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SUCCESS STORIES from the 2012-2013

North Dakota Cancer Coalition Community Sub-Contract Projects

The North Dakota Department of Health, Comprehensive Cancer Program and members of the

North Dakota Cancer Coalition work in communities across North Dakota to promote healthy

lifestyles, support recommended cancer screenings, educate people about cancer symptoms,

increase access to quality cancer care, and enhance cancer survivors’ quality of life.

The success of this work is grounded in the tremendous collaboration and valuable partnerships

making comprehensive cancer control a reality in communities across North Dakota. The North

Dakota Cancer Coalition is an army of dedicated individuals, professionals, and cancer survivors

who share expertise, resources, and ideas to tackle priorities that are too broad to confront alone.

The result is a powerful statewide network of groups collaborating to conquer cancer.

The following 2012 – 2013 community sub-contract narratives illustrate the strength of the North

Dakota Cancer Coalition and highlight some of the extraordinary work of the community

partners in all areas of the cancer continuum, including emphasizing the primary prevention of

cancer, supporting early detection and treatment activities, and addressing the needs of cancer

survivors. In addition, there is an increased recognition of using policy, systems, and

environmental changes to guide sustainable cancer control. There is also an increased

recognition of the need to promote health equity as it relates to cancer control. Throughout all of

the sub-awards is the importance of demonstrating outcomes through evaluation.

We hope these narratives inspire readers and spark new ideas to continue the coalition’s mission

to reduce the incidence and impact of cancer for all North Dakotans.

Cancer Sub-Awards 2012-2013

Prevention:

1. On the Move to Cancer Prevention (Young People’s Healthy Heart Program at Mercy

Hospital)

2. Breastfeed for Life (Grand Forks Public Health Department)

3. Decreasing Obesity, One Step at a Time (Walsh County Health District)

4. Wellness Works – Lifelong Health (Rolette County Public Health District)

Screening:

5. Standing Rock Reservation Colorectal Cancer Screening and Education Project (Custer

Health)

Survivorship:

6. Live Well, Life Beyond Cancer (Bismarck Cancer Center Foundation)

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PREVENTION

ON THE MOVE to Cancer Prevention

Cancer is the number one cause of death in Barnes County and North Dakota for ages 45-84.

Forty-one percent of Americans will develop cancer with a third of these being prevented

through diet and lifestyle changes. The cancer incidence in Barnes County is higher than the state

rate. Twenty-six percent of North Dakota children are obese or overweight. In Barnes County,

the majority of kindergarteners through sixth graders receive less than the recommended 60

minutes of vigorous exercise daily.

ON THE MOVE to Cancer Prevention ran from January 1, 2013 to April 15, 2013. The goals

were to help Barnes County residents increase their awareness and knowledge of cancer

prevention and cancer survivorship and make two behavior changes: increase their physical

activity and fruit/veggie consumption.

Barnes County

ON THE MOVE

partners

assisting local

families in

preparing

healthy meals

and learning

ways to improve

the nutrition in

their daily meals.

The Barnes ON THE MOVE OTM)/ACHIEVE Partnership, which consists of 15 non-profit

organizations and government agencies, conducted a community-wide campaign to inform 6,000

(74% of adults) Barnes County residents about cancer prevention and survivorship, emphasizing

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setting a physical activity goal and joining OTM. The target was to enlist 650 Barnes County

residents to set an exercise goal and join OTM Goals (free membership where participants set a

physical activity goal and exercise on their own) or OTM Goals Plus (a $12 membership which

includes classes and Try-It sessions). We exceeded our goal with 711 participants.

As part of OTM, a class was held called “Nutrition for Cancer Prevention and Survivorship.” For

the class, we served samples of recipes that were rich in fruits and veggies to the 29 participants.

We also partnered with all Barnes County school districts to promote healthy meals for families

by offering two classes on how to make healthy meals rich in fruits/veggies that are fast,

inexpensive and easy. Eighteen families attended the classes.

Barnes County OTM members worked to implement the newly passed Valley City Public School

Wellness Policy which focuses on nutrition and physical activity changes. To increase

understanding of some elements of the policy, we developed and distributed three handouts that

focus on new food guidelines for meetings, concessions and fundraising.

ON THE MOVE for Students was an exciting aspect of our program where 931 students were

challenged to exercise for 60 minutes a day at least 5 days a week. Eight schools participated in

the challenge that was offered during the 4 weeks in March. Research shows that students who

are more physically active perform better academically.

Students in grades 4-6 kept a record of their physical activity during the 4 weeks in March using

a student activity log. Each student who met the weekly goal of at least 300 minutes per week

hung a ‘tennis shoe’ (made out of paper) on the gym wall or school hallway. Students who

completed the required number of minutes and turned in their activity logs earned an ON THE

MOVE t-shirt. For grades K-3, the school had them either earn the t-shirts like grades 4-6 or

chose to give all students a t-shirt.

To join the fun and act as role models, teachers and staff were encouraged to set an activity goal

of at least 150 minutes per week. Focus groups held with Barnes County students found that

students were motivated to exercise by seeing their teachers, school staff, and parents exercise or

set exercise goals.

The partners also enlisted the help of the Valley City State University football players through

their “Champions of Character” program. A group of football players visited each school to help

promote physical activity midway through the month-long program. The students were excited to

meet these ‘local celebrities’ and the players did a fantastic job promoting both nutrition and

physical activity.

At the end of OTM for Students, 68 percent of K- 6 students met their goal and received a t-shirt.

There were 64 percent of teachers/staff that set a goal, with 97 percent of those meeting their goal.

ON THE MOVE 2013 was successful. OTM partners see new prospects in policy, system, and

environment change such as a local walking path promotion as well as new interest in worksite

wellness opportunities in the upcoming months. Although ON THE MOVE for Cancer

Prevention has concluded, we welcome new and exciting opportunities to improve the health of

everyone in Barnes County!

For more information, contact Andrea Winter at: andreawinter@catholichealth.net.

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Breastfeed for Life

Breast cancer is the most commonly diagnosed cancer for women and is the second leading

cause of cancer deaths in North Dakota. Breastfeeding has been proven to reduce a woman’s risk

of both breast and ovarian cancer and obesity in children. Although breastfeeding is

recommended as the sole source of nutrition for the first six months and the continuation of

breastfeeding for at least 12 months, only 19% of women in North Dakota successfully meet the

one-year recommendation. Returning to work is one of the main barriers to long-term

breastfeeding as worksites are often logistically unprepared to support mothers as they return

from maternity leave.

The Grand Forks Public Health Department was awarded a North Dakota Cancer Coalition

Community grant to address breastfeeding support in worksites. The objective was to increase

the number of worksites obtaining the “Infant-friendly” designation through the North Dakota

Department of Health. To attain worksite “Infant-friendly” designation organizations must:

Allow flexible break times for expression of milk,

Provide a clean, private space (not a restroom) for pumping/nursing,

Provide access to a clean water source for washing hands and cleaning breast pump equipment,

Provide a place for storing breast milk.

Be A

BREASTFEED Reduce Your Risk of

Breast Cancer And

Baby’s Risk of Obesity

Need help with breastfeeding?

Contact Grand Forks Public Health

701-787-8100

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Twenty-five businesses in Grand Forks County were contacted to offer assistance with policy

development for breastfeeding employees. Over the course of the grant, nine businesses were

designated “Infant-friendly” and seven are in the process of becoming designated. Over 1,050

employees benefitted from their worksites passing a policy to protect and support breastfeeding

mothers.

Another component of this grant was a Public Service Announcement (PSA) campaign. Six local

breastfeeding mothers from the Grand Forks area and their babies were photographed in

Superman, “Supermom” t-shirts. These pictures were used to saturate Grand Forks County with

the message that breastfeeding moms are “Supermoms” because breastfeeding reduces the risk of

obesity among children and reduces the risk of breast and cervical cancer among women. The

campaign included visual (billboard/flyers/banner) and audio (radio) advertising. Approximately

79 percent of those surveyed had seen one source of advertising. Flyers were placed in worksites,

churches, and medical facilities just to name a few locations.

The last component of this grant was to survey employees of businesses that passed a

breastfeeding policy, for eligibility to the Women’s Way (ND Breast and Cervical Cancer

Program). Seven out of one hundred and fifty-six women were referred and one woman was

enrolled.

The spectrum of prevention teaches us that, through Policy, Systems, and Environment Change,

we can make a lasting difference; we can change the lives of many. Upon discharge from the

hospital after delivering their babies, 80 percent of women are breastfeeding, but this drops soon

after moms return to work. If all worksites protected and supported breastfeeding mothers, this

rate could remain high and the health benefits for both mom and baby could be seen by all.

For more information on the “Infant-friendly” designation program go to,

http://www.ndhealth.gov/breastfeeding/?id=1 or contact Mandy Burbank at:

mburbank@grandforksgov.com.

Decreasing Obesity, One Step at a Time (Walsh County Health District)

Being overweight as an adult is a risk factor for many chronic diseases including cancer.

According to the July 24, 2009, “Morbidity and Mortality Weekly Report,” approximately two-

thirds of United States adults and one fifth of United States children are obese or overweight.

Since the 1970s, the prevalence of overweight among children has more than doubled for

adolescents ages 12-19 and more than tripled for children 6-11 years old. Children have over a

40 percent increased chance of being overweight as an adult if they are overweight as an

adolescent.

Evidence suggests that more than one-third of cancer deaths are preventable by not using

tobacco, getting sufficient physical activity, and eating healthy foods in moderation. According

to the 2011 National Youth Behavior Survey, Walsh County has a higher percent of high school

students that are obese and lower percentages of students eating fruits and vegetables and getting

physical activity, than the national average. With so many families eating meals and snacks away

from home during the school year to support youth in sports, improving the concession stand

offerings by providing healthier options can improve the health of our youth.

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The goals of this grant were

to introduce policy changes

that promote healthy dietary

choices and increase

physical activity of Walsh

County high school students

to decrease obesity and

therefore reduce the risk of

cancer. Walsh County

Health District used a multifaceted approach which included policy change,

classroom education, increased opportunities for healthier food and beverage

choices, and increased opportunities for physical activity.

Walsh County schools were sent packets of information about adopting

healthy concessions stand policies and implementing a walking program with

their students. Two of the five schools, Minto High School and Valley Edinburg High School,

participated in the project. Discussions were held with school administration and booster club

representatives to discuss a healthy concessions model policy. Although the schools did not

adopt a concessions policy, the school administration entertained the idea of endorsing a policy

and representatives from the booster clubs were receptive to the idea.

Both schools participating provided class time for educational presentations about healthy eating

and physical activity. With help from NDSU Extension, a total of eight presentations were held

with students’ grades 9 – 12 at these schools. The students were very receptive to the

presentations and want healthier food and beverage choices at concession stands. The students’

knowledge about the importance of physical activity increased by 25 percent at Valley Edinburg

High School and by 33 percent at Minto High School based on the pre and post tests that were

administered.

A two-week walking challenge was also implemented at each school to address the importance

of physical activity. The physical education instructor provided leadership for the walking

program at Minto High School, while the secondary principal provided leadership at the Valley

Edinburg High School.

Policy changes have more impact and are more sustainable than education and programming

alone. Even though the schools participating were not able to adopt a healthy concession stand

policy this year, the school’s administration entertained the idea of endorsing a policy that

promotes offering healthier choices.

For more information, contact Deb Anderson at: dkanderson@nd.gov.

Wellness Works – Life Long Health (Rolette County Public Health District)

Rolette County Public Health District (RCPHD) serving Rolette County partnered with Microlap

Inc. worksite wellness program to improve the health of its employees. The majority of Rolette

county is Native American (77 percent) and 30 to 40 percent of the population live below the

poverty line. In the 2012 County Health Rankings, Rolette County was ranked second to last in

regards to health outcomes and ranked last in regards to health factors.

Walsh County

Public Health

working with

the schools

and the

school

booster clubs

to provide

healthy

choices for

school

concessions.

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In the past decade, 22-26 percent of deaths in Rolette County were deemed cancer deaths

according to ND Vital Statistics. RCPHD worked with Microlap Inc. employees to continue

with their “Wellness Works – Life Long Health” program, which is a prevention worksite

wellness program aimed to improve the health of Microplap Inc. employees.

The initial assessment of “Wellness Works – Life Long Health” participants showed that 98

percent of participants have a high risk for cancer. The assessment showed that 94 percent of

participants are over-weight, 91 percent need more physical activity, 87 percent need to make

nutritional changes, and 36 percent are tobacco users. The goals of this project were to empower

participants to adopt a lifelong healthy lifestyle which will lower their individual risk of multiple

forms of cancer and to influence policy/environmental change within the workplace environment

and community.

RCPHD worked on several initiatives with Microlap Inc. through the “Wellness Works – Life

Long Health” wellness program. Implementing a vending policy to revamp the vending machine

options was one initiative. RCPHD surveyed employees about their vending habits and

preferences. The Employee Committee President and Administration changed the food and drink

items to include healthier options based on the survey results. Two out of five beverages were

replaced with fruit or vegetable juice and 27 percent of the items were replaced with healthier

options. Although a formal vending policy was not obtained, action steps were made to provide

healthier snack items. The employees’ response to the new vending choices was favorable with

38 percent of participants saying they were pleased with the changes and opportunity to try new

snacks.

Another initiative to create a healthier environment at Microlap Inc. was to designate it as an

infant-friendly business. An infant-friendly business supports breastfeeding mothers by having a

clean/private space other than a bathroom, access to clean water, and something to store milk in

safely, along with allowing flexible break times to express milk. Breastfeeding has been shown

to reduce the risk of breast cancer and promotes weight loss for the nursing mother. Although a

written policy was not formalized, Microlap Inc. meets all the criteria for being infant-friendly.

Rolette County Public Health District worksite wellness project with Microlap in Rolla, making strides to better health for the employees.

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RCPHD implemented an 8-week walking challenge, “Walk Across America,” with participants

of the wellness program. Each participant was given a pedometer and tracking sheet to track their

steps each day. Twenty-eight employees started the program and thirteen finished the full eight

weeks. Participants walked approximately 3,341 miles combined.

NDSU Extension provided two cooking demonstrations with a great turnout of 70 percent of all

employees and 94 percent of wellness program participants. Participants were surveyed about

fruit and vegetable consumption in 2012 and 2013. Those reported eating more than 5 servings a

day increased by 4 percent from 2012 to 2013.

Employees were also educated through presentations, newsletters, fact sheets, and displays about

Women’s Way, the HOM Colorectal Cancer Program, and the ND Quitline/Quitnet. Of those

surveyed in 2013, 34 percent indicated the use of tobacco products which was 2 percent less than

those in the 2012 survey. Spit or Quit Kits were distributed to 12 individuals expressing interest

in tobacco cessation.

Through the worksite wellness program, RCPHD and Microlap Inc. were able to provide a

healthier work environment for program employees. Although no formal policies were

implemented, the policies were introduced and action steps were taken to make healthy changes

in the work environment at Microlap Inc.

For more information, contact Barbara Frydenlund at bfrydenlund@nd.gov.

SCREENING

Standing Rock Reservation

Colorectal Cancer Screening and Education Project (Custer Health) Colorectal cancer is the third most common cancer for the Northern Plains Native American

population. Northern Plains Native Americans have a higher risk for colorectal cancer than

whites or Native Americans in other regions of the United States, except Alaskan Natives. The

mortality rate of colorectal cancer in the Northern Plains Native Americans is 32 deaths per

100,000 for both men and women.

The goal of this project was to increase colorectal cancer screening and education for the men

and women of the Standing Rock Reservation. Custer Health partnered with Indian Health

Service and Tribal Health for the men’s and women’s health cancer screening days. Multiple

education stations were available at each screening event including those focusing on healthy

eating, diabetes education, tobacco cessation education, and a variety of other topics.

Custer Health sent invitation and reminder letters to prospective participants of the men and

women’s health screening events. Fourteen events were held with 45 percent of the men and

women invited attending. Transportation to the events was offered by community health

representatives and utilized by 34 participants.

Fecal Occult Blood Test kits were distributed to 151 participants at the screening events. A letter

to remind participants to send their kit in was sent two weeks after they were distributed and if

no response, again in four weeks. Reminder calls were also made to those who did not respond to

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the letters. As an incentive, a $5 gift certificate for fruit and vegetables from the local grocery

store was given to participants who sent their kits back. The total return rate for the kits was 33

percent, 48 percent returning rate for men and 23 percent return rate for women. Any abnormal

results were reported to the Indian Health Service providers for further testing.

Custer Health also provided one on one education at each screening event and at a Cancer Walk

that was held at Standing Rock. A total of 247 community members were educated between the

screening events and the Cancer Walk. A pre and post test was administered at each event with

participants from 13 out of the 14 events showing an increase in knowledge about colorectal

cancer from the pre to the post-test.

A system change that occurred with implementation of the community sub-contract for 2012-

2013 was the change in fecal occult blood testing for colorectal cancer screening. Providers

were informed that the one-time test of the digital rectal occult blood test during the office visit

is not an accepted form of colorectal cancer screening. The Standing Rock Indian Health

Services (IHS) lab converted from Hemocult Sensa II, take home test kits, which require red

meat and some medication restrictions prior to and during the test period to the Hemocult ICT.

This version of the three day immunochemical fecal occult blood test kit, is used by all IHS

facilities and is more commonly known as iFOBT.

The men’s and women’s health screening days were great opportunities to target and educate

those at risk for colorectal cancer on Standing Rock about the importance of colorectal

screening.

For more information, contact Jodie Fetsch at: jfetsch@custerhealth.com.

Community Members from the Standing Rock Reservation participating in a walk to promote

physical activity while honoring or remembering those who have or have had cancer.

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SURVIVORSHIP

Live Well, Life Beyond Cancer (Bismarck Cancer Center Foundation) Each year in the United States an estimated 1.4 million people are diagnosed with cancer. Major

advances in cancer prevention, early detection, and treatment have resulted in longer survival. In

the 1970’s, less than 50 percent of people diagnosed with cancer lived five years or longer.

Today over 70 percent of people with cancer are surviving greater than five years, with an

approximated 14 percent diagnosed 20 or more years ago (CancerCare, 2010 and NCI, 2006).

According to the Center for Disease Control and Prevention (CDC) the number of Americans

living as post-treatment cancer survivors has grown to nearly 13.7 million, with over 33,000

cancer survivors living in North Dakota (North Dakota Cancer Registry, 2012).

However, through feedback from local survivors, the Bismarck Cancer Center has found that

surviving cancer can leave a host of uncertainties and questions in its wake. Physical, emotional,

and practical concerns often persist for years after diagnosis and treatment.

A group of cancer survivors learning yoga while participating in the Bismarck Cancer Center Survivorship Classes

The feedback and grant funding allowed an opportunity for the Bismarck Cancer Center

Foundation to collaborate and partner with the North Dakota Cancer Coalition to use grant funds

to develop and implement a free educational cancer survivorship lecture series for cancer

survivors and caregivers throughout North Dakota. The goal of the lectures was to address

survivorship issues by empowering cancer survivors and caregivers though education, support,

resources, and connecting with other survivors; inspiring them to live a healthy and productive

life on their own terms without fear or anxiety related to cancer survivorship.

Each month, from February to May, a new lecture was provided to cancer survivors. Topics

included stress reduction, the importance of physical exercise after cancer, the importance of

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nutrition after cancer, and taking care of the caregiver. Each lecture had at least 25 cancer

survivors or caregivers attend.

Attendees learned different methods of stress management to cope with fear and anxiety such as

yoga, reflexology/massage therapy, and guided imagery. They learned the importance of exercise

during survivorship, including the benefits of group and individual fitness routines. Attendees

learned the value of a healthy diet during survivorship, how to use local resources such as

farmers’ markets, and how to plan and prepare healthy meals. Caregivers and survivors learned

what to expect emotionally when navigating a cancer diagnosis and treatment as well as how to

cope with and explore their feelings.

Over the course of the four workshops a total of 62 evaluations were completed. The results of

the evaluations showed that 94 percent of attendees were very satisfied with the overall quality

of the presentation, 97 percent were very satisfied with the overall quality of the speakers, and 89

percent were very satisfied with the overall quality of printed materials provided.

Feedback received on the evaluation form was very positive with many suggestions for future

survivorship topics. Utilizing clinical partners allowed the opportunity to provide this lecture

series and opened a door for future collaboration.

For more information, contact Sara Klein at: sklein@bismarckcancercenter.com.