Magee C, Browning C, Stokes-Walters R
… +3 more, Maxwell L, Buendia J, Bhakta N
Prev Chronic Dis
· 2024 Jun · PMID 38900694
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Built environment approaches that improve active transportation infrastructure and environmental design can increase physical activity. Funded by the Centers for Disease Control and Prevention, the Texas Department of St...Built environment approaches that improve active transportation infrastructure and environmental design can increase physical activity. Funded by the Centers for Disease Control and Prevention, the Texas Department of State Health Services rejuvenated the Texas Plan4Health program from 2018 to 2023 to expand such approaches in Texas by providing technical assistance to teams of local public health professionals and planners to identify and implement projects connecting people to everyday destinations via active transport in their communities. However, the COVID-19 pandemic prompted Texas Plan4Health to modify the delivery of technical assistance to accommodate restrictions on travel and in-person gatherings. We used qualitative methods to conduct a postintervention process evaluation to describe the modified technical assistance process, understand the experiences of the 4 participating communities, and identify short-term outcomes and lessons learned. Texas Plan4Health helped communities overcome common barriers to built environment change, facilitated collaboration across community public health and planning professionals, and educated professionals about active transportation infrastructure and the relationship between their disciplines, thereby increasing community capacity to implement built environment improvements. This outcome, however, was mediated by the pre-existing resources and previous experiences with active transportation planning among the participating communities. Public health practitioners seeking to improve active transportation infrastructure and environmental design for physical activity should consider community-engaged approaches that advance partnership-building and collaborative experiential education among public health, planning, and other local government representatives, directing particular attention and additional training toward communities with fewer resources.
Watson KB, Carlson SA, Lu H
… +3 more, Wooten KG, Pankowska MM, Greenlund KJ
Prev Chronic Dis
· 2024 Jun · PMID 38900693
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Easy access and display of state-level estimates of the prevalence of chronic diseases and their risk factors can guide evidence-based decision-making, policy development, and tailored efforts to improve population healt...Easy access and display of state-level estimates of the prevalence of chronic diseases and their risk factors can guide evidence-based decision-making, policy development, and tailored efforts to improve population health outcomes; however, these estimates are often presented across multiple websites and reports. The Chronic Disease Indicators (CDI) web tool (www.cdc.gov/cdi) disseminates state-level data compiled from various data sources, including surveys, vital records, and administrative data, and applies standardized definitions to estimate and track a wide range of key indicators of chronic diseases and their risk factors. In 2022-2024, the indicators were refreshed to include 113 measures across 21 topic areas, and the web tool was modernized to enhance its key features and functionalities, including standardized indicator definitions; interactive charts, graphs, and maps that present data in a visually appealing format; an easy-to-use web-based interface for users to query and extract the data they need; and state comparison reports to identify geographic variations in disease and risk factor prevalence. National and state-level estimates are provided for the overall population and, where applicable, by sex, race and ethnicity, and age. We review the history of CDIs, describe the 2022-2024 refresh process, and explore the interactive features of the CDI web tool with the goal of demonstrating how practitioners, policymakers, and other users can easily examine and track a wide range of key indicators of chronic diseases and their risk factors to support state-level public health action.
Hohman KH, Klompas M, Zambarano B
… +3 more, Wall HK, Jackson SL, Kraus EM
Prev Chronic Dis
· 2024 Jun · PMID 38870031
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INTRODUCTION: Surveillance modernization efforts emphasize the potential use of electronic health record (EHR) data to inform public health surveillance and prevention. However, EHR data streams vary widely in their comp...INTRODUCTION: Surveillance modernization efforts emphasize the potential use of electronic health record (EHR) data to inform public health surveillance and prevention. However, EHR data streams vary widely in their completeness, accuracy, and representativeness. METHODS: We developed a validation process for the Multi-State EHR-Based Network for Disease Surveillance (MENDS) pilot project to identify and resolve data quality issues that could affect chronic disease prevalence estimates. We examined MENDS validation processes from December 2020 through August 2023 across 5 data-contributing organizations and outlined steps to resolve data quality issues. RESULTS: We identified gaps in the EHR databases of data contributors and in the processes to extract, map, integrate, and analyze their EHR data. Examples of source-data problems included missing data on race and ethnicity and zip codes. Examples of data processing problems included duplicate or missing patient records, lower-than-expected volumes of data, use of multiple fields for a single data type, and implausible values. CONCLUSION: Validation protocols identified critical errors in both EHR source data and in the processes used to transform these data for analysis. Our experience highlights the value and importance of data validation to improve data quality and the accuracy of surveillance estimates that use EHR data. The validation process and lessons learned can be applied broadly to other EHR-based surveillance efforts.
Michaud TL, Zagurski C, Wilson KE
… +3 more, Porter GC, Johnson G, Estabrooks PA
Prev Chronic Dis
· 2024 Jun · PMID 38843118
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We examined participation rates, engagement, and weight-loss outcomes of comparison group participants in a diabetes prevention trial who enrolled in a digitally delivered diabetes prevention program (ie, an active inter...We examined participation rates, engagement, and weight-loss outcomes of comparison group participants in a diabetes prevention trial who enrolled in a digitally delivered diabetes prevention program (ie, an active intervention) after the original trial ended. We evaluated these outcomes by using the Wilcoxon signed-rank test and 1-sample z test. We found a high participation rate (73%) among comparison group participants and comparable weight-loss outcomes at 12 months (6.8 lb) after initiating participation in the active intervention relative to intervention group participants during the original trial. Findings support providing evidence-based interventions for comparison or control group participants post-trial. Findings also support examining the cost-effectiveness of post-trial interventions, regardless of the limitations of acquiring post-trial data on weight in an uncontrolled setting.
Barth O, Anderson B, Jones K
… +4 more, Nickles A, Dawkins K, Burnett A, Quartermus K
Prev Chronic Dis
· 2024 Jun · PMID 38843117
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Michigan's CHRONICLE, the Chronic Disease Registry Linking Electronic Health Record Data, is a near-real-time disease monitoring system designed to harness electronic health record (EHR) data and existing health informat...Michigan's CHRONICLE, the Chronic Disease Registry Linking Electronic Health Record Data, is a near-real-time disease monitoring system designed to harness electronic health record (EHR) data and existing health information exchange (HIE) infrastructure for transformative public health surveillance. Strong evidence indicates that using EHR data in chronic disease monitoring will provide rapid insight over time on health care use, outcomes, and public health interventions. We examined the potential of EHR data for chronic disease surveillance through close collaboration with our statewide HIE network and 2 participating health systems. We describe the development of CHRONICLE, the promising findings from its implementation, the identified challenges, and how those challenges will inform the next steps in testing, refining, and expanding the system. By detailing our approach to developing CHRONICLE and the considerations and early steps required to build an innovative, EHR-based chronic disease registry, we aim to inform public health leaders and professionals on the value of EHR data for chronic disease surveillance. With systematic testing, evaluation, and enhancement, our goal for CHRONICLE, as a fully realized and comprehensive surveillance system, is to model how collaborative health information exchange can support evidence-based strategies, resource allocation, and precision in disease monitoring.
Prev Chronic Dis
· 2024 May · PMID 38815050
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To reduce youth access to tobacco products, the California Tobacco Prevention Program funded local tobacco prevention programs from July 2017 through December 2021 to address its Communities of Excellence Indicator 3.2.9...To reduce youth access to tobacco products, the California Tobacco Prevention Program funded local tobacco prevention programs from July 2017 through December 2021 to address its Communities of Excellence Indicator 3.2.9: "the number of jurisdictions with a policy eliminating or restricting the sale and/or distribution of any mentholated cigarettes and other flavored tobacco products, and paraphernalia." We examined the strategies by which community coalitions attempted to limit the number of stores selling flavored tobacco across California. Thirty-six final evaluation reports (FERs) were used for our analysis. We examined certain elements or factors as primary areas of interest because of their apparent link to successful outcomes in analyses of FERs in the past. Over half (19 of 36) of FERs reported successfully passing at least 1 policy to regulate the sale of flavored tobacco products. Urban communities passed more policies (16 of 18) compared with rural communities (3 of 18). Successful campaigns tended to involve youth, demonstrate illegal sales to minors and public support for a ban, and identify a champion. Barriers included the COVID-19 pandemic, California wildfires, staffing shortages, and conservative political climates. This evaluation offers insights into the successes and challenges faced by local coalitions seeking policy changes for tobacco use prevention, which can be different for urban and rural communities. The evaluation also indicates the necessity of adopting flexible tactical plans for overcoming environmental factors that affected intervention and evaluation activities.
Cornelius ME, Gentzke AS, Loretan CG
… +2 more, Hawkins NA, Jamal A
Prev Chronic Dis
· 2024 May · PMID 38815049
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INTRODUCTION: Menthol cigarettes have been associated with increased smoking initiation. Although numerous studies have focused on correlates of menthol cigarette smoking among youths, fewer studies have assessed the pre...INTRODUCTION: Menthol cigarettes have been associated with increased smoking initiation. Although numerous studies have focused on correlates of menthol cigarette smoking among youths, fewer studies have assessed the prevalence and correlates of overall menthol-flavored tobacco product use among middle and high school students. METHODS: We analyzed 2022 National Youth Tobacco Survey data to estimate the prevalence of menthol-flavored tobacco product use among US middle and high school students who used tobacco products within the past 30 days. Characteristics associated with menthol-flavored tobacco product use were also examined. RESULTS: Use of menthol-flavored tobacco products was reported by 23.8% of students who currently used any tobacco product and by 39.5% of students who currently used any flavored tobacco product. Among students who reported past 30-day use of a flavored tobacco product, characteristics associated with a higher prevalence of menthol-flavored tobacco product use included non-Hispanic White race and ethnicity, frequent tobacco product use, use of multiple tobacco products, wanting to use a tobacco product within the first 30 minutes of awakening, and craving tobacco products within the past 30 days. CONCLUSION: Unlike results of prior research focused on cigarette smoking among young people, prevalence of use of any menthol-flavored tobacco product was highest among non-Hispanic White youths. Any use of menthol-flavored tobacco products of any type (alone or in combination with other flavors) among young people may be associated with continued product use and symptoms of dependence.
Prev Chronic Dis
· 2024 May · PMID 38781045
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The Center for Black Health & Equity's approach to addressing health inequities relies on the inherent ability within community-based organizations to respond to public health priorities while addressing the political an...The Center for Black Health & Equity's approach to addressing health inequities relies on the inherent ability within community-based organizations to respond to public health priorities while addressing the political and social determinants of health. By using Dr. Robert Robinson's Community Development Model as a foundational framework, communities can address systemic barriers that impede optimal health outcomes. The model includes community engagement and mobilization activities that motivate communities to achieve equity-centered policy change and offers milestones that show progress made toward their goals and objectives. We operationalized the Community Development Model into the Community Capacity Building Curriculum to train community partners to form a multicultural coalition through asset mapping as a tool for community mobilization. This curriculum is both cost effective and efficient because it enables communities to address health disparities beyond tobacco control, such as food and nutrition, housing, and environmental issues. Coalitions are prepared to identify and make recommendations to address policies that perpetuate health disparities. Facing off against a powerful tobacco industry giant is challenging for small grassroots organizations advocating for stricter tobacco regulations and policies. Such organizations struggle for resources; however, their passion and dedication to the mission of saving Black lives can promote change.
Prev Chronic Dis
· 2024 May · PMID 38753527
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INTRODUCTION: Homeownership is crucial for stability and healthy life. We examined the role of homeownership in predicting the prevalence of common chronic health conditions in the United States. METHODS: We used 2020 Be...INTRODUCTION: Homeownership is crucial for stability and healthy life. We examined the role of homeownership in predicting the prevalence of common chronic health conditions in the United States. METHODS: We used 2020 Behavioral Risk Factor Surveillance System data (N = 401,958) to assess the association between homeownership and self-reported diagnosed diabetes, asthma, cancer, coronary heart disease (CHD), stroke, and kidney disease. We analyzed data by using logistic regression, adjusting for age, sex, race and ethnicity, education, employment, and income and computed odds ratios (ORs) and corresponding 95% CIs. RESULTS: Most survey participants (66.8%) owned their residences. Age, marital status, education, and income significantly influenced homeownership. Odds of homeownership progressively increased with age, reaching a peak at 17.45 (95% CI, 16.21-18.79) for adults aged 65 years or older, and non-Hispanic White adults had the highest odds (OR = 3.34; 95% CI, 3.18-3.52). Compared with renters, homeowners generally had lower prevalence of chronic health conditions, especially among those aged 45 to 64 years. After adjusting for age, sex, and race and ethnicity, the odds of having chronic health conditions among renters were higher than those of homeowners: CHD, 1.39 (1.27-1.52); diabetes, 1.27 (1.20-1.35); asthma, 1.29 (1.23-1.36); stroke, 1.89 (1.71-2.09); and kidney disease, 1.59 (1.44-1.77). CONCLUSION: Homeownership can be used to predict the prevalence of several chronic health conditions. Considering its significant influence, public health initiatives should focus on housing-related interventions to improve population health.
See C, Hegde K, Reid L
… +5 more, Shi R, Luthra R, Dong W, Lee V, Kang-Giaimo A
Prev Chronic Dis
· 2024 May · PMID 38753526
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INTRODUCTION: Haven is a student-run free clinic in New Haven, Connecticut, that serves more than 500 patients annually. Haven's pharmacy department helps patients obtain medications by providing discount coupons or medi...INTRODUCTION: Haven is a student-run free clinic in New Haven, Connecticut, that serves more than 500 patients annually. Haven's pharmacy department helps patients obtain medications by providing discount coupons or medications from the clinic's in-house pharmacy, directly paying for medications at local pharmacies, and delivering medications to patients' homes. This study aimed to identify prescriptions that have the highest cost among Haven patients. METHODS: Our sample consisted of all Haven patients who attended the clinic from March 2021 through March 2023. Patients were eligible to be seen at Haven if they were aged 18 to 65 years, lacked health insurance, and lived in New Haven. We determined the lowest cost of each medication prescribed to Haven patients by comparing prices among local pharmacies after applying a GoodRx discount. We defined expensive medication as more than $20 per prescription. We excluded medical supplies. RESULTS: Of the 594 Haven patients in our sample, 64% (n = 378) required financial assistance and 22% (n = 129) were prescribed at least 1 expensive medication. Among 129 patients prescribed an expensive medication, the mean (SD) age was 45.0 (12.3) years; 65% were women, and 87% were Hispanic or Latino. Median (IQR) household annual income was $14,400 [$0-$24,000]. We identified 246 expensive medications; the median (IQR) price per prescription was $31.43 ($24.00-$52.02). The most frequently prescribed expensive medications were fluticasone propionate/salmeterol (accounting for 6% of all expensive medications), medroxyprogesterone acetate (6%), albuterol sulfate (5%), and rosuvastatin (5%). CONCLUSION: The average Haven patient has an income well below the federal poverty level, and many have chronic cardiovascular and respiratory conditions that require expensive medications. Future research should work toward making medications universally affordable.
Watson KB, Croft JB, Wheaton AG
… +5 more, Liu Y, Punturieri A, Postow L, Carlson SA, Greenlund KJ
Prev Chronic Dis
· 2024 May · PMID 38723273
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We estimated the prevalence of respiratory symptoms, chronic obstructive pulmonary disease (COPD) risk level, and receipt of a breathing test among adults without reported COPD in 26 states and the District of Columbia b...We estimated the prevalence of respiratory symptoms, chronic obstructive pulmonary disease (COPD) risk level, and receipt of a breathing test among adults without reported COPD in 26 states and the District of Columbia by using 2017-2018 Behavioral Risk Factor Surveillance System data. Among adults without reported COPD, the 3 respiratory symptoms indicating COPD (chronic cough, phlegm or mucus production, shortness of breath) were common (each >10%). About 15.0% were at higher COPD risk (based on the number of symptoms, age, and smoking status); 41.4% of adults at higher risk reported receipt of a breathing test. Patient-provider recognition and communication of risk symptoms, appropriate screening, and follow-up are important for early diagnosis and treatment.
Guglielmo D, Dang A, Fischbach L
… +6 more, Toruno R, Chavez-Sosa G, Messex M, Gallow TG, Moradian C, Kuo T
Prev Chronic Dis
· 2024 May · PMID 38696254
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We examined whether a community engagement approach and jurisdictional attributes were associated with local action to restrict the sale of flavored tobacco products in Los Angeles County during 2019-2022. We estimated c...We examined whether a community engagement approach and jurisdictional attributes were associated with local action to restrict the sale of flavored tobacco products in Los Angeles County during 2019-2022. We estimated crude and adjusted risk ratios to examine these associations. Jurisdictions that used an active community engagement approach to adopt a flavored tobacco ban ordinance, those with previous experience adopting other tobacco-related ordinances, and those located next to communities that have an existing tobacco retail license ordinance were more likely than jurisdictions without these attributes to adopt a new ordinance to restrict the sale of flavored tobacco products. Efforts to adopt such an ordinance were generally more successful in jurisdictions where community members were engaged and policy makers were familiar with the adoption of public health ordinances.
Olmstead T, Spencer JC, Kluz N
… +3 more, Zhan FB, Shokar NK, Pignone M
Prev Chronic Dis
· 2024 May · PMID 38696253
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INTRODUCTION: Mailed stool testing for colorectal cancer (CRC) may improve screening uptake and reduce the incidence and mortality of CRC, especially among patients at federally qualified health centers (FQHCs). To expan...INTRODUCTION: Mailed stool testing for colorectal cancer (CRC) may improve screening uptake and reduce the incidence and mortality of CRC, especially among patients at federally qualified health centers (FQHCs). To expand screening programs it is important to identify cost-effective approaches. METHODS: We developed a decision-analytic model to estimate the cost, effects on screening and patient outcomes (CRCs detected, CRCs prevented, CRC deaths prevented), and cost-effectiveness of implementing a state-wide mailed stool testing program over 5 years among unscreened, age-eligible (aged 50-75 y) patients at FQHCs in Texas. We compared various outreach strategies and organizational structures (centralized, regional, or a hybrid). We used data from our existing regional mailed stool testing program and recent systematic reviews to set parameters for the model. Costs included start-up and ongoing activities and were estimated in 2022 US dollars from the perspective of a hypothetical third-party payer. Cost-effectiveness was assessed by using both incremental and average cost-effectiveness ratios. RESULTS: Using either a statewide centralized or hybrid organizational configuration to mail stool tests to newly eligible FQHC patients and patients who have responded at least once since program inception is likely to result in the best use of resources over 5 years, enabling more than 110,000 additional screens, detecting an incremental 181 to 194 CRCs, preventing 91 to 98 CRCs, and averting 46 to 50 CRC deaths, at a cost of $10 million to $11 million compared with no program. CONCLUSIONS: A statewide mailed stool testing program for FQHC patients can be implemented at reasonable cost with considerable effects on CRC screening outcomes, especially when its structure maximizes program efficiency while maintaining effectiveness.