The Los Angeles County Department of Health Services proposes to engage its resources in the systematic application of existing technology toward the national cancer prevention and control objectives. With a budget of $1.6 billion and nearly 22,000 employees the Department operates six hospitals, each affiliated with a local teaching institution, forty-two public health centers and five comprehensive ambulatory care facilities. Drawing upon the considerble experience of the Johnson Comprehensive Cancer Center (JCCC) and the linkage to the School of Public Health at the University of California, Los Angeles, the Department will enhance its cancer prevention and control capacity specifically within its ambulatory care facilities where more than 1.8 million patient visits occur annually. The capacity building program over a five year period will proceed in three phases and will establish within the Department's public health organization a central focus for cancer prevention program planning, implementation, and assessment. Phase I is essentially a preparation period in which Departmental staff who will in turn carry out the new cancer prevention and control emphasis, are provided essential orientation by JCC's Division of Cancer Control (DCC) experts. Phase II provides for the same staff the practicum, a period of close collaboration with DCC experts in the actual application of existing technology. Phase III transfers responsibility for on-going systematic cancer prevention activities to the Department. Within this framework, four specific projects will be conducted, each serving as a """"""""learning laboratory"""""""" for Departmental staff. One will enhance the Department's cancer related data resources and the capacity to use them in planning strategic interventions. A second project will test the Departmental's capacity to increase its cervical cancer detection activity, directed toward low income, minority females between the ages of 45 and 60. The third project also addressing a priority intervention, will train Departmental staff to offer smoking cessation programs, initially to employees and later extending to patients. As the fourth project, the Departmental's mammography capability, services, and experience will be reviewed to determine the feasibility of establishing a screening service for the benefit of high risk patients. This application offers the National Cancer Institute an opportunity to test the translation of its cancer technology into primary and secondary prevention programming within one of the largest local health departments in the nation.
