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

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

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 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

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

Use of Policy Map for Public Health Education

Dr. Russell McIntire of Thomas Jefferson University as he describes his use of PolicyMap for teaching map-making skills to visualize community-based public health data for his Public Health class. Dr. Russell K. McIntire, Assistant Professor, Jefferson College of Population Health (JCPH) at Thomas Jefferson University: Dr. McIntire received his doctorate in Health Behavior and his Master of Public Health at Indiana University School of Public Health- Bloomington. His major research interests include identifying and analyzing the social, behavioral, and geographic risk factors of substance use among adolescents and other vulnerable populations. In addition to his research, Dr. McIntire teaches epidemiology, social and behavioral theory, and geographic information systems (GIS) classes in the JCPH Master of Public Health program. Presentation: 2:35-22:21 minute

Use of Propensity Score Matching to Identify a Strong Association Between Health Care Provider Advice Not to Smoke and Quit Attempts Among Mid-Adolescent Smokers

Background: Nearly 1 out of 7 U.S. adolescents is a current cigarette smoker by the time they leave high school. 1 Although almost one third of adolescents who saw a healthcare provider in the past month were advised to quit or avoid tobacco,2 research on the influence of provider advice on quit attempts among adolescent smokers has shown mixed results. 3 These results may be due to selection bias—adolescent smokers who get advice may be different from those who do not on a range of factors including age of initiation, smoking frequency, attitudes toward smoking, exposure to other anti-tobacco messages, and number of smoking friends. Additionally, the effects of provider advice on quit attempts may be different between the stages of adolescence, namely early adolescence (ages 11-13), mid adolescence (ages 14-16) and late adolescence (ages 17-18), as studies have shown for parental advice not to smoke.4https://jdc.jefferson.edu/jcphposters/1002/thumbnail.jp

Health care providers advice not to smoke and quit attempts among mid-adolescent smokers

Background Nearly 1 out of 7 U.S. adolescents is a current cigarette smoker by the time they leave high school. 1 Although almost one third of adolescents who saw a healthcare provider in the past month were advised to quit or avoid tobacco,2 research on the influence of provider advice on quit attempts among adolescent smokers has shown mixed results. 3 These results may be due to selection bias—adolescent smokers who get advice may be different from those who do not on a range of factors including age of initiation, smoking frequency, attitudes toward smoking, exposure to other anti-tobacco messages, and number of smoking friends. Additionally, the effects of provider advice on quit attempts may be different between the stages of adolescence, namely early adolescence (ages 11-13), mid adolescence (ages 14-16) and late adolescence (ages 17-18), as studies have shown for parental advice not to smoke.4 Research Questions 1) Does healthcare provider advice make adolescent smokers more likely to try to quit smoking? 2) Does the effect of health care provider advice on adolescent smoker quit attempts vary among the different stages of adolescence?https://jdc.jefferson.edu/jcphposters/1001/thumbnail.jp