Tobacco and Comprehensive Cancer Control: Strategies, Benefits and Barriers of a Chronic Disease Partnership

Introduction: Chronic diseases are the leading cause of death and disability in the United States, and tobacco use is one of the leading preventable causes of chronic disease. Cancer prevention and control, tobacco prevention and control, and other chronic disease programs have traditionally been funded and implemented through programs whose funding sources tend to have led to isolated or “siloed” efforts. Coordinated efforts between these diverse programs have the potential to increase their reach and effectiveness.

Methods: The purpose of this study was to document the extent to which CDC-funded Comprehensive Cancer Control (CCCP) and Tobacco Control Programs (TCP) coordinate planning and programmatic efforts.  Specifically investigators examined efforts aimed at program cross-collaboration, challenges encountered, and factors facilitating collaboration within a coordinated chronic disease model.  After receiving Institutional Review Board approval, semi-structured interviews were conducted with a total of 80 key stakeholders (a combination of individual and group interviews) from health department leadership staff, CCCPs, TCPs, and members of the State cancer coalitions in six states (approximately 10 interviews per state).  Data were grouped around themes and analyzed using nVivo v10.0.

Results: A common theme that emerged was that state health departments had already begun to focus efforts on a more integrated chronic disease programmatic approach.  Several benefits and drawbacks of this integrated approach were noted.  For example, several respondents noted that an integrated approach has the potential to optimize resources, prevent duplication and provide further support for developing program priorities and goals.  On the other hand, it was noted that integration may ‘dilute’ a program such that the focus on program priorities may become diminished.  Additionally, many chronic disease management staff in these health departments routinely collaborated to efficiently utilize resources to make the most impact.

Conclusion: Efforts to promote cross-cutting partnerships and integration of chronic disease programs is underway at the federal, state, tribal, territorial, and local levels. As integration across disease programs becomes more common, many public health chronic disease program staff, including those in cancer and tobacco control programs, may find these results to be relevant to their work.  Staff can use these findings to learn effective strategies to adopt a coordinated approach to chronic disease control.