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Sickness Prevention Achieved through Regional Collaboration (SPARC, Inc.®)

  • Need: Population-based rates of adult vaccinations and cancer screenings are low. Delivery rates are lower still in low-income and minority communities.
  • Intervention: SPARC was established to develop and test new community-wide strategies to increase the delivery of clinical preventive services.
  • Results: Across the United States in both rural and urban communities, SPARC programs, which broaden the delivery of potentially life-saving preventive services, have been successfully launched, improving residents' health.


Evidence-Based (About evidence-level criteria)


Preventive measures, such as vaccinations, cancer screenings, and cardiovascular case-finding, have been shown to be effective at preventing or mitigating illnesses, not to mention saving lives. These services are covered by almost all health insurance programs including Medicare. Despite wide access and a medical consensus regarding their high effectiveness, preventive services remain underutilized, especially in low-income and minority populations.

To address the underuse of preventive medicine, the Sickness Prevention Achieved through Regional Collaboration (SPARC) program was created in 1994. SPARC develops ways to link people with local community organizations and healthcare providers, providing greater access to basic prevention services. Initially designed to serve the residents of four rural counties in Connecticut, Massachusetts, and New York, the program now works in urban and rural communities across the U.S.

The program has utilized a variety of funding sources over the years and has partnered with over 150 organizations, including the CDC, the American Cancer Society, local health departments, and visiting nurse associations.

SPARC has been honored with several national awards and is recognized as a model program by the Centers for Disease Control and Prevention (CDC) and the Robert Wood Johnson Foundation.

SPARC Honors and Awards

  • 2008: The Vote & Vax program was recognized by the National Adult and Influenza Immunization Summit and received the Season Activity Award.
  • 2005: Recipient of the American Public Health Association Susan B. Anthony Aetna Award for Excellence in Research on Older Women and Public Health
  • 2001: Achievement Award in Adult Immunization, Massachusetts Department of Public Health and the Massachusetts Peer Review Organization (MassPRO)
  • 1999: Public Health Partnership Award, Dutchess County Board of Health, Poughkeepsie, New York
  • 1998: Achievement Award, Massachusetts Peer Review Organization (MassPRO) and Massachusetts Coalition for Adult Immunization

Services offered

SPARC has developed many projects to improve the rate of adults receiving primary preventive services such as cancer screenings and immunizations. These projects included:

  • The scheduling of mammography appointments at flu vaccine clinics
  • A 24-hour flu clinic information hotline
  • Hepatitis B immunizations in schools
  • Promotions of various cancer screenings, including colon, breast, and cervical cancers
  • 5 over 50, a program encouraging adults over 50 to receive 5 major preventive services
  • Vote & Vax®, where local providers organize vaccination clinics at polling centers on election days


  • The SPARC program has been successful in providing increased access to preventive care.
  • The Vote & Vax project has been implemented in 42 states and has helped deliver over 30,000 flu vaccines across the country. The program was active in the 2008, 2012, and 2016 national elections.
  • Litchfield County, Connecticut (one of the first Vote & Vax sites), has gone from third place to first place among counties in the state for delivery of flu shots to older adults.
  • In its first two years, SPARC's school-based vaccination program for hepatitis B served 1,560 adolescents and grew by 140%.
  • In the early years of coupling flu shots with mammography appointments, the program served 338 women in a three-month period by helping them schedule mammograms for which they were overdue.
  • One study found that, by offering mammography appointments at flu clinics, SPARC's efforts doubled the number of women receiving needed mammograms.

The SPARC model was replicated by the Atlanta Regional Commission in 2006, where it successfully increased the percentage of adults receiving preventive vaccines and referrals for cancer screenings. SPARC's Vote & Vax program also has been successfully replicated in hundreds of communities across the U.S.

Research and publications relating to SPARC

Shenson, D., Moore, R.T., Benson, W., & Anderson L.A. (2015). Polling Places, Pharmacies, and Public Health: Vote & Vax 2012. American Journal of Public Health, 105(6), e12-e15.

Krist, A.H., Shenson, D., Woolf, S.H., Bradley, C., Liaw, W.R., Rothemich, S.F., ... & Anderson, L.A. (2013). Clinical and Community Delivery Systems for Preventive Care: An Integration Framework. American Journal of Preventive Medicine, 45(4), 508-516.

Ogden, L.L., Richards, C.L., & Shenson, D. (2012). Clinical Preventive Services for Older Adults: The Interface between Personal Health Care and Public Health Services. American Journal of Public Health, 102(3), 419-425.

Shenson, D., Adams, M., Bolen, J., Wooten, K., Clough, J., Giles, W.H., & Anderson, L. (2012). Developing an Integrated Strategy to Reduce Ethnic and Racial Disparities in the Delivery of Clinical Preventive Services for Older Americans. American Journal of Public Health, 102(8): e44-e50.

Shenson, D., Anderson, L., Slonim, A., & Benson, W. (2012). Vaccinations and Preventive Screening Services for Older Adults: Opportunities and Challenges in the USA. Perspectives in Public Health (Royal Society for Public Health), 132(4), 165-170.

Shenson, D., Adams, M., Bolen, J., & Anderson, L. (2011). Routine Checkups Don't Ensure that Seniors Get Preventive Services. Journal of Family Practice, 60(1), E1-E10. Article Abstract

Shenson, D. & Adams, M. (2008). The Vote and Vax Program: Public Health at Polling Places. Journal of Public Health Management & Practice, 14(45), 476-480. Article Abstract

Shenson, D. (2006). Putting Prevention in its Place: The Shift from Clinic to Community. Health Affairs, 25(4), 1012-1015. Article Abstract

Shenson, D., Cassarino, L., DiMartino, D., Marantz, P., Bolen, J., Good, B., & Alderman, M. (2001). Improving Access to Mammograms through Community-Based Influenza Clinics: A Quasi-Experimental Study. American Journal of Preventive Medicine, 20(2), 97-102. Article Abstract

Shenson, D., Quinley, J., DiMartino, D., Stumpf, P., Caldwell, M., & Lee, T. (2001). Pneumococcal Immunizations at Flu Clinics: The Impact of Community-Wide Outreach. Journal of Community Health, 26(3), 191-201. Article Abstract


To learn more about replicating SPARC in your community, check out the CDC SPARC Action Guide.

Contact Information

Douglas Shenson, MD, MPH, Executive Director
Sickness Prevention Achieved through Regional Collaboration, Inc.

Health screening
Wellness, health promotion, and disease prevention

States served
National/Multi-State, Connecticut, Massachusetts, New York

Date added
June 12, 2007

Date updated or reviewed
July 26, 2023

Suggested citation: Rural Health Information Hub, 2023. Sickness Prevention Achieved through Regional Collaboration (SPARC, Inc.®) [online]. Rural Health Information Hub. Available at: [Accessed 17 April 2024]

Please contact the models and innovations contact directly for the most complete and current information about this program. Summaries of models and innovations are provided by RHIhub for your convenience. The programs described are not endorsed by RHIhub or by the Federal Office of Rural Health Policy. Each rural community should consider whether a particular project or approach is a good match for their community’s needs and capacity. While it is sometimes possible to adapt program components to match your resources, keep in mind that changes to the program design may impact results.