Michelle S. Wong

Provider communication quality: Influence of patients’ weight and race

OBJECTIVE To examine the relationship between patient weight and provider communication quality and determine whether patient race/ethnicity modifies this association. METHODS We conducted a cross-sectional analysis with 2009-2010 medical expenditures panel survey-household component (N=25,971). Our dependent variables were patient report of providers explaining well, listening, showing respect, and spending time. Our independent variables were patient weight status and patient weight-race/ethnicity groups. Using survey weights, we performed multivariate logistic regression to examine the adjusted association between patient weight and patient-provider communication measures, and whether patient race/ethnicity modifies this relationship. RESULTS Compared to healthy weight whites, obese blacks were less likely to report that their providers explained things well (OR 0.78; p=0.02) or spent enough time with them (OR 0.81; p=0.04), and overweight blacks were also less likely to report that providers spent enough time with them (OR 0.78; p=0.02). Healthy weight Hispanics were also less likely to report adequate provider explanations (OR 0.74; p=0.04). CONCLUSION Our study provides preliminary evidence that overweight/obese black and healthy weight Hispanic patients experience disparities in provider communication quality. PRACTICE IMPLICATION Curricula on weight bias and cultural competency might improve communication between providers and their overweight/obese black and healthy weight Hispanic patients.

Using a computational model to quantify the potential impact of changing the placement of healthy beverages in stores as an intervention to "Nudge" adolescent behavior choice

BackgroundProduct placement influences consumer choices in retail stores. While sugar sweetened beverage (SSB) manufacturers expend considerable effort and resources to determine how product placement may increase SSB purchases, the information is proprietary and not available to the public health and research community. This study aims to quantify the effect of non-SSB product placement in corner stores on adolescent beverage purchasing behavior. Corner stores are small privately owned retail stores that are important beverage providers in low-income neighborhoods – where adolescents have higher rates of obesity.MethodsUsing data from a community-based survey in Baltimore and parameters from the marketing literature, we developed a decision-analytic model to simulate and quantify how placement of healthy beverage (placement in beverage cooler closest to entrance, distance from back of the store, and vertical placement within each cooler) affects the probability of adolescents purchasing non-SSBs.ResultsIn our simulation, non-SSB purchases were 2.8 times higher when placed in the “optimal location” – on the second or third shelves of the front cooler – compared to the worst location on the bottom shelf of the cooler farthest from the entrance. Based on our model results and survey data, we project that moving non-SSBs from the worst to the optional location would result in approximately 5.2 million more non-SSBs purchased by Baltimore adolescents annually.ConclusionsOur study is the first to quantify the potential impact of changing placement of beverages in corner stores. Our findings suggest that this could be a low-cost, yet impactful strategy to nudge this population—highly susceptible to obesity—towards healthier beverage decisions.

Spatially continuous local rate modeling for communication in public health: a practical approach.

A primary function of Environmental Public Health Tracking is the communication of spatial trends of diseases. Traditional (choropleth) approaches to disease mapping}?> have difficulty conveying intuitive understandings of the spatial continuity of disease risk, rate calculations in rural areas, and degrees of statistical significance. A spatial loess function can be utilized to depict continuous variations in preterm birth risk for the state of California on the basis of a 3-year birth cohort. Results from this function were graphically depicted and incorporated into a Web mapping service to maximize public accessibility. The function was evaluated as a tool for communication by considering its intuitive interpretation and comparing information derived from the function with that, which would be derived from a choropleth map using the same data. In general, the loess function was able to generate risk information for a variety of both urban and rural settings. Although richer in detail, this information was mostly consistent with that which would come from choropleth maps. Occasionally, information from the loess function stood in contradiction to the choropleth mapping procedure; however; we enumerate these occasions and discuss ways to maximize the consistency of the loess function with intuitive understandings of disease risk.

Simulating the Impact of Sugar-Sweetened Beverage Warning Labels in Three Cities

INTRODUCTION A number of locations have been considering sugar-sweetened beverage point-of-purchase warning label policies to help address rising adolescent overweight and obesity prevalence. METHODS To explore the impact of such policies, in 2016 detailed agent-based models of Baltimore, Philadelphia, and San Francisco were developed, representing their populations, school locations, and food sources, using data from various sources collected between 2005 and 2014. The model simulated, over a 7-year period, the mean change in BMI and obesity prevalence in each of the cities from sugar-sweetened beverage warning label policies. RESULTS Data analysis conducted between 2016 and 2017 found that implementing sugar-sweetened beverage warning labels at all sugar-sweetened beverage retailers lowered obesity prevalence among adolescents in all three cities. Point-of-purchase labels with 8% efficacy (i.e., labels reducing probability of sugar-sweetened beverage consumption by 8%) resulted in the following percentage changes in obesity prevalence: Baltimore: -1.69% (95% CI= -2.75%, -0.97%, p<0.001); San Francisco: -4.08% (95% CI= -5.96%, -2.2%, p<0.001); Philadelphia: -2.17% (95% CI= -3.07%, -1.42%, p<0.001). CONCLUSIONS Agent-based simulations showed how warning labels may decrease overweight and obesity prevalence in a variety of circumstances with label efficacy and literacy rate identified as potential drivers. Implementing a warning label policy may lead to a reduction in obesity prevalence. Focusing on warning label design and store compliance, especially at supermarkets, may further increase the health impact.

The association between parent-reported provider communication quality and child obesity status: Variation by parent obesity and child race/ethnicity

OBJECTIVE To examine the association between healthcare provider communication quality and child obesity status, and the role of parent obesity and child race/ethnicity regarding this association. METHODS We conducted a cross-sectional secondary data analysis with the 2011-2013 Medical Expenditures Panel Survey of parents with children ages 6-12 (n=5390). We used multivariable logistic regression to examine the association of parent-reported healthcare provider communication quality (explaining well, listening carefully, showing respect, and spending enough time) with child obesity status, and effect modification by parent obesity and child race/ethnicity. RESULTS Parents of obese children were more likely to report that their childs healthcare provider listened carefully (OR=1.41, p=0.002) and spent enough time (OR=1.33, p=0.022) than parents of non-obese children. Non-obese parents of obese children experienced better communication in the domains of listening carefully (p<0.001) and spending enough time (p=0.007). Parents of obese non-Hispanic Asian children and non-Hispanic Black children were more likely to report that providers explained things well (p=0.043) and listened carefully (p=0.012), respectively. CONCLUSION Parents of obese children experienced better communication if parents were non-obese or children were non-Hispanic Black or Asian. PRACTICE IMPLICATIONS Healthcare providers should ensure effective communication with obese parents of obese children.

Simulating the Impact of Crime on African American Women's Physical Activity and Obesity

The objective of this study was to quantify the impact of crime on physical activity location accessibility, leisure‐time physical activity (LTPA), and obesity among African American women.

Development of a Web-based tool to collect and display water system customer service areas for public health action.

CONTEXT Significant illness is associated with biological contaminants in drinking water, but little is known about health effects from low levels of chemical contamination in drinking water. To examine these effects in epidemiological studies, the sources of drinking water of study populations need to be known. OBJECTIVE The California Environmental Health Tracking Program developed an online application that would collect data on the geographic location of public water system (PWS) customer service areas in California, which then could be linked to demographic and drinking water quality data. DESIGN We deployed the Water Boundary Tool (WBT), a Web-based geospatial crowdsourcing application that can manage customer service boundary data for each PWS in California and can track changes over time. We also conducted a needs assessment for expansion to other states. SETTING/PARTICIPANTS The WBT was designed for water system operators, local and state regulatory agencies, and government entities. RESULTS Since its public launch in 2012, the WBT has collected service area boundaries for about 2300 individual PWS, serving more than 90% of the California population. Results of the needs assessment suggest interest and utility for deploying such a tool among states lacking statewide PWS service area boundary data. CONCLUSIONS Although the WBT data set is incomplete, it has already been used for a variety of applications, including fulfilling legislatively mandated reporting requirements and linking customer service areas to drinking water quality data to better understand local water quality issues. Development of this tool holds promise to assist with outbreak investigations and prevention, environmental health monitoring, and emergency preparedness and response.

Advancing Environmental Health Literacy Through Community-Engaged Research and Popular Education

This chapter describes the process of increasing and sustaining environmental health literacy (EHL) within communities impacted by environmental hazards and associated health conditions through the comprehensive engagement of community members in environmental health research and education projects. The chapter discusses the use of popular education approaches to facilitate more effective collaboration and optimize mutual co-learning among community members and their project partners. It also explores how, by using this approach, community members can contribute their own knowledge and awareness of environmental and health conditions to advance the research and education process, thereby increasing the EHL of their academically-credentialed partners.

HUD Housing Assistance and Levels of Physical Activity Among Low-Income Adults

Introduction Receipt of housing assistance from the US Department of Housing and Urban Development (HUD) is associated with improved health among adults and lower rates of unmet medical need among adults and young children. However, it is unclear whether HUD housing assistance is associated with healthier behaviors. The objective of our study was to assess whether participation in HUD housing assistance programs is associated with increased physical activity among low-income adults. Methods In 2017, we pooled cross-sectional data from the 2004–2012 National Health Interview Survey (NHIS) linked to administrative records of HUD housing assistance participation. Our primary sample was low-income adults (aged ≥18; <200% of federal poverty level). Using multivariate logistic regression, we calculated the odds of being physically active (≥150 min/week of moderate-intensity activity or equivalent combination of moderate- and vigorous-intensity activity) among current HUD housing assistance residents compared with a control group of future residents (adults who would receive assistance within the next 2 years). In a secondary analyses, we examined neighborhood socioeconomic status as a modifier and conducted a subanalysis among nonsenior adults (aged <65). Results Among all low-income adults, the adjusted odds of being physically active were similar for current and future residents (odds ratio =1.17; 95% confidence interval, 0.95–1.46). Among nonseniors, current residents were more likely to be physically active than future residents (odds ratio = 1.47; 95% confidence interval, 1.10–1.97). Associations did not differ by neighborhood socioeconomic status. Conclusion Receiving HUD housing assistance is associated with being physically active among nonsenior low-income adults.

The neighborhood environment and obesity: Understanding variation by race/ethnicity

Neighborhood characteristics have been associated with obesity, but less is known whether relationships vary by race/ethnicity. This study examined the relationship between soda consumption - a behavior strongly associated with obesity - and weight status with neighborhood sociodemographic, social, and built environments by race/ethnicity. We merged data on adults from the 2011-2013 California Health Interview Survey, U.S. Census data, and InfoUSA (n=62,396). Dependent variables were soda consumption and weight status outcomes (body mass index and obesity status). Main independent variables were measures of three neighborhood environments: social (social cohesion and safety), sociodemographic (neighborhood socioeconomic status, educational attainment, percent Asian, percent Hispanic, and percent black), and built environments (number of grocery stores, convenience stores, fast food restaurants, and gyms in neighborhood). We fit multi-level linear and logistic regression models, stratified by individual race/ethnicity (NH (non-Hispanic) Whites, NH African Americans, Hispanics, and NH Asians) controlling for individual-level characteristics, to estimate neighborhood contextual effects on study outcomes. Lower neighborhood educational attainment was associated with higher odds of obesity and soda consumption in all racial/ethnic groups. We found fewer associations between study outcomes and the neighborhood, especially the built environment, among NH African Americans and NH Asians. While improvements to neighborhood environment may be promising to reduce obesity, null associations among minority subgroups suggest that changes, particularly to the built environment, may alone be insufficient to address obesity in these groups.