CPHI Fellow Highlights and Publications
THE OPIOID CRISIS
Mayor James Kenney introduced a coordinated effort to confront this issue, with The Mayor’s Task Force to Combat the Opioid Epidemic in Philadelphia. The task force developed a plan to reduce opioid use disorder and associated morbidity and mortality. Read more.
Adverse events in veterans affairs inpatient psychiatric units: Staff perspectives on contributing and protective factors
True, G., Frasso, R., Cullen, S.W., Hermann, R.C., Marcus, S.C.
CPHI Fellow Gala True and colleagues identified protective factors that mitigate the risk of adverse events in inpatient psychiatric units; these factors include engaging in a culture of safety, embracing patient-centeredness, and encouraging local experts to share their knowledge to leadership to implement any changes. These findings were gathered from 20 interviews with informants in Veterans Health Administration hospitals. These protective factors, when engaged with all stakeholders, including patients, can improve the quality of inpatient psychiatric care. Read more.
No effect of commercial cognitive training on brain activity, choice behavior, or cognitive performance
CPHI Fellows Rebecca Ashare, Robert Hornik, Caryn Lerman, and collaborators explored the effects of cognitive training on choice behavior and brain responses. Among other measures of cognitive and choice behavior, the group tested the effects of cognitive training specifically on delay discounting and risk sensitivity; with delay discounting referring to choosing between immediate small rewards and larger rewards in the future and risk sensitivity referring to choosing between larger, riskier rewards and smaller, certain rewards. The group found that cognitive training has no effect on choice behavior or brain activity during decision-making. Read more.
Sociodemographic characteristics and health outcomes among Lesbian, Gay, and Bisexual U.S. Adults Using Healthy People 2020 leading health indicators
Lunn, M.R., Cui, W., Zack, M.M., Thompson, W.W., Blank, M.B., Yehia, B.R.
CPHI Fellow Baligh R. Yehia and collaborators have published the results from an analysis of health determinants amongst sexual minorities. The investigators administered a cross-sectional survey that, among other points of interest, assessed health outcomes using nine leading health indicators (LHIs) from Healthy People 2020. These nine indicators looked at health behaviors (BMI, if one is a smoker, etc.) and access to care (health insurance, screenings, etc.). It was concluded that more sexual minority adults met the nine LHIs than heterosexual adults. These health inequities call for targeted health assessments as well as further research exploring all LHIs. Read more.Publication
Coping with the stress in the cardiac intensive care unit: Can mindfulness be the answer?
Golfenshtein, N., Deatrick, J.A., Lisanty, A.J., Medoff-Cooper, B.
CPHI Fellow Janet A. Deatrick and colleagues investigate the feasibility of engaging in mindfulness as an effective coping mechanism for the stress felt by mothers with infants suffering from complex congenital heart disease (CHD); this stress can lead to adverse health outcomes for both mother and child. The results show that mothers engage in common coping mechanisms, such as positive thinking, distraction, and relying on support systems. It was also found that mindfulness was acceptable and feasible, but mothers expressed concerns relating to time and space as well as exhibited general unfamiliarity with the concept. The results from this study set the stage for further research into tailored intervention regarding coping mechanisms, such as mindfulness. Read more.
Movement patterns in women at risk for perinatal depression: Use of a mood-monitoring mobile application in pregnancy
Faherty, L.J., Hantsoo, L., Appleby, D., Sammel, M.D., Bennett, I.M., Wiebe, D.J.
CPHI Fellow Douglas J. Wiebe and colleagues have shown an association between symptoms of perinatal depression and daily radius of travel through a study using a mood-monitoring smartphone application. The application asks several questions daily to assess mood, while also tracking travel and mobility. Women with milder perinatal depression symptoms had a daily radius of travel that was 0.8 miles more than that of women with severe symptoms (2.7 miles compared to 1.9 miles). Moreover, there appears to be an association between mood and a contracted radius of travel, leading to a worsening of mood compared to the previous day. This study lays the groundwork for future studies and interventions involving smartphone technology. Read more.
Motor vehicle crash risk among adolescents and young adults with attention-deficit/hyperactivity disorder
CPHI Fellows Allison E. Curry, Flaura K. Winston and collaborators have found that adolescents and young adults with Attention-Deficit/Hyperactivity Disorder (ADHD) have a 36% higher risk of getting into a motor vehicle crash than those without ADHD. Additional results show that these individuals with ADHD are also licensed less often and at older ages. The researchers examined the electronic health records and New Jersey state traffic safety databases for a cohort of 18,000 individuals within the CHOP healthcare network. Read more.
The relationship between pay day and violent death in Guatemala: A time series analysis
CPHI Fellows Therese S. Richmond, Kent Bream, Douglas J. Wiebe, and collaborators explored the relationship between pay days, holidays, and occurrences of violent death in Guatemala. By itself, pay day does not correlate with heightened rates of violent death; however, their results show that holidays and pay days occurring on holidays are associated with an increased risk of violent death. The collaborators offer several suggestions for intervention, including a staggered system of pay days and increased guardianship. Read more.
Sociodemographic characteristics and health outcomes among Lesbian, Gay, and Bisexual U.S. Adults Using Healthy People 2020 leading health indicators
Purpose: This study aimed to characterize the sociodemographic characteristics of sexual minority (i.e., gay, lesbian, bisexual) adults and compare sexual minority and heterosexual populations on nine Healthy People 2020 leading health indicators (LHIs). Methods: Using a nationally representative, cross-sectional survey (National Health Interview Survey 2013-2015) of the civilian, noninstitutionalized population (228,893,944 adults), nine Healthy People 2020 LHIs addressing health behaviors and access to care, stratified using a composite variable of sex (female, male) and sexual orientation (gay or lesbian, bisexual, heterosexual), were analyzed individually and in aggregate. Results: In 2013-2015, sexual minority adults represented 2.4% of the U.S. population. Compared to heterosexuals, sexual minorities were more likely to be younger and to have never married. Gays and lesbians were more likely to have earned a graduate degree. Gay males were more likely to have a usual primary care provider, but gay/lesbian females were less likely than heterosexuals to have a usual primary care provider and health insurance. Gay males received more colorectal cancer screening than heterosexual males. Gay males, gay/lesbian females, and bisexual females were more likely to be current smokers than their sex-matched, heterosexual counterparts. Binge drinking was more common in bisexuals compared to heterosexuals. Sexual minority females were more likely to be obese than heterosexual females; the converse was true for gay males. Sexual minorities underwent more HIV testing than their heterosexual peers, but bisexual males were less likely than gay males to be tested. Gay males were more likely to meet all eligible LHIs than heterosexual males. Overall, more sexual minority adults met all eligible LHIs compared to heterosexual adults. Similar results were found regardless of HIV testing LHI inclusion. Conclusion: Differences between sexual minorities and heterosexuals suggest the need for targeted health assessments and public health interventions aimed at reducing specific negative health behaviors.
The Honor Society of Nursing, Sigma Theta Tau International, Names Dr. Therese S. Richmond as Its 2017 Episteme Award Recipient
"The Honor Society of Nursing, Sigma Theta Tau International (STTI), today named Therese S. Richmond, PhD, CRNP, FAAN, the 2017 recipient of the Baxter International Foundation-supported STTI Episteme Award. The award, which was established in 1989, is bestowed to a nurse who has contributed significantly to nursing knowledge development, application, or discovery that resulted in a recognizable and sizable benefit to the public. Dr. Richmond is being honored for her work on the psychological effects of violence and injury." READ MORE
How to Improve Driving Skills of Teens With ADHD
A study authored by Flaura Winston that was published in the June issue of JAMA Pediatrics found that teens with attention deficit hyperactivity disorder are about one-third more likely to be involved in a car accident than people without ADHD. They're also more likely to obtain their driver's license at a later time. This article discusses the findings.
Women with in-home technology reject wife beating as a norm
Findings published in the American Journal of Public Health by CPHI Fellow Susan B. Sorenson and Lauren Ferreira Cardoso of the School of Social Policy & Practice show that women with technology in the home more frequently reject wife beating as an acceptable norm. The PennCurrent article highlights the study.
Penn’s Netter Center Expands Global Impact and Outreach
CPHI Fellow Ira Harkavy, the associate vice president and founding director of the Netter Center, co-chaired “The Global Forum on Higher Education for Diversity, Social Inclusion and Community: A Democratic Imperative" which is being highlighted in this article.
Community health workers lead to better health, lower costs for Medicaid patients
This news article highlights Penn Medicine's IMPaCT community health worker program and that it can reduce hospitalization and improve control of obesity, diabetes and smoking. CPHI Fellow David Grande is one of the study authors.
A 5% rent increase would push 2,000 Angelenos into homelessness, study warns
This news article discusses a study that was conducted by the real estate firm Zillow using census figures and homeless counts for the 25 largest U.S. metropolitan areas. CPHI Fellow Dennis P. Culhane was consulted for his expertise in this topic.
Development of a youth-report measure of DPN symptoms: Conceptualization and Content Validation
Moser, J., Lipman, T., Langdon, D., Bevans, K.
Aims: To develop a content valid youth-report measure of diabetic peripheral neuropathy (DPN) symptoms. Methods: Semi-structured interviews with 5 clinicians and 15 youth aged 8–17 with diabetes were conducted to elicit and clarify youth’s DPN experiences. A systematic review of existing adult-report DPN symptom measures was conducted to identify item concepts representative of each experience. The concepts were transformed into items that were iteratively revised based on cognitive interviews (n = 13 youth aged 8–17) and readability analyses. Results: Clinician and youth interviews supported a tripartite conceptual framework of youth DPN symptoms: paresthesia, pain, and anesthesia. Forty-eight youth-report items were generated to represent DPN symptoms identified through the semi-structured interviews and a systematic review of 13 symptom questionnaires for adults. Of these, 23 were eliminated and 3 were revised based on cognitive interviews conducted with youth. The remaining 25 items were on average, written at a 3rd grade reading level. Conclusions: This study is the first to generate a content valid self-report measure of youth’s lived experiences with DPN that uses developmentally appropriate terminology. With further psychometric testing, the measure could be used to advance research on pediatric DPN and enhance clinicians’ capacity to identify the condition in childhood.
Ensuring Community Participation During Program Planning: Lessons Learned During the Development of a HIV/STI Program for Young Sexual and Gender Minorities
Bauermeister JA, Pingel ES, Sirdenis TK, Andrzejewski J, Gillard G, Harper GW; Michigan Forward in Enhancing Research and Community Equity (MFIERCE) Coalition
HIV/STI incidence has shifted to a younger demographic, comprised disproportionately of gay and bisexual men, transgender women, and people of color. Recognizing the importance of community organizing and participatory engagement during the intervention planning process, we describe the steps taken to engage diverse constituents (e.g., youth and practitioners) during the development of a structural-level HIV/STI prevention and care initiative for young sexual and gender minorities in Southeast Michigan. Our multi-sector coalition (MFierce; Michigan Forward in Enhancing Research and Community Equity) utilized a series of community dialogues to identify, refine, and select programmatic strategies with the greatest potential. Evaluation data (N = 173) from the community dialogues highlighted constituents’ overall satisfaction with our elicitation process. Using a case study format, we describe our community dialogue approach, illustrate how these dialogues strengthened our program development, and provide recommendations that may be used in future community-based program planning efforts.
Pediatric Emergency Department and Primary Care Provider Attitudes on Assessing Childhood Adversity.
Objective: The purpose of this study was to understand pediatric emergency department (ED) and primary care (PC) health care provider attitudes and beliefs regarding the intersection between childhood adversities and health care.
Methods: We conducted in-depth, semistructured interviews in 2 settings (ED and PC) within an urban health care system. Purposive sampling was used to balance the sample among 3 health care provider roles. Interview questions were based on a modified health beliefs model exploring the "readiness to act" among providers. Interviews were recorded, transcribed, and coded. Interviews continued until theme saturation was reached.
Results: Saturation was achieved after 26 ED and 19 PC interviews. Emergency department/primary care providers were similar in their perception of patient susceptibility to childhood adversity. Childhood mental health problems were the most frequently referenced adverse outcome, followed by poor childhood physical health. Adult health outcomes because of childhood adversity were rarely mentioned. Many providers felt that knowing about childhood adversity in the medical setting was important because it relates to provision of tangible resources. There were mixed opinions about whether or not pediatric health care providers should be identifying childhood adversities at all.
Conclusions: Although providers exhibited knowledge about childhood adversity, the perceived effect on health was only immediate and tangible. The effect of childhood adversity on lifelong health and the responsibility and potential accountability health systems have in addressing these important health determinants was not recognized by many respondents in our study. Addressing these provider perspectives will be a critical component of successful transformation toward more accountable health care delivery systems.
The Association Between Pregnancy Intention and Breastfeeding
Background: Although breastfeeding is associated with proven benefits to both mother and child, there are many factors that influence a mother's decision to breastfeed. Pregnancy intentionality at the time of conception is associated with postpartum maternal behavior including breastfeeding. Research aim: We sought to understand how maternal and paternal pregnancy intentions were associated with breastfeeding initiation and duration in a nationally representative sample. Methods: We used a cross-sectional, retrospective study of the CDC National Survey of Family Growth data to examine the link between pregnancy intentionality and breastfeeding initiation and duration among women ages 15 to 44 years. Results: We found that whereas the mother's intention to have a child was a factor in how long she breastfed, the paternal intention to have a child predicted whether the mother breastfed at all. Additionally, Hispanic mothers were most likely to breastfeed and breastfed the longest of any other group. Age and education were also positive predictors of ever breastfeeding. Conclusion: Understanding the father's and mother's attitudes toward the pregnancy and influence on breastfeeding intention is important for intervention planning. READ MORE.
Individual and Neighborhood Characteristics of Children Seeking Emergency Department Care for Firearm Injuries Within the PECARN Network
Carter, P.M. , Cook, L.J., Macy, M.L., Zonfrillo, M.R., Stanley, R.M., Chamberlain, J.M., Fein, J.A., Alpern, E.R.l, Cunningham, R.M.
In a study looking at the characteristics, individual and neighborhood factors of firearm-related injury among children, assault (51.4%, n = 904) and unintentional injury (33.2%, n = 584) were the most common injury mechanisms. Among children with firearm injuries, 68.3% were older adolescents (15–19 years old), 82.3% were male, 68.2% were African American, and 76.3% received public insurance/were uninsured. Distinct demographic and neighborhood factors were found, such as unintentional injury among younger children (<10 years old) vs. assault-type injuries among older adolescents. Male adolescents living in neighborhoods characterized by high levels of concentrated disadvantage had an elevated risk for firearm injury. Reccomendations are to direct public health efforts at both the individual and the community level, including ED-based interventions to reduce the risk for firearm injuries among high-risk pediatric populations. READ MORE.
Current Trends in ATV Crash Injuries
A new study reports the incidence, mortality trend, and anatomic distribution of fractures due to ATV use in children and teens. Read more for details, along with safety tips for families.
How virtual reality is changing cardiovascular care
Aug 4, 2017
This news article explores how virtual reality is increasingly being used in the health sciences. CPHI Fellow Marion Leary is featured in the article, showcasing how Penn is studying whether virtual reality can better prepare bystanders to perform CPR.
Mass Incarceration in the United States
Although the U.S. only contributes 5% of the world's population, it incarcerates 25% of the global prisoners. Contributing factors include the ongoing “War on Drugs”; institutionalized racism which leads to drug/arrest rate discrepancies between races; and the adoption of Zero Tolerance policies to stop violence in schools which in turn led to adverse effects on African American students. Read more.
Developing implementation strategies for firearm safety promotion in paediatric primary care for suicide prevention in two large US health systems: a study protocol for a mixed-methods implementation study
The promotion of safe firearm practices, or firearms means restriction, is a promising but infrequently used suicide prevention strategy in the USA. Safety Check is an evidence-based practice for improving parental firearm safety behaviour in paediatric primary care. However, providers rarely discuss firearm safety during visits, suggesting the need to better understand barriers and facilitators to promoting this approach. This study, Adolescent Suicide Prevention In Routine clinical Encounters, aims to engender a better understanding of how to implement the three firearm components of Safety Check as a suicide prevention strategy in paediatric primary care. SEE MORE
New Research: Newly Licensed Adolescents with ADHD Crash Risk Elevated, Yet Manageable
A study conducted by Allison E. Curry, PhD, MPH and her colleagues at Children's Hospital of Philadelphia (CHOP) found adolescents with attention-deficit hyperactivity disorder (ADHD) have a 36 percent higher crash risk than other newly licensed teens. This large-scale study is the first to provide detailed information on the proportion of adolescents with ADHD who get licensed and their crash risk as compared with other newly licensed drivers. SEE MORE