Progress in Community Health Partnerships: Research, Education, and Action, 2018
Abstract:Background: WIC Farmers’ Market Nutrition Program (FMNP) aims to increase consumption of... more Abstract:Background: WIC Farmers’ Market Nutrition Program (FMNP) aims to increase consumption of fresh produce among Special Supplemental Nutrition Program for Women, Infants and Children (WIC) participants while supporting local farmers. Area stakeholders are addressing the existing barriers to FMNP use that keep participation low.Objectives: Increase FMNP check redemption by participants in a Pittsburgh WIC office.Methods: Quasiexperimental design including cooking demonstrations, tours of FMs, and community garden visits. Program participation and check redemption rates were tracked.Results: The redemption rate of FMNP checks among research participants and nonparticipants was 46.5% and 39.0% (P < .001), respectively. Lessons learned point to needed changes on the local, state, and federal levels.Conclusions: Barriers to the use of WIC FMNP checks were consistent with the literature. Allowing mobile markets to accept FMNP checks may address barriers to FM shopping while suppo...
Background Communities need to efficiently estimate the burden from specific pollutants and ident... more Background Communities need to efficiently estimate the burden from specific pollutants and identify those most at risk to make timely informed policy decisions. We developed a risk-based model to estimate the burden of black carbon (BC) and nitrogen dioxide (NO2) on coronary heart disease (CHD) across environmental justice (EJ) and non-EJ populations in Allegheny County, PA. Methods Exposure estimates in census tracts were modeled via land use regression and analyzed in relation to US Census data. Tracts were ranked into quartiles of exposure (Q1-Q4). A risk-based model for estimating the CHD burden attributed to BC and NO2 was developed using county health statistics, census tract level exposure estimates, and quantitative effect estimates available in the literature. Results For both pollutants, the relative occurrence of EJ tracts (> 20% poverty and/or > 30% non-white minority) in Q2 – Q4 compared to Q1 progressively increased and reached a maximum in Q4. EJ tracts were 4 ...
Although blood lead levels (BLLs) in US children have dramatically declined over the past 40 year... more Although blood lead levels (BLLs) in US children have dramatically declined over the past 40 years, there remain pockets of children living in areas with elevated BLLs. While some increases (≥10 μg/dL) may be associated with legacy lead paint, ambient air lead may be contributing to the problem. A deidentified dataset of information on over 60,000 Kansas children under 3 years of age who were tested for BLL was provided through the Kansas Environmental Public Health Tracking Network for the period 2000-2005. Using ArcGIS, we calculated distance (in miles) from a lead-emitting industry referred to as a toxic release inventory (TRI) site. The USEPA TRI database tracks the management of certain toxic chemicals that may pose a threat to human health. US facilities in different industry sectors must report annually amount of substances like lead into the environment including their exact location. Distance from a TRI site was inversely related to BLL after controlling for area-level pove...
Background and Objective: High concentrations of air pollutants have been linked to increased inc... more Background and Objective: High concentrations of air pollutants have been linked to increased incidence of stroke in North America and Europe but not yet assessed in mainland China. The aim of this study is to evaluate the association between stroke hospitalization and short-term elevation of air pollutants in Wuhan, China. Methods: Daily mean NO2, SO2 and PM10 levels, temperature and humidity were obtained from 2006 through 2008. Data on stroke hospitalizations (ICD 10: I60–I69) at four hospitals in Wuhan were obtained for the same period. A time-stratified case-crossover design was performed by season (April-September and October-March) to assess effects of pollutants on stroke hospital admissions. Results: Pollution levels were higher in October-March with averages of 136.1 mg/m3 for PM10, 63.6 mg/m3 for NO2 and 71.0 mg/m3 for SO2 than in April-September when averages were 102.0 mg/m3, 41.7 mg/m3 and 41.7 mg/m3, respectively (p,.001). During the cold season, every 10 mg/m3 increa...
Background and Aim: Exposure to ozone (O3) has been associated with increased cardiovascular morb... more Background and Aim: Exposure to ozone (O3) has been associated with increased cardiovascular morbidity and mortality, a hypothesized biological mechanism being systemic inflammation. The goal of th...
This decision analytical model describes the use of a semisynthetic population to identify the di... more This decision analytical model describes the use of a semisynthetic population to identify the distribution of excess cardiovascular death risk and its correlation with social and biological risk factors.
Journal of Public Health Management and Practice, 2020
OBJECTIVES To compare city and census tract-level diabetes and hypertension prevalence using 500 ... more OBJECTIVES To compare city and census tract-level diabetes and hypertension prevalence using 500 Cities Project modeled estimates from the Centers for Disease Control and Prevention (CDC) and insurance claims data. METHODS Insurance claims by census tract were collected from 3 local health plans for the city of Pittsburgh, Pennsylvania, for 2015-2016; conditions were defined using International Classification of Diseases, Ninth Revision (ICD-9) and Tenth Revision (ICD-10) codes. Crude prevalence estimates with 95% confidence intervals were downloaded from the CDC 500 Cities Web site to obtain modeled estimates by census tract. Confidence intervals were calculated for claims and compared with modeled estimates; nonoverlapping intervals were considered significant. Pearson correlation coefficients were generated for census tract-level comparison. RESULTS City-level model-based and claims estimates were 9% versus 10% for diabetes and 31% versus 21% for hypertension. At the census tract level, model-based and insurance claims estimates were more concordant for diabetes (r = 0.366) than for hypertension (r = 0.220). Modeled estimates were significantly higher than claims estimates for 89% of census tracts for hypertension and 35% for diabetes. CONCLUSIONS Modeled estimates from the 500 Cites Project were significantly higher than insurance claims estimates for hypertension but were more consistent for diabetes. Utilization of multiple data sources to understand local-level chronic disease burden requires consideration of the strengths and limitations of each.
Introduction: In Allegheny County (AC), PA, US, closure of a large coke plant in January 2016 pre... more Introduction: In Allegheny County (AC), PA, US, closure of a large coke plant in January 2016 presented an opportunity to investigate the contribution of air pollutants to health outcomes in a nearby community. Materials and methods: The Allegheny County Health Department, (ACHD), Division of Air Quality, had begun monitoring pollutants near the plant since June 2011. The rates of hospitalizations and ED visits for cardio- vascular and respiratory disease were compared in the exposed community and two control areas: exposed control, with another coking operation; and unexposed control. Results: Of the study and two control areas, particulate matter concentrations decreased the most in the study area, from 10.9 µg/m3 to 9.7 µg/m3. Benzene decreased substantially in that area, from 0.27 ppm to 0.10 ppm. ED visits for cardiovascular, respiratory, and asthma were significantly higher in the ex- posed group in 2015 compared to 2016. There were no temporal differences in either control gr...
Public health reports (Washington, D.C. : 1974), 2018
In Allegheny County, Pennsylvania, the incidence of opioid-related overdose deaths increased from... more In Allegheny County, Pennsylvania, the incidence of opioid-related overdose deaths increased from 17.4 per 100 000 population in 2008 to 23.9 per 100 000 population in 2014. Our objectives were to describe local demographic characteristics of this epidemic, identify public human services targets for intervention, determine temporal relationships between use of public human services and overdose mortality, and provide recommendations about potentially beneficial interventions. We used autopsy data from the Allegheny County Medical Examiner to link people who died of overdoses from 2008 through 2014 to their premortem incarcerations and use of mental health services and substance use disorder services. We calculated the frequency of use of public human services by decedents and the interval between the last use of these services and overdose death. Of the 1399 decedents, 957 (68.4%) had a public human service encounter before overdose death. Of these 957 decedents, 531 (55.5%) had eve...
Archives of environmental & occupational health, Jan 4, 2016
Although blood lead levels in the U.S. have fallen dramatically since 1980, there remain subgroup... more Although blood lead levels in the U.S. have fallen dramatically since 1980, there remain subgroups of children with high blood lead levels. We assessed the relationship between environmental lead sources and blood lead levels in children age 1 to 5 years from the National Health and Nutrition Examination Survey (NHANES), 1999-2006. Modeled ambient air lead levels and industrial lead releases at the census tract level were assigned to each child's residence with adjustment for confounding factors. A total of 272 of 3223 children (8.4%) had blood lead levels ≥ 5 ug/dL. Industrial releases (2252 v. 1696 lbs/mi(2)) and ambient air lead levels (2.28 v. 1.75 ng/m(3)) were greater in exposed versus unexposed children. For every 10,000 pounds per mile squared (lb/mi(2)) increase in inverse distance squared weighted exposure there was a 1.13% (95% CI: 0.45%, 1.81%) increase in blood lead (p = 0.001).
Noise induced hearing loss (NIHL) is among the 10 leading occupational diseases, afflicting betwe... more Noise induced hearing loss (NIHL) is among the 10 leading occupational diseases, afflicting between 7.4 and 10.2 million people who work in noise above 85 dBA. Although mandatory hearing conservation programs (HCPs) have been in effect since 1972, this problem persists, as hearing protectors are not consistently used by workers, or may not attenuate to manufacturer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s estimates in real world conditions. In this study, information from noise and hearing protection use measurements taken at an automobile assembly plant were used to construct average lifetime noise exposure and hearing protection compliance estimates for use in modeling to predict both total hearing loss and onset of two accepted definitions of hearing loss. There were 301 males and females in this cohort; their mean age was 42.6 (7.2) years, and mean tenure was 14.3 (3.5) years. Average length of follow-up was 14.0 years. There were 16 members of this cohort who had hearing loss at the speech frequencies (defined as an average hearing level &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 25 dB at 500, 1000, and 2000 Hz). In cross-sectional multivariate analyses, years of employment, male gender, and proportion of time wearing hearing protection were the factors most associated with hearing loss at the average of 2000, 3000, and 4000 Hz (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001) controlling for age, transfer status (as a surrogate for previous noise exposure), race, and lifetime average noise exposure. The most consistent predictor of hearing loss in both univariate and multivariate analyses was percentage of time having used hearing protection during the workers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; tenure.
Progress in Community Health Partnerships: Research, Education, and Action, 2018
Abstract:Background: WIC Farmers’ Market Nutrition Program (FMNP) aims to increase consumption of... more Abstract:Background: WIC Farmers’ Market Nutrition Program (FMNP) aims to increase consumption of fresh produce among Special Supplemental Nutrition Program for Women, Infants and Children (WIC) participants while supporting local farmers. Area stakeholders are addressing the existing barriers to FMNP use that keep participation low.Objectives: Increase FMNP check redemption by participants in a Pittsburgh WIC office.Methods: Quasiexperimental design including cooking demonstrations, tours of FMs, and community garden visits. Program participation and check redemption rates were tracked.Results: The redemption rate of FMNP checks among research participants and nonparticipants was 46.5% and 39.0% (P < .001), respectively. Lessons learned point to needed changes on the local, state, and federal levels.Conclusions: Barriers to the use of WIC FMNP checks were consistent with the literature. Allowing mobile markets to accept FMNP checks may address barriers to FM shopping while suppo...
Background Communities need to efficiently estimate the burden from specific pollutants and ident... more Background Communities need to efficiently estimate the burden from specific pollutants and identify those most at risk to make timely informed policy decisions. We developed a risk-based model to estimate the burden of black carbon (BC) and nitrogen dioxide (NO2) on coronary heart disease (CHD) across environmental justice (EJ) and non-EJ populations in Allegheny County, PA. Methods Exposure estimates in census tracts were modeled via land use regression and analyzed in relation to US Census data. Tracts were ranked into quartiles of exposure (Q1-Q4). A risk-based model for estimating the CHD burden attributed to BC and NO2 was developed using county health statistics, census tract level exposure estimates, and quantitative effect estimates available in the literature. Results For both pollutants, the relative occurrence of EJ tracts (> 20% poverty and/or > 30% non-white minority) in Q2 – Q4 compared to Q1 progressively increased and reached a maximum in Q4. EJ tracts were 4 ...
Although blood lead levels (BLLs) in US children have dramatically declined over the past 40 year... more Although blood lead levels (BLLs) in US children have dramatically declined over the past 40 years, there remain pockets of children living in areas with elevated BLLs. While some increases (≥10 μg/dL) may be associated with legacy lead paint, ambient air lead may be contributing to the problem. A deidentified dataset of information on over 60,000 Kansas children under 3 years of age who were tested for BLL was provided through the Kansas Environmental Public Health Tracking Network for the period 2000-2005. Using ArcGIS, we calculated distance (in miles) from a lead-emitting industry referred to as a toxic release inventory (TRI) site. The USEPA TRI database tracks the management of certain toxic chemicals that may pose a threat to human health. US facilities in different industry sectors must report annually amount of substances like lead into the environment including their exact location. Distance from a TRI site was inversely related to BLL after controlling for area-level pove...
Background and Objective: High concentrations of air pollutants have been linked to increased inc... more Background and Objective: High concentrations of air pollutants have been linked to increased incidence of stroke in North America and Europe but not yet assessed in mainland China. The aim of this study is to evaluate the association between stroke hospitalization and short-term elevation of air pollutants in Wuhan, China. Methods: Daily mean NO2, SO2 and PM10 levels, temperature and humidity were obtained from 2006 through 2008. Data on stroke hospitalizations (ICD 10: I60–I69) at four hospitals in Wuhan were obtained for the same period. A time-stratified case-crossover design was performed by season (April-September and October-March) to assess effects of pollutants on stroke hospital admissions. Results: Pollution levels were higher in October-March with averages of 136.1 mg/m3 for PM10, 63.6 mg/m3 for NO2 and 71.0 mg/m3 for SO2 than in April-September when averages were 102.0 mg/m3, 41.7 mg/m3 and 41.7 mg/m3, respectively (p,.001). During the cold season, every 10 mg/m3 increa...
Background and Aim: Exposure to ozone (O3) has been associated with increased cardiovascular morb... more Background and Aim: Exposure to ozone (O3) has been associated with increased cardiovascular morbidity and mortality, a hypothesized biological mechanism being systemic inflammation. The goal of th...
This decision analytical model describes the use of a semisynthetic population to identify the di... more This decision analytical model describes the use of a semisynthetic population to identify the distribution of excess cardiovascular death risk and its correlation with social and biological risk factors.
Journal of Public Health Management and Practice, 2020
OBJECTIVES To compare city and census tract-level diabetes and hypertension prevalence using 500 ... more OBJECTIVES To compare city and census tract-level diabetes and hypertension prevalence using 500 Cities Project modeled estimates from the Centers for Disease Control and Prevention (CDC) and insurance claims data. METHODS Insurance claims by census tract were collected from 3 local health plans for the city of Pittsburgh, Pennsylvania, for 2015-2016; conditions were defined using International Classification of Diseases, Ninth Revision (ICD-9) and Tenth Revision (ICD-10) codes. Crude prevalence estimates with 95% confidence intervals were downloaded from the CDC 500 Cities Web site to obtain modeled estimates by census tract. Confidence intervals were calculated for claims and compared with modeled estimates; nonoverlapping intervals were considered significant. Pearson correlation coefficients were generated for census tract-level comparison. RESULTS City-level model-based and claims estimates were 9% versus 10% for diabetes and 31% versus 21% for hypertension. At the census tract level, model-based and insurance claims estimates were more concordant for diabetes (r = 0.366) than for hypertension (r = 0.220). Modeled estimates were significantly higher than claims estimates for 89% of census tracts for hypertension and 35% for diabetes. CONCLUSIONS Modeled estimates from the 500 Cites Project were significantly higher than insurance claims estimates for hypertension but were more consistent for diabetes. Utilization of multiple data sources to understand local-level chronic disease burden requires consideration of the strengths and limitations of each.
Introduction: In Allegheny County (AC), PA, US, closure of a large coke plant in January 2016 pre... more Introduction: In Allegheny County (AC), PA, US, closure of a large coke plant in January 2016 presented an opportunity to investigate the contribution of air pollutants to health outcomes in a nearby community. Materials and methods: The Allegheny County Health Department, (ACHD), Division of Air Quality, had begun monitoring pollutants near the plant since June 2011. The rates of hospitalizations and ED visits for cardio- vascular and respiratory disease were compared in the exposed community and two control areas: exposed control, with another coking operation; and unexposed control. Results: Of the study and two control areas, particulate matter concentrations decreased the most in the study area, from 10.9 µg/m3 to 9.7 µg/m3. Benzene decreased substantially in that area, from 0.27 ppm to 0.10 ppm. ED visits for cardiovascular, respiratory, and asthma were significantly higher in the ex- posed group in 2015 compared to 2016. There were no temporal differences in either control gr...
Public health reports (Washington, D.C. : 1974), 2018
In Allegheny County, Pennsylvania, the incidence of opioid-related overdose deaths increased from... more In Allegheny County, Pennsylvania, the incidence of opioid-related overdose deaths increased from 17.4 per 100 000 population in 2008 to 23.9 per 100 000 population in 2014. Our objectives were to describe local demographic characteristics of this epidemic, identify public human services targets for intervention, determine temporal relationships between use of public human services and overdose mortality, and provide recommendations about potentially beneficial interventions. We used autopsy data from the Allegheny County Medical Examiner to link people who died of overdoses from 2008 through 2014 to their premortem incarcerations and use of mental health services and substance use disorder services. We calculated the frequency of use of public human services by decedents and the interval between the last use of these services and overdose death. Of the 1399 decedents, 957 (68.4%) had a public human service encounter before overdose death. Of these 957 decedents, 531 (55.5%) had eve...
Archives of environmental & occupational health, Jan 4, 2016
Although blood lead levels in the U.S. have fallen dramatically since 1980, there remain subgroup... more Although blood lead levels in the U.S. have fallen dramatically since 1980, there remain subgroups of children with high blood lead levels. We assessed the relationship between environmental lead sources and blood lead levels in children age 1 to 5 years from the National Health and Nutrition Examination Survey (NHANES), 1999-2006. Modeled ambient air lead levels and industrial lead releases at the census tract level were assigned to each child's residence with adjustment for confounding factors. A total of 272 of 3223 children (8.4%) had blood lead levels ≥ 5 ug/dL. Industrial releases (2252 v. 1696 lbs/mi(2)) and ambient air lead levels (2.28 v. 1.75 ng/m(3)) were greater in exposed versus unexposed children. For every 10,000 pounds per mile squared (lb/mi(2)) increase in inverse distance squared weighted exposure there was a 1.13% (95% CI: 0.45%, 1.81%) increase in blood lead (p = 0.001).
Noise induced hearing loss (NIHL) is among the 10 leading occupational diseases, afflicting betwe... more Noise induced hearing loss (NIHL) is among the 10 leading occupational diseases, afflicting between 7.4 and 10.2 million people who work in noise above 85 dBA. Although mandatory hearing conservation programs (HCPs) have been in effect since 1972, this problem persists, as hearing protectors are not consistently used by workers, or may not attenuate to manufacturer&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s estimates in real world conditions. In this study, information from noise and hearing protection use measurements taken at an automobile assembly plant were used to construct average lifetime noise exposure and hearing protection compliance estimates for use in modeling to predict both total hearing loss and onset of two accepted definitions of hearing loss. There were 301 males and females in this cohort; their mean age was 42.6 (7.2) years, and mean tenure was 14.3 (3.5) years. Average length of follow-up was 14.0 years. There were 16 members of this cohort who had hearing loss at the speech frequencies (defined as an average hearing level &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;gt; or = 25 dB at 500, 1000, and 2000 Hz). In cross-sectional multivariate analyses, years of employment, male gender, and proportion of time wearing hearing protection were the factors most associated with hearing loss at the average of 2000, 3000, and 4000 Hz (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.0001) controlling for age, transfer status (as a surrogate for previous noise exposure), race, and lifetime average noise exposure. The most consistent predictor of hearing loss in both univariate and multivariate analyses was percentage of time having used hearing protection during the workers&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; tenure.
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