Examining the Relationship Between Social Cohesion and Health in Kensington

This quantitative cross-sectional survey study was conducted in collaboration with the New Kensington Community Development Corporation (NKCDC) to improve our understanding of the role of social cohesion in the Somerset neighborhood. Its aims were to help guide future efforts to improve the health of this community by considering whether social factors might contribute to overall health. In previous studies, social cohesion has been hypothesized to be related to overall self-reported health. In this study we examined the nature and strength of this relationship in a low socio-economic status population in Kensington. We used linear regression to evaluate cross-sectional survey data collected from 328 neighborhood residents. Data was collected on health information, social cohesion, demographic factors, health behaviors, and financial stability. Variables that were significantly associated with self-reported health were included in a multiple regression model to examine the relationship between social cohesion and self-reported health. Our findings were that social cohesion and overall health were related. We also found that stress was significantly associated with social cohesion as well as overall health; while the reach of this study stops short of being able to identify the causality of these relationships, organizations such as NKCDC could combine the strength of the relationships with their expertise in the relevant population to better inform their future programming. This study also revealed a number of areas that could be worthy of future study, including the importance of collective efficacy in improving population health and the effect of social cohesion on people’s health over the course of a longitudinal study

Purchase of Loose Cigarettes by Adult Smokers in Philadelphia: Individual-level Correlates and Neighborhood Characteristics

Background • Philadelphia has the highest adult smoking rate1 and the highest rate of tobacco retailers2 among the 10 largest U.S. cities. • Governmental reports have identified high rates of illegal sale of cigarettes in Philadelphia2. • Studies have found that a main source of cigarette use in low income communities is single (loose) cigarettes purchased at tobacco retailers or from unregulated street vendors3,4. • While studies have shown that loose cigarette use is a problem among urban youth who reside in disadvantaged neighborhoods, less research has been performed among adults on this topic5,6, and no studies focus on Philadelphia. • In order to efficiently target tobacco control efforts towards reducing smoking rates in Philadelphia, demographic, geographic, and behavioral factors affecting the purchase of loose cigarettes need to be determined. Research Questions: 1. What are the demographic and smoking-related correlates of having purchased loose cigarettes among adult smokers in Philadelphia? 2. Are smokers who purchased loose cigarettes more likely to reside in Philadelphia neighborhoods with high poverty rates, compared to smokers who did not? 3. Are smokers who purchased loose cigarettes more likely to reside in Philadelphia neighborhoods with high tobacco retail density, compared to smokers who did not? Poster presented at APHA in Chicago, Illinois.https://jdc.jefferson.edu/jcphposters/1000/thumbnail.jp

The Correlation Between Perceptions of Safety and Perceived Stress Among Residents of the Somerset Neighborhood of Kensington, Philadelphia

Background: The Somerset neighborhood of Kensington, Philadelphia is affected by economic, environmental, and social issues that come with disinvestment. The average median income for Somerset is $26,015 per year which is much lower than Philadelphia’s city-wide income of$36, 957. This study evaluated the connection between perceptions of safety and perceived stress among residents of the Somerset neighborhood. Methods: This study was a secondary data analysis from a cross-sectional study in the Somerset neighborhood. The data included self-reported surveys from Somerset residents that were completed at their homes. The surveys were completed using an electronic (tablet) format which took approximately 20 to 30 minutes to complete. Trained members of the neighborhood collected the data from July to December 2017. We used SPSS to quantify relationships between perceptions of safety and perceived stress using Spearman’s Rank Order Correlation for each of our 12 perceptions of safety variables and stress. Our final model was created using a multivariable linear regression model. Results: We had 328 adults with an average age of 48 years old in our study sample. We found that most of the residents were female, 35.3% were Latino, predominantly single, and mainly employed full-time. Additionally, over half of the residents owned their home and 16 years was the average amount of time lived in the neighborhood. We found that the average score on the stress scale was a 5.18 (range 0-16). In our final model, we found 4 variables to be statistically significant (α= .10) age, years lived in the community, police should spend more time working with community members and groups to solve problems, and members of my community are interested in crime prevention activities. Discussion: Overall, the mean stress levels were lower than we expected. We found associations between demographics and perceptions of safety variables specifically, as age increased, stress decreased and as the years lived in the community increased, stress increased. Our results also indicated as police spent more time working with community members and as crime prevention activities increased in the community, stress decreased. The strongest predictor of stress was the variable: “police should spend more time working with community members and groups to solve problems.” Collaborations between police officers and community members have the potential to improve health and may also help residents feel safer and less stressed in the neighborhood

Borders and Blood Pressure: Understanding the Role of Acculturation in a Hypertension Diagnosis Among Hispanic Americans: 2014 California Health Interview Survey

Background: In the U.S. Hispanic population overall, heart disease is the leading cause of death. The prevalence of hypertension among Mexican American immigrants is lower than the general population, yet it is on the rise. Health risks among Hispanics vary depending on their length of stay in the US (as proxy measure of acculturation). The purpose of this study was to examine the association between acculturation and the individual\u27s likelihood of being diagnosed with hypertension among Hispanic Americans. Methods: We used data from the 2014 California Health Interview Survey (CHIS) and performed univariate analysis to examine racial differences in prevalence of hypertension. We also performed a multivariate logistic regression to identify if acculturation was significantly related to hypertension diagnoses, after controlling for sociodemographic characteristics (e.g., age, gender, level of education, marital status), access to care, and health status (e.g., self-reported health status, BMI), among Mexican Americans and all Hispanics, respectively. Results: Of 3,793 Hispanic American participating in the survey, 81.8% were Mexican Americans and 18.2% were other Hispanics. The prevalence of hypertension among Hispanic was 24.0% (95% CI: 21.5%. 26.7%) which was lower than that of African Americans (39.2%, 95% CI 33.7%, 44.9%) and White (30.2%, 95% CI: 28.5%, 31.9%). In multivariate analyses, acculturation was associated with hypertension among Mexican Americans, but not all Hispanics. For both Mexican Americans and Hispanics, age, health status and BMI were associated with having hypertension: Older people, those with poor health status, and overweight and obese people were more likely than their comparison groups to have hypertension. Those without health insurance were less likely to have hypertension. Conclusion: The results show a positive association between length of time in the United States for longer periods of time, and a diagnosis of hypertension. These results, along with others conducted around Hispanic American immigration, acculturation and chronic disease prevalence, help medical providers, to understand the effects of acculturation on specific health care needs among immigrants, and offer suggestions to patients which are culturally sensitive and relevant. Poster presented at AHPA conference in Atlanta Georgia.https://jdc.jefferson.edu/jcphposters/1014/thumbnail.jp

The Association Between Opioid-Related Industry Payments and Opioid Prescribing at the Individual and Ecological Level in Pennsylvania

Objective: to understand how industry payments related to opioid products are associated with opioid prescribing in Pennsylvania. Methods: we merged the Open Payments data, Medicare Part D public use file, and Dartmouth Hospital Atlas of Health Care Hospital Service Areas from 2015 to analyze relationships between opioid related payments and opioid prescribing. We used a binomial regression model to investigate individual-level trends and a log-linear model to investigate Hospital Service Area-level trends. We mapped the distribution of opioid-related payments in Pennsylvania using GIS software. Results: One additional payment to a physician was associated with 4.2% higher opioid-prescribing rate (OR = 1.0418, 95% CI 1.0416-1.0420, Chi-Square(1) = 122678, p Conclusions: We found a positive association between opioid-related payments to physicians and opioid prescribing. Policy makers and administrators should consider revising rules related to pharmaceutical company marketing tactics and promote judicious opioid prescribing

Using a Smartphone App to Teach Students Practical Epidemiological Skills

Background: Despite the evidence that shows the pedagogical benefits of experiential education, epidemiology instructors rarely utlize experiential activities to teach epidemiological concepts and skills. Poster presented at 8th annual 2016 Thomas Jefferson University Faculty Days

Do Employees From Less-Healthy Communities Use More Care and Cost More? Seeking to Establish a Business Case for Investment in Community Health.

INTRODUCTION: Few studies have examined the impact of community health on employers. We explored whether employed adults and their adult dependents living in less-healthy communities in the greater Philadelphia region used more care and incurred higher costs to employers than employees from healthier communities. METHODS: We used a multi-employer database to identify adult employees and dependents with continuous employment and mapped them to 31 zip code regions. We calculated community health scores at the regional level, by using metrics similar to the Robert Wood Johnson Foundation (RWJF) County Health Rankings but with local data. We used descriptive analyses and multilevel linear modeling to explore relationships between community health and 3 outcome variables: emergency department (ED) use, hospital use, and paid claims. Business leaders reviewed findings and offered insights on preparedness to invest in community health improvement. RESULTS: Poorer community health was associated with high use of ED services, after controlling for age and sex. After including a summary measure of racial composition at the zip code region level, the relationship between community health and ED use became nonsignificant. No significant relationships between community health and hospitalizations or paid claims were identified. Business leaders expressed interest in further understanding health needs of communities where their employees live. CONCLUSION: The health of communities in which adult employees and dependents live was associated with ED use, but similar relationships were not seen for hospitalizations or paid claims. This finding suggests a need for more primary care access. Despite limited quantitative evidence, business leaders expressed interest in guidance on investing in community health improvement

Association Between Lack of Access to a Neighborhood Park and High Blood Pressure in the Philadelphia Metropolitan Area

INTRODUCTION: Studies have shown a lower risk of high blood pressure (HBP) among people who live near parks; however, little information exists on how feeling safe and comfortable visiting the park affects blood pressure. We identified associations between neighborhood park access, comfort visiting a park, and HBP to understand how these factors may contribute to disparities in HBP prevalence. METHODS: The 2018 Southeastern Pennsylvania Household Health Survey of 3,600 residents in the Philadelphia metropolitan area asked if respondents had ever been told they had HBP and whether they had a neighborhood park or outdoor space that they were comfortable visiting during the day. To assess the association between park access and HBP, we built multilevel logistic models to account for variation in HBP by zip code. We examined the effect modification of perceptions of park access (having a neighborhood park, not having a neighborhood park, or having a neighborhood park but not comfortable visiting it) and HBP by race, education, and poverty status. RESULTS: Both not having a neighborhood park and having a park but not feeling comfortable visiting it were associated with higher unadjusted odds of HBP, 70% and 90%, respectively, compared with having a neighborhood park. Adjusted odds ratios for the lack-of-park responses remained significant (no neighborhood park, adjusted odds ratio [aOR] = 1.4; 95% CI, 1.1-1.7; neighborhood park but not comfortable visiting, aOR = 1.4; 95% CI, 1.03-2.0). A significant gradient was observed for Black respondents compared with White respondents with odds of HBP increasing by perceptions of park access (aOR = 1.95 for people with a park; aOR = 2.69 for those with no park; aOR = 3.5 for people with a park that they are not comfortable visiting). CONCLUSION: Even accounting for other risk factors for HBP, not having a neighborhood park or not feeling comfortable visiting one may influence individual HBP. Neighborhood factors that deter park access may contribute to racial disparities in HBP

Sociodemographic Background Characteristics of Patients Who Participate in a Lung Cancer Screening Program

Introduction: Despite decreasing lung cancer incidence and mortality rates, disparities in prevalence and outcomes persist between Black and White patients. Secondary analysis of the National Lung Screening Trial found screening with low-dose CT (LDCT) reduced lung cancer mortality more in Blacks than Whites. However, it is unknown if racial disparities exist in screening results, and the involved sociodemographic factors. Objective: The study aims to analyze characteristics that may predict screening outcomes (Lung-RADS category) in patients who received LDCT through the Jefferson Lung Cancer Screening Program (LCSP). Methods: Retrospective data (n=733, May 2015 to July 2017) were merged with prospective data (n=292, January to September 2018). Lung-RADS scores were categorized into a binary variable (negative=1 and 2 vs. positive=3, 4A, 4B, and 4X). Chi-square and multivariate logistic regression were conducted to examine risk factors (race, gender, age, marital status, smoking status, COPD, and BMI). Results: Of 1025 total participants, 688 met eligibility criteria and underwent LDCT. In adjusted analysis, age and marital status were associated with Lung-RADS result. Older patients (aOR=1.04, 95% CI=1.01-1.08) and never-married patients (aOR=1.88, 95% CI=1.09-3.26) had significantly higher odds of a positive screen. An interaction between race and gender was also identified. Compared to White women, White men (aOR=2.13, 95% CI=1.08-4.19) and Black men (aOR=2.10, 95% CI=1.01-4.42) had higher odds of positive screening results. Discussion: Despite no main effect of race on screening results, an interaction existed between race and gender. These findings can be further explored to develop education programs for earlier detection and treatment, increasing screening awareness in vulnerable populations

Disparities in Neighborhood Park Access Among Adults in Philadelphia

Researchers have clearly identified the importance of green space to promote mental and physical health among humans. In urban areas, public parks are essential for providing access to green space for many residents. This study identified the relationships between demographics, neighborhood social capital, violent crime, and residential distance to the closest park (park proximity) with self-reported access to neighborhood parks, among a population-representative sample of adults in Philadelphia. Women, older age groups, minorities, and those with lower education levels had lower self-reported access to neighborhood parks. Those reporting high neighborhood social capital had higher self-reported access to neighborhood parks. Park proximity and number of violent crimes within 100 m from respondents’ residence were inversely associated with self-reported access to neigh- borhood parks. Interestingly, those living proximal to parks had higher odds of self-reported access to parks, but only among residents living in lower violent crime quartiles, and not in the highest violent crime quartile. These results suggest that those who lived in areas with high violent crime might be deterred from using neighborhood parks, even if there are parks close to their residence. Results of the study show that demographic groups that have been historically marginalized in the U.S., including women, older age groups and minorities, had lower self-reported access to parks in Philadelphia. The study also highlights the potential importance of neighborhood social capital and perceptions of safety to self-reported access to neighborhood parks