Acheampong, Tracy (Georgetown University Human Science)
Barrington, Debbie (Georgetown University Human Science)
Background: Low-income individuals disproportionately suffer from disparities in oral health access. Dental services are an essential health benefit for children, providing them with a robust safety net, but dental care access remains limited for non-elderly adults.
Goal: To describe the racial/ethnic differences in dental insurance and utilization.
Objectives: 1. To describe dental services provided by Medicaid for each state. 2. To describe racial differences in dental insurance and utilization. 3. To describe racial differences in dental insurance and utilization for Medicaid recipients.
Approach: We analyzed 2007-2015 data from the nationally representative Medical Expenditure Panel Survey (MEPS) on approximately 164,000 non-elderly adults aged 18-64 years. Race and ethnicity, health and dental insurance coverage, dental visits, and frequency of dental checkups were self-reported. Chi square tests and associated p-values <0.05 determined statistical significance of racial differences in dental insurance and utilization. Multivariable logistic regression models will be utilized to adjust for socio-demographic factors and describe the independent associations between race/ethnicity and dental insurance and utilization. All statistical analyses were performed in SAS version 9.4.
Results: Descriptive analyses indicate that 64% of Hispanics, 88% of Non-Hispanic Whites, 81% of Non-Hispanic Blacks, and 85% of Non-Hispanic Asians had health insurance (p<0.0001). However, 32% of Hispanics, 53% of Non-Hispanic Whites, 43% of Non-Hispanic Blacks, and 54% of Non-Hispanic Asians had dental insurance (p<0.0001). 25% of Hispanics, 46% of Non-Hispanic Whites, 28% of Non-Hispanic Blacks, and 37% of Non-Hispanic Asians had a dental visit within the previous year (p<0.0001).
Importance to public health: These results indicate that the dental safety net for non-elderly adults needs to be fortified.
Amador BS, Maria Aileen (UMD SPH Behavioral and Community Health)
Garza PhD MPH, Mary (UMD SPH Behavioral and Community Health)
Boyle MPH CPH, Meleah (UMD SPH Maryland Institute for Applied Environmental Health)
Merlo, Leyla (UMD SPH Maryland Institute for Applied Environmental Health)
Feldman PhD FAAHB, Robert (UMD SPH Behavioral and Community Health)
Quiros-Alcala PhD MS, Lesliam (UMD SPH Maryland Institute for Applied Environmental Health)
Background: The “food insecurity-obesity” paradox differentially affects individuals in the US based on gender, income, and race/ethnicity. Latinos are a rapidly growing population in the US with high levels of food insecurity and higher obesity prevalence rates compared to non-Latino white adults. Research to reduce these health disparities, especially among Latino populations, is limited with most studies focused on children.
Goal: To address this gap, we examined barriers and facilitators to understand this paradox.
Objectives: Identify barriers and facilitators of the food insecurity-obesity paradox among US Latina Immigrants
Approach: As part of a larger study whose aim is to assess the health needs, lifestyle behaviors and other risk factors linked to chronic diseases among Latino immigrants in Prince Georges County, MD, we conducted a comprehensive survey and collected biospecimens. The survey captured information on demographics, cancer screening behaviors, mental health, nutrition, and food insecurity, using validated measures. Recruitment is ongoing with 123 participants recruited to date.
Results: Our study population is female (87%), obese (67%), and Central America natives (78%) with a mean age of 51 years. Preliminary analyses indicate that participants who reported: “worried about money for food” were more likely to be obese (p<0.04) and “hungry but no money for food” were less likely to graduate high school (p<0.02). Those who reported “cannot afford to eat balanced meals” were more likely to have high school degree (p<0.03), lived less time in US (p<0.02), less income (p<0.03) and be single (p<0.06). Additional analyses are underway.
Importance to public health: Understanding the “food insecurity-obesity” paradox and related factors will inform future culturally-tailored interventions to address obesity among Latina immigrants.
Raab, Constance (UMD SPH Health Services Administration)
Amaize, Aitalohi (UMD SPH Health Services Administration)
Simon-Rusinowitz, Lori (UMD SPH Health Services Administration)
Background: Senate Bill 707 Freestanding Medical Facilities- Certificate of Need, Rates and Definition (SB 707) established the Rural Health Care Workgroup to oversee a study of healthcare delivery in the Middle Shore region and develop recommendations to the legislature to meet the health care needs of the five counties – Caroline, Dorchester, Kent, Queen Anne’s and Talbot. Maryland Health Care Commission (MHCC) contracted with the University of Maryland School of Public Health and the NORC Walsh Center for Rural Health Analysis to conduct a study to develop rural health care delivery and payment options for the five counties. Five focus groups were conducted as part of this study, the results of which were published in November of 2017.
Goal: To gain insight into the health care perceptions and behaviors of consumers and to understand their views, opinions and preferences for a regional health care system. Additionally, to gather direct feedback on the needs, wants, availability and accessibility of health care for Mid-Shore consumers.
Objectives: To gain insight into the health care perceptions and behaviors of consumers and to understand their views, opinions and preferences for a regional health care system. Additionally, to gather direct feedback on the needs, wants, availability and accessibility of health care for Mid-Shore consumers.
Approach: Between March and April of 2017, five focus groups (45 participants total), one in each county, were conducted, audio-recorded, transcribed, and analyzed. Participants addressed assets and challenges related to health care in the region, identified defining characteristics of improved health services, and provided recommendations for the MHCC.
Results: Analysis revealed the following areas of need: • An environment that supports care coordination and case management and includes health care professionals who know their patients and focus on their needs. • Improvements to the health care environment, including reforms in drug pricing, health insurance, reimbursement for care coordination, mental and behavioral health services and non-pharmaceutical interventions. • Increased involvement of patients and families • Enhanced health literacy around specific health conditions, health insurance, and the health care system • Special attention to the needs of vulnerable populations including older people, young people, caregivers, those at the end of life, people with disabilities, low-income individuals, and others.
Importance to public health: By listening to residents’ voices, policymakers, program planners and others can better understand and address the healthcare needs and priorities facing the five Mid-Shore counties.
Bell, Caryn (UMD)
Background: Poor or predominately African American communities have fewer healthy food resources. Previous studies have not fully addressed important factors such as complex interrelationships between race and higher income and the interplay between “healthy” and “unhealthy” food resources.
Goal: To examine the effects of racial segregation and SES on food environments in Maryland.
Objectives: This study's objective is to determine if racial segregation and SES interact on "healthy" and "unhealthy" food environments in a unique way in Maryland.
Approach: Using data from the Census Bureau and InfoUSA, variations in associations between healthy and unhealthy food environments were assessed by neighborhood racial segregation and income. Associations between segregation and food environment were assessed using spatial regressions to account for neighboring communities using a 3rd order Rook contiguity. Multiplicative interaction terms were used to assess the potential modifying effects of income.
Results: Supermarket and grocery store density were negatively associated with fast food and convenience store density. Supermarkets were negatively associated with fast food and convenience stores among neighborhoods with fewer African American residents. Spatial regression analyses found that income was inversely, and segregation positively, associated with fast food and grocery store density with significant interactions. Spatial lag and error were detected for grocery store density.
Importance to public health: Unhealthy food resources were not negatively associated with healthy food resources in African American neighborhoods suggesting that African Americans are more likely to be simultaneously exposed to both healthy and unhealthy food environments. This has implications for racial disparities in obesity and diet. Moreover, neighborhood SES is implicated in these associations. Policymakers and researchers should examine food environments with specificity rather than broadly.
Choi, Yoon Sun (UMD SPH Health Services Administration)
Boudreaux, Michel (UMD SPH Health Services Administration)
Background: Racial and ethnic minorities in the U.S. are more likely to be uninsured than non-Hispanic Whites. The Affordable Care Act (ACA) reduced these disparities; however, previous work has focused on broad racial-ethnic categories that inadequately address the heterogeneity existing within minority communities.
Goal: This study investigates the interplay between socio-demographic factors and ethnicity for six major Asian-American subgroups related to continued post-ACA disparities.
Objectives: 1. Describe the socio-demographic variations between Asian-American ethnic subgroups related to health insurance status. 2. Assess existing disparities in health insurance coverage within the Asian-American population after the implementation of the Affordable Care Act.
Approach: Using the American Community Survey, we examined relative changes in health insurance coverage rates for non-elderly non-Hispanic Whites compared to Chinese, Japanese, Filipino, Indian, Korean, and Vietnamese Americans between 2012-2016 (before and after major provisions of the ACA were implemented). We then used a regression framework to examine the contribution of demographics (e.g. age, family structure), socioeconomic status (e.g. education, income), and community characteristics (e.g. concentration of local ethnic populations) on coverage disparities in the post ACA period (2014-2016).
Results: We observed n=5,275,791 non-elderly individuals in our analytic sample. Overall, between 2012-2016, there was a substantial decline in the absolute percentage-point disparity in uninsurance for Chinese, Vietnamese, and Koreans. In 2014-2016, Vietnamese and Koreans still had 2.3-5.6 percentage-points higher uninsured rates (p<0.05) than non-Hispanic Whites. The disparities for Vietnamese, but not for Koreans, were explained by their socio-demographic characteristics. Further results are upcoming.
Importance to public health: Results suggest the ACA reduced uninsured rates for major Asian-American subgroups, yet Koreans continue to experience disparities in insurance status. This highlights the need to use disaggregated data for further investigations into the impact of health policies across diverse racial and ethnic groups.
Do, Kieu Anh (UMD)
Ross, Ana-Sophia (UMD)
Wang, Cixin (UMD)
Frese, Kristen (UMD)
Barlis, Julia (UMD)
Sullivan, Kate (UMD)
Background: Mental disorders are prevalent during adolescence; however, adolescents from immigrant families tend to underutilize mental health services in both the community setting and at school, which negatively impacts their development. Parents and teachers are important gatekeepers of mental health services for adolescents; however, few studies have examined their perspectives concerning mental health.
Goal: The current study explored teachers’ and immigrant parents’ perception and identification of contributing factors of mental illnesses.
Objectives: The objective of the current study was to identify the contributing factors of eating disorders, depression, and anxiety as described by teachers and immigrant parents.
Approach: In-depth interviews were conducted with 34 secondary-school teachers/ staff (70% White) and 23 Latino and Asian immigrant parents (91.3% mothers, mean age = 43.8 years, SD = 6.3).
Results: Both teachers and parents described various contributing factors ranging from the micro- to the macro-system. For example, they discussed parental pressure, adolescents’ identity struggles, media influence, as well as beliefs and values relating to femininity and masculinity, and ethnic/ cultural expectations. Parents discussed additional factors, such as genetic and immigration experiences contributing to mental disorders, specifically discordant family relationships between parents and their adolescents. Findings showed that teachers and parents have a general understanding of the contributing factors of three common mental disorders, however, parents also reported many barriers preventing teens from seeking help such as lack of communication between parents and adolescents.
Importance to public health: The findings from this study could inform the development of effective public health education and promotion, particularly with immigrant families. Specifically, more work is needed to increase communication and collaboration between teachers and parents to monitor and to address adolescent mental health needs.
Ekwunife, Odera (UMB SOP Pharmaceutical Health Services Research)
Onukwugha, Eberechukwu (UMB SOP Pharmaceutical Health Services Research)
Botwe, Theophilus (UMD Upper Chesapeake Medical Center)
Background: Continuity of care post-discharge allows for a seamless transition between the inpatient care that was received and any post-discharge care such as filling prescriptions and visiting a primary care physician. The literature to date on continuity of care has not focused on foreign-born populations who can be at risk of poor transitions following an inpatient stay. There is limited information regarding the factors that represent barriers to a successful transition from hospital to home.
Goal: The objective of this pilot project is to explore perspectives on the barriers to adequate post-discharge transitional care among foreign-born patients and identify ways to improve the quality of the transition from hospital to home.
Objectives: 1. To explore perspectives on the barriers to adequate post-discharge transitional care among foreign-born patients 2. To identify ways to improve the quality of transitions of care from hospital to home
Approach: We recruited physicians who provided care in a suburban hospital that serves a significant foreign-born population. We conducted in-depth key informant interviews (KIIs) with providers who self-identified as knowledgeable about inpatient and post-discharge care for foreign-born individuals. We explored barriers to adequate post-discharge, identified reasons for hospital readmission, and asked about approaches to improve the quality of the transition from hospital to home among FB patients. We conducted a preliminary coding of the interview data and report results to date.
Results: The KIIs included 4 physicians. The distribution according to specialty: 2 hospitalists, 1 family medicine physician, 1 emergency room physician. The distribution according to gender: 1 woman and 3 men. Three of the physicians were African immigrants. The following factors were common across the interviews: language barriers, limited transportation, lack of trust, poor mental health, and unreliable community support leading to inadequate post-discharge care and hospital readmissions. The health care providers identified the following options for improving the transition from hospital to home: increase access to community health programs, provide education at discharge in a foreign language, provide access to health care providers from similar ethnic groups, and familial support interventions.
Importance to public health: Health care providers with specific foreign-born patient populations equipped with an understanding of the factors presented in this project will undoubtedly be in a better position to provide quality healthcare and advance our community's public health. The findings from this study ultimately identify areas for further exploration in qualitative and quantitative inclusive public health research for patients and healthcare providers.
Kittner, Steven (UMB SOM Neurology)
Background: Although the incidence of ischemic stroke in individuals under age 50 has increased in recent years, risk factors affecting this population remain poorly understood. Poverty has been identified as an independent risk factor for stroke, but the extent to which poverty impacts risk for younger adults is not known.
Goal: This project aimed to evaluate the role of age, race, and poverty in determining the risk for young-onset ischemic stroke.
Objectives: 1. To determine whether age modifies the risk for ischemic stroke associated with poverty 2. To determine whether this age-poverty-stroke relationship differs according to race.
Approach: The data source for this project is the Stroke Prevention in Young Adults Study, a case control study that enrolled patients (n=1200) aged 15-49 with first-ever ischemic stroke, along with age-matched controls (n=1154). First, the odds ratio for stroke associated with poverty was estimated in unadjusted and adjusted models, and then in age- and race-based strata. A logistic regression model including other known risk factors was then applied separately to white and black populations.
Results: Poverty was a significant risk factor for ischemic stroke (OR 2.16, p<.0001) even after adjustment for other risk factors (OR 1.72, p = .001). Among black participants under 40, the odds ratio associated with poverty was 4.43 (95% CI 2.38-8.23), where in those over 40, the odds ratio was only 1.29 (0.78-2.11). In comparison, odds ratios for white participants under and over 40 were 2.85 and 2.80, respectively. In the regression analysis, an interaction term between age and poverty was statistically significant in the black population (p=0.0067), but not in the white population (p=0.36).
Importance to public health: These findings demonstrate that younger black individuals living in poverty are at a uniquely high risk for stroke, suggesting that the underlying mechanisms linking poverty and ischemic stroke are more complex than a simple accumulation of social and biological stresses across the lifecourse. These results indicate a role for public health interventions targeting the development of resiliency to cope with stressors like poverty in high-risk communities in order to decrease the risk of stroke.
Huang, Shuo (Jim) (UMD SPH Health Services Administration)
Background: In the 1930's, Home Owners Loan Corporations (HOLC) categorized neighborhoods by investment risk, a process known as redlining. These maps were often racially discriminatory, especially against black people. Aaronson et al (2017) found associations of categories and current impacts on racial segregation. Analysis of current health impacts have not used these maps before.
Goal: To determine if historical redlining is associated with health impacts today.
Objectives: Hypothesis 0. There is no association between neighborhood categorization by the HOLC and current health outcomes in Baltimore. Hypothesis 1. Neighborhoods categorized by HOLC as red or yellow in 1937 have lower life expectancy than neighborhoods categorized as green or blue in 2013 in Baltimore.
Approach: HOLC map from 1937 for the Baltimore area and neighborhood health and vital statistics maps from 2013 for 54 Baltimore neighborhoods were superimposed using QGIS 2.18.13. An intersection was taken, and the 54 neighborhoods were assigned red, yellow, green, and blue HOLC categories by predominance. Categories were dichotimized as red/yellow vs. blue/green. Neighborhood life expectancy (LE) was regressed against dichotimized categories, while controlling for TANF and % African American using Stata/IC 15.0 for Mac.
Results: 33 neighborhoods were categorized as red/yellow, 21 as green/blue. Red/yellow categorized neighborhoods are associated with a 4.91 year reduction in life expectancy (95% CI: 2.94, 6.88) compared with green/blue categorized neighborhoods while controlling for TANF uptake and proportion of African American residents.
Importance to public health: Results support the hypothesis that historical redlining impacts health today nearly a century later. It lends weight to proposed policy fixes to health disparities that are reparative and structural in nature.
Hurtado Choque, Ghaffar (School of Public Health - Family Science)
Ezel, Patsy (University of Maryland Extension)
Brown, Virginia (University of Maryland Extension)
Morris, Jamie (University of Maryland Extension)
Background: The University of Maryland Extension is working along with 14 Universities nationwide, Robert Wood Johnson Foundation, and 4-H National Foundation in the initiative titled: 'Well-Connected Communities', towards building a culture of health in our nation.
Goal: To demonstrate a participative process of addressing a health issue through health coalitions in urban and rural Maryland.
Objectives: In Maryland, we are implementing the Well-Connected Communities initiative, with national and local collaborators, in 3 communities (all are at different stages of implementation): 1. Innovator community – Garret County, 2. Implementer community – Cecil County & 3. Planner community – Baltimore City (Highland town area). In the next year and a half, we will be developing/strengthening existing health coalitions to address a relevant health issue and engage youth and adult volunteers as key components of the process.
Approach: The 'Well-Connected Communities' is a national initiative implemented by 15 National Universities. Each University is collaborating with local partners to identify and address a relevant health issue in a participative way. In Maryland, we are focusing on learning about the collaborative process and the factors associated quality collaboration. In addition, we are using a project-specific dashboard developed by RWJF connected to the county health rankings.
Results: At this point, we do not have results to share. This presentation will focus on the unique approach to address community health issues in a participative way (through coalitions) and youth-&-adult volunteers.
Importance to public health: This project is relevant to Public Health because it addresses a health priority (based on the county health rankings) in urban and rural Maryland. This project uses a collaborative (participatory action research) process in the design and implementation.
Wilson, Sacoby (UMD SPH Applied Environmental Health)
Ravichandran, Vivek (UMD SPH)
Merlo, Leyla (UMD SPH)
Background: Emissions from industrial traffic and commuter traffic can impact air quality. Individuals who live near or go to school near heavily trafficked roadways can be exposed to traffic-related air pollution (TRAP) including particulate matter which can lead to negative health effects such as asthma, stroke, and heart disease. Langley Park, a predominately low-income Hispanic community within the Capital Beltway, has a network of heavily trafficked roadways. This could lead to disparities in exposure to air pollution for individuals who live in the area.
Goal: Given that PM2.5 is often perceived as the best indicator of combustion-related health impacts, we aim to address gaps in knowledge about pollution levels in neighborhoods near heavily trafficked areas in Langley Park.
Objectives: We had several research objectives including: 1) Explore the use of real-time sensors to measure particulate matter and noise levels in a community with heavily trafficked roadways; 2) Assess traffic related disparities through the use of US EPA’s EJSCREEN; and 3) Examine differences in particulate matter and noise levels during rush hour and non-rush hour time periods.
Approach: We used the Airbeam and the Aircasting system to perform real-time measurements of PM2.5 (µg/m3), temperature (℉), humidity (%), and sound levels (db) during July 2017. These values were recorded at 5-min intervals for a total of 30 minutes during the morning rush, afternoon off-peak, and evening rush time periods, respectively. Traffic counts were conducted in a similar manner to identify areas with a dense number of vehicles as a proxy for high exposure. We also used the USEPA’s EJSCREEN tool to map traffic-related hazards in the community and assess any traffic-related disparities compared to the rest of the state, region, and the US.
Results: The data revealed mean values ranging from 0.125 to 46 µg/m3 of particulate matter. Some mean values were above the daily standard of 35 µg/m3. Levels were the highest at commercial areas including the Takoma/Langley Crossroads Transit Center and University Blvd.
Importance to public health: This research provides a foundation to further explore the link between exposure to TRAP and health disparities in Langley Park, Maryland.
Rudy, Jonathan (UMD SPH Health Services Administration)
Hager, Erin (UMB SOM Pediatrics)
Saksvig, Brit (UMD SPH Epidemiology and Biostatistics)
Background: Modes of Active Transportation (AT, including walking and biking) are often under-utilized and could further integrate physical activity into regular life. For some school-aged children, AT is used in commuting to and from school. For children who live close enough to school to consider AT, school-level barriers may exist, including absence of crossing guards, designated safe routes to school, and safe bike storage facilities, or lack of provision of safe walking and biking education.
Goal: Understand disparities in school-level AT practices among Maryland schools
Objectives: Assess disparities in school-level AT practices by student body race/ethnicity (predominantly African American or Hispanic student body), income (% eligible for free/reduced price meals (FARMS), proxy for low-income] and by the school’s geographic location (urban, suburban, rural).
Approach: Data from the Maryland Wellness Policies and Practices Project (MWPPP) for the 2016-17 school year in conjunction with school demographic data obtained from public sources was used for the analysis. Knowledgeable administrators from each of the Maryland schools completed the survey. Four questions concerning AT practices were included: (1) providing secure storage facilities for bicycles or helmets; (2) providing instruction on walking/bicycling safety; (3) designating safe or preferred routes to school; and (4) using crossing guards. An analysis was completed using bivariate chi-square tests and multi-level regression modeling.
Results: Among the XXXX schools that received the survey, 950 responded to the survey (response rate=XX%) and 908 completed the AT survey and had school demographic data. Schools were 67.0% elementary, 19.1% middle, and 14.0 high. Rural schools were less likely to endorse each of the AT practices (compared to suburban and urban schools; ps<0.05). Schools with a predominantly African American/Hispanic student body were less likely to have storage facilities (2=26.9, p<0.001). Low income schools were less likely to have storage facilities and more likely to have crossing guards (2=12.9, p<0.005 and 2=19.5, p<0.001, respectively).
Importance to public health: By understanding the barriers to AT that schools face in Maryland, schools can more effectively implement programs to increase childhood physical activity and reduce childhood obesity.
XU, YIXI (UMD SPH Epidemiology and Biostatistics)
Carter-Pokras, Olivia (UMD SPH Epidemiology and Biostatistics)
Background: Human Papillomavirus (HPV) vaccine has been shown to prevent cervical cancer. While factors associated with initiation of HPV vaccine haven been well characterized, little is known about factors associated with completion of HPV vaccine.
Goal: This study aims to examine factors associated with completion of the HPV vaccine series among Hispanic/Latino and non-Hispanic/Latino White teen girls who initiated HPV series.
Objectives: We hypothesized that Hispanics girls ages 13 to 17 would have higher rates of risk factors (poverty status, mother’s education level, access to healthcare services et.al.) associated with completion of HPV series when compared with non-Hispanic Whites.
Approach: We performed a secondary data analysis on 1,043 Hispanic/Latino and 3,426 non-Hispanic/Latino White girls aged 13 to 17 years who initiated the series from the 2016 National Immunization Survey-Teen. We used weighted logistic regression models to examine the independent effects of race/ethnicity on HPV vaccine series completion and performed chi-square tests to look for significant results.
Results: While 74.60% of the non-Hispanic/Latino White girls who initiated the HPV vaccine series in this sample completed the series, 69.15% of Hispanic/Latino girls who had initiated the series achieved completion (p=.11). There were significant socio-demographic differences between there two groups of girls. Compared to non-Hispanic/Latino White girls, Hispanic/Latino girls were less likely to have seen a doctor visit in the previous year, more likely to be raised by a single mother, or mother with lower educational level, live in households with 4 or more children, live in poverty, live in rental homes, and be younger at the time of initiation of the HPV vaccine series.
Importance to public health: As HPV vaccination rates in the United States remain below the Healthy People 2020 goal, messages may need to be targeted based on maternal education, age appropriate series initiation and provider recommendation.