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P6.075 Attend to the “Small P” Policy Issues: State Policy Issues Preventing Effective Cervical Cancer Efforts
  1. B E Meyerson1,
  2. C A Lawrence1,
  3. J S Smith2
  1. 1Indiana University School of Public Health-Bloomington, Bloomington, IN, United States
  2. 2UNC Gillings School of Global Public Health, Chapel Hill, NC, United States


Background We know little about policy issues at state level that impede cervical cancer efforts in the US. This study identifies and explores state policy issues in cervical cancer to inform future policy and programme strategies.

Methods Sixty minute key informant interviews were conducted with 15 professionals working in and around cervical cancer: federal and state government breast and cervical cancer programmes; women’s health and cancer control; national advocacy organisations engaged in sexual health and cancer; legislative affairs; researchers working in cervical cancer intervention and evaluation; state coalitions engaged in cervical cancer efforts; and partners from industry working on diagnostics, therapeutics or vaccines.

Results State policy issues included health system complexity; lack of state level cervical cancer programme and policy coordination, and socio-organisational culture issues. System complexity was fueled by disparate and uncoordinated financing, controlled by different state programmes/agencies. A paucity of state level coordination exacerbated by a lack of cervical cancer inter-agency/programme influence prevented comprehensive, streamlined systems of care. Despite recent efforts to coordinate statewide cancer planning, cervical cancer issues and actors were not active in state priority setting. Socio-organisational cultural issues prevented normalisation of HPV vaccine for boys and girls, as well as programme and practitioner adoption of recent screening recommendations focused on identifying and monitoring persistent HPV.

Conclusions Critical state policy issues are not ‘big p’ issues or laws, but ‘small p’ issues of implementation and unintended systems outcomes of policy. Cross-agency, statewide planning could streamline systems for comprehensive and coordinated funding and policy. Critical need to address state leadership vacuum for cervical cancer efforts. Increasing the policy acumen and skill set of cervical cancer related programmes and coalitions could facilitate change navigation. Success at this ‘small p’ policy level will help to make big strides toward removing structural barriers to cervical cancer efforts in the U.S.

  • cervical cancer
  • policy
  • states

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