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Wilson CC, Therrien NL, MacLeod KE, Soloe C, Johnson M, Rivera MD, Jordan J, Shantharam S, Minaya-Junca J, Fulmer EB, Choe HM. Enhancing Availability of Services to Control Hypertension Through a Team-based Care Approach That Includes Pharmacists. J Am Pharm Assoc (2003) 2024:102055. [PMID: 38401838 DOI: 10.1016/j.japh.2024.102055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Primary care physician (PCP) shortages are expected to increase. The Michigan Medicine Hypertension Pharmacists' Program uses a team-based care (TBC) approach to redistribute some patient care responsibilities from PCPs to pharmacists for patients with diagnosed hypertension. OBJECTIVES This evaluation analyzed whether the Michigan Medicine Hypertension Pharmacists' Program increased the availability of hypertension management services and described facilitators that addressed barriers to program sustainability and replicability. METHODS We conducted a retrospective observational study that used a mixed methods approach. We examined the availability of hypertension management services using the number of pharmacists' referrals of patients to other services and the number of PCP appointments. We analyzed qualitative interviews with program staff and site-level quantitative data to examine the program's impact on the availability of services, the impact of TBC that engage pharmacists, and program barriers and facilitators. RESULTS Patients who visited a pharmacist had fewer PCP visits over 3- and 6-month periods compared to a matched comparison group that did not see a pharmacist and were 1.35 times more likely to receive a referral to a specialist within a 3-month period. Support from leaders and physicians, shared electronic health record access, and financial backing emerged as leading factors for program sustainability and replicability. CONCLUSION Adding pharmacists to the care team reduced the number of PCP appointments per patient while increasing the availability of hypertension management services; this may in turn improve PCPs' availability. Similar models may be sustainable and replicable by relying on organizational buy-in, accessible infrastructure, and financing.
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Affiliation(s)
| | | | - Kara E MacLeod
- Centers for Disease Control and Prevention, Atlanta, GA; ASRT, Inc., Smyrna, GA
| | - Cindy Soloe
- RTI International, Research Triangle Park, NC
| | | | - Mark D Rivera
- Centers for Disease Control and Prevention, Atlanta, GA
| | - Julia Jordan
- Centers for Disease Control and Prevention, Atlanta, GA
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Abstract
Introduction Tracking social needs can provide information on barriers to controlling hypertension and the need for wraparound services. No recent studies have examined ICD-10-CM social determinants of health-related Z codes (Z55-Z65) to indicate social needs with a focus on patients with hypertension. Methods Three cohorts were identified with a diagnosis of hypertension during 2016-2017 and continuously enrolled in fee-for-service insurance through June 2021: (1) commercial, age 18-64 years (n=1,024,012); (2) private insurance to supplement Medicare (Medicare Supplement), age ≥65 years (n=296,340); and (3) Medicaid, age ≥18 years (n=146,484). Both the proportion of patients and healthcare encounters or visits with social determinants of health-related Z code were summarized annually. Patient and visit characteristics were summarized for 2019. Results In 2020, the highest annual documentation of social determinants of health-related Z codes was among Medicaid beneficiaries (3.02%, 0.46% commercial, 0.42% Medicare Supplement); documentation was higher among inpatient than among outpatient visits for all insurance types. Z63 (related to primary support group) was more common among commercial and Medicare Supplement beneficiaries, and Z59 (housing and economic circumstances) was more common among Medicaid beneficiaries. The 2019 total unadjusted medical expenditures were 1.85, 1.78, and 1.61 times higher for those with social determinants of health-related Z code than for those without commercial, Medicare Supplement, and Medicaid, respectively. Patients with social determinants of health-related Z code also had higher proportions of diagnosed chronic conditions. Among Medicaid beneficiaries, differences in the presence of social determinants of health-related Z code by race or ethnicity were observed. Conclusions Although currently underreported, social determinants of health-related Z codes provide an opportunity to integrate social and medical data and may help decision makers understand the need for additional services among individuals with hypertension.
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Affiliation(s)
- Jun Soo Lee
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kara E. MacLeod
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
- ASRT, Inc., Atlanta, Georgia
| | - Elena V. Kuklina
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Xin Tong
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sandra L. Jackson
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
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MacLeod KE, Cole BL, Musselwhite C. Commuting to work post-pandemic: Opportunities for health? J Transp Health 2022; 25:101381. [PMID: 35540370 PMCID: PMC9074865 DOI: 10.1016/j.jth.2022.101381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Affiliation(s)
| | - Brian L Cole
- Department of Environmental Health Sciences, University of California, Los Angeles, USA
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Abstract
A literature review of peer-reviewed articles published 2000-2019 was conducted to determine the types and extent of hypertension-associated productivity loss among adults in the United States. All monetary outcomes were standardized to 2019 $ by using the Employment Cost Index. Twenty-seven articles met the inclusion criteria. Nearly half of the articles (12 articles) presented monetary outcomes of productivity loss. Absenteeism (14 articles) and presenteeism (8 articles) were most frequently assessed. Annual absenteeism was estimated to cost more than $11 billion, nationally controlling for sociodemographic characteristics. The annual additional costs per person were estimated at $63 for short-term disability, $72-$330 for absenteeism, and $53-$156 for presenteeism, controlling for participant characteristics; and may be as high as $2362 for absenteeism and presenteeism when considered in combination. The annual additional time loss per person was estimated as 1.3 days for absenteeism, controlling for common hypertension comorbidities, including stroke and diabetes; and 15.6 days for work and home productivity loss combined, controlling for sociodemographic characteristics. The loss from absenteeism alone might be more than 20% of the total medical expenditure of hypertension. Although the differences in estimation methods and study populations make it challenging to synthesize the costs across the studies, this review provides detailed information on the various types of productivity loss. In addition, the ways in which methods could be standardized for future research are discussed. Accounting for the costs from productivity loss can help public health officials, health insurers, employers, and researchers better understand the economic burden of hypertension.
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Affiliation(s)
- Kara E. MacLeod
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia, USA
- ASRT, Inc., Atlanta, Georgia, USA
| | - Zhiqiu Ye
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia, USA
| | - Bruce Donald
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia, USA
- ASRT, Inc., Atlanta, Georgia, USA
| | - Guijing Wang
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia, USA
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MacLeod KE, Chapel JM, McCurdy M, Minaya-Junca J, Wirth D, Onwuanyi A, Lane RI. The implementation cost of a safety-net hospital program addressing social needs in Atlanta. Health Serv Res 2021; 56:474-485. [PMID: 33580501 DOI: 10.1111/1475-6773.13629] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To describe the cost of integrating social needs activities into a health care program that works toward health equity by addressing socioeconomic barriers. DATA SOURCES/STUDY SETTING Costs for a heart failure health care program based in a safety-net hospital were reported by program staff for the program year May 2018-April 2019. Additional data sources included hospital records, invoices, and staff survey. STUDY DESIGN We conducted a retrospective, cross-sectional, case study of a program that includes health education, outpatient care, financial counseling and free medication; transportation and home services for those most in need; and connections to other social services. Program costs were summarized overall and for mutually exclusive categories: health care program (fixed and variable) and social needs activities. DATA COLLECTION Program cost data were collected using a activity-based, micro-costing approach. In addition, we conducted a survey that was completed by key staff to understand time allocation. PRINCIPAL FINDINGS Program costs were approximately $1.33 million, and the annual per patient cost was $1455. Thirty percent of the program costs was for social needs activities: 18% for 30-day supply of medications and addressing socioeconomic barriers to medication adherence, 18% for mobile health services (outpatient home visits), 53% for navigating services through a financial counselor and community health worker, and 12% for transportation to visits and addressing transportation barriers. Most of the program costs were for personnel: 92% of the health care program fixed, 95% of the health care program variable, and 78% of social needs activities. DISCUSSION Historically, social and health care services are funded by different systems and have not been integrated. We estimate the cost of implementing social needs activities into a health care program. This work can inform implementation for hospitals attempting to address social determinants of health and social needs in their patient population.
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Affiliation(s)
- Kara E MacLeod
- ASRT, Inc., Atlanta, Georgia, USA.,Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - John M Chapel
- Department of Economics, University of Southern California, Los Angeles, California, USA
| | - Matthew McCurdy
- Office of the Assistant Secretary for Planning and Evaluation, Washington, District of Columbia, USA
| | - Jasmin Minaya-Junca
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Diane Wirth
- Grady Memorial Hospital, Atlanta, Georgia, USA
| | - Anekwe Onwuanyi
- Grady Memorial Hospital, Atlanta, Georgia, USA.,Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Rashon I Lane
- Division for Heart Disease and Stroke Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Rajbhandari-Thapa J, Zhang D, MacLeod KE, Thapa K. Impact of Medicaid Expansion on Insurance Coverage Rates Among Adult Populations with Low Income and by Obesity Status. Obesity (Silver Spring) 2020; 28:1219-1223. [PMID: 32304356 PMCID: PMC8627371 DOI: 10.1002/oby.22793] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/25/2020] [Accepted: 02/28/2020] [Indexed: 11/10/2022]
Abstract
OBJECTIVE This study examines insurance coverage rates among working-age adults with low income and with or without obesity before and after Medicaid expansion under the Affordable Care Act. METHODS Individual-level data on noninstitutionalized and nonpregnant adult participants aged 18 to 64 years with household income below $15,000 from the Centers for Disease Control and Prevention 2006-2017 Behavioral Risk Factor Surveillance System were used. A difference-in-differences design with logistic regression was used to examine the likelihood of insurance coverage before and after Medicaid expansion. RESULTS Working-age adults (analytic sample N = 316,151) who were white, female, less educated, unemployed, and living in a Medicaid-expansion state were more likely to have insurance coverage. The insurance coverage rate in Medicaid-expanded states in years after expansion increased for both subgroups with and without obesity. However, the increase was slightly lower for the subpopulation with obesity (5.59%, 95% CI: 2.35%-8.83%) compared with the subpopulation without obesity (7.35%, 95% CI: 5.35%-9.34%). CONCLUSIONS Increased attention should be paid to reduce insurance coverage barriers for working-age adults with low income and obesity to address potential health disparities caused by lack of access to care. This is important, as access to care provides opportunities to increase prevention and treatment-oriented services to address obesity and associated health care costs.
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Affiliation(s)
- Janani Rajbhandari-Thapa
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia, USA
| | - Donglan Zhang
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia, USA
| | - Kara E. MacLeod
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, California, USA
| | - Kiran Thapa
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia, USA
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MacLeod KE, Thorhauge M, Villalobos V, van Meijgaard J, Karriker-Jaffe KJ, Kelley-Baker T, Ragland DR. To drive or not to drive? A study of travel behavior for a recent drinking occasion. Travel Behav Soc 2020; 20:74-82. [PMID: 34703766 PMCID: PMC8545274 DOI: 10.1016/j.tbs.2020.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Despite decades of education and enforcement campaigns, alcohol-impaired driving persists as a social problem in the U.S. Are there other factors influencing decisions to drive after alcohol consumption that may be amenable to change? We conducted a roadside survey in California in 2012 to assess whether residential accessibility, travel attitudes (indicated by ratings of convenience and safety for travel options), and perceptions of arrest risk affect travel choices made subsequent to alcohol consumption. We conducted hybrid choice modeling for 580 participants. Mode-specific travel attitudes were valid constructs and predictive of travel behavior. Perceived level of service (speed) increased the utility for taxi and getting a ride. Perceiving high risk of arrest affected mode choice through travel attitudes. Not everyone assessed their mode options in the same way. For example, frequent binge drinkers appear to be more willing to consider taxis, men had stronger preferences towards active modes, and younger drivers were less pro-driving in this context. Past drinking and driving behavior affected one's attitude towards driving, while the number of drinks was related to mode choice. While our accessibility measure was not significantly related to attitudes or choice, decreasing urbanicity corresponded with stronger preferences for driving. This pilot study suggests that improving level of service (speed), convenience, and overall safety are considerations for public health in terms of promoting alternatives to drinking and driving. This line of research also has implications for emerging options, such as ride hailing, and how these might be optimized for specific segments of the population.
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Affiliation(s)
- Kara E MacLeod
- Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA 90095
| | - Mikkel Thorhauge
- Technical University of Denmark, Transport Modeling, Department of Management Engineering, DK-2800 Kgs. Lyngby
| | - Victor Villalobos
- School of Public Health, University of California, Berkeley, Berkeley, CA 94720
- Mexican Center for Disease Prevention and Control, Mexico
| | - Jeroen van Meijgaard
- Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA 90095
| | | | | | - David R Ragland
- School of Public Health, University of California, Berkeley, Berkeley, CA 94720
- Safe Transportation Research & Education Center, University of California, Berkeley, Berkeley, CA 94720-7374
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8
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Cole BL, MacLeod KE, Spriggs R. Health Impact Assessment of Transportation Projects and Policies: Living Up to Aims of Advancing Population Health and Health Equity? Annu Rev Public Health 2019; 40:305-318. [DOI: 10.1146/annurev-publhealth-040617-013836] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Health impact assessment (HIA) is a forward-looking, evidence-based tool used to inform stakeholders and policy makers about the potential health effects of proposed projects and policies and to identify options for maximizing potential health benefits and minimizing potential harm. This review examines how health equity, a core principle of health impact assessment (HIA), has been operationalized in HIAs conducted in the United States in one sector, transportation. Two perspectives on promoting health equity appear in the broader public health research literature; one aims at reducing disparities in health determinants and outcomes in affected populations, whereas the other focuses on facilitating community participation and self-determination. Variations in how these perspectives are applied in HIA informed our typology of five ways of addressing health equity in HIA. Transportation HIAs commonly included two of these—selecting vulnerable populations for the focus of the HIA and stakeholder engagement, seen in more than 70% of the 96 HIAs reviewed. Fewer than half of the HIAs assessed current health disparities or changes in their distribution. Only 15% of HIAs addressed equity by focusing on capabilities development or empowerment. Routinely assessing and reporting how an HIA aims to address health equity might better manage expectations and could make HIA practitioners and users more conscious of how an HIA can realistically be used to advance health equity.
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Affiliation(s)
- Brian L. Cole
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California, Los Angeles, California 90095-1772, USA
- Center for Health Advancement, Fielding School of Public Health, University of California, Los Angeles, California 90095-1772, USA
| | - Kara E. MacLeod
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, California 90095-1772, USA
| | - Raenita Spriggs
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California, Los Angeles, California 90095-1772, USA
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9
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Ortega Hinojosa AM, MacLeod KE, Balmes J, Jerrett M. Influence of school environments on childhood obesity in California. Environ Res 2018; 166:100-107. [PMID: 29883903 DOI: 10.1016/j.envres.2018.04.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 04/19/2018] [Accepted: 04/19/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To conduct a state-wide examination of public schools and the school neighborhood as potential targets for environmental public health tracking to address childhood obesity. METHODS We examined the relationship of social and physical environmental attributes of the school environment (within school and neighborhood) and childhood obesity in California with machine learning (Random Forest) and multilevel methods. We used data compiled from the California Department of Education, the U.S. Geological Survey, ESRI's Business Analyst, the U.S. Census, and other public sources for ecologic level variables for various years and assessed their relative importance to obesity as determined from the statewide Physical Fitness Test 2003 through 2007 for grades 5, 7, and 9 (n = 5,265,265). RESULTS In addition to individual-level race and gender, the following within and school neighborhood variables ranked as the most important model contributors based on the Random Forest analysis and were included in multilevel regressions clustered on the county. Violent crime, English learners, socioeconomic disadvantage, fewer physical education (PE) and fully credentialed teachers, and diversity index were positively associated with obesity while academic performance index, PE participation, mean educational attainment and per capita income were negatively associated with obesity. The most highly ranked built or physical environment variables were distance to the nearest highway and greenness, which were 10th and 11th most important, respectively. CONCLUSIONS Many states in the U.S. do not have school-based surveillance programs that collect body mass index data. System-level determinants of obesity can be important for tracking and intervention. The results of these analyses suggest that the school social environment factors may be especially important. Disadvantaged and low academic performing schools have a higher risk for obesity. Supporting such schools in a targeted way may be an efficient way to intervene and could impact both health and academic outcomes. Some of the more important variables, such as having credentialed teachers and participating in PE, are modifiable risk factors.
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Affiliation(s)
- Alberto M Ortega Hinojosa
- School of Public Health, University of California, Berkeley, Berkeley, CA 94720, United States; IMPAQ International, LLC, Oakland, CA 94612, United States
| | - Kara E MacLeod
- Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA 90095, United States
| | - John Balmes
- School of Public Health, University of California, Berkeley, Berkeley, CA 94720, United States
| | - Michael Jerrett
- School of Public Health, University of California, Berkeley, Berkeley, CA 94720, United States; Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA 90095, United States.
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Schoner J, Chapman J, Fox EH, Iroz-Elardo N, Brookes A, MacLeod KE, Frank LD. Bringing health into transportation and land use scenario planning: Creating a National Public Health Assessment Model (N-PHAM). J Transp Health 2018; 10:401-418. [PMID: 35350107 PMCID: PMC8958996 DOI: 10.1016/j.jth.2018.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
There is mounting evidence linking land development and transportation investments to physical activity with resulting implications for chronic disease prevention. Links between the physical environment and health have traditionally focused on harmful exposures such as air pollution, noise, and traffic injury. Given limited funds and competition for how and where investments are made, there is a need to prioritize and target resources to maximize health benefits that can include activity related chronic disease prevention. The ability to apply this evidence to decision making has been limited by the complexity and inconsistency of research methods, and lack of a direct connection with the planning contexts in which decisions are made. Scenario planning tools provide a method to apply evidence with spatial planning decisions at a range of geographic scales. The US Environmental Protection Agency commissioned the development of a National Public Health Assessment Model (N-PHAM). This project utilized built and natural environment data at the block-group level and large population surveys to model the relationships of the environment with several health outcomes for a range of age and income groups. N-PHAM is the first health assessment tool that can connect to multiple existing scenario planning platforms utilizing nationally available data and can be consistently applied nationally. Such tools can empower communities to choose investments that have the greatest potential to improve public health and quality of life, reduce health care costs, and address environmental justice related disparities.
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Affiliation(s)
- Jessica Schoner
- Urban Design 4 Health Inc., 353 Rockingham St., Rochester, NY 14620, USA
| | - Jim Chapman
- Urban Design 4 Health Inc., 353 Rockingham St., Rochester, NY 14620, USA
| | - Eric H Fox
- Urban Design 4 Health Inc., 353 Rockingham St., Rochester, NY 14620, USA
| | - Nicole Iroz-Elardo
- Urban Design 4 Health Inc., 353 Rockingham St., Rochester, NY 14620, USA
| | - Allen Brookes
- US Environmental Protection Agency, 200 S.W. 35th Street, Corvallis, OR 97333-4902, USA
| | - Kara E MacLeod
- Fielding School of Public Health, University of California, Los Angeles, Life Sciences Building, Office 5127, Los Angeles, CA 90095, USA
| | - Lawrence D Frank
- University of British Columbia Schools of Population & Public Health & Community & Regional Planning, 2206 East Mall, Vancouver, BC, Canada V6T 1Z3
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Wang MC, Crespi CM, Jiang LH, Nobari T, Roper-Fingerhut H, Rauzon S, Robles B, Blocklin M, Davoudi M, Kuo T, MacLeod KE, Seto E, Whaley S, Prelip M. Developing an index of dose of exposure to early childhood obesity community interventions. Prev Med 2018; 111:135-141. [PMID: 29501476 PMCID: PMC5930075 DOI: 10.1016/j.ypmed.2018.02.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 01/19/2018] [Accepted: 02/26/2018] [Indexed: 10/17/2022]
Abstract
The recognition of the role of the environment in contributing to the obesity epidemic has led to increasing efforts to address obesity through environmental or place-based approaches in the past decade. This has challenged the use of the quasi-experimental design for evaluating community interventions. The objective of this study is to describe the development of an index of dose of exposure to community interventions that impact early childhood obesity. The goal is to provide an alternative means for evaluating the impact of multiple intervention strategies that target the same community at the same time. Two workgroups developed domains, constructs and protocols for estimating a "community intervention dose index" (CIDI). Information used to develop the protocol came from multiple sources including databases and reports of major funding organizations on obesity-related interventions implemented in Los Angeles County from 2005 to 2015, key informant interviews, and published literature. The workgroups identified five domains relevant to the consideration of dose of exposure to interventions: physical resources, social resources, context, capacity development, and programs and policies; developed a system for classifying programs and policies into macro- and micro-level intervention strategies; and sought ratings of strategy effectiveness from a panel of 13 experts using the Delphi technique, to develop an algorithm for calculating CIDI that considers intervention strength, reach and fidelity. This CIDI can be estimated for each community and used to evaluate the impact of multiple programs that use a myriad of intervention strategies for addressing a defined health outcome.
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Affiliation(s)
- May C Wang
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States.
| | - Catherine M Crespi
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
| | - Linghui H Jiang
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
| | - Tabashir Nobari
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
| | | | - Suzanne Rauzon
- Nutrition Policy Institute, University of California, Berkeley, CA, United States
| | - Brenda Robles
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, CA, United States
| | | | - Mehrnaz Davoudi
- Kaiser Permanente Southern California Community Benefit, Pasadena, CA, United States
| | - Tony Kuo
- Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health, Los Angeles, CA, United States
| | - Kara E MacLeod
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
| | - Edmund Seto
- Department of Environmental and Occupational Health Sciences, University of Washington School of Public Health, Seattle, WA, United States
| | - Shannon Whaley
- Public Health Foundation Enterprises-Special Supplemental Nutrition Program for Women, Infants and Children (PHFE-WIC), Irwindale, CA, United States
| | - Michael Prelip
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
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12
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MacLeod KE, Sanders RL, Griffin A, Cooper JF, Ragland DR. Latent analysis of Complete Streets and traffic safety along an urban corridor. J Transp Health 2018; 8:15-29. [PMID: 36578816 PMCID: PMC9794175 DOI: 10.1016/j.jth.2017.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
BACKGROUND To evaluate Complete Street implementations that covary, the present paper aims to: 1) explore the development of typologies of intersections; and 2) examine how these typologies relate to traffic safety. METHODS The study site is a five-mile segment in Los Angeles County, California. Multiple indicators of environmental features were collected in 2012 and were included in a latent analysis. Latent classes were then analyzed as a predictor of the number of pedestrian injuries/fatalities and injuries/fatalities for all modes in separate models using negative binomial regression and controlling for exposures. Injuries/fatalities represent the most recent 3 years of crash data available surrounding the environmental data collection (2009-2014). We also examined the role of alcohol. RESULTS For a relatively short segment of an urban corridor, we identified two distinct classes of intersections. One class was more complete with respect to pedestrian features but was also associated with indicators of increased potential conflict and was predictive of higher overall injuries/fatalities for all modes. This class also had higher pedestrian volumes but was not predictive of higher pedestrian injuries/fatalities in the final models. The alcohol involvement in crash injuries at these locations did not differ by intersection class but was positively associated with injuries/fatalities for all modes and with severe/fatal injuries for pedestrians in the final models. CONCLUSIONS Identifying typologies can be used to understand the combination of features and prioritize locations for treatment. While Complete Streets may help counter pedestrian injury trends, the efforts captured in this data are insufficient for municipalities aiming for Vision Zero. Ideally, future research can examine these intersections after the implementation of additional improvements in order to isolate treatment effects. These findings suggest additional intersection countermeasures are needed, in addition to efforts to address social problems such as alcohol use and traffic safety.
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MacLeod KE, Karriker-Jaffe KJ, Satariano WA, Kelley-Baker T, Lacey JH, Ragland DR. Drinking and driving and perceptions of arrest risk among California drivers: Relationships with DUI arrests in their city of residence. Traffic Inj Prev 2017; 18:566-572. [PMID: 28107033 PMCID: PMC5580395 DOI: 10.1080/15389588.2017.1285022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 01/16/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE Addressing drinking and driving remains a challenge in the United States. The present study aims to provide feedback on driving under the influence (DUI) in California by assessing whether drinking and driving behavior is associated with the DUI arrest rates in the city in which the driver lives; whether this is due to perceptions that one can get arrested for this behavior; and whether this differed by those drivers who would be most affected by deterrence efforts (those most likely to drink outside the home). METHODS This study consisted of a 2012 roadside survey of 1,147 weekend nighttime drivers in California. City DUI arrest rates for 2009-2011 were used as an indicator of local enforcement efforts. Population average logistic modeling was conducted modeling the odds of perceived high arrest likelihood for DUI and drinking and driving behavior within the past year. RESULTS As the DUI arrest rates for the city in which the driver lives increased, perceived high risk of DUI arrest increased. There was no significant relationship between either city DUI arrest rates or perceived high risk of DUI arrest with self-reported drinking and driving behavior in the full sample. Among a much smaller sample of those most likely to drink outside the home, self-reported drinking and driving behavior was negatively associated with DUI arrests rates in their city of residence but this was not mediated by perceptions. CONCLUSION The results of the present study suggest that perceptions are correlated with one aspect of DUI efforts in one's community. Those who were more likely to drink outside the home could be behaviorally influenced by these efforts.
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Affiliation(s)
- Kara E MacLeod
- a University of California, Los Angeles , Fielding School of Public Health , Los Angeles , California
| | | | - William A Satariano
- c School of Public Health , University of California, Berkeley , Berkeley , California
| | | | - John H Lacey
- e Pacific Institute for Research and Evaluation , Calverton , Maryland
| | - David R Ragland
- f Safe Transportation Research & Education Center , University of California, Berkeley , Berkeley , California
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Smith ML, Prohaska TR, MacLeod KE, Ory MG, Eisenstein AR, Ragland DR, Irmiter C, Towne SD, Satariano WA. Non-Emergency Medical Transportation Needs of Middle-Aged and Older Adults: A Rural-Urban Comparison in Delaware, USA. Int J Environ Res Public Health 2017; 14:E174. [PMID: 28208610 PMCID: PMC5334728 DOI: 10.3390/ijerph14020174] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 01/17/2017] [Accepted: 01/25/2017] [Indexed: 12/16/2022]
Abstract
Background: Older adults in rural areas have unique transportation barriers to accessing medical care, which include a lack of mass transit options and considerable distances to health-related services. This study contrasts non-emergency medical transportation (NEMT) service utilization patterns and associated costs for Medicaid middle-aged and older adults in rural versus urban areas. Methods: Data were analyzed from 39,194 NEMT users of LogistiCare-brokered services in Delaware residing in rural (68.3%) and urban (30.9%) areas. Multivariable logistic analyses compared trip characteristics by rurality designation. Results: Rural (37.2%) and urban (41.2%) participants used services more frequently for dialysis than for any other medical concern. Older age and personal accompaniment were more common and wheel chair use was less common for rural trips. The mean cost per trip was greater for rural users (difference of $2910 per trip), which was attributed to the greater distance per trip in rural areas. Conclusions: Among a sample who were eligible for subsidized NEMT and who utilized this service, rural trips tended to be longer and, therefore, higher in cost. Over 50% of trips were made for dialysis highlighting the need to address prevention and, potentially, health service improvements for rural dialysis patients.
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Affiliation(s)
- Matthew Lee Smith
- College of Public Health, The University of Georgia, Athens, GA 30602, USA.
- Texas A&M School of Public Health, Texas A&M University, College Station, TX 77844, USA.
| | - Thomas R Prohaska
- College of Health and Human Services, George Mason University, Fairfax, VA 22030, USA.
| | - Kara E MacLeod
- Fielding School of Public Health, University of California, Los Angeles, CA 90095, USA.
| | - Marcia G Ory
- Texas A&M School of Public Health, Texas A&M University, College Station, TX 77844, USA.
| | - Amy R Eisenstein
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60209, USA.
| | - David R Ragland
- School of Public Health, University of California, Berkeley, CA 92521, USA.
- SafeTREC, University of California, Berkeley, CA 92521, USA.
| | | | - Samuel D Towne
- Texas A&M School of Public Health, Texas A&M University, College Station, TX 77844, USA.
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15
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Abstract
OBJECTIVE To assess whether poor geographic accessibility to prenatal care, as indicated by long distance trips to prenatal care, produced high blood pressure (HPB) during pregnancy. METHODS Using the 2007 Los Angeles Mommy and Baby Study for women without hypertension prior to pregnancy (n = 3405), we compared self-reported HBP by travel distance to prenatal care controlling for age, race/ethnicity, marital status, education, household income, weight status, and physical activity. RESULTS Results of the multilevel logistic regression shows traveling more than 50 mi to prenatal care is associated with an increased odds for having HPB during pregnancy (odds ratio [OR] = 2.867, 95% confidence interval [CI] = 1.079,7.613), as compared with a travel distance shorter than 5 mi. Traveling 5-14 mi (OR = 0.917, 95% CI = 0.715-1.176), 15-29 mi (OR = 0.955, 95% CI = 0.634-1.438), or 30-50 mi (OR = 1.101, 95% CI = 0.485-2.499) were not significantly associated with more risk of HBP during pregnancy. CONCLUSION To our knowledge, no previous studies have examined the association between poor geographic accessibility to care and the possible harms of travel burdens for pregnant women. Future research that replicates these findings can assist in developing recommendations for pregnant women and health-care accessibility.
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Affiliation(s)
- Lu Shi
- a Department of Public Health Sciences , Clemson University , Clemson , South Carolina , USA
| | - Kara E MacLeod
- b Department of Environmental Health Sciences , UCLA Fielding School of Public Health , Los Angeles , California , USA
| | - Donglan Zhang
- c Department of Health Policy and Management, College of Public Health , University of Georgia , Athens , Georgia , USA
| | - Fan Wang
- d Department of Obstetrics, The Second Affiliated Hospital , Wenzhou Medical University , Wenzhou , China
| | - Margaret Shin Chao
- e Department of Public Health Los Angeles County , Maternal, Child, and Adolescent Health Programs , Los Angeles , California , USA
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16
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Jerrett M, Su JG, MacLeod KE, Hanning C, Houston D, Wolch J. Safe Routes to Play? Pedestrian and Bicyclist Crashes Near Parks in Los Angeles. Environ Res 2016; 151:742-755. [PMID: 27689542 PMCID: PMC5512561 DOI: 10.1016/j.envres.2016.07.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 07/17/2016] [Accepted: 07/19/2016] [Indexed: 06/01/2023]
Abstract
BACKGROUND Areas near parks may present active travelers with higher risks than in other areas due to the confluence of more pedestrians and bicyclists, younger travelers, and the potential for increased traffic volumes. These risks may be amplified in low-income and minority neighborhoods due to generally higher rates of active travel or lack of safety infrastructure. This paper examines active travel crashes near parks and builds on existing research around disparities in park access and extends research from the Safe Routes to School and Safe Routes to Transit movements to parks. METHODS We utilized the Green Visions Parks coverage, encompassing Los Angeles County and several other cities in the LA Metropolitan area. We used negative bionomial regression modeling techniques and ten years of geolocated pedestrian and bicyclist crash data to assess the number of active travel injuries within a quarter mile (~400m) buffer around parks. We controlled for differential exposures to active travel using travel survey data and Bayesian smoothing models. RESULTS Of 1,311,736 parties involved in 608,530 crashes, there were 896,359 injuries and 7317 fatalities. The number of active travel crash injuries is higher within a quarter-mile of a park, with a ratio of 1.52 per 100,000 residents, compared to areas outside that buffer. This higher rate near parks is amplified in neighborhoods with high proportions of minority and low-income residents. Higher traffic levels are highly predictive of active travel crash injuries. CONCLUSIONS Planners should consider the higher risks of active travel near parks and the socioeconomic modification of these risks. Additional traffic calming and safety infrastructure may be needed to provide safe routes to parks.
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Affiliation(s)
- Michael Jerrett
- Department of Environmental Health Sciences, Fielding School of Public Health, University of California, Los Angeles 90095, USA; Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley 94720, USA.
| | - Jason G Su
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley 94720, USA
| | - Kara E MacLeod
- Center for Health Advancement, Fielding School of Public Health, University of California, Los Angeles 90095, USA
| | - Cooper Hanning
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley 94720, USA
| | - Douglas Houston
- Department of Planning, Policy, and Design, University of California, Irvine 92697, USA
| | - Jennifer Wolch
- College of Environmental Design, University of California, Berkeley 94720, USA
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Zhang X, Ra CK, Zhang D, Zhang Y, MacLeod KE. Impact of School Social Support and Bullying Victimization on Psychological Distress among California Adolescents. CALIF J HEALTH PROMOT 2016. [DOI: 10.32398/cjhp.v14i2.1875] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background and Purpose: National reports showed that over 20% of high school students were victims of bullying, which could potentially lead to psychological problems. School social support may be protective against mental distress linked with victimization. This study examined the main and moderating effects of social support from adults in schools on non-specific serious psychological distress (SPD) related to victimization among California adolescents. Methods: Utilizing the 2011-2012 California Health Interview Survey (CHIS), we analyzed a representative sample of 2,799 adolescents aged 12-17 years old. Logistic regression analyses were conducted modeling the odds of SPD in relation to school social support and victimization. Results: Adolescents who were victimized were twice as likely to have SPD compared to non-victims. Higher level of social support from adults in schools was protective against SPD, but did not buffer the effect of bullying exposure. Discussion: Findings from the present study suggested that adult support from schools can help with students’ psychological problems but does not appear to prevent the psychological consequences of victimization. Additional intervention is needed, above and beyond social support, to prevent victimization and its psychological consequences.
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18
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Zhang X, Ra CK, Zhang D, Zhang Y, MacLeod KE. The Impact of School Social Support and Bullying Victimization on Psychological Distress among California Adolescents. Calif J Health Promot 2016; 14:56-67. [PMID: 27708555 PMCID: PMC5045968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND AND PURPOSE National reports showed that over 20% of high school students were victims of bullying, which could potentially lead to psychological problems. School social support may be protective against mental distress linked with victimization. This study examined the main and moderating effects of social support from adults in schools on non-specific serious psychological distress (SPD) related to victimization among California adolescents. METHODS Utilizing the 2011-2012 California Health Interview Survey (CHIS), we analyzed a representative sample of 2,799 adolescents aged 12-17 years old. Logistic regression analyses were conducted modeling the odds of SPD in relation to school social support and victimization. RESULTS Adolescents who were victimized were twice as likely to have SPD compared to non-victims. Higher level of social support from adults in schools was protective against SPD, but did not buffer the effect of bullying exposure. DISCUSSION Findings from the present study suggested that adult support from schools can help with students' psychological problems but does not appear to prevent the psychological consequences of victimization. Additional intervention is needed, above and beyond social support, to prevent victimization and its psychological consequences.
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Affiliation(s)
- Xiaoyan Zhang
- Department of Preventive Medicine, University of Southern California Keck School of Medicine
| | - Chaelin Karen Ra
- Department of Preventive Medicine, University of Southern California Keck School of Medicine
| | - Donglan Zhang
- Department of Health Policy and Management, College of Public Health, University of Georgia
| | - Yunting Zhang
- Shanghai Children’s Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai
| | - Kara E. MacLeod
- Department of Health Policy and Management, Fielding School of Public Health, UCLA
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MacLeod KE, Karriker-Jaffe KJ, Ragland DR, Satariano WA, Kelley-Baker T, Lacey JH. Acceptance of drinking and driving and alcohol-involved driving crashes in California. Accid Anal Prev 2015; 81:134-142. [PMID: 25980918 PMCID: PMC4801781 DOI: 10.1016/j.aap.2015.04.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Revised: 03/04/2015] [Accepted: 04/28/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND Alcohol-impaired driving accounts for substantial proportion of traffic-related fatalities in the U.S. Risk perceptions for drinking and driving have been associated with various measures of drinking and driving behavior. In an effort to understand how to intervene and to better understand how risk perceptions may be shaped, this study explored whether an objective environmental-level measure (proportion of alcohol-involved driving crashes in one's residential city) were related to individual-level perceptions and behavior. METHODS Using data from a 2012 cross-sectional roadside survey of 1147 weekend nighttime drivers in California, individual-level self-reported acceptance of drinking and driving and past-year drinking and driving were merged with traffic crash data using respondent ZIP codes. Population average logistic regression modeling was conducted for the odds of acceptance of drinking and driving and self-reported, past-year drinking and driving. RESULTS A non-linear relationship between city-level alcohol-involved traffic crashes and individual-level acceptance of drinking and driving was found. Acceptance of drinking and driving did not mediate the relationship between the proportion of alcohol-involved traffic crashes and self-reported drinking and driving behavior. However, it was directly related to behavior among those most likely to drink outside the home. DISCUSSION The present study surveys a particularly relevant population and is one of few drinking and driving studies to evaluate the relationship between an objective environmental-level crash risk measure and individual-level risk perceptions. In communities with both low and high proportions of alcohol-involved traffic crashes there was low acceptance of drinking and driving. This may mean that in communities with low proportions of crashes, citizens have less permissive norms around drinking and driving, whereas in communities with a high proportion of crashes, the incidence of these crashes may serve as an environmental cue which informs drinking and driving perceptions. Perceptual information on traffic safety can be used to identify places where people may be at greater risk for drinking and driving. Community-level traffic fatalities may be a salient cue for tailoring risk communication.
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Affiliation(s)
- Kara E MacLeod
- Safe Transportation Research & Education Center, University of California, Berkeley, 2614 Dwight Way, Berkeley, CA 94720-7374, USA; School of Public Health, University of California, Berkeley, Berkeley, CA 94720, USA.
| | | | - David R Ragland
- Safe Transportation Research & Education Center, University of California, Berkeley, 2614 Dwight Way, Berkeley, CA 94720-7374, USA.
| | - William A Satariano
- School of Public Health, University of California, Berkeley, Berkeley, CA 94720, USA.
| | - Tara Kelley-Baker
- Pacific Institute for Research and Evaluation, 11720 Beltsville Drive, Calverton, MD 20705, USA.
| | - John H Lacey
- Pacific Institute for Research and Evaluation, 11720 Beltsville Drive, Calverton, MD 20705, USA.
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20
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Shi L, Zhang D, van Meijgaard J, MacLeod KE, Fielding JE. The Interaction Between an Individual's Acculturation and Community Factors on Physical Inactivity and Obesity: A Multilevel Analysis. Am J Public Health 2015; 105:1460-7. [PMID: 25973827 DOI: 10.2105/ajph.2014.302541] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined whether the interactions between primarily speaking English at home and community-level measures (median household income and immigrant composition) are associated with physical inactivity and obesity. METHODS We pooled the 2005 and 2007 Los Angeles County Health Survey data to construct a multilevel data set, with community-level median household income and immigrant density as predictors at the community level. After controlling for individual-level demographic variables, we included the respondent's perceived community safety as a covariate to test the hypothesis that perceived public safety mediates the association between acculturation and health outcomes. RESULTS The interaction between community median household income and primarily speaking English at home was associated with lower likelihoods of physical inactivity (odds ratio [OR] = 0.644; 95% confidence interval [CI] = 0.502, 0.825) and obesity (OR = 0.674; 95% CI = 0.514, 0.882). These odds remained significant after we controlled for perceived community safety. CONCLUSIONS Resources in higher-income areas may be beneficial only to residents fully integrated into the community. Future research could focus on understanding how linguistic isolation affects community-level social learning and access to resources and whether this differs by family-level acculturation.
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Affiliation(s)
- Lu Shi
- Lu Shi is with the Department of Public Health Science, Clemson University, Clemson, SC. Donglan Zhang, Jeroen van Meijgaard, and Jonathan E. Fielding are with the Center for Health Advancement, Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles. Kara E. MacLeod is with the Institute for Health Promotion and Disease Prevention Research, Keck School of Medicine, University of Southern California, Los Angeles
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21
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Abstract
OBJECTIVE This study assesses the impact of health problems on driving status (current driver vs. ex-driver) among older adults to identify which of those health problems have the greatest individual and population impact on driving cessation. METHODS Data were from baseline and 5 year follow-up waves of a longitudinal survey of adults age 55 years and older (N=1,279). The impact of several health problems on driving status was assessed using a relative risk ratio and a population attributable risk percent. Analyses controlled for age, gender, and the presence of additional baseline health problems. RESULTS Many health conditions were not associated with driving cessation. Functional limitations, cognitive function, and measures of vision were significant predictors of driving cessation. Self-care functional limitations were associated with the highest risk for driving cessation, while visual function was associated with the highest attributable risks. DISCUSSION In order to effectively address healthy aging and mobility transitions, it is important to consider the implications of targeting individuals or populations who are most at risk for driving cessation. The risk ratio is relevant for evaluating individuals; the attributable risk is relevant for developing interventions in populations.
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Affiliation(s)
- Kara E. MacLeod
- Safe Transportation Research and Education Center,
University of California at Berkeley, 2614 Dwight Way, Berkeley, CA 94720-7374,
USA
- School of Public Health, University of California at
Berkeley, Berkeley, CA 94720-7374, USA
- Corresponding author.
, (1) 510-642-4049
| | - William A. Satariano
- School of Public Health, University of California at
Berkeley, Berkeley, CA 94720-7374, USA
| | - David R. Ragland
- Safe Transportation Research and Education Center,
University of California at Berkeley, 2614 Dwight Way, Berkeley, CA 94720-7374,
USA
- School of Public Health, University of California at
Berkeley, Berkeley, CA 94720-7374, USA
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22
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MacLeod KE, Ragland DR, Prohaska TR, Smith ML, Irmiter C, Satariano WA. Missed or Delayed Medical Care Appointments by Older Users of Nonemergency Medical Transportation. Gerontologist 2014; 55:1026-37. [PMID: 24558264 DOI: 10.1093/geront/gnu002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 01/14/2014] [Indexed: 11/13/2022] Open
Abstract
PURPOSE OF THE STUDY This study identified factors associated with canceling nonemergency medical transportation appointments among older adult Medicaid patients. DESIGN AND METHODS Data from 125,913 trips for 2,913 Delaware clients were examined. Mediation analyses, as well as, multivariate logistic regressions were conducted. RESULTS Over half of canceled trips were attributed to client reasons (e.g., no show, refusal). Client characteristics (e.g., race, sex, functional status) were associated with cancelations; however, these differed based on the cancelation reason. Regularly scheduled trips were less likely to be canceled. IMPLICATIONS The evolving American health care system may increase service availability. Additional policies can improve service accessibility and overcome utilization barriers.
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Affiliation(s)
- Kara E MacLeod
- Safe Transportation Research & Education Center, University of California, Berkeley. School of Public Health, University of California at Berkeley.
| | - David R Ragland
- Safe Transportation Research & Education Center, University of California, Berkeley. School of Public Health, University of California at Berkeley
| | - Thomas R Prohaska
- College of Health and Human Services, George Mason University, Fairfax, Virginia
| | - Matthew Lee Smith
- Department of Health Promotion and Behavior, The University of Georgia College of Public Health, Athens. Department of Health Promotion and Community Health Sciences, Texas A&M Health Science Center School of Rural Public Health, College Station, Texas
| | - Cheryl Irmiter
- Easter Seals, Business Innovation Solutions, Chicago, Illinois
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MacLeod KE, Griswold JB, Arnold LS, Ragland DR. Factors associated with hit-and-run pedestrian fatalities and driver identification. Accid Anal Prev 2012; 45:366-372. [PMID: 22269520 DOI: 10.1016/j.aap.2011.08.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Revised: 07/12/2011] [Accepted: 08/03/2011] [Indexed: 05/31/2023]
Abstract
As hit-and-run crashes account for a significant proportion of pedestrian fatalities, a better understanding of these crash types will assist efforts to reduce these fatalities. Of the more than 48,000 pedestrian deaths that were recorded in the United States between 1998 and 2007, 18.1% of them were caused by hit-and-run drivers. Using national data on single pedestrian-motor vehicle fatal crashes (1998-2007), logistic regression analyses were conducted to identify factors related to hit-and-run and to identify factors related to the identification of the hit-and-run driver. Results indicate an increased risk of hit-and-run in the early morning, poor light conditions, and on the weekend. There may also be an association between the type of victim and the likelihood of the driver leaving and being identified. Results also indicate that certain driver characteristics, behavior, and driving history are associated with hit-and-run. Alcohol use and invalid license were among the leading driver factor associated with an increased risk of hit-and-run. Prevention efforts that address such issues could substantially reduce pedestrian fatalities as a result of hit-and-run. However, more information about this driver population may be necessary.
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Affiliation(s)
- Kara E MacLeod
- Safe Transportation Research & Education Center, University of California, Berkeley, 2614 Dwight Way, #7374, Berkeley, CA 94720, USA.
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Varghese TK, Wood DE, Farjah F, Oelschlager BK, Symons RG, MacLeod KE, Flum DR, Pellegrini CA. Variation in esophagectomy outcomes in hospitals meeting Leapfrog volume outcome standards. Ann Thorac Surg 2011; 91:1003-9; discussion 1009-10. [PMID: 21440116 DOI: 10.1016/j.athoracsur.2010.11.006] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Revised: 11/02/2010] [Accepted: 11/08/2010] [Indexed: 12/17/2022]
Abstract
BACKGROUND The Leapfrog Group established a minimum hospital case volume of 13 for esophageal resection in a response to known improved outcomes in larger volume centers. The aim of this study was to evaluate variation in short-term outcomes among hospitals that met the Leapfrog volume criteria. METHODS Using the Washington State Comprehensive Hospital Abstract Reporting System, a retrospective cohort design evaluated all patients (≥18 years) undergoing esophageal resection for any diagnosis since the introduction of Leapfrog standards (2000 to 2007). The main outcome measures were hospital stay, readmissions within 30 days of discharge, discharge to an institutional care facility, operative reinterventions, and 90-day mortality. RESULTS A total of 1,505 adult Washington state residents underwent esophageal resection without complex reconstruction (1,352 elective [89.8%]). Of 45 hospitals reporting at least one procedure, 5 (11%) met Leapfrog volume standards. Leapfrog hospitals accounted for 62% of the total elective volume. Overall, elective patients at Leapfrog hospitals had a lower adjusted risk of death compared with those at hospitals that did not meet criteria (odds ratio 0.50, p = 0.02). Across the different Leapfrog hospitals there was over fivefold variation in 90-day mortality (1.7% to 10.2%), 2.5-fold variation in reinterventions (8% to 20%), and fourfold variation in discharges to an institutional care facility (5.3% to 19.8%). Length of stay and readmission rate varied less. CONCLUSIONS Although referral to high-volume centers has been an important advance for complex surgical procedures, there is still a substantial degree of variability in outcomes among hospitals that met Leapfrog volume criteria for esophagectomy. Metrics such as process, individual surgeon volume, and risk-adjusted outcome measures may yield further opportunities for quality improvement that extend beyond hospital volume-based assessments.
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Affiliation(s)
- Thomas K Varghese
- Division of Cardiothoracic Surgery, University of Washington Medical School, Seattle, Washington 98195, USA.
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25
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Salvalaggio PR, Dzebisashvili N, MacLeod KE, Lentine KL, Gheorghian A, Schnitzler MA, Hohmann S, Segev DL, Gentry SE, Axelrod DA. The interaction among donor characteristics, severity of liver disease, and the cost of liver transplantation. Liver Transpl 2011; 17:233-42. [PMID: 21384505 PMCID: PMC4447593 DOI: 10.1002/lt.22230] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Accurate assessment of the impact of donor quality on liver transplant (LT) costs has been limited by the lack of a large, multicenter study of detailed clinical and economic data. A novel, retrospective database linking information from the University HealthSystem Consortium and the Organ Procurement and Transplantation Network registry was analyzed using multivariate regression to determine the relationship between donor quality (assessed through the Donor Risk Index [DRI]), recipient illness severity, and total inpatient costs (transplant and all readmissions) for 1 year following LT. Cost data were available for 9059 LT recipients. Increasing MELD score, higher DRI, simultaneous liver-kidney transplant, female sex, and prior liver transplant were associated with increasing cost of LT (P < 0.05). MELD and DRI interact to synergistically increase the cost of LT (P < 0.05). Donors in the highest DRI quartile added close to $12,000 to the cost of transplantation and nearly $22,000 to posttransplant costs in comparison to the lowest risk donors. Among the individual components of the DRI, donation after cardiac death (increased costs by $20,769 versus brain dead donors) had the greatest impact on transplant costs. Overall, 1-year costs were increased in older donors, minority donors, nationally shared organs, and those with cold ischemic times of 7-13 hours (P < 0.05 for all). In conclusion, donor quality, as measured by the DRI, is an independent predictor of LT costs in the perioperative and postoperative periods. Centers in highly competitive regions that perform transplantation on higher MELD patients with high DRI livers may be particularly affected by the synergistic impact of these factors.
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Affiliation(s)
| | - Nino Dzebisashvili
- Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO
| | - Kara E. MacLeod
- Department of Surgery, University of Washington, Seattle, WA, Surgical Outcomes Research Center, University of Washington, Seattle, WA
| | - Krista L. Lentine
- Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO
| | - Adrian Gheorghian
- Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO
| | - Mark A. Schnitzler
- Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO
| | | | - Dorry L. Segev
- Department of Surgery, Johns Hopkins University, Baltimore, MD
| | - Sommer E. Gentry
- Department of Mathematics, United States Naval Academy, Baltimore, MD
| | - David A. Axelrod
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Hanover, NH
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Abstract
BACKGROUND Television watching, a sedentary activity, has been associated with overweight in children. While the family environment is known to influence television watching, little is known about the influence of the neighbourhood environment. This study is an exploratory examination of the association of socioeconomic characteristics of the neighbourhood environment with television watching among 9-10 year old girls. METHODS Data collected by the Berkeley site of the National Heart, Lung and Blood Institute Growth and Health Study (NGHS) in 1987-8 from 787 girls who had a complete set of measurements relevant to the analysis were used. These measures included parental education, household income, race and weekly hours spent watching television. Addresses of the girls were geocoded and the median household income for the census tracts in which they lived was used to indicate neighbourhood socioeconomic characteristics. Multilevel modelling procedures were used to estimate fixed effect coefficients for individual and neighbourhood level variables. RESULTS Living in high income areas was associated with less television watching, a finding that held even when controlling for parental education, household income and race. Race and parental education were also associated with television watching. CONCLUSION Television watching among girls was associated not only with the socioeconomic characteristics of their households, but also of their neighbourhoods. Future studies should explore the mechanisms that mediate this relation and determine if these results are generalisable to other populations.
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Affiliation(s)
- K E MacLeod
- University of California, School of Public Health and Traffic Safety Center, 140 Warren Hall No 7360, Berkeley, CA 94720, US.
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Wang MC, MacLeod KE, Steadman C, Williams L, Bowie SL, Herd D, Luluquisen M, Woo M. Is the Opening of a Neighborhood Full-Service Grocery Store Followed by a Change in the Food Behavior of Residents? Journal of Hunger & Environmental Nutrition 2007. [DOI: 10.1080/19320240802077789] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Wang MC, Kim S, Gonzalez AA, MacLeod KE, Winkleby MA. Socioeconomic and food-related physical characteristics of the neighbourhood environment are associated with body mass index. J Epidemiol Community Health 2007; 61:491-8. [PMID: 17496257 PMCID: PMC2465719 DOI: 10.1136/jech.2006.051680] [Citation(s) in RCA: 236] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2006] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine whether socioeconomic and food-related physical characteristics of the neighbourhood are associated with body mass index (BMI; kg/m(2)) independently of individual-level sociodemographic and behavioural characteristics. DESIGN AND METHODS Observational study using (1) individual-level data previously gathered in five cross-sectional surveys conducted by the Stanford Heart Disease Prevention Program between 1979 and 1990 and (2) neighbourhood-level data from (a) the census to describe socioeconomic characteristics and (b) data obtained from government and commercial sources to describe exposure to different types of retail food stores as measured by store proximity, and count of stores per square mile. Data were analysed using multilevel modelling procedures. The setting was 82 neighbourhoods in agricultural regions of California. PARTICIPANTS 7595 adults, aged 25-74 years. RESULTS After adjusting for age, gender, ethnicity, individual-level socioeconomic status, smoking, physical activity and nutrition knowledge, it was found that (1) adults who lived in low socioeconomic neighbourhoods had a higher mean BMI than adults who lived in high socioeconomic neighbourhoods; (2) higher neighbourhood density of small grocery stores was associated with higher BMI among women; and (3) closer proximity to chain supermarkets was associated with higher BMI among women. CONCLUSION Living in low socioeconomic neighbourhoods, and in environments where healthy food is not readily available, is found to be associated with increased obesity risk. Unlike other studies which examined populations in other parts of the US, a positive association between living close to supermarkets and reduced obesity risk was not found in this study. A better understanding of the mechanisms by which neighbourhood physical characteristics influence obesity risk is needed.
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Affiliation(s)
- May C Wang
- School of Public Health, University of California at Berkeley, Berkeley, CA, USA.
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Abstract
BACKGROUND To understand the consequences of driving cessation in older adults, the authors evaluated depression in former drivers compared with active drivers. METHODS Depression (as assessed using the Center for Epidemiological Studies Depression Scale), driving status, sociodemographic factors, health status, and cognitive function were evaluated for a cohort of 1953 residents of Sonoma County, California, aged 55 years and older, as part of a community-based study of aging and physical performance. The authors re-interviewed 1772 participants who were active drivers at baseline 3 years later. RESULTS At baseline, former drivers reported higher levels of depression than did active drivers even after the authors controlled for age, sex, education, health, and marital status. In a longitudinal analysis, drivers who stopped driving during the 3-year interval (i.e., former drivers) reported higher levels of depressive symptoms than did those who remained active drivers, after the authors controlled for changes in health status and cognitive function. Increased depression for former drivers was substantially higher in men than in women. CONCLUSIONS With increasing age, many older adults reduce and then stop driving. Increased depression may be among the consequences associated with driving reduction or cessation.
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Affiliation(s)
- David R Ragland
- University of California Traffic Safety Center, University of California at Berkeley, 140 Warren Hall, Berkeley, CA 94720-7360, USA.
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Satariano WA, MacLeod KE, Cohn TE, Ragland DR. Problems with vision associated with limitations or avoidance of driving in older populations. J Gerontol B Psychol Sci Soc Sci 2004; 59:S281-6. [PMID: 15358803 DOI: 10.1093/geronb/59.5.s281] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES This report examines the role of (a) disease processes affecting vision, (b) reported troubles with vision, (c) physical symptoms affecting the eyes, and (d) objective measures in reported driving limitation due to problems with eyesight among older drivers. METHODS Data for this study (N = 1,840) were obtained from participants in a community-based study of aging and physical performance in people age 55 or older in the city of Sonoma, California. Each of 16 visual conditions was assessed for impact on reported driving limitation due to eyesight by calculating a "risk" ratio. Then, prevalence of the condition was combined with the ratio to generate an attributable risk for that condition for vision-related limitations in driving. RESULTS Each condition was significantly associated with reported limitations in driving due to eyesight. "Avoiding physical activity due to vision" (ratio = 3.4) and "trouble seeing steps up/down stairs" (ratio = 2.9) had the strongest association. However, "glasses/contacts required for driving" and "trouble with glare from sun/lights" had the highest attributable risks (35.8 and 29.4). DISCUSSION The risk ratio is relevant for evaluating individuals; the attributable risk is relevant to planning countermeasures in populations. Addressing specific problems related to vision should substantially reduce driving limitations due to eyesight.
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Affiliation(s)
- William A Satariano
- Division of Epidemiology, School of Public Health, 140 Warren Hall, University of California at Berkeley, Berkeley, CA 94720-7360, USA.
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Abstract
PURPOSE To understand the driving behavior of older adults, this study examines self-reported reasons for driving limitation or avoidance. DESIGN AND METHODS Baseline interviews were conducted (n = 2,046) as part of a community-based study of aging and physical performance in persons aged 55 years or older in Sonoma, California. Twenty-one medical and nonmedical reasons for limiting or avoiding driving were examined by age and gender. RESULTS Most older people continue to drive; however, many, especially older women, report one or more reasons to limit or avoid driving. Among medical reasons, problems with eyesight are by far the most often cited; no other health problem was identified as a major reason for limitation. Among nonmedical reasons, being concerned about an accident, being concerned about crime, and having no reason to drive were often cited. Important predictors of reported driving limitations were low income, limited functional status, and self-report of poor vision. IMPLICATIONS Understanding factors that affect driving patterns in older adults, including medical and nonmedical reasons, will assist in developing both enhancements to extend safe driving years and responses to the consequences of driving reduction.
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Affiliation(s)
- David R Ragland
- Traffic Safety Center, University of California at Berkeley, 140 Warren Hall, Berkeley, CA 94720-7360, USA.
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Bristol DW, Crist HL, Lewis RG, MacLeod KE, Sovocool GW. Chemical analysis of human blood for assessment of environmental exposure to semivolatile organochlorine chemical contaminants. J Anal Toxicol 1982; 6:269-75. [PMID: 6819409 DOI: 10.1093/jat/6.6.269] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
A chemical method for the quantitative analysis of organochlorine pesticide residues present in human blood was scaled-up to provide increased sensitivity and extended to include organochlorine industrial chemicals. Whole blood samples were extracted with hexane, concentrated, and analyzed without further cleanup by gas chromatography with electron capture detection. The methodology used was validated by conducting recovery studies at 1 and 10 ng/g (ppb) levels. Screening and confirmational analyses were performed by gas chromatography/mass spectrometry on samples collected from potentially exposed residents of the Love Canal area of Niagara Falls, New York and from volunteers in the Research Triangle Park area of North Carolina for 25 specific semivolatile organochlorine contaminants including chlorobenzene and chlorotoluene congeners, hexachloro-1,3-butadiene, pesticides, and polychlorinated biphenyls as Aroclor 1260. Dichlorobenzene, hexachlorobenzene, and beta-hexachlorocyclohexane residues fell in the range of 0.1 to 26 ppb in a high percentage of both the field and volunteer blood samples analyzed. Levels of other organochlorine compounds were either non-detectable or present in sub-ppb ranges.
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MacLeod KE, Hanisch RC, Lewis RG. Evaluation of gel permeation chromatography for clean up of human adipose tissue samples for GC/MS analysis of pesticides and other chemicals. J Anal Toxicol 1982; 6:38-40. [PMID: 7078104 DOI: 10.1093/jat/6.1.38] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Gel permeation chromatography (GPC) has been evaluated for clean up of human adipose tissue sample extracts in preparation for confirmatory analysis by gas chromatography-mass spectrometry (GC/MS). Studies were conducted with standard solutions, fortified chicken fat, and actual human adipose tissue samples. Nearly quantitative removal of lipid material was achieved with minimal losses of 16 organochlorine pesticides and metabolites: two polychlorinated biphenyl (PCB) mixtures, two chlorinated naphthalene (PCN) mixtures, and a polybrominated biphenyl (PBB) mixture. Mass spectra free from interferences were obtained over the mass range from 46 m/z to 560 m/z.
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Jackson MD, Hodgson DW, MacLeod KE, Lewis RG. Evaluation of three sorbents for retention of PCBs in a natural gas stream. Bull Environ Contam Toxicol 1981; 27:226-229. [PMID: 6794686 DOI: 10.1007/bf01611012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
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