Problem: Cancer is the second leading overall cause of death in New York State.1 In 2014, the age-adjusted cancer incidence rate was 476.5 cases per 100,000 New Yorkers, the fifth highest cancer incidence rate in the United States and above the national average of 436.6 cases per 100,000 people.2 Effective, affordable, population-based screening tests for breast, cervical and colorectal cancer have been successful in reducing cancer incidence and mortality. Evidence shows that people may be more likely to get cancer screenings if they are given time off from work to do so.3,4
1New York State Department of Health (2016). Leading Causes of Death, New York State, 2005-2014. Retrieved from https://www.health.ny.gov/statistics/leadingcauses_death/nys_by_year.htm
2U.S. Cancer Statistics Working Group. (2017). United States Cancer Statistics: 1999-2014 Incidence and Mortality Web-based Report. Retrieved from https://www.cdc.gov/cancer/uscs/
3Cook, W. K. (2011). Paid sick days and health care use: An analysis of the 2007 national health interview survey data. American Journal of Industrial Medicine, 54, 771–779. doi:10.1002/ajim.20988
4Peipins, L. A., Soman, A., Berkowitz, Z., & White, MC. (2012). The lack of paid sick leave as a barrier to cancer screening and medical care-seeking: results from the National Health Interview Survey. BMC Public Health, 12, 520. doi: 10.1186/1471-2458-12-520
PSE Change Solution: The New York State Department of Health (NYSDOH) worked with partners including contractors, health systems, local health departments and other community organizations to engage the community and build support for paid leave policies for cancer screenings in worksites. Their multi-pronged approach included organizational assessments with businesses and municipalities regarding readiness and capacity for paid time off policies; identification of community champions to build momentum; and community education to promote the connection between paid time off and improved cancer screening rates. As a result of these efforts, municipalities, community-based organizations, businesses, and one health care agency implemented paid time off policies.
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Cancer is the second leading overall cause of death in New York State (New York State Department [NYSDOH], 2016). Approximately 110,000 cases of cancer are diagnosed each year, with more than 95 New Yorkers dying each day from cancer (NYSDOH, 2017). In 2014, the age-adjusted cancer incidence rate was 476.5 cases per 100,000 New Yorkers, the fifth highest cancer incidence rate in the United States and above the national average of 436.6 cases per 100,000 people (U.S. Cancer Statistics Working Group, 2017).
Effective, affordable, population-based screening tests for breast, cervical and colorectal cancer are available, and these tests have been successful in reducing overall cancer incidence and mortality. New York implements a multi-sectoral approach in its work to achieve the breast, cervical and colorectal cancer screening goals set by Healthy People 2020.
Early detection of breast, colorectal and cervical cancer finds these cancers when they most treatable. Routine cervical and colorectal cancer screening can prevent these cancers from occurring altogether by finding pre-cancerous, abnormal cells and removing them before they become cancerous. Increases in cancer screening rates could be achieved by reducing structural barriers to screenings, as recommended by The Guide to Community Preventive Services.
Evidence shows that people may be more likely to get cancer screenings if they are given time off from work to get these screenings (Cook, 2011; Peipins, 2012). Promoting employer policies to increase paid time off for cancer screening that is not charged against other sick or vacation time may specifically encourage employees to obtain age-appropriate cancer screenings. This intervention aligns with strategies in the New York State Comprehensive Cancer Control Plan and is supported by the results of an annual, random digit-dial phone survey of New York State residents ages 18 and older. The survey found nearly 90% of the adults surveyed were in support of requiring employers to offer all employees paid leave to receive preventive health screenings such as cancer screening tests, and 78% were in support of requiring employers to offer flex time options for health screenings.
NYSDOH is working with 27 Cancer Services Program (CSP) contractors, including health systems, local health departments, YWCAs and other community organizations, to engage their community partners and build support for paid leave policies for cancer screenings in worksites. CSP provides breast, cervical and colorectal cancer screenings and diagnostic services at no cost to low-income, uninsured or underinsured New York residents. Prior to contacting worksites, contractors conduct environmental scans to gather data and information to make informed decisions about the businesses and municipalities to engage in this initiative (Step 2: Scan). Next, they conduct organizational assessments with select businesses and municipalities to collect and evaluate information regarding readiness and capacity to plan, develop and implement paid time off for cancer screening policies (Step 3: Assess). Contractors are encouraged to identify and work with community champions early in the process to build momentum toward changing or adopting new policies (Step 4: Review). Finally, contractors conduct community education to promote the importance of cancer screening and how paid time off for cancer screening improves cancer screening rates (Step 5: Promote). Examples of community education tasks conducted by contractor staff and community champions include:
- Disseminating information about paid leave for cancer screenings at community venues and/or public events
- Building relationships with news reporters and media personalities to disseminate cancer prevention and control messages and information
- Generating earned media coverage about paid leave for cancer screenings
- Writing articles for organizations or employee newsletters
- Using social media tools to disseminate information
- Attending and/or speaking at events, meetings or hearings
Contractors report quarterly performance, process and short-term outcome measures to NYSDOH (Step 7: Evaluate). The quarterly data collection provides information on the key steps or milestones that lead to the desired project outcomes. The performance measures link to required work plan activities and are used to identify areas of success and opportunities for improvement.
Process and short-term outcome measures are collected to document progress towards the desired organizational policy change and describe key components of a successful intervention. This information is useful in determining whether the approach to organizational policy change is effective, and documenting whether successful implementation of work plan strategies is associated with measurable changes in health-related behaviors in communities.
Additionally, the NYSDOH conducts an annual random digit-dial telephone survey of adult residents to measure public support for priority comprehensive cancer control policy initiatives, including paid time off for cancer screening. Assessing public support is a crucial step to inform and evaluate initiatives aimed at fostering communities’ support of policy changes. Survey respondents are read a description of a policy and asked whether they are in favor of or opposed to the policy using a four-option scale. Strong rates of public support for a paid time off for cancer screening policy suggests that contractor efforts should focus on mobilizing community action and educating government and organizational decision-makers.
As of fall 2017, eight municipalities, eight community-based organizations, seven for-profit businesses and one health care agency have successfully implemented paid time off for cancer screening policies that reach over 10,000 employees. Contractors garnered 226 earned media placements and identified over 60 champions to help support this work.
Success Factors and Key Questions Addressed
Which stakeholders needed to be included in your efforts and how did you assemble them?
Contractors engage community champions, such as health care providers, legislators, employers, employees and survivors to help build and promote this work. They also work to engage organizational decision-makers (CEOs, union leaders, human resource managers, etc.) and government decision-makers (local or state representatives) who have the ability to implement, support or help sustain policies. To begin to build support, educate communities and assemble champions, contractors and/or their champions speak at events (Chamber of Commerce, Rotary, etc.), set up meetings with union leaders, keep legislators informed through regular communications via in-person meetings, social media messaging, invitations to events, etc. The American Cancer Society (ACS) is a valuable stakeholder in this effort and works with many contractors in their communities to identify target worksites and potential champions.
How did the missions of diverse stakeholders align for the purpose of the PSE change effort?CSP contractors work to reduce cancer incidence and mortality by increasing cancer screening rates throughout their communities. Partnering with employers who want a healthy and productive workforce was a natural collaboration.
What resources (tangible and intangible) were needed that stakeholders could provide?CSP contractors engage community champions; build relationships with local media outlets; and promote the initiative within their own organizations and other mediums.
ACS helps to support contractors by providing guidance and introductions to potential champions and by making the policy ask while the contractors provide the education.
NYSDOH develops resources for contractors (trainings, toolkits and factsheets) to build their skill levels to engage worksites and champions in this effort and provides evaluation tools and data for contractor use.
For information about recommended age- and risk-appropriate cancer screenings, please see the U.S. Preventive Services Task Force and search “cancer.” For information about reducing structural barriers to cancer screenings, please see The Community Guide. NYSDOH offers numerous resources regarding paid leave, including:
Developing a Paid Leave Policy for Cancer Screenings
Paid Leave: A Benefit for Employers and Employees
Offering Paid Time off for Cancer Screenings
Information for Action: Paid Leave for Cancer Screening
For additional information about cancer in New York, see:
Public Support for Policies to Prevent and Control Cancer: New York State Adults, 2013
New York State Cancer Consortium/New York State Comprehensive Cancer Control Plan
New York State Comprehensive Cancer Control Plan Dashboard
Cook, W. K. (2011). Paid sick days and health care use: An analysis of the 2007 national health interview survey data. American Journal of Industrial Medicine, 54, 771–779. doi:10.1002/ajim.20988
New York State Department of Health (2017). Cancer Incidence and Mortality for New York State, 2010-2014. Retrieved from www.health.ny.gov/statistics/cancer/registry/vol1/v1rnys.htm
New York State Department of Health (2016). Leading Causes of Death, New York State, 2005-2014. Retrieved from https://www.health.ny.gov/statistics/leadingcauses_death/nys_by_year.htm
Peipins, L. A., Soman, A., Berkowitz, Z., & White, MC. (2012). The lack of paid sick leave as a barrier to cancer screening and medical care-seeking: results from the National Health Interview Survey. BMC Public Health, 12, 520. doi: 10.1186/1471-2458-12-520
U.S. Cancer Statistics Working Group. (2017). United States Cancer Statistics: 1999-2014 Incidence and Mortality Web-based Report. Retrieved from https://www.cdc.gov/cancer/uscs/
Resources to Support Similar Evidence-Based Initiatives
The Community Guide:
• New York: Increasing Cancer Screenings, Saving Lives
• Client-Oriented Interventions to Increase Cancer Screening
• Provider-Oriented Interventions to Increase Cancer Screening
• Cancer Screening: Multicomponent Interventions (breast, cervical, colorectal)
Evidence-Based Cancer Control Programs:
• Workplace Cancer Screening Program