboration/networking and cross-promotion of services and programs. The outcomes of the partnerships study will be used internally by CDC to inform policies and externally to disseminate information about collaboration practices of state agencies. Information will be collected over a one-year period. CDC’s authority to conduct the study is established by Section 301 of the Public Health Service Act (see Appendix 1a). The partnership study is one component of a larger Comparative Effectiveness Research (CER) study that also includes a promotion/cessation component. These activities are funded by the American Recovery and Reinvestment Act of 2009 (see Appendix 1b). An overview of both studies is provided in Appendix 3.

The CDC Division of Cancer Prevention and Control defines comprehensive cancer control as “an integrated and coordinated approach to reducing cancer incidence, morbidity, and mortality through prevention (primary prevention), early detection (secondary prevention), treatment, rehabilitation, and palliation” (http://www.cdc.gov/chronicdisease/resources/publications/aag/dcpc.htm). In 1998 CDC established the National Comprehensive Cancer Control Program (NCCCP) which provides funding and technical support for the development and implementation of CCC plans in states, tribes, and territories. Currently 50 states, the District of Columbia, seven tribes/tribal organizations, and seven U.S. territories/Pacific Island Jurisdictions receive funding to develop and implement plans addressing cancer interventions across the cancer continuum. This comprehensive view is further characterized by the need for coordination of efforts among diverse groups of stakeholders that involve information sharing, research collaborations, and partnerships with community agencies (Richard et al., 2004).

Among its primary prevention areas, all federally funded CCCs identify tobacco control as one of their top priorities. In 1999, CDC’s Office on Smoking and Health developed the National Tobacco Control Program (NTCP) to encourage coordinated, national efforts to reduce tobacco-related diseases and deaths through comprehensive programs. The program provides funding and technical support to all 50 states, the District of Columbia, seven tribal support centers, eight U.S. territories/jurisdictions, and six national networks to offer evidence-based cessation interventions that increase successful quit attempts, such as telephone quitlines (QLs). After soliciting applications from all CCCs and TCPs, CDC has selected the following CCC/TCP states for participation in the partnerships study: Alabama, Arkansas, Colorado, Delaware, Florida, Nebraska, and Vermont.

Although tobacco control is a key primary prevention intervention for cancer CCCs do not consistently integrate tobacco control into their planning. Beyond the fundamental notion that “tobacco control is cancer control,” there is broad agreement that both the cancer control community and the tobacco control community can benefit from closer collaboration (C-Change, 2003).

NCCDPHP is strongly invested in enhancing the relationship between two key programs: CCC and TCP. Examining these efforts within the context of the larger quitline comparative effectiveness research (CER) study provides a unique opportunity for CDC to better understand how CCCs and TCPs currently work together to address cancer control and, more specifically, how each program uses its network of resources to cross-promote the other’s activities. Findings from this study will add to the evidence base for activities conducted by communities and/or states selected for Recovery Act State Quitline Supplemental Funding under the American Recovery and Reinvestment Act announcement “Communities Putting Prevention to Work.”

Through a case study approach using semi-structured key stakeholder interviews, the partnership study will collect narrative information on the organizational context, infrastructure, and partnership efforts between CCC and TCP in seven states. Specifically, the focus will be on how each state has implemented its strategies for collaboration, challenges encountered and addressed, key factors that facilitate collaboration, cross-utilization of networks, and lessons learned along the way. Findings will be used to identify collaborative efforts being conducted or planned in participating states and help states to identify collaboration gaps or missed opportunities for enhanced collaboration. The findings will also enumerate recommendations in which this knowledge can be appropriately applied to the broader cancer control and tobacco control communities. Through in-person stakeholder interviews CDC proposes to collect information from key CCC, TCP, and quitline program staff/stakeholders from each of the seven states. The purpose of the interviews will be to obtain in-depth information about each program’s infrastructure and level of integration within a state-level structure, past/current partnership efforts, as well as factors and barriers influencing CCC/TCP collaborations. The information will be used to develop examples of strategies used by selected CCCs and TCPs to cross-collaborate and cross-promote programs/ services and identify new areas of potential collaboration that may be shared with other CCC and TCP states.

The insights to be gained from this data collection will be critical to improving partnership efforts in achieving the goals of disseminating and replicating community-based strategies for promoting health and preventing chronic disease through reductions in tobacco use.

Privacy Impact Assessment

The proposed study involves a minimum amount of information in identifiable form (IIF). Respondents will be recruited from the seven states for participation. The data collection contractor, RTI International (RTI), will have access to respondents’ names, telephone numbers, and e-mail addresses, in order to schedule their participation in the in-person interview.

Case study site visit interviews will be conducted with key CCC/TCP staff in each of the seven participating states to better understand aspects of each program’s organizational structure, activities, and collaborative efforts around cancer and tobacco control. Upon OMB approval, each site will be notified by e-mail to discuss the process and timeline for the site visits.

Overview of the Data Collection System

At least one month before a site visit, RTI will schedule a preparatory call with the CCC and TCP Directors at each site (Appendix 4: Introductory E-mail to Schedule Site Visit Preparatory Call). The purpose of these calls will be to explain the purpose of the visit, introduce the RTI staff, and discuss the roles of the individuals to be interviewed so that the site can begin to identify and address any key logistical issues prior to the visit. The information collection process will be discussed during the introductory phone call with each site and then completed by the RTI project staff. Approximately two weeks before the call, the site will receive Site Visit Preparation: Guidance and Worksheets (Appendix 5) to assist in identifying appropriate individuals for the interviews.

After the planning call, a site visit coordinator on the RTI staff will ensure that the schedules are set up adequately and provide for the team to meet with the maximum number of appropriate people as time allows. These instructions will be reviewed with the program leadership to help guide the site visit planning process. The coordinator will also work with the site to obtain other relevant documents (e.g., organizational charts) that may be useful in planning for the site visit. The dates of the site visit will be finalized at least four weeks before the site visit. Two weeks before the site visit the sites will provide a schedule of interviewees and their roles and any travel logistics will be finalized.

Semi-structured individual interviews will be conducted with approximately 15 key informants at each site selected for the study. Respondents at each site will typically include state health department leadership and CCC and TCP/QL leadership and project staff. With input from the participating states CDC and RTI will determine the most appropriate individuals/groups of individuals to ask the related interview questions.

To reduce burden and ensure that questions are tailored to each respondent type separate interview guides have been created for Health Department Leadership (Appendix 6), CCC Leadership/Program Staff (Appendix 7), and TCP Leadership/Program Staff (Appendix 8). Site visits will be conducted by teams of two RTI staff (a lead interviewer and notetaker) and a CDC observer, and will average two to three days in length, enabling the case study team to meet with a range of key informants.

Items of Information to be Collected

The following topics will be addressed during the site visit interviews:

Infrastructure

Organizational structure
Integration of CCC and TCP
State and federal funding

Leadership

Perceived support

Priority of cancer control/tobacco control activities

Overlap in priorities and programs

CCC/TCP Collaborative Efforts

Joint activities
Pooling of resources

Cross-Promotion of Programs/Services

Utilization of networks

Perceived Barriers to Collaboration
Perceived Facilitators to Collaboration

The unit of analysis is the site and/or organizations that are participating in the effort at each CCC/TCP state. The information collected will be analyzed and the results will be used to develop a cross-site report.

Identification of Web Site(s) and Web Site Content Directed at Children Under 13 Years of Age

This information collection does not involve Web-based data collection methods or refer respondents to Web sites. There are no Web sites with content directed at children younger than 13 years of age, and there are no issues of privacy related to Web-based data collection for this information collection.

A.2 Purpose and Use of the Information Collection

The key stakeholder interviews will provide critical information about the extent of collaboration between CCC and TCP state programs.

Information collected in this study will be used to

Describe the current organizational structure of each CCC and TCP; probe for level of integration within the state health department and other organizational factors that may influence collaboration;
Identify and characterize the factors associated with each CCC/TCP level of collaboration;
Describe the current partnership efforts between each CCC and TCP; and
Identify the key factors that facilitate (or hinder) collaboration between CCCs and TCPs.

With input from CDC, RTI will develop a cross-site report, “Program Profiles,” for each participating CCC/TCP state, and one to two publications to ensure dissemination of the case study findings to the sites and other key stakeholders.

The cross-site report will be a synthesis of information about each state’s CCC/TCP and provide an overarching perspective on the breadth of collaborative efforts being conducted or planned by each state. Additionally, the cross-site report will enumerate recommendations for various stakeholders in a way that will be suitable for multiple audiences.

The “Program Profiles” will provide a concise overview of key elements of each program and highlight unique strategies used by CCC and TCP states that promote collaboration that can be shared with other states. They will be designed to be graphically appealing and ready to be used for dissemination for other CDC purposes. The text of the Profiles will be prepared in such a way that it can be easily transferred to Web sites or used in other dissemination venues.

The proposed study will collect data needed to inform the level of communication and collaboration between the CCCs and the TCPs. Specifically, this pilot study will enroll health department, CCC, and TCP staff. Goals of the study are to:

1) Develop an exemplar of strategies used by the selected CCCs and TCPs to cross-collaborate and cross-promote programs/services,

2) Disseminate these strategies as models of collaboration to other CCC and TCP states by the Comprehensive Cancer Control (CCC) Program and the Office of Smoking and Health (OSH) at CDC; and

3) Inform administrative, policy, and funding decisions made by CDC and HHS regarding the most efficient and effective use of funds to address tobacco cessation.

To meet these study objectives qualitative data will be collected from staff members of the health department, CCC, and TCP by in-person interviews. For those staff who are not available for in-person interviews, telephone calls will be conducted with them. Responses will be collected for RTI’s data entry process. Other CCC or TCP staff will not have access to the interviews or to the database containing data.

Privacy Impact Assessment Information

As noted earlier, the proposed study involves a minimum amount of information in identifiable form (IIF) solely for the purposes of contacting people in their role as staff of an organization. The data collection contractor, RTI International, will have access to respondents’ names, agency role, and contact information in order to schedule their participation in the interviews. The information to be obtained through interviews concerns organizational activities and priorities and is not considered highly sensitive.

This information will be stored separately from response data. A linking file will be created and available only to senior project management at the data collection contractor, RTI. This information will only be used to ensure completeness of the data files. The linking file will include the role of the respondent and the respondent’s organization (it will not include the individual’s name or contact information), the community or state name, the date of interview, and the code assigned to the data file. This will ensure that no personally identifiable information, outside of the individual’s role and organization, is re-linkable. The linking file will be an administrative file used by the RTI project management team and will not be available to CDC staff. The IIF used for recruitment and scheduling purposes will not be linkable to the response data collected subsequently.

All of the questions will be largely descriptive; there will be no questions regarding controversial, sensitive, or personal information. Some interviewees may be asked about the state quitline, including questions about the types of resources provided to callers and the level of support from the CCC. In the final report descriptive information for each program will be presented such that specific data, including quotes, will not be linked to or attributed to a particular individual.

A.3 Use of Improved Information Technology and Burden Reduction

The proposed information collection is based on qualitative methods, primarily semi-structured individual interviews. While several efforts are being made to reduce burden on respondents, electronic information collection methods have limited utility for these case studies.

Because the intent is to understand the collaborations between CCC and TCP states all data will be collected during on-site, personal interviews involving key informants at each site. Interviews will be facilitated by an interview guide that will be customized based on the organization type (i.e., health department, CCC, and TCP).

To facilitate and streamline the on-site interviews, CDC will prepare interviewers by providing the contractor with existing documentation of the strategies and intended outcomes relevant to this study. These documents may include organizational charts, progress reports, and site-specific work plans. Only the minimum information necessary for the purposes of this project will be collected.

A.4 Efforts to Identify Duplication and Use of Similar Information

This research is part of a larger comparative effectiveness initiative as described above. No current instruments exist to collect data at the levels described herein. CDC program consultants and project officers from separate units within CDC communicate with individual CCC and TCP states on an ongoing basis, including monthly conference calls. However, these routine calls and progress reports do not provide a systematic overview of larger context and key issues that seem to hinder or facilitate cross-collaboration.

A.5 Impact on Small Businesses or Other Small Entities

Our data collection efforts will not impact any small businesses or other small entities.

A.6 Consequences of Collecting the Information Less Frequently

This is a one-time data collection effort to describe the level of collaboration between the state-based CCC and TCP in reducing tobacco-related cancer incidence.

A.7 Special Circumstances Relating to the Guidelines of 5 CFR 1320.5

There are no other special circumstances that require the data collection to be conducted in a manner inconsistent with 5 CRF 1320.5(d)(2). This data collection request fully complies with the regulation.

A.8 Comments in Response to the Federal Register Notice and Efforts to Consult Outside the Agency

Federal Register Announcement

A Notice was published in the Federal Register on June 8, 2011 (Volume 76, Number 110, pages 33302-33303). A copy of the Notice is provided in Appendix 2a. One public comment was received and acknowledged (Appendix 2b).

Consultants

A list of key study consultants for this project is provided in Exhibit 1. RTI staff consulted with CDC staff on the study design and key research questions. In addition, RTI has worked closely with CDC throughout the development of the interview protocols and the identification/ recruitment of appropriate CCC/TCP stakeholders. In addition, we will consult with representatives from CCCs and TCPs as needed throughout the site visit planning process.

Exhibit 1. Study Consultants

CDC Staff

CDC Division of Cancer Prevention and Control

Susan Henderson, MD, MPH

Technical Monitor

Medical Officer

Divison of Cancer Prevention and Control
Comprehensive Cancer Control Branch

770-488-3111

[email protected]

Behnoosh Momin, MS, MPH

Technical Monitor and Health Scientist

Division of Cancer Prevention and Control
Comprehensive Cancer Control Branch

770-488-3112

[email protected]

Antonio Neri, MD, MPH

Medical Epidemiologist

Division of Cancer Control and Prevention

Comprehensive Cancer Control Branch

770-488-3288

[email protected]

Laura Seeff, MD

Chief, Comprehensive Cancer Control Branch

[email protected]

CDC Office on Smoking and Health

Ann Malarcher, PhD

Senior Epidemiologist

770-488-8006

[email protected]

Jennifer Kahende, PhD

Health Scientist

770-488-5279

[email protected]

Lei Zhang, PhD

Associate Service Fellow

770-488-1144

[email protected]

RTI Staff

Jennifer Duke, PhD

RTI Project Director

Senior Research Analyst

3040 Cornwallis Road
Research Triangle Park, NC 27709
919-485-2669
[email protected]

Sonya Goode Green, MPH

RTI Associate Project Director