Thomas K. Bias

Changes in Cardiovascular Health in the United States, 2003–2011

Background Cardiovascular disease is the leading cause of death in the United States, making improving cardiovascular health a key population health goal. As part of efforts to achieve this, the American Heart Association has developed the first comprehensive cardiovascular health index (CVHI). Our objective was to investigate the changes in CVHI in US states from 2003 to 2011. Methods and Results CVHI was examined using Behavioral Risk Factor Surveillance System data between 2003 and 2011 (odd-numbered years). Total CVHI decreased from 3.73±0.01 in 2003 to 3.65±0.01 in 2009. The majority of states (88%) experienced a decline in CVHI and an increase in the prevalence of “poor” CVHI between 2003 and 2009. Among CVHI components, the highest prevalence of “ideal” was observed for blood glucose followed by smoking, whereas the lowest prevalence of “ideal” was observed for physical activity and diet. Between 2003 and 2009, prevalence of “ideal” smoking and diet status increased, while “ideal” prevalence of blood pressure, cholesterol, blood glucose, body mass index, and physical activity status decreased. We observed statistically significant differences between 2009 and 2011, outside the scope of the 2003–2009 trend, which we hypothesize are partially attributable to differences in sample demographic characteristics related to changes in Behavioral Risk Factor Surveillance System methodology. Conclusions Overall, CVHI decreased, most likely due to decreases in “ideal” blood pressure, body mass index, and cholesterol status, which may stem from low prevalence of “ideal” physical activity and diet status. These findings can be used to inform state-specific strategies and targets to improve cardiovascular health.

The importance of being parsimonious: reliability of a brief community walkability assessment instrument.

This research presents the Leyden Walkability Instrument (LWI), a brief survey checklist designed to measure the perceived walkability of a neighborhood or community where a respondent lives. The reliability of this instrument was tested using the intra-class correlation and found to be moderately substantially reliable (Landis-Koch rating) in every survey item (ranging from .54 to .76 and ranging in observed agreement from 72.8% to 93.9% with an overall instrument score of .71 and an observed agreement of 81.6%). The LWI is discussed in the context of other survey instruments designed to measure perceived walkability and found to be a useful addition because of its brevity and ease of use.

Exploring Health Insurance Status and Emergency Department Utilization

Emergency department (ED) use, by both insured and uninsured, leads to significant health care costs in the United States. While frequent ED use is often attributed to the uninsured, there is some evidence that insured populations also report utilizing the ED when otherwise preventable or nonurgent. We conducted in-person surveys of patients visiting the ED at a large research hospital and examined the differences in their characteristics based on the health insurance status. While less than the uninsured, insured individuals still report barriers to access to care outside the ED that include lack of access to another health care facility and unavailability of a doctor’s office or clinic.

Prevalence and Geographic Variations of Polypharmacy Among West Virginia Medicaid Beneficiaries

Background: West Virginia (WV) residents are at high risk for polypharmacy given its considerable chronic disease burdens. Objective: To evaluate the prevalence, correlates, outcomes, and geographic variations of polypharmacy among WV Medicaid beneficiaries. Methods: In this cross-sectional study, we analyzed 2009-2010 WV Medicaid fee-for-service (FFS) claims data for adults aged 18-64 (N=37,570). We defined polypharmacy as simultaneous use of drugs from five or more different drug classes on a daily basis for at least 60 consecutive days in one year. Multilevel logistic regression was used to explore the individual- and county-level factors associated with polypharmacy. Its relationship with healthcare utilization was assessed using negative binomial regression and logistic regression. The univariate local indicators of spatial association method was applied to explore spatial patterns of polypharmacy in WV. Results: The prevalence of polypharmacy among WV Medicaid beneficiaries was 44.6%. High-high clusters of polypharmacy were identified in southern WV, indicating counties with above-average prevalence surrounded by counties with above-average prevalence. Polypharmacy was associated with being older, female, eligible for Medicaid due to cash assistance or medical eligibility, having any chronic conditions or more chronic conditions, and living in a county with lower levels of education. Polypharmacy was associated with more hospitalizations, emergency department visits, and outpatient visits, as well as higher non-drug medical expenditures. Conclusions: Polypharmacy was prevalent among WV Medicaid beneficiaries and was associated with substantial healthcare utilization and expenditures. The clustering of high prevalence of polypharmacy in southern WV may suggest targeted strategies to reduce polypharmacy burden in these areas.

Depression Treatment Among Elderly Medicare Beneficiaries With Incident Cases of Cancer and Newly Diagnosed Depression

OBJECTIVE Depression treatment can improve the health outcomes of elderly cancer survivors. There is a paucity of studies on the extent to which depression is treated among elderly cancer survivors. Therefore, this study estimated the rates of depression treatment among elderly cancer survivors and identified the factors affecting depression treatment. METHODS A retrospective cohort study design was adopted, and data were obtained from the linked Surveillance, Epidemiology and End Results (SEER) and Medicare database. Elderly individuals (≥ 66 years) with incident cases of breast, colorectal, or prostate cancer and newly diagnosed depression (N=1,673) were followed for six months after the depression diagnosis to identify depression treatment (antidepressants only, psychotherapy only, combined treatment with both antidepressants and psychotherapy, and no depression treatment). Chi-square tests and multinomial logistic regressions were used to analyze the factors associated with depression treatment. RESULTS In this study population, 46% received antidepressants only, 27% received no treatment, 18% received combined therapy, and 9% received psychotherapy only. Factors associated with depression treatment included anxiety, the percentage of psychologists at the county level, the number of visits to primary care physicians, ongoing cancer treatment, the presence of other chronic conditions, and race-ethnicity. CONCLUSIONS The study findings indicate that two-thirds of cancer survivors received depression treatment in the first six months after depression diagnosis. Our study findings indicate that racial-ethnic disparities in depression treatment persist and competing demands for cancer treatment may take priority over depression care. Also, the availability of psychologists may influence receipt of psychotherapy among cancer survivors.

Measuring policy and related effects of a health impact assessment related to connectivity

Health Impact Assessments are an important tool to help policymakers perceive the potential positive and negative contributions of decisions to public health. While they have been increasingly used in the United States, studies have not examined intermediate effects. Using key stakeholder interviews, this manuscript examines policy outcomes and other related effects of the HIA 21months after completing a Health Impact Assessment Report around connectivity policy. Further, it reflects on the measurement of these effects as part of the monitoring and evaluation stage of the Health Impact Assessment process.

Factors Associated With Emergency Department Visits A Multistate Analysis of Adult Fee-for-Service Medicaid Beneficiaries

Objective: The objective of this study was to examine the association of patient- and county-level factors with the emergency department (ED) visits among adult fee-for-service (FFS) Medicaid beneficiaries residing in Maryland, Ohio, and West Virginia. Methods: A cross-sectional design using retrospective observational data was implemented. Patient-level data were obtained from 2010 Medicaid Analytic eXtract files. Information on county-level health-care resources was obtained from the Area Health Resource file and County Health Rankings file. Results: In adjusted analyses, the following patient-level factors were associated with higher number of ED visits: African Americans (incidence rate ratios [IRR] = 1.47), Hispanics (IRR = 1.63), polypharmacy (IRR = 1.89), and tobacco use (IRR = 2.23). Patients with complex chronic illness had a higher number of ED visits (IRR = 3.33). The county-level factors associated with ED visits were unemployment rate (IRR = 0.94) and number of urgent care clinics (IRR = 0.96). Conclusion: Patients with complex healthcare needs had a higher number of ED visits as compared to those without complex healthcare needs. The study results provide important baseline context for future policy analysis studies around Medicaid expansion options.

Exploring Policy-Maker Perceptions of Small City Downtowns in the USA

Using original survey data from a national sample of small cities in the USA, this paper explores the perceptions of policy-makers as to what matters for the viability of their downtowns. How do policy-makers of small cities perceive the viability of their downtowns? What policies and programs are associated with perceptions of viability? The results show policy-makers across the USA believe their downtown districts have strengths and weaknesses. Perceived strengths include safety from crime, access to government services, pedestrian safety, cultural opportunities, availability of restaurants and tolerance of diversity. Perceived weaknesses include a lack of available grocery stores, hotels, housing and economic competitiveness with areas outside of downtown. These perceptions indicate policy-makers are concerned about their downtowns ability to compete in the marketplace and that they feel more positively about issues perceived to be within their locus of control. A controlled multivariate model suggest...

Evaluation of an Intimate Partner Violence Training for Home Visitors Using the Theory of Planned Behavior

Introduction. Intimate partner violence (IPV) is a public health issue with recent intervention focus by home visiting programs with at-risk families in the United States. Home visitors are typically required to assess IPV but feel unprepared to do so and desire training. Our aim was to evaluate the impact of a daylong IPV training on the intention to enact three key IPV behaviors (screening, making referrals, and safety planning) using the theory of planned behavior. Method. Survey of 125 home visitors in West Virginia was conducted before and after a daylong IPV training. Results. The IPV training had a positive impact on intention to perform the three behaviors of interest, with the greatest impact on the intention to conduct IPV screenings. Discussion. Results provide important preliminary evidence supporting the effectiveness of professional development as a means of increasing intentions to conduct activities related to IPV. The impact on IPV screening intention is promising because screening is the first step in addressing IPV. Conclusion. The IPV training proved beneficial in increasing intentions and such trainings should be expanded, but further study is needed to link intentions to subsequent behaviors to address IPV with at-risk families.

The Impact of Community Input in Community Health Needs Assessments

Objective: To determine the impact of community participation on nonprofit hospital priorities as outlined in a Community Health Needs Assessment. Design: Using 3 completed Community Health Needs Assessments, we compare key stakeholder survey responses with community survey responses and determine their contribution to the finalized priorities. Setting: Three communities in West Virginia served by nonprofit hospitals (1 metropolitan statistical area, 1 micropolitan statistical area, and 1 rural community). Participants: Key stakeholders and the general population of communities served by the hospital. Main Outcome Measure: Finalized priorities as outlined in the Community Health Needs Assessment. Results: Community participation had an impact on finalized priorities. Conclusion: Community participation is key in identifying unique health needs and should be incorporated into the assessment process by nonprofit hospitals, local health departments, and other public health practitioners. As reforms are considered to the Patient Protection and Affordable Care Act, it will be important to emphasize the importance of community input in identifying ways nonprofit hospitals contribute community benefit. CHNAs without adequate public input may not translate into implementation plans that accurately address pressing health concerns.