NCCDPHP - National Center for Chronic Disease Prev and Health Promo Grants

NCCDPHP - National Center for Chronic Disease Prev and Health Promo

PROJECT SUMMARY/ABSTRACT Cancer remains a leading cause of morbidity and mortality in the United States, with an estimated 2 million new cases and over 620,000 deaths projected in 2025. While significant progress has been made in prevention, early detection, and treatment, widespread implementation of evidence-based interventions (EBIs) remains a challenge. The Centers for Disease Control and Prevention’s (CDC) National Comprehensive Cancer Control Program (NCCCP) supports 66 sites nationwide in developing and implementing comprehensive cancer control plans. To enhance the reach and impact of effective EBIs, NCCCP sites require increased capacity to scale and sustain these initiatives. Building on findings from the 2023–2024 Scaling What Works (SWW) Pilot, we propose the SWW-IMPACTS (Improving and Accelerating Cancer Prevention, Treatment, and Survivorship) initiative, a tailored capacity-building program designed to strengthen NCCCP sites’ ability to implement and sustain four CDC-identified pilot projects. Using the Leeman et al. Framework for Capacity Building, we will apply multi-modal capacity-building strategies—including training, tools, technical assistance, assessment, and feedback—delivered through a community of practice, virtual learning sessions, and an in-person symposium. Our overarching goal is to strengthen NCCCP sites’ capacity to implement, adapt, and sustain effective cancer prevention and control EBIs while identifying the most effective strategies for building capacity at scale. Our specific aims are to: 1. Assess NCCCP sites’ capacity-building needs to refine SWW-IMPACTS protocols and align strategies with site staff’s preferences; 2. Develop a community of practice that fosters EBI selection, adaptation, implementation, evaluation, and sustainment through structured training and technical assistance; and 3. Evaluate the effectiveness of capacity-building strategies to determine how different formats and mechanisms influence practitioner capacity and EBI planning behaviors. By systematically examining changes in practitioner capacity and EBI planning behaviors, SWW-IMPACTS will generate insights to inform future capacity-building efforts. The long-term impact of this work will be a stronger, more sustainable infrastructure for implementing and scaling EBIs, ensuring that NCCCP sites can continually improve cancer prevention, treatment, and survivorship outcomes nationwide.

NCCDPHP - National Center for Chronic Disease Prev and Health Promo

Abstract Diabetes and its related complications are major causes of morbidity among youth and young adults in the US. The Assessing the Burden of Diabetes by Type in Children, Adolescents, and Young Adults (DiCAYA) Network was funded to develop new methodologies for diabetes surveillance using electronic health record (EHR) data. We served as DiCAYA’s Coordinating Center (CoC) for eight sites across the country. Together, we developed and validated computable phenotypes (CPs) to identify diabetes cases, type, and incidence in youth and young adults. Before DiCAYA, this work had yet to be done on such a large scale. Informed by the experience of DiCAYA, we are in an even stronger position to provide the leadership, expertise, and infrastructure needed to support and guide the CASSIDY Network. As the Component B site, we offer the expertise and support services required in statistics, diabetes epidemiology, clinical informatics, natural language processing, geographic information systems (GISs), and project and data management. As the NYU Coordinating Center (NYU CoC) for CASSIDY, we will provide the infrastructure and expertise to guide development and validation of harmonized and standardized surveillance measures and develop analytical methods to provide unbiased estimates of diabetes trends among individuals 44 or younger. Specifically, the NYU CoC aims to: 1) develop and maintain a central data repository and provide the infrastructure for secure transmission and management of data; 2) develop and maintain a study website for data entry and dissemination of information among study investigators and to the public; 3) provide required training for clinical staff and facilitate their interaction with study materials, documentation, and data collection; 4) provide expertise and leadership in developing, implementing, and evaluating a network of surveillance systems designed for population-based estimation; 5) provide statistical, epidemiologic, and analytic expertise and support for all aspects of the study; and 6) support the timely dissemination of study results. The NYU CoC leadership has significant experience leading multi- center studies and data coordinating centers, as well as specific expertise in designing surveillance systems based on electronic health records (EHRs) that integrate sound epidemiologic and study design principles to ensure completeness, appropriate representativeness, and generalizability of results. With this combination of skills, the NYU CoC is poised to deliver an unrivaled system for surveillance of diabetes in youth and young adults that provides accurate, representative, timely, and stable data over time to help determine trends in the incidence, prevalence, and clinical characteristics of both type 1 and type 2 diabetes among youth and young adults across the United States, ultimately informing public health interventions and reducing the burden of diabetes in these populations.

NCCDPHP - National Center for Chronic Disease Prev and Health Promo

PROJECT SUMMARY / ABSTRACT Early childcare and education (ECE) centers are trusted institutions that engage with parents regularly, positioning them as key messengers for childhood immunization and respiratory health promotion. While ECE centers ensure compliance with mandated vaccines, their potential to support uptake of non-mandated immunizations—such as influenza vaccine, COVID-19 vaccine, maternal RSV vaccine, and nirsevimab antibody—remains underutilized. The BREATHE Well (Building Readiness, Engagement, and Trust for Healthy Environments) Toolkit is an evidence-based intervention designed to enhance ECE-originating vaccine communication, training ECE staff to effectively engage parents on immunization topics. This study will evaluate the feasibility, acceptability, and effectiveness of the BREATHE Well toolkit using a cluster- randomized controlled trial (RCT). The project will be guided by three specific aims: (1) Develop and refine the BREATHE Well toolkit through formative research, incorporating input from ECE staff, parents, and public health officials; (2) Assess the acceptability and feasibility of the toolkit through focus groups and surveys with ECE staff and parents in demonstration sites within Michigan; and (3) Evaluate the effectiveness of the toolkit in a cluster-randomized trial of ECE centers, measuring changes in parental vaccine confidence, intent to vaccinate, and staff capacity to serve as trusted messengers. The BREATHE Well toolkit will be designed as a scalable approach usable in different types of ECEs. Findings from this study will inform best practices for integrating vaccine-related education into ECE settings, with the goal of increasing parental vaccine confidence and improving uptake of recommended immunizations.

NCCDPHP - National Center for Chronic Disease Prev and Health Promo

Project Summary Alarming increases in both type 1 and type 2 diabetes have been observed among youth in the United States over the past decade. There is an urgent need for a comprehensive surveillance system to monitor the prevalence, incidence, and complications of diabetes among youth and young adults, while evaluating disparities and contributing factors. However, national surveys lack sufficient data on youth and young adults to support rigorous diabetes surveillance. The recent development of the EPIC COSMOS database—which includes EHR records from over 289 million unique individuals, encompassing more than 60% of U.S. residents across all 50 states—offers an unprecedented opportunity to build a nationwide young-onset diabetes surveillance system. The rich data elements within COSMOS—including demographics, biomarkers, diagnoses, prescriptions, and social determinants of health—allow for accurate identification of diabetes cases and examine disparities in risk factors, complications, and medication use in diabetes. Given our strong experience as a leading user of the COSMOS network, we propose to develop a nationwide diabetes surveillance system based on this database, in response to CASSIDY’s RFA (Component A). The detailed aims are as follows: Aim 1: Refine the DiCAYA CP algorithms for automated identification of prevalent and incident cases of type 1 and type 2 diabetes among youth and young adults. Aim 2: Estimate the prevalence and incidence of type 1 and type 2 diabetes. Aim 3: Assess the risk factors for diabetes complications, the onset of acute and chronic complications, and the use of diabetes medications among youth and young adults with diabetes. Dissemination: We will work closely with the CDC and coordinating center to (1) adopt a CDM for data analysis and sharing across centers, and (2) disseminate study results through EPIC stakeholders and nationally by contributing to the CDC’s National Diabetes Statistical Report and high-impact scientific publications.

NCCDPHP - National Center for Chronic Disease Prev and Health Promo

PROJECT SUMMARY People with diabetes are at high risk of developing a range of diverse microvascular, macrovascular and neuropathic complications that are associated with high morbidity and erode their quality of life. Diabetes is expected to take an increasingly large financial toll in in the United States (U.S.) in the future, particularly among working age adults. Ongoing, timely and efficient surveillance of incidents and prevalent type 1 and type 2 diabetes diagnosed among youth and young adults is essential to identify health disparities and inform health care systems and the public health community on prioritizing strategies to prevent diabetes and its complications. The Colorado CASSIDY surveillance team is ideally situated to generate timely and accurate estimates of the prevalence and incidence of diabetes in youth and young adults from a near complete representation of health systems throughout our state, established in SEARCH, expanded in the Assessing the Burden of Diabetes by Type in Children, Adolescents, and Young Adults (DiCAYA) and further enriched for CASSIDY to allow our state to function as a health system site with a demographically and geographically representative population under surveillance. Our longstanding leadership in diabetes surveillance and research, institutional and statewide healthcare system partner commitment and the opportunity to directly validate the coverage and representativeness of statewide, deduplicated utilization-based denominators make us a valuable partner for the CASSIDY project. Our integrated surveillance approach was honed during our participation in DiCAYA, utilizing a combination of algorithms, incremental record linkage and chart review to identify individuals with diabetes, distinguish diabetes type and estimate date of diagnosis. Our specific aims are: Aim 1: SURVEILLANCE (Prevalence)- To ascertain cases of prevalent diabetes among individuals aged <45, by age, sex, race/ethnicity, geography and diabetes type; Aim 2: SURVEILLANCE (Incidence)- To ascertain newly diagnosed diabetes cases in young adults age <45 years at diagnosis, by age, sex, race/ethnicity, geography and diabetes type; Aim 3: EVALUATE PUBLIC HEALTH SURVEILLANCE METHODS - To evaluate the strengths and challenges of our integrated surveillance approach to determine the burden and risk of diabetes among youth and young adults by assessing validity, completeness and representativeness of case ascertainment methods and the potential utility of utilization-based denominators.

NCCDPHP - National Center for Chronic Disease Prev and Health Promo

Project summary Type 1 and type 2 diabetes mellitus (T1D, T2D) continue to rise in youth and young adults (YYA) worldwide, with disproportionately high rates of T2D among historically underserved populations. Young people with early-onset diabetes face decades of managing a complex chronic disease and are at heightened risk of complications. Despite advancements, key knowledge gaps persist regarding trends in early onset T1D and T2D incidence, disease management, and outcomes in real-world settings, particularly for young adults, rural communities, and those receiving care outside specialty centers. The transition to adulthood, which often involves changes in residence, employment, and insurance, complicates surveillance through traditional methods. To address these challenges, we have brought together a highly collaborative, multi-institutional team of endocrinologists, biostatisticians, epidemiologists, nephrologists and informaticists with experience in diabetes surveillance and electronic health record-based research. We have established a unique regional network of five major health systems across the Pacific Northwest (PNW) to conduct comprehensive diabetes surveillance in YYA. This network includes Seattle Children’s Hospital, University of Washington Medicine, Providence Health System, Virginia Mason Franciscan Health, and the Veterans Affairs VISN 20 region, collectively serving diverse urban and rural populations across Washington, Oregon, Idaho, Montana, and Alaska. By integrating EHR, claims data, and established research infrastructure, we will conduct systematic surveillance of diabetes incidence, prevalence, clinical management, and complications in YYA. Our central hypothesis is that tracking diverse demographics, including rural and Native populations, will uncover critical disparities in the diabetes burden, healthcare delivery, and outcomes amenable to targeted interventions. Data will be harmonized across the health systems in our network. We will contribute to and implement the shared protocol developed with other funded sites in this cooperative grant mechanism. This project will deliver the first large-scale, real-world surveillance system for YYA with diabetes in the PNW, capturing underrepresented populations and addressing a pressing need for timely data on evolving trends in care and outcomes. By systematically identifying disparities in disease burden and clinical management, results will inform interventions to prevent disease progression, reduce complications, and improve long-term quality of life. The focus on rural and Native populations ensures that our approach is inclusive, contextually relevant, and poised to directly influence public health efforts in regions often overlooked by surveillance studies.