- Award ID(s):
- NSF-PAR ID:
- Rosenbaum, Janet E.
- Date Published:
- Journal Name:
- PLOS ONE
- Page Range / eLocation ID:
- Medium: X
- Sponsoring Org:
- National Science Foundation
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West, Brooke (Ed.)Objectives An Opioid Treatment Desert is an area with limited accessibility to medication-assisted treatment and recovery facilities for Opioid Use Disorder. We explored the concept of Opioid Treatment Deserts including racial differences in potential spatial accessibility and applied it to one Midwestern urban county using high resolution spatiotemporal data. Methods We obtained individual-level data from one Emergency Medical Services (EMS) agency (Columbus Fire Department) in Franklin County, Ohio. Opioid overdose events were based on EMS runs where naloxone was administered from 1/1/2013 to 12/31/2017. Potential spatial accessibility was measured as the time (in minutes) it would take an individual, who may decide to seek treatment after an opioid overdose, to travel from where they had the overdose event, which was a proxy measure of their residential location, to the nearest opioid use disorder (OUD) treatment provider that provided medically-assisted treatment (MAT). We estimated accessibility measures overall, by race and by four types of treatment providers (any type of MAT for OUD, Buprenorphine, Methadone, or Naltrexone). Areas were classified as an Opioid Treatment Desert if the estimate travel time to treatment provider (any type of MAT for OUD) was greater than a given threshold. We performed sensitivity analysis using a range of threshold values based on multiple modes of transportation (car and public transit) and using only EMS runs to home/residential location types. Results A total of 6,929 geocoded opioid overdose events based on data from EMS agencies were used in the final analysis. Most events occurred among 26–35 years old (34%), identified as White adults (56%) and male (62%). Median travel times and interquartile range (IQR) to closest treatment provider by car and public transit was 2 minutes (IQR: 3 minutes) and 17 minutes (IQR: 17 minutes), respectively. Several neighborhoods in the study area had limited accessibility to OUD treatment facilities and were classified as Opioid Treatment Deserts. Travel time by public transit for most treatment provider types and by car for Methadone-based treatment was significantly different between individuals who were identified as Black adults and White adults based on their race. Conclusions Disparities in access to opioid treatment exist at the sub-county level in specific neighborhoods and across racial groups in Columbus, Ohio and can be quantified and visualized using local public safety data (e.g., EMS runs). Identification of Opioid Treatment Deserts can aid multiple stakeholders better plan and allocate resources for more equitable access to MAT for OUD and, therefore, reduce the burden of the opioid epidemic while making better use of real-time public safety data to address a public health epidemic that has turned into a public safety crisis.more » « less
null (Ed.)The U.S. has merely 4% of the world population, but contains 25% of the world’s COVID-19 cases. Since the COVID-19 outbreak in the U.S., Massachusetts has been leading other states in the total number of COVID-19 cases. Racial residential segregation is a fundamental cause of racial disparities in health. Moreover, disparities of access to health care have a large impact on COVID-19 cases. Thus, this study estimates racial segregation and disparities in testing site access and employs economic, demographic, and transportation variables at the city/town level in Massachusetts. Spatial regression models are applied to evaluate the relationships between COVID-19 incidence rate and related variables. This is the first study to apply spatial analysis methods across neighborhoods in the U.S. to examine the COVID-19 incidence rate. The findings are: (1) Residential segregations of Hispanic and Non-Hispanic Black/African Americans have a significantly positive association with COVID-19 incidence rate, indicating the higher susceptibility of COVID-19 infections among minority groups. (2) Non-Hispanic Black/African Americans have the shortest drive time to testing sites, followed by Hispanic, Non-Hispanic Asians, and Non-Hispanic Whites. The drive time to testing sites is significantly negatively associated with the COVID-19 incidence rate, implying the importance of the accessibility of testing sites by all populations. (3) Poverty rate and road density are significant explanatory variables. Importantly, overcrowding represented by more than one person per room is a significant variable found to be positively associated with COVID-19 incidence rate, suggesting the effectiveness of social distancing for reducing infection. (4) Different from the findings of previous studies, the elderly population rate is not statistically significantly correlated with the incidence rate because the elderly population in Massachusetts is less distributed in the hotspot regions of COVID-19 infections. The findings in this study provide useful insights for policymakers to propose new strategies to contain the COVID-19 transmissions in Massachusetts.more » « less
null (Ed.)Wright College, an urban open-access community college, independently accredited within the City Colleges of Chicago (CCC) system, is a federally recognized Hispanic-Serving Institution (HSI) with one of the largest community college enrollments of Hispanic students in Illinois. Wright College’s student success rates measured by completion have been strong and improving relative to other national urban community colleges, but are below state and national averages. In 2015 the college piloted a selective guaranteed admission program, Engineering Pathways (EP), to one of the nation’s top engineering schools (The Grainger College of Engineering at the University of Illinois Urbana Champaign, UIUC). Initial results for the small first-year cohort were very positive: 89% transfer rate and all students who transferred to UIUC graduated. The program’s initial success rested on a) cohort model with a small number of students and strong controls; b) co-branding that attracted local students interested in pursuing engineering at UIUC who might not otherwise have enrolled at Wright; c) academic rigor (small class size with Wright College’s curricula matching UIUC); d) robust student support services and structures; and e) a holistic college commitment to equity and inclusive excellence. Wright College obtained a National Foundation Science (NSF)-HSI research grant in 2018 to support the Engineering Pathways. The grant examines EP students’ self-efficacy and sense of belonging. Wright College foregrounds student “belonging” in its equity efforts. Equity work calls for the systemic analysis and tracking of student performance, engagement and participation throughout the student life-cycle, with data-informed analysis of behavior and outcomes through a lens of race, gender and wealth. EP students shared similar racial and ethnic backgrounds as Wright College’s non-engineering students. They attended the same elementary and public schools, have similar family structures, socioeconomic status (SES) and supports. NSF resources assisted Wright College’s creation of a contextualized engineering summer bridge and a more structured pre-engineering program. As enrollment in the EP program increased, the college dedicated additional resources, including faculty, enhanced student support, and guaranteed junior-level transfer to other nearby baccalaureate engineering schools. Central to the effort was significantly greater structure and monitoring of student performance, including academic and support frameworks for non-EP students. Wright College and baccalaureate transfer institutions reviewed and updated articulation agreements. In the Engineering Summer Bridge Program’s first two years, forty-five (45) students who would otherwise have been denied admission to EP are thriving and are positioned to transfer to four-year engineering programs. In this paper, Wright College will review the college’s equity efforts, the structure and implementation of the Engineering Pathways, and the creation of new engineering transfer programs. It will explore visible and invisible barriers to students’ success, contrasting students in Wright College’s EP program with other Wright College students. The authors argue that the systemic pursuit of equity, particularly with a focus on self-efficacy, belonging, and the creation of an environment committed to inclusive excellence, will result in very strong student outcomes.more » « less
Rural and remote communities were especially vulnerable to the COVID-19 pandemic due to the availability and capacity of rural health services. Research has found that key issues surrounded (1) the lack of staff, (2) the need for coordinated health services, and (3) operational and facility issues. Similarly, research also confirms that irrespective of hospital capacity issues existing during crisis, compared to urban communities, rural communities typically face poorer access to health services. Telehealth programs have long held promise for addressing health disparities perpetuated by inadequate health care access. In response to the current COVID-19 pandemic, Adventist Health Saint Helena Hospital, a rural hospital in northern California, urgently worked to expand telehealth services. However, as Adventist Health Saint Helena Hospital is the longest-serving rural hospital in the state of California, administrators were also able to draw on experiences from the pandemic of 1918/1919. Understanding their historically rural and heavily Latino populations, their telehealth approach was coupled with cultural approaches for prioritizing socially responsive and equitable access to health services.
This study aimed to present one rural community’s holistic sociotechnical response to COVID-19 in redesigning their health care delivery approach. Redesign efforts included the expansion of digital health services coupled with county-wide collaborations for nondigital mobile health centers, testing, and vaccination clinics to meet the needs of those with limited digital access and language barriers.
We present data on telehealth services for maintaining critical care services and a framework on the feasibility of private-public partnerships to address COVID-19 challenges.
In this paper, we provide a critical review of how a rural hospital adapted its health care approach to incorporate telehealth services and distance services to meet the needs of a diverse population.
This paper contributes empirical data on how rural communities can use telehealth technologies and community partnerships for a holistic community approach to meet health needs during a natural disaster.
Conflicts of Interest
null (Ed.)Background Cardiovascular disease (CVD) disparities are a particularly devastating manifestation of health inequity. Despite advancements in prevention and treatment, CVD is still the leading cause of death in the United States. Additionally, research indicates that African American (AA) and other ethnic-minority populations are affected by CVD at earlier ages than white Americans. Given that AAs are the fastest-growing population of smartphone owners and users, mobile health (mHealth) technologies offer the unparalleled potential to prevent or improve self-management of chronic disease among this population. Objective To address the unmet need for culturally tailored primordial prevention CVD–focused mHealth interventions, the MOYO app was cocreated with the involvement of young people from this priority community. The overall project aims to develop and evaluate the effectiveness of a novel smartphone app designed to reduce CVD risk factors among urban-AAs, 18-29 years of age. Methods The theoretical underpinning will combine the principles of community-based participatory research and the agile software development framework. The primary outcome goals of the study will be to determine the usability, acceptability, and functionality of the MOYO app, and to build a cloud-based data collection infrastructure suitable for digital epidemiology in a disparity population. Changes in health-related parameters over a 24-week period as determined by both passive (eg, physical activity levels, sleep duration, social networking) and active (eg, use of mood measures, surveys, uploading pictures of meals and blood pressure readings) measures will be the secondary outcome. Participants will be recruited from a majority AA “large city” school district, 2 historically black colleges or universities, and 1 urban undergraduate college. Following baseline screening for inclusion (administered in person), participants will receive the beta version of the MOYO app. Participants will be monitored during a 24-week pilot period. Analyses of varying data including social network dynamics, standard metrics of activity, percentage of time away from a given radius of home, circadian rhythm metrics, and proxies for sleep will be performed. Together with external variables (eg, weather, pollution, and socioeconomic indicators such as food access), these metrics will be used to train machine-learning frameworks to regress them on the self-reported quality of life indicators. Results This 5-year study (2015-2020) is currently in the implementation phase. We believe that MOYO can build upon findings of classical epidemiology and longitudinal studies like the Jackson Heart Study by adding greater granularity to our knowledge of the exposures and behaviors that affect health and disease, and creating a channel for outreach capable of launching interventions, clinical trials, and enhancements of health literacy. Conclusions The results of this pilot will provide valuable information about community cocreation of mHealth programs, efficacious design features, and essential infrastructure for digital epidemiology among young AA adults. International Registered Report Identifier (IRRID) DERR1-10.2196/16699more » « less