CPHI Fellow Highlights and Publications
The mediating role of sleep in the fish consumption – cognitive functioning relationship: a cohort study
CPHI Senior Fellow Jianghong Liu, CPHI Executive Director Jennifer Pinto-Martin and colleagues have linked regular consumption of fish to better sleep and higher IQ scores in children. Fish consumption grants ingestion of omega-3s, which are known to be related to better sleep and improved intelligence. The present study makes the connection between these three variables. The group found that children who consume fish at least once a week have IQ scores 4 points higher on average. These findings implicate recommendations for introducing regular fish consumption to children’s diets. Read more.
Perceptions about supervised injection facilities among people who inject drugs in Philadelphia
CPHI Senior Fellow Evan Anderson and collaborators evaluated the perceptions of injection drug users on prospective use of a supervised injection facility (SIF). SIFs are locations which provide a safe and clean environment for sterile injection drug use, though none exist currently in the United States. The group enlisted perceptions from individuals at a Philadelphia syringe exchange program. The researchers found a difference in preferences regarding a prospective SIF between individuals with and without stable housing. Those with stable housing explained that they would prefer to continue injecting at home for security reasons. Other findings include the overall perception that SIFs would improve public health and neighborhoods. Read more.
Impact of school-based and out-of-school mental health services on reducing school absence and school suspension among children with psychiatric disorders
CPHI Senior Fellows Rinad S. Beidas and David S. Mandell, along with collaborators, investigated the impact of Philadelphia’s School Therapeutic Services (STS) teams, specifically regarding absenteeism and suspension. Additionally, the researchers examined the effects of such interventions relating to out-of-school, community-based mental health services. STS teams are responsible for optimizing the integration of mental health services in schools. They found that community-implemented, school-based mental health services reduce school suspensions, and out-of-school mental health services correlated to reduced absences. Also, they found an increase in the use of out-of-school services during the STS enrollment year. These findings are important for policy decisions regarding the most effective settings for youth and adolescent mental health services. Read more.
Risky movies, risky behaviors, and ethnic identity among Black adolescents
Amy Bleakley, Morgan E. Ellithorpe, Michael Hennessy, Patrick E. Jamieson, Atika Khurana, Ilana Weitz
CPHI Associate Fellow Amy Bleakley and colleagues examine whether a relationship exists between exposure to explicit content in mainstream and Black-oriented movies and corresponding behavior among Black youth. To do so, the researchers examined survey data from 1000 Black adolescents, which granted data on self-reported exposure to alcohol, sexual activity, and violence in popular and Black-oriented films. Corresponding risky behaviors included actions such as frequent alcohol use, risky sexual behavior, and physical aggression. The group found that films including violent or alcohol content were associated with the aforementioned corresponding risky behaviors. Moreover, they found that strong group identity, related to ethnicity, strengthened the relationship between certain films involving sexual activity. Read more.
Measurement Error Due to Patient Flow in Estimates of Intensive Care Unit Length of Stay
Michael O. Harhay, Sarah J. Radcliffe, Scott D. Halpern
CPHI Associate Fellow Michael Harhay and colleagues investigated the effects of immutable time, or additional time accrued by patients after they are deemed ready for discharge, on the measurement and statistical comparison of patients’ intensive care unit (ICU) length of stay. ICU length of stay is a common endpoint measurement in related randomized clinical trials, and it is often compared between trials. The group found that, on average, immutable time attributed to an additional one-third of a day to patients’ total length of stay in the ICU. The group explains that such effects “might either mask true treatment effects or suggest false treatment effects relative to analyses of time to discharge readiness.” Read more.
Declining Medicaid Fees and Primary Care Appointment Availability for New Medicaid Patients
CPHI Senior Fellow Daniel Polsky, Fellow Karin Rhodes, and partners examine whether lower fee levels for Medicaid was associated with decreased primary care appointment availability for new Medicaid patients. Historically, when Medicaid fees increased in 2013-2014, primary care appointment availability for new Medicaid patients also increased. The team conducted an audit study, in which new Medicaid patients were simulated and called randomly selected primary care offices to request the earlier appointment available; this study occurred in 2012, 2014, and 2016, representing key points in the Medicaid fee transitions. The appointment availability in 2012 was 56.2%, 65.5% in 2014, and 61.5% in 2016, following the pattern of fee increase followed by fee decrease. Though, this relationship is robust, and the researchers claim that it is not a dependent relationship. Read more.
Critical Access to Care: Bringing Contraception to Adolescents in Nontraditional Settings
Melissa K. Miller and Cynthia J. Mollen
CPHI Associate Fellow Cynthia J. Mollen and a colleague provide a comprehensive overview of the climate surrounding contraceptives for adolescents, specifically in nontraditional settings such as the emergency department, which is sometimes the only source of healthcare for some individuals. The pair discuss issues currently faced by stakeholders of this topic. For example, a prominent obstacle involves confidentiality and policies surrounding an adolescent’s ability to consent to contraceptive care. Mollen and colleague call for more research, program, and policy efforts in this arena to improve health outcomes for adolescents. Read more.
A qualitative study of the experience of lower extremity wounds and amputations among people with diabetes in Philadelphia
Frances K. Barg, Peter F. Cronholm, Ebony E. Easley, Trocon Davis, Michelle Hampton, Scot Malay, Cornelius Donohue, Jinsup Song, Stephen R. Thom, David J. Margolis
CPHI Senior Fellows Frances K. Barg, Peter F. Cronholm, and collaborators studied the perspectives of diabetes patients who had either a foot ulcer or a lower extremity amputation. Data for this research was purely qualitative, gathered through interviews, coded, and assessed for similarities. Notable results include: both groups of patients expressed disruption and loss of independence, patients with foot ulcers expressed difficulty in treatment recommendations, and patients with amputations expressed initial fear, but eventual adaptation and acceptance. Overall, an important point of discussion was quality of life, and the researchers discuss how quality of life should factor into care decisions. Read more.
Coercive Control in Intimate Partner Violence: Relationship With Women’s Experience of Violence, Use of Violence, and Danger
CPHI Senior Fellow Melissa E. Dichter and Fellow Karin V. Rhodes, along with colleagues, investigate coercive control and its associations with women’s experiences of forms of intimate partner violence, use of violence, and risk of future violence. Coercive control is defined as a “systematic pattern of behavior that establishes dominance over another person through intimidation, isolation, and terror-inducing violence or threats of violence.” Findings show that those experiencing coercive control reported higher frequency of each form of intimate partner violence as well as high levels of risk of revictimization. Additionally, the group found an association between coercive control and use of physical intimate partner violence, which may be a survival strategy. The group further discusses implications of the discovered associations. Read more.
Where do bike lanes work best? A Bayesian spatial model of bicycle lanes and bicycle crashes
Michelle C. Kondo, Christopher Morrison, Erick Guerra, Elinore J. Kaufman, Douglas J. Wiebe
CPHI Senior Fellow Douglas J. Wiebe and colleagues seek to identify specific locations where bike lanes would effectively reduce crash incidence. The group utilize Bayesian conditional autoregressive logit models to determine where such locations may exist in Philadelphia. The results show that bike lanes were “associated with reduced crash odds of 48% in street segments adjacent to 4-exit interactions.” Furthermore, areas of one- or two-way stop intersections were associated with reduced crash odds of 40%, and high traffic volume regions were associated with odds of 43%. The group concludes that “the effectiveness of bicycle lanes appears to depend on most of the configuration of the adjacent interactions and on the volume of vehicular traffic.” Such findings can be transferrable to other municipalities, as claimed by the researchers. Read more.
CPHI Senior Fellow Jason Karlawish was mentioned in a Philly.com article titled “Elders and Money,” for his presentation at a conference in December 2017 featuring the Federal Reserve Bank of Philadelphia and the University of Pennsylvania. Karlawish presented research demonstrating a correlation between “decline in cognitive ability in older adults and poor financial judgment.” Implications for this correlation include vulnerability to exploitation and fraud.
Does Seeking e-Cigarette Information Lead to Vaping? Evidence from a National Longitudinal Survey of Youth and Youth Adults
Qinghua Yang, Jiaying Liu, Kirsten Lochbuehler, Robert Hornik
CPHI Senior Fellow Robert Hornik and colleagues investigate the relationship between health information seeking behavior and e-cigarette use and vaping among young adults. Interestingly, e-cigarette use has recently been put under the oversight of the Food and Drug Administration, and the results of this study is designed to inform on how information seeking behaviors influence the beginning or continuation of such behaviors. The group administered a nationally representative survey of teens and adolescents. The results show that “both vaping intentions and e-cigarette information seeking predicted vaping or using e-cigarettes six months later.” The group comments on the implications of the high volume of pro-e-cigarette information available and offers suggestions regarding regulation. Read more.
Weight status, diet quality, perceived stress, and functional health of caregivers of children with autism spectrum disorder
CPHI Executive Director Jennifer Pinto-Martin and Associate Fellow Tanja Kral, along with colleagues, investigate the role of possible increased levels of stress in caregivers of children with autism spectrum disorder (ASD). Specifically, the group compares the weight status, diet quality, perceived stress, and functional health and well-being of caregivers of children with ASD and typically developing children. The results are as follows. In terms of weight status, the two groups of caregivers did not differ in BMI or obesity prevalence, despite caregivers of children with ASD consuming significantly fewer empty calories. In terms of perceived stress, the parents of children with ASD reported significantly higher levels of stress related to parenting. Overall, though, the two did not differ significantly in health outcomes. Read more.
Applying behavioral insights to delay school start times
Kohl Malone, S., Ziporyn, T., Buttenheim, A.M.
CPHI Senior Fellow Alison M. Buttenheim and collaborators provide four behavioral strategies to further the implementation of delayed start times in more schools across the country. Promoted by organizations like the American Medical Association, school start times should not be earlier than 8:30AM to allow for sufficient amounts of sleep in teenagers and adolescents, and Healthy People 2020 endorses the goal to increase the proportion of high schools reporting sufficient amounts of sleep. Despite this, widespread implementation has been slow. The authors offer four strategies that have been effective in driving similar health campaigns: 1) making delayed start times the default option; 2) promote success stories to demonstrate delayed start times as the social norm; 3) increase salience of messaging; and 4) counter omission bias by disseminating information about the negative consequences of inaction. Read more.
CPHI Senior Fellow Jason Karlawish was featured in the New York Times article: “What if You Knew Alzheimer’s Was Coming for You?” The article details the upcoming development of a blood test to detect early signs of Alzheimer’s before obvious symptoms are present. As a researcher in the study of Alzheimer’s, Dr. Karlawish shared insight for the piece stating, “We have to make it socially acceptable to talk about having risk of getting dementia.” Read more.
The Center for Public Health Initiatives congratulates Dr. Karen Glanz on her recognition as a Highly Cited Researcher! This means that Dr. Glanz’s work ranks in the top 1% of cited research in her field.
CPHI Fellows Rinad Beidas, David Mandell, and Kevin Volpp have been awarded $6.4 million in funding from the National Institute of Mental Health to create a center focused on the use of behavioral economics and implementation science in mental health services. Three projects will ensue; the first, led by Volpp and colleagues, will focus on antidepressant medication adherence in newly diagnosed populations; the second, led by Mandell and colleague, will examine the effectiveness of non-financial incentives in the implementation of evidence-based practices (EBPs) in childhood autism aides; the third, headed by Beidas and colleague, will examine clinician perspectives on the use of incentives to engage community mental health centers with EBPs. Read more.
CPHI Senior Fellows Robin Stevens and Bridgette Brawner have been researching youth sexual behaviors and the outlets in which youth learn about sexual risk reduction. The pair have found a link between social media as an outlet of sexual health information and increased use of birth control or protection. These findings pave the way for further research on the efficacy of social media in reducing risky sexual behaviors in youth populations. Read more.
Pebbles, Rocks, and Boulders: The Implementation of a School-Based Social Engagement Intervention for Children with Autism
CPHI Senior Fellows Frances Barg, David Mandell, Rinad Beidas and collaborators looked at the implementation of evidence-based practices (EBPs), specifically those involved in social engagement interventions for children with autism, in schools. The group interviewed school administrators, principals, teachers, and other personnel about their experiences with implementing EBPs in general as well a specific model, Remarking Recess, which uses strategies such as role-play and behavioral rehearsal. The findings suggest that there are multiple factors, especially at the individual- and the school-level that must be considered when implementing EBPs, specifically social engagement interventions. The group calls for further research on the interdependence of such factors. Read more.
What Barriers and Facilitators Do School Nurses Experience When Implementing an Obesity Intervention?
Krista Schroeder and Arlene Smaldone
CPHI Fellow Krista Schroeder and colleague have examined the factors affecting implementation of the Healthy Options and Physical Activity Program (HOP), a school nurse-led obesity intervention. This program engages eligible children in individualized obesity education, healthy eating practices, and physical activity. Despite the quantity of children eligible and with parental consent, the implementation rates have been low. Schroeder and colleague interviewed school nurses and discovered several barriers, including parental and administrative gatekeeping, risk of stigmatizing enrolled children, heavy workload, and effectiveness as it pertains to home and community settings. The authors offer several recommendations, including classroom obesity education sessions and a program overview at parent-teacher meetings. Read more.
The Guatemala-Penn Partners: An Innovative Inter-Institutional Model for Scientific Capacity-Building, Healthcare Education, and Public Health
Maria Alejandra Paniagua-Avila, Elizabeth Messenger, Caroline A. Nelson, Erwin Calgua, Frances K. Barg, Kent W. Bream, Charlene Compher, Anthony J. Dean, Sergio Martinez-Siekavizza, Victor Puac-Polanco, Therese S. Richmond, Rudolf R. Roth, and Charles C. Branas
CPHI Fellows Frances K. Barg, Kent W. Bream, Therese S. Richmond, Charles C. Branas, and collaborators examine the history of as well as the present-day version of the Guatemala-Penn Partners (GPP) initiative. Following the guidelines of the WHO’s Global Health Workforce Alliance, which recognizes the need for research institutions for an effective public health system, GPP is a collaborative effort between Guatemalan universities and the University of Pennsylvania. Countless scientific and public health initiatives have resulted from this collaboration, including the Independent Investigator Program and a Medical Anthropology field school. The program operates based on the following principles: university-to-university connections, which fosters enduring partnerships and facilitates interdisciplinary engagement, dual autonomies, and mutually-beneficial exchanges. To learn more about GPP, read more here.
End-of-Life Care Among Immigrants: Disparities or Differences in Preferences?
Michael O. Harhay and Scott D. Halpern
CPHI Fellow Michael Harhay and colleague synthesize the research on end-of-life care preferences and habits of immigrants in Ontario conducted by Yarnell et al. The study finds that recent immigrants were more commonly admitted to and spent more time in the intensive care unit (ICU) as well as more often received forms of life support. The results show that these patterns are more prominent for the most recent immigrants, and with greater time spent in the country, the end-of-life care patterns resemble that of long-standing residents. Harhay and colleague call for more research before further recommendations can be made. Read more.
Perspectives on HIV testing among wic-enrolled postpartum women: Implications for intervention development
Yukiko Washio, Elizabeth Novack Wright, Dalmacio Flores, Annet Davis, Jesse Chittams, Claire Anagnostopulos, Linda M. Kilby, and Anne M. Teitelman
CPHI Senior Fellow Anne M. Teitelman collaborated on a study of the HIV-testing views of postpartum women enrolled in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC). The researchers’ goal is to develop an intervention that would increase HIV testing among vulnerable female populations. To do so, the researchers administered a survey and several focus groups to understand the perspectives of WIC-enrolled women living in predominantly minority low-income neighborhoods. In addition to gathering perspectives on testing, they assessed the role of intimate relationships, partner violence, and substance use. Among those studied, seemingly most women would be interested in HIV testing offered by WIC, but some potential barriers did arise, including concerns over confidentiality, psychological impacts, and intimate partner violence. Read more.
A Tale of Four Practices: A Comparative Analysis of High and Low Performing Patient-Centered Medical Homes
Michelle Miller-Day, Janelle Applequist, Keri Zabokrtsky, Alexandra Dalton, Katherine Kellom, Robert Gabbay, Peter F. Cronholm
CPHI Senior Fellow Peter Cronholm collaborated on research investigating the successful and unsuccessful primary care practice transformation to the Patient-Centered Medical Home (PCMH) model within the realm of diabetes care. According to the authors, the PCMH model “restructures, yet enhances, the existing primary care delivery system to improve the quality and efficiency of patient care while reducing overall costs.” The group found several barriers to successful PCMH transformation, including lack of comprehension of PCMH overall, inadequate resources and training, and low team cohesion. Successful transformation featured clear understanding of the purpose, goals, and benefits of PCMH, a team-based approach, case management services and coordinated care. Read more.
The 50-state Laboratory: How Can Behavioral Science Bolster Vaccination Policy?
CPHI Senior Fellow Alison Buttenheim discusses vaccination exemption laws in Behavioral Scientist. All states have legalized medical exemptions for declining vaccination, and many have nonmedical exemptions, such as religious, philosophical, or personal objections. According to Buttenheim, “Vaccine exemption law is fertile ground to apply behavioral science to public policy.” Buttenheim provides several example behavioral insights relevant to vaccine exemption, including the addition of “hassle factors,” such as an opt-in feature, incentives, participation in vaccine education programs before exemption, and leveraging social norms and peer pressure. Read more.
REDUCING INCARCERATION IN PHILADELPHIA
Written by Ruth Shefner, MSW with consultation from Evan Anderson, JD, PhD and Derek Riker, JD
Reducing incarceration is an important public health priority. As a leader in implementing criminal justice reforms, Philadelphia has seven specialized diversion programs that attempt to prevent future criminal activity by diverting offenders away from incarceration and into community supervision. Programs also provide access to appropriate social and health services, and utilize a more collaborative approach between prosecutors, defense attorneys, judges and social services staff. Read more.
CPHI Fellow Karen Glanz has recently been appointed to a position on the editorial board of the American Journal of Preventive Medicine (AJPM). As a member of the AJPM editorial board, Dr. Glanz will peer review publications, recommend other reviewers, serve as a guest editor for supplemental materials, and take on the role of an ambassador for the journal. The American Journal of Preventive Medicine is a highly-esteemed journal in the fields of public health and prevention, and we congratulate Dr. Karen Glanz on her appointment.
CPHI Senior Fellow Catherine C. McDonald has been inducted as a 2017 Fellow of the American Academy of Nursing (AAN). Fellows are selected on a basis of significant contributions to nursing and health care as well as how one’s career has influenced health policies and the health of patients overall. We congratulate Dr. McDonald on this impressive accomplishment!
CPHI Fellows Flaura K. Winston and Therese S. Richmond were elected to the National Academy of Medicine (NAM). Election to the National Academy of Medicine is a prestigious honor, and we congratulate Dr. Winston and Dr. Richmond on this tremendous accomplishment.
“Nonvoluntary Psychiatric Treatment is Distinct from Involuntary Psychiatric Treatment”
CPHI Fellow Dominic A. Sisti discusses the ethical challenges and implications surrounding the use of phrases “involuntary” and “nonvoluntary” in psychiatric treatment. Sisti defines “involuntary” treatment as that which is imposed on a person who in some way is coerced or incapacitated. Conversely, “nonvoluntary” treatment is that which is given to a patient, despite their current refusal, on the basis of previously expressed values and desires; in other words, there exists sound reason to believe that a patient would have agreed to treatment. Justification for nonvoluntary treatment could include psychiatric advance directives or testimony from family or case managers. The concern with using a phrase such as “involuntary” is that treatment providers are risking the patient’s autonomy and individual liberty. Sisti closes with a call for a reevaluation of the term “involuntary” by healthcare professionals and policy makers. Read more.
The Association between Urban Tree Cover and Gun Assault: A Case-Control and Case-Crossover Study
CPHI Senior Fellows Therese Richmond and Douglas J. Wiebe and colleagues investigated whether an association exists between green space and gun assault, in an urban environment. This study focused on adolescent subjects, aged 10-24 years, who suffered gunshot wounds in Philadelphia. Subjects and controls were asked to map their activity path using GIS programming, from the start of day until the assault or until they went to bed, in the case of controls. This mapping was cross-examined with data displaying the tree cover in Philadelphia. The investigators found that there exists an inverse relationship between tree cover/green space and gun assault. This potential for violence and gun assault reduction would be a positive implication of efforts to expand urban green spaces. Read more.
Lasting impression of violence: Retained bullets and depressive symptoms
Smith, R.N., Seamon, M.J., Kumar, V., Robinson, A., Shults, J., Reilly, P.M., Richmond, T.S.
CPHI Senior Fellow Therese Richmond, Fellow Randi Smith, and collaborators have demonstrated an association between retained bullets and symptoms of severe depression. In a cohort study of Black males in an urban Level I trauma center, the researchers found that gunshot victims experience adverse psychological effects following injury, and that retention of the bullets in the body is associated with depressive symptoms. Results show that these patients rated their health as “very good” or “excellent” less often than their counterparts without retained bullets, and 61% of these patients did not return to work. The researchers call for an epidemiological study that assess prevalence, cost, interventions, etc. to offer further guidance regarding the psychological and physical impact of retained bullets. Read more.
Developing a Community-Wide Initiative to Address Childhood Adversity and Toxic Stress: A Case Study of The Philadelphia ACE Task Force
Pachter, L.M., Lieberman, L., Bloom, S.L., Fein, J.A.
CPHI Fellow Joel A. Fein and collaborators examined the evolution of the Philadelphia ACE Task Force (PATF). The PATF began as an initiative to implement screening for adverse childhood experiences (ACEs) in healthcare settings. However, over the course of its existence, the PATF has expanded to encompass multiple sectors for a more community-based approach to managing ACEs. Read more.
Patient experiences of trauma resuscitation
CPHI Senior Fellows Sara Jacoby, Therese Richmond, and Douglas J. Wiebe examine patients’ perspectives regarding patient-centered care within trauma units. Patient-centeredness in the trauma bay is especially important, as responders may be able to avoid retraumatizing patients. Through a series of interviews and observations, the researchers aimed to define patient experiences of trauma resuscitation as well as identify areas for improvement. Results show that patients “drew satisfaction from trauma team members’ demeanor, expertise and efficiency, and valued clear clinical communication, as well as words of reassurance.” These results lead to the conclusion that emphasizing communication in trauma units could improve patient experience and engage in patient-centeredness. Read more.
The relationship between consumer, clinician, and organizational characteristics and use of evidence-based and non-evidence-based therapy strategies in a public mental health system
December (?) 2017
CPHI Fellows Rinad Beidas, David Mandell, and collaborators explore factors affecting the implementation of evidence-based practices in a youth-serving behavioral health setting. Specifically, the researchers evaluate several factors, namely consumer, clinician, and organizational factors, and their relationship to behavioral health clinicians’ use of cognitive-behavioral therapy, which is an evidence-based practice, and psychodynamic therapy, which is a non-evidence-based practice. With many health systems tending to implement evidence-based practices, the factors identified by this study could serve as areas in which to focus and strategize to allow for effective implementation of evidence-based practices. Read more.
The house is not a home: The great residential divide in autism care
CPHI Fellow David Mandell explores the history of psychiatric treatment institutions in comparison to modern residential patterns for those afflicted by serious mental and developmental illnesses. Mandell explains that the transition from institutional care to community-based care was supposed to be an improvement, but instead has resulted in placement in circumstances such as “psychiatric ghettos.” Today, there are a variety of housing options, ranging from unmonitored apartment-like settings to intensely-monitored farming communities. Mandell calls for more research in the subject of residential patterns, specifically in examining the interests of the individual, as he claims that little research exists that looks into important indicators of well-being such as health, life satisfaction, and happiness.
Recall of “The Real Cost” Anti-Smoking Campaign Is Specifically Associated With Endorsement of Campaign-Targeted Beliefs
Kranzler, E.C., Gibson, L.A., Hornik, R.C
CPHI Fellow Robert C. Hornik and colleagues examine the effectiveness of health campaign advertisements by analyzing the relationship between the recall of select advertisements from the FDA’s “The Real Cost” anti-smoking campaign and targeted anti-smoking beliefs. This study was conducted by surveying non-smoking youths following exposure and recall to four “The Real Cost” advertisements and one fake advertisement. The results demonstrate a significant relationship between recall of the four specific “The Real Cost” advertisements and the targeted ad-specific beliefs, which embed the ideology of having no intention to smoke. The association established in this study demonstrates that beliefs about smoking can be targeted and influenced by health campaigns such as “The Real Cost” campaign. Read more.
An interrupted time-series analysis of ridesharing and motor vehicle crashes in us cities
CPHI Senior Fellows Douglas J. Wiebe and Sarah Jacoby, alongside collaborators, explore the effects of ride-share services on the incidence of motor-vehicle crashes in several cities. Cities differ in regard to driving norms and traffic patterns, and because of this, the efficacy of ride-share services like Uber may differ as well. Wiebe, Jacoby, and team investigated the rates of motor vehicle crashes through a study of State Department of Transportation in four U.S. cities, namely Las Vegas, Portland, Reno, and San Antonio. These cities were selected, as it is these cities in which Uber was launched, ceased operations at some point, and then resumed again. The results were mixed; the number of alcohol-related incidents decreased as Uber resumed operations in Portland and San Antonio, but not in Reno. There was also not conclusive evidence that the rate of overall incidence of motor-vehicle accidents decreased following resumed ride-sharing operations. Penn Medicine News discusses the study here, and the article can be found here.
U.S. Hospital Employment of Foreign-Educated Nurses and Patient Experience: A Cross-Sectional Study
Germack, H.D, McHugh, M.D., Sloane, D.M., Aiken, L.H.
CPHI Associate Fellow Hayley Germack and colleagues explored the relationship between patient satisfaction with care and the rates of employment of foreign-educated nurses in the United States. Germack and colleagues used data from patient care surveys, nurse surveys, and administrative data for hospitals in four states: California, Florida, New Jersey, and Pennsylvania. California, Florida, and New Jersey are among the top five states with the highest rates of foreign-educated nurses. They found that there exists a significant association between lower patient satisfaction and employment of foreign-educated nurses. These findings are consistent with similar studies in other countries. Read more.
Discrete choice model of food store trips using national household food acquisition and purchase survey (FoodAPS)
Hillier, A., Smith, T.E., Whiteman, E.D., Chrisinger, B.W.
CPHI Senior Fellow Amy Hillier and associates analyzed data from the National Household Food Acquisition and Purchase Survey (FoodAPS) to understand purchasing patterns and their relation to store type and distance travelled. FoodAPS collected data about food purchasing behaviors from a sample of 4826 households. Hillier and associates found that race and ethnicity, rather than income as measured by enrollment status in programs such as SNAP, were important factors in determining food store type and location. Ethnicity has a significant interaction effect on choice of food store type, as indicated by Hispanic families choosing full-service supermarkets most often. Race is also significant, as indicated by the willingness of White families to travel further for grocery shopping than non-White families. These findings demonstrate the importance of race and ethnicity on where families shop for groceries, and this could have implications for health outcomes and public policy. Read more.
Special Issue on Social Determinants of Health
Terri Lipman and Marie Lobo
CPHI Fellow Terri Lipman and collaborator have conducted a review of recent, innovative research pertaining to social determinants of health in pediatric patients. As stated by Lipman, social determinants of health account for over 75% of health outcomes, and are thus exceedingly important to address in pediatric care. The articles reviewed in this piece features a variety of pediatric populations, including those afflicted by diabetes, obesity, juvenile arthritis, and bullying. Read more.
Infectious Disease Careers in Healthcare Epidemiology and Antimicrobial Stewardship
CPHI Senior Fellow Ebbing Lautenbach writes on the importance and trendiness of individuals invested in the careers of healthcare epidemiology and antimicrobial stewardship. In recent years and for the foreseeable future, both the government and the general population have become invested in addressing healthcare-associated infections and antibiotic resistance, areas in which healthcare epidemiology and antimicrobial stewardship are especially relevant. Lautenbach highlights the various roles and responsibilities that fall under these diverse fields, including focus on non-acute care settings, development of definitions of adverse events, and the creation of appropriate risk adjustments, among others. Read more.
Effects of State Insurance Mandates on Health Care Use and Spending for Autism Spectrum Disorder
Colleen L. Barry, Andrew J. Epstein, Steven C. Marcus, Alene Kennedy-Hendricks, Molly K. Candon, Ming Xie, and David S. Mandell
CPHI Fellow David Mandell and collaborators examine the efficacy of insurance mandates on the use and spending on services treating autism spectrum disorder (ASD). Currently, 46 states and the District of Columbia have enacted such mandates. The researchers found that there was an positive association between insurance mandates and use and spending on services related to ASD. In fact, their results show that there was a 3.4% increase in monthly use of such services, and spending increased by $77 per month on ASD-related services. These results show that insurance mandates are effective in granting greater access to illness-specific services. Read more.
The Opioid Crisis
Written by Caroline Stark and Sara Solomon with consultation from Carolyn Cannuscio, Jeffrey Hom, and Zachary Meisel.
Opioid use and addiction have reached epidemic proportions in Philadelphia, making drug overdose involving opioids a leading cause of death. 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.
Place Still Matters: Racial/Ethnic and Geographic Disparities in HIV Transmission and Disease Burden
Brawner, B.M., Guthrie, B., Stevens, R., Taylor, L., Eberhart, M., Schensul, J.J.
CPHI Senior Fellow Bridgette M. Brawner and colleagues explored racial and geographic differences in the mode of HIV transmission in Philadelphia, PA. In doing so, the investigators also examined how neighborhood factors shaped HIV/AIDS outcomes. Two populations were compared in this study: High HIV prevalence among black males, who consequently tended to not have insurance, and among white males, who mostly had private insurance. Interesting results included: higher-than-average transmission via heterosexual relations, which was 7 times more likely to occur in the black population; and heightened rates of transmission via injection drug use, which was more prevalent in black, male populations as well as among those on Medicaid or without insurance. These findings can be used to guide larger studies as well as the development of neighborhood-level, structural interventions. 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.
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
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