Carol A. Gotway Crawford

A New Source of Data for Public Health Surveillance: Facebook Likes

Background Investigation into personal health has become focused on conditions at an increasingly local level, while response rates have declined and complicated the process of collecting data at an individual level. Simultaneously, social media data have exploded in availability and have been shown to correlate with the prevalence of certain health conditions. Objective Facebook likes may be a source of digital data that can complement traditional public health surveillance systems and provide data at a local level. We explored the use of Facebook likes as potential predictors of health outcomes and their behavioral determinants. Methods We performed principal components and regression analyses to examine the predictive qualities of Facebook likes with regard to mortality, diseases, and lifestyle behaviors in 214 counties across the United States and 61 of 67 counties in Florida. These results were compared with those obtainable from a demographic model. Health data were obtained from both the 2010 and 2011 Behavioral Risk Factor Surveillance System (BRFSS) and mortality data were obtained from the National Vital Statistics System. Results Facebook likes added significant value in predicting most examined health outcomes and behaviors even when controlling for age, race, and socioeconomic status, with model fit improvements (adjusted R 2) of an average of 58% across models for 13 different health-related metrics over basic sociodemographic models. Small area data were not available in sufficient abundance to test the accuracy of the model in estimating health conditions in less populated markets, but initial analysis using data from Florida showed a strong model fit for obesity data (adjusted R 2=.77). Conclusions Facebook likes provide estimates for examined health outcomes and health behaviors that are comparable to those obtained from the BRFSS. Online sources may provide more reliable, timely, and cost-effective county-level data than that obtainable from traditional public health surveillance systems as well as serve as an adjunct to those systems.

Perspectives on Public Health Workforce Research

The Centers for Disease Control and Prevention Office of Workforce and Career Development is committed to developing a competent, sustainable, and diverse public health workforce through evidence-based training, career and leadership development, and strategic workforce planning to improve population health outcomes. This article reviews the previous efforts in identifying priorities of public health workforce research, which are summarized as eight major research themes. We outline a strategic framework for public health workforce research that includes six functional areas (ie, definition and standards, data, methodology, evaluation, policy, and dissemination and translation). To conceptualize and prioritize development of an actionable public health research agenda, we constructed a matrix of key challenges in workforce analysis by public health workforce categories. Extensive reviews were conducted to identify valuable methods, models, and approaches to public health workforce research. We explore new tools and approaches for addressing priority areas for public health workforce and career development research and assess how tools from multiple disciplines of social sciences can guide the development of a research framework for advancing public health workforce research and policy.

Predeployment Mental Health and Trauma Exposure of Expatriate Humanitarian Aid Workers: Risk and Resilience Factors

Expatriate aid workers (n = 214) representing 19 nongovernmental organizations (NGOs) completed a predeployment survey, including measures of mental health (depression, anxiety, and posttraumatic stress disorder [PTSD]); risk factors (childhood trauma, family risk, and adult trauma exposure); and resilience factors (coping, social support, and healthy lifestyle) to assess their baseline mental health during preparation for deployment. Multiple regression analysis indicated that childhood trauma/family risk was not significantly related to depression, anxiety, or PTSD symptoms when controlling for report of prior mental illness; yet, adult trauma exposure was significantly related to all three. Social support contributed significant variance to depression and PTSD. NGOs can help applicants recognize the effects of recent trauma and the resilience provided by a healthy social network.

Spatial and Probability Distribution of Mexican Bean Beetle (Coleoptera: Coccinellidae) Egg Mass Populations in Dry Bean

Abstract The spatial pattern and probability distribution of Mexican bean beetle, Epilachna varivestis Mulsant, egg masses were studied in four dry bean, Phaseolus vulgaris L., fields near Scottsbluff, NE, during the 1994 and 1995 growing seasons. Sampling was conducted in a regular and uniform grid to guarantee coverage of the field. The experimental unit in all fields was 0.30 row-m, and five measurements were made at 0.76-m intervals. A total of 12,290 locations was sampled. Geostatistics and discrete statistics were used to describe the egg mass distribution. Regression was used to detect and separate macroscale trends from the microscale variation. The presence of macroscale variation indicated a significant edge effect with ovipositing females moving into dry bean fields from their overwintering sites. The microscale variation estimated from the estimated residuals from regressions to estimate trends was studied using semivariograms for all fields. Semivariograms strongly indicate that Mexican bean beetle eggs are randomly distributed across the field and that this random distribution holds across 10-fold differences in population densities. As a result of the significant macroscale trends observed, we conclude that egg mass densities may be greater in areas of the field near edges adjacent to beetle overwintering sites. The probability distribution that best fit the data was the negative binomial. Our results illustrate the importance of scale in discussing and characterizing distribution. Although there is evidence of edge effect at the field level, there is no evidence of spatial dependence between egg samples at the sampling region level. At an even lower level, the egg mass itself, eggs are aggregated.

The role of geographic scale in testing the income inequality hypothesis as an explanation of health disparities

This study re-examined the role of geographic scale in measuring income inequality and testing the income inequality hypothesis (IIH) as an explanation of health disparities. We merged Behavioral Risk Factor Surveillance System (BRFSS) 2000 data with income inequality indices constructed at different geographic scales to test the association between income inequality and four different health indicators, i.e., self-assessed health status as a morbidity measure, vaccination against influenza as a measure of use of preventive healthcare, having any kind of health insurance as a measure of access, and obesity as a modifiable health risk factor measure. Multilevel models are used in our regression of the health indicators on measures of income inequalities and control variables. Our analysis suggests that because income inequality is a contextual variable, income inequalities measured at different geographic scales have different interpretations and relate to societal characteristics at different levels. Therefore, a rejection of the IIH at one level does not necessarily negate the possibility that income inequality affects health at another level. Assessment across a variety of scales is needed to have a comprehensive picture of the IIH in any given study. Empirical results also show that whether the IIH holds could depend on the sex group examined and the health indicator used, which implies different mechanisms of IIH exist for different sex groups and health indicators, in addition to the geographic scale. The role of geographic scale should be more rigorously considered in social determinants of health research.

Breath acidification in adolescent runners exposed to atmospheric pollution: a prospective, repeated measures observational study.

BackgroundVigorous outdoors exercise during an episode of air pollution might cause airway inflammation. The purpose of this study was to examine the effects of vigorous outdoor exercise during peak smog season on breath pH, a biomarker of airway inflammation, in adolescent athletes.MethodsWe measured breath pH both pre- and post-exercise on ten days during peak smog season in 16 high school athletes engaged in daily long-distance running in a downwind suburb of Atlanta. The association of post-exercise breath pH with ambient ozone and particulate matter concentrations was tested with linear regression.ResultsWe collected 144 pre-exercise and 146 post-exercise breath samples from 16 runners (mean age 14.9 years, 56% male). Median pre-exercise breath pH was 7.58 (interquartile range: 6.90 to 7.86) and did not change significantly after exercise. We observed no significant association between ambient ozone or particulate matter and post-exercise breath pH. However both pre- and post-exercise breath pH were strikingly low in these athletes when compared to a control sample of 14 relatively sedentary healthy adults and to published values of breath pH in healthy subjects.ConclusionAlthough we did not observe an acute effect of air pollution exposure during exercise on breath pH, breath pH was surprisingly low in this sample of otherwise healthy long-distance runners. We speculate that repetitive vigorous exercise may induce airway acidification.

Factors Associated With Adverse Mental Health Outcomes in Locally Recruited Aid Workers Assisting Iraqi Refugees in Jordan

Nongovernmental organizations (NGOs) serve Iraqis living in Jordan as “guests.” In 2008, 258 Jordanian humanitarian staff and Iraqi volunteers working for NGOs completed a needs assessment survey. Work characteristics, stressors, and support variables were evaluated regarding their influence on depression, anxiety, post-traumatic stress disorder (PTSD), and burnout through multivariate logistic regressions. There was a significant difference in depression, anxiety, and burnout across nationality. Traumatic exposure increased the risk for anxiety, depression, and PTSD. Working longer in the humanitarian sector was associated with less risk of anxiety and depression, and lower social support was a risk for anxiety. Managers were at higher risk for burnout, and low team cohesion was a risk for burnout. Implications for aid organizations are discussed.

Obesity Prevention: The Impact of Local Health Departments

OBJECTIVE To examine the association between bodyweight status and provision of population-based prevention services. DATA SOURCES The National Association of City and County Health Officials 2005 Profile survey data, linked with two cross-sections of the Behavioral Risk Factor Surveillance System (BRFSS) survey in 2004 and 2005. STUDY DESIGN Multilevel logistic regressions were used to examine the association between provision of obesity-prevention services and the change in risk of being obese or morbidly obese among BRFSS respondents. The estimation sample was stratified by sex. Low-income samples were also examined. Falsification tests were used to determine whether there is counterevidence. PRINCIPAL FINDINGS Provision of population-based obesity-prevention services within the jurisdiction of local health departments and specifically those provided by the local health departments are associated with reduced risks of obesity and morbid obesity from 2004 to 2005. The magnitude of the association appears to be stronger among low-income populations and among women. Results of the falsification tests provide additional support of the main findings. CONCLUSIONS Population-based obesity-prevention services may be useful in containing the obesity epidemic.

Evaluation of variance estimators for the concentration and health achievement indices: a Monte Carlo simulation.

Although the concentration index (CI) and the health achievement index (HAI) have been extensively used, previous studies have relied on bootstrapping to compute the variance of the HAI, whereas competing variance estimators exist for the CI. This paper provides methods of statistical inference for the HAI and compares the available variance estimators for both the CI and the HAI using Monte Carlo simulation. Results for both the CI and the HAI suggest that analytical methods and bootstrapping are well behaved. The convenient regression method gives standard errors close to the other methods, provided the CI is not too large (< 0.2), but otherwise tends to understate the standard errors. In our simulation setting, the improvement from the Newey-West correction over the convenient regression method has mixed evidence when the CI ≤ 0.1 and is modest when the CI > 0.1. Published 2011. This article is a US Government work and is in the public domain in the USA.

Examining the Role of Gender in Career Advancement at the Centers for Disease Control and Prevention

During the past decade, efforts to promote gender parity in the healing and public health professions have met with only partial success. We provide a critical update regarding the status of women in the public health profession by exploring gender-related differences in promotion rates at the nations leading public health agency, the Centers for Disease Control and Prevention (CDC). Using personnel data drawn from CDC, we found that the gender gap in promotion has diminished across time and that this reduction can be attributed to changes in individual characteristics (e.g., higher educational levels and more federal work experience). However, a substantial gap in promotion that cannot be explained by such characteristics has persisted, indicating continuing barriers in womens career advancement.