Using 311 data to develop an algorithm to identify urban blight for public health improvement

The growth of administrative data made available publicly, often in near-real time, offers new opportunities for monitoring conditions that impact community health. Urban blight—manifestations of adverse social processes in the urban environment, including physical disorder, decay, and loss of anchor institutions—comprises many conditions considered to negatively affect the health of communities. However, measurement strategies for urban blight have been complicated by lack of uniform data, often requiring expensive street audits or the use of proxy measures that cannot represent the multifaceted nature of blight. This paper evaluates how publicly available data from New York City’s 311-call system can be used in a natural language processing approach to represent urban blight across the city with greater geographic and temporal precision. We found that our urban blight algorithm, which includes counts of keywords (‘tokens’), resulted in sensitivity ~90% and specificity between 55% and 76%, depending on other covariates in the model. The percent of 311 calls that were ‘blight related’ at the census tract level were correlated with the most common proxy measure for blight: short, medium, and long-term vacancy rates for commercial and residential buildings. We found the strongest association with long-term (>1 year) commercial vacancies (Pearson’s correlation coefficient = 0.16, p < 0.001). Our findings indicate the need of further validation, as well as testing algorithms that disambiguate the different facets of urban blight. These facets include physical disorder (e.g., litter, overgrown lawns, or graffiti) and decay (e.g., vacant or abandoned lots or sidewalks in disrepair) that are manifestations of social processes such as (loss of) neighborhood cohesion, social control, collective efficacy, and anchor institutions. More refined measures of urban blight would allow for better targeted remediation efforts and improved community health.

Clinical implications of Landing Error Scoring System calculation methods

OBJECTIVES

To explore whether final Landing Error Scoring System (LESS) scores differ between calculation methods used in literature.

DESIGN

Cross-sectional.

SETTING

Laboratory.

PARTICIPANTS

328 individuals.

MAIN OUTCOME MEASURES

LESS scores from 984 drop-jumps were extracted. Final LESS scores were calculated for every participant according to five methods: mean of 3 jumps, 1st jump score, 3rd jump score, best jump score, and sum of errors present in at least 2 jumps. The influence of the calculation method on group mean LESS score and group-level risk categorization using threshold of 5 errors was estimated using Generalized Estimating Equations, with the mean of 3 jumps score set as the reference method. The agreement in individual-level risk categorization was assessed using odds ratios and McNemar's tests.

RESULTS

Compared to the reference, estimated group mean LESS score was 0.92 errors lower (p < 0.001) using the best jump method, as was group-level risk categorization (odds ratio: 0.50, p < 0.001). Individual-level risk categorization between calculation methods was inconsistent for 8-15% of participants compared to the reference method, significantly different from reference for the best jump score method (p < 0.001).

CONCLUSIONS

Calculation method meaningfully influences final LESS scores and risk categorization.

Do sedentary behavior and physical activity spatially cluster? Analysis of a population-based sample of Boston adolescents

Sedentary behavior and lack of physical activity are key modifiable behavioral risk factors for chronic health problems, such as obesity and diabetes. Little is known about how sedentary behavior and physical activity among adolescents spatially cluster. The objective was to detect spatial clustering of sedentary behavior and physical activity among Boston adolescents. Data were used from the 2008 Boston Youth Survey Geospatial Dataset, a sample of public high school students who responded to a sedentary behavior and physical activity questionnaire. Four binary variables were created: 1) TV watching (>2 hours/day), 2) video games (>2 hours/day), 3) total screen time (>2 hours/day); and 4) 20 minutes/day of physical activity (≥5 days/week). A spatial scan statistic was utilized to detect clustering of sedentary behavior and physical activity. One statistically significant cluster of TV watching emerged among Boston adolescents in the unadjusted model. Students inside the cluster were more than twice as likely to report > 2 hours/day of TV watching compared to respondents outside the cluster. No significant clusters of sedentary behavior and physical activity emerged. Findings suggest that TV watching is spatially clustered among Boston adolescents. Such findings may serve to inform public health policymakers by identifying specific locations in Boston that could provide opportunities for policy intervention. Future research should examine what is linked to the clusters, such as neighborhood environments and network effects.

EBT Payment for Online Grocery Orders: a Mixed-Methods Study to Understand Its Uptake among SNAP Recipients and the Barriers to and Motivators for Its Use

OBJECTIVE

To examine Supplemental Nutrition Assistance Program (SNAP) recipients' use of the first online supermarket accepting Electronic Benefit Transfer (EBT) payment.

METHODS

In this mixed-methods study, the authors collected EBT purchase data from an online grocer and attempted a randomized controlled trial in the South Bronx, New York City, followed by focus groups with SNAP beneficiaries aged ≥18 years. Participants were randomized to shop at their usual grocery store or an online supermarket for 3 months. Focus groups explored barriers and motivators to online EBT redemption.

RESULTS

Few participants made online purchases, even when incentivized in the randomized controlled trial. Qualitative findings highlighted a lack of perceived control over the online food selection process as a key barrier to purchasing food online. Motivators included fast, free shipping and discounts.

CONCLUSIONS AND IMPLICATIONS

Electronic Benefit Transfer for online grocery purchases has the potential to increase food access among SNAP beneficiaries, but challenges exist to this new food buying option. Understanding online food shopping barriers and motivators is critical to the success of policies targeting the online expansion of SNAP benefits.

Neighborhood walk score and selected Cardiometabolic factors in the French RECORD cohort study

Background

Walkable neighborhoods are purported to impact a range of cardiometabolic outcomes through increased walking, but there is limited research that examines multiple cardiometabolic outcomes. Additionally, few Walk Score (a novel measure of neighborhood walkability) studies have been conducted in a European context. We evaluated associations between neighborhood Walk Score and selected cardiometabolic outcomes, including obesity, hypertension and heart rate, among adults in the Paris metropolitan area.

Methods and results

We used data from the second wave of the RECORD Study on 5993 participants recruited in 2011–2014, aged 34–84 years, and residing in Paris (France). To this existing dataset, we added Walk Score values for participants’ residential address. We used multilevel linear models for the continuous outcomes and modified Poisson models were used for our categorical outcomes to estimate associations between the neighborhood Walk Score (both as a continuous and categorical variable) (0–100 score) and body mass index (BMI) (weight/height² in kg/m²), obesity (kg/m²), waist circumference (cm), systolic blood pressure (SBP) (mmHg), diastolic blood pressure (DBP) (mmHg), hypertension (mmHg), resting heart rate (RHR) (beats per minute), and neighborhood recreational walking (minutes per week). Most participants lived in Walker’s Paradise (48.3%). In multivariate models (adjusted for individual variables, neighborhood variables, and risk factors for cardiometabolic outcomes), we found that neighborhood Walk Score was associated with decreased BMI (β: -0.010, 95% CI: -0.019 to −0.002 per unit increase), decreased waist circumference (β: -0.031, 95% CI: -0.054 to −0.008), increased neighborhood recreational walking (β: +0.73, 95% CI: +0.37 to +1.10), decreased SBP (β: -0.030, 95% CI: -0.063 to −0.0004), decreased DBP (β: -0.028, 95% CI: -0.047 to −0.008), and decreased resting heart rate (β: -0.026 95% CI: -0.046 to −0.005).

Conclusions

In this large population-based study, we found that, even in a European context, living in a highly walkable neighborhood was associated with improved cardiometabolic health. Designing walkable neighborhoods may be a viable strategy in reducing cardiovascular disease prevalence at the population level.

Measuring Micro-Level Effects of a New Supermarket: Do Residents Within 0.5 Mile Have Improved Dietary Behaviors?

BACKGROUND

Local and national policies to encourage supermarket opening or expansion are popular strategies for improving access to healthy food for residents in neighborhoods lacking these types of stores, yet few evaluations of such initiatives exist.

OBJECTIVE

Our aim was to test whether a newly opened supermarket in the Bronx, NY, changed household availability of healthy and unhealthy food items and reported daily consumption of these items among respondents residing in close proximity (≤0.5 mile) to the new supermarket.

DESIGN

This quasi-experimental study evaluated changes in purchasing and consumption habits of residents within 0.5 mile of the new supermarket as compared to residents living more than 0.5 mile from the supermarket. Data were collected through street intercept surveys at three different times: once before the store opened (March to August 2011) and in two follow-up periods (1 to 5 months and 13 to 17 months after the store opened). This study analyzed a subset of successfully geocoded resident intersections from the larger study.

PARTICIPANTS/SETTING

We surveyed 3,998 residents older than the age of 18 years in two Bronx neighborhoods about their food-purchasing behaviors before the store opened and in two follow-up periods. Responses from residents whose intersections were successfully geocoded (N=3,378) were analyzed to examine the consumption and purchasing behaviors of those in close proximity to the new store.

INTERVENTION

A new supermarket opened in a low-access neighborhood in the Bronx with the help of financial incentives through New York City's Food Retail Expansion to Support Health (FRESH) program.

MAIN OUTCOME MEASURES

The primary outcome evaluated was the change in percent of respondents reporting that the following food items were "always available" in the home: milk, fruit juice, soda, pastries, packaged snacks, fruits, and vegetables. As a secondary outcome, we explored changes in self-reported daily servings of these items.

STATISTICAL ANALYSIS PERFORMED

A difference-in-difference analysis was performed, controlling for age, education, marital status, income, sex, race, and ethnicity.

RESULTS

Residents within 0.5 mile of the store had increased household availability of both healthy and unhealthy foods. After the introduction of the supermarket, the percent of residents in close proximity to the store who reported always having produce available in the home increased by 8.8% compared to those living >0.5 mile from the store in the first post-period and by 10.6% compared to those living >0.5 mile from the store in the second post-period. A similar positive increase in household availability of salty snacks and pastries was observed. Residents living in close proximity also reported greater consumption of healthy foods like produce and water, and lower intake of soft drinks and pastries.

CONCLUSIONS

Given the financial support at the national and local levels to encourage supermarket development and expansion in high-need communities, it is imperative to evaluate the impact of such initiatives. Although the findings have so far been equivocal, our findings give weight to the argument that, at a micro-level, the siting of a new supermarket can indeed impact local purchasing and consumption behavior. Although purchasing for both healthy and unhealthy food items increased, reported consumption showed an increase in servings of healthy items (water, vegetables, and fruit) and a decrease in servings of unhealthy foods (soft drinks, salty snacks, and pastries).

Quantifying spatial misclassification in exposure to noise complaints among low-income housing residents across New York City neighborhoods: a Global Positioning System (GPS) study

PURPOSE

To examine if there was spatial misclassification in exposure to neighborhood noise complaints among a sample of low-income housing residents in New York City, comparing home-based spatial buffers and Global Positioning System (GPS) daily path buffers.

METHODS

Data came from the community-based NYC Low-Income Housing, Neighborhoods and Health Study, where GPS tracking of the sample was conducted for a week (analytic n = 102). We created a GPS daily path buffer (a buffering zone drawn around GPS tracks) of 200 m and 400 m. We also used home-based buffers of 200 m and 400 m. Using these "neighborhoods" (or exposure areas), we calculated neighborhood exposure to noisy events from 311 complaints data (analytic n = 143,967). Friedman tests (to compare overall differences in neighborhood definitions) were applied.

RESULTS

There were differences in neighborhood noise complaints according to the selected neighborhood definitions (P < .05). For example, the mean neighborhood noise complaint count was 1196 per square kilometer for the 400-m home-based and 812 per square kilometer for the 400-m activity space buffer, illustrating how neighborhood definition influences the estimates of exposure to neighborhood noise complaints.

CONCLUSIONS

These analyses suggest that, whenever appropriate, GPS neighborhood definitions can be used in spatial epidemiology research in spatially mobile populations to understand people's lived experience.

Promoting Data Reuse and Collaboration at an Academic Medical Center

A need was identified by the Department of Population Health (DPH) for an academic medical center to facilitate research using large, externally funded datasets. Barriers identified included difficulty in accessing and working with the datasets, and a lack of knowledge about institutional licenses. A need to facilitate sharing and reuse of datasets generated by researchers at the institution (internal datasets) was also recognized. The library partnered with a researcher in the DPH to create a catalog of external datasets, which provided detailed metadata and access instructions. The catalog listed researchers at the medical center and the main campus with expertise in using these external datasets in order to facilitate research and cross-campus collaboration. Data description standards were reviewed to create a set of metadata to facilitate access to both externally generated datasets, as well as the internally generated datasets that would constitute the next phase of development of the catalog. Interviews with a range of investigators at the institution identified DPH researchers as most interested in data sharing, therefore targeted outreach to this group was undertaken. Initial outreach resulted in additional external datasets being described, new local experts volunteering, proposals for additional functionality, and interest from researchers in inclusion of their internal datasets in the catalog. Despite limited outreach, the catalog has had ~250 unique page views in the three months since it went live. The establishment of the catalog also led to partnerships with the medical center’s data management core and the main university library. The Data Catalog in its present state serves a direct user need from the Department of Population Health to describe large, externally funded datasets. The library will use this initial strong community of users to expand the catalog and include internally generated research datasets. Future expansion plans will include working with DataCore and the main university library.

Measuring the environmental health of Wisconsin's counties

INTRODUCTION

Environmental factors-such as air and water pollution, lead exposure in homes, or aspects of urban design-influence the health of a community. Monitoring these environmental health influences is a core function of public health, making it necessary to identify critical priorities and effectively target outreach and intervention efforts. This paper reviews the methods used to develop a summary measure of the environmental health of Wisconsin's 72 counties and the city of Milwaukee.

METHODS

We collected publicly available data on 9 indicators of environmental health, divided into 3 constructs-air quality, water quality, and the built environment. We looked at how the counties ranked in each construct and then combined the estimates into a summary measure of environmental health. We ranked the summary measure from lowest to highest risk, with higher representing a worse physical environment.

RESULTS

In 2007, Wisconsin regions with major metropolitan areas had the worst environmental health risk. In contrast, the 10 counties with the best environmental health were all located in rural areas of the state.

CONCLUSION

Publicly available data can be used to compare and contrast environmental health in Wisconsin's communities. Although the measures used to collect these data could be improved, the results can still be used in community health planning and improvement efforts.

Adjuvant CMFVP versus melphalan for operable breast cancer with positive axillary nodes: 10-year results of a Southwest Oncology Group Study

Four hundred forty-one women with operable breast cancer with histologically positive axillary nodes were randomized to receive either combination cyclophosphamide (60 mg/m2 orally everyday for 1 year); fluorouracil (300 mg/m2 intravenously [IV] weekly for 1 year); methotrexate (15 mg/m2 IV weekly for 1 year); vincristine (0.625 mg/m2 IV for 10 weeks); prednisone (30 mg/m2 orally days 1 to 14, 20 mg/m2 days 15 to 28, 10 mg/m2 days 29 to 42) (CMFVP) or single-agent melphalan (L-PAM) (5 mg/m2 orally every day for 5 days every 6 weeks for 2 years) chemotherapy after a modified or radical mastectomy between January 1975 and February 1978. Patients were stratified according to menopausal status and number of positive nodes (one to three, more than three nodes) before randomization. Seventy-eight patients were ineligible, most (56) because they were registered more than 42 days from surgery. Maximum duration of follow-up is 12 years, with a median of 9.8 years. The treatment arms were balanced with respect to age, menopausal status, and number of positive nodes. Among eligible patients, disease-free survival and survival were superior with CMFVP (P = .002, .005, respectively). At 10 years, 48% of patients treated with CMFVP remain alive and disease-free and 56% remain alive, compared with 35% alive and disease-free and 43% alive on the L-PAM arm. Disease-free survival and survival were significantly better with CMFVP compared with L-PAM only in premenopausal patients and patients with four or more positive nodes. Both regimens were well tolerated, although toxicity was more severe and more frequent with CMFVP. We conclude that after 10 years of follow-up, adjuvant combination chemotherapy with CMFVP is superior to single-agent L-PAM in patients with axillary node-positive primary breast cancer. The major advantage is in premenopausal women and in patients with more than three positive axillary nodes.

Drug combinations in the treatment of gastric adenocarcinoma: a randomized Southwest Oncology Group study

The FAM combination with the simultaneous administration of 5-fluorouracil, doxorubicin, and mitomycin C is considered standard chemotherapy for gastric adenocarcinoma. This study was initiated to determine whether a kinetically designed sequential administration of these three drugs would be superior and whether the presence or absence of easily measurable tumor would imply differences in survival. To do so, the Southwest Oncology Group tested two schedules in a randomized study of 239 patients. Independent judgments of response were made by two authors with the same results. Equivalent response rates (23% of all eligible sequential and 30% simultaneous) and median survival durations (22 and 23 weeks, respectively) were seen. Patients with and without readily measurable tumors each lived a median of 22 weeks. Higher degrees of hematologic toxicity were associated with prolonged survival (median 27 weeks versus 20 weeks, p = 0.04). Patients treated by community oncologists were described as having higher response rates than those treated in major medical centers (64% versus 31%, p = 0.03). The meaning of this is questionable in that there were no statistical differences in survival or toxicity. Those with prior exposure to 5-fluorouracil had only a tendency, without statistical significance, for a slightly inferior response and survival.

Combination chemotherapy (CMFVP) versus L-phenylalanine mustard (L-PAM) for operable breast cancer with positive axillary nodes: a Southwest Oncology Group Study

The Southwest Oncology Group in a prospective randomized study compared one year of adjuvant combination chemotherapy with continuous CMFVP to two years of intermittent L-PAM in women with operable breast cancer with histologically positive axillary lymph nodes. In fully evaluable patients with a 42-month median and 30-month minimum follow-up, treatment failures have occurred in 26% of 145 receiving CMFVP and 47% of 167 women given L-PAM (P = 0.002). Disease-free survival times were significantly longer with CMFVP than with L-PAM in the following subgroups: premenopausal women (P = 0.002), postmenopausal women (P = 0.002), women with 1-3 involved axillary nodes (P = 0.003), and women with four or more involved axillary nodes (P = 0.002). CMFVP was effective in pre- and postmenopausal women. There is a significant difference in survival in favor of CMFVP compared to L-PAM (P = 0.005). The life table estimates of survival at 42 months are 86% for women on the CMFVP treatment arm and 73% for women on the L-PAM treatment arm. There was no correlation between the interval from mastectomy to onset of chemotherapy (between one and six weeks) and recurrence rates. Acute toxicity with both treatment arms was moderate and reversible. These results show that continuous CMFVP is superior to intermittent L-PAM in decreasing recurrences and increasing survival in both pre- and postmenopausal women with operable breast cancer with histologically involved axillary nodes.