From Big-Data Injury Prevention to Mapping Travel for Prenatal Care: Drexel Public Health Research at APHA 2014

An emergency responder exits an ambulance

Researchers from Drexel University in Philadelphia this week presented research on a wide range of public health topics emphasizing urban health challenges, geographic methods in public health, community resilience and more, at the 142nd annual meeting and exposition of the American Public Health Association in New Orleans.

A few selected highlights among the dozens of posters and presentations by faculty, staff and students from the Drexel University School of Public Health include:

What Makes Communities Resilient in Times of Adversity?

Psychologists have long studied what makes individuals resilient, but when groups and entire communities of people together face disaster, violence, or other disadvantages, how do they survive and thrive together? Amy Carroll-Scott, PhD, an assistant professor in the Drexel University School of Public Health, organized moderated a session encompassing multiple presentations on Monday, Nov. 17, “Understanding and Building Resilience for Healthier Communities. The session kicked off with her own systematic, cross-disciplinary literature review of community resilience. Carroll-Scott’s research examines the conditions and characteristics of neighborhoods to better understand community-level health disparities and community-driven efforts to address them.

Another Drexel team also presented work at this session, “Understanding How to Support and Build Resilience within Community Leaders,” based on a project done in partnership with a community organization in Southwest Philadelphia to help community leaders in high-crime, high-poverty neighborhoods. “Many times people in these community leadership roles can burn out without proper support and tools,” said Nicole Vaughn, PhD, an assistant professor at Drexel and co-leader of this project. Vaughn, along with Crystal Wyatt (a community research coordinator at Drexel) and Carey Davis, D.Min (co-leader of this project and director of CityLights Network) met with a small group of community leaders to understand the stressors associated with being the “go to” people for neighbors in crisis. They worked with these leaders to develop a plan to adapt the Sanctuary Model® for communities. The Sanctuary Model®, developed by project co-leader Sandra Bloom, MD, an associate professor at Drexel, is an evidence-based model for organizations to operate using trauma-informed approaches. “Many of these leaders wanted more in-depth training in the Sanctuary Model ®and more opportunities for connecting, debriefing and self-care,” Vaughn said. “All of these identified needs are important if you’re shouldering the weight of the community’s issues.”

Additional panelists discussed the state of community resilience in public health, including the RAND Corporation’s Community Resilience Project, lessons learned from New Orleans-based efforts to build community resilience post-Katrina and grassroots community resilience teams focusing on reducing gun violence in New Haven, Ct. “This session at APHA will highlight important efforts in our field that draw from and strengthen community assets in order to overcome threats to residents' health and well being,” said Carroll-Scott in advance of the session.

How Many Buses Must a Low-Income Mother Take to Get Prenatal Care?

Travel to care is a recognized challenge for low-income pregnant women seeking prenatal care. “As a nurse, I try to make sense of what the data may mean based on my experiences caring for real pregnant women in Philadelphia,” said Joan Bloch, PhD, an associate professor in Drexel’s College of Nursing and Health Professions and School of Public Health. “If a mother arrives 15 or 20 minutes late because of delays or the hassle of traveling by bus with young children in tow to all the locations for prenatal care services, she often won’t be seen.” So in her research aiming to reduce health disparities in preterm birth – which is associated with a stunning two-fold racial disparity in infant mortality – Bloch and her collaborators combined large-scale geographical map data with a case-vignette method she calls “ground truthing.” Bloch’s poster, “More than Just Bus Fare: Critical Theory and GIS to Deconstruct Prenatal Care Travel among Low-income Urban Mothers,” discusses this simulated case quantifying the challenges facing a low-income pregnant woman in a Philadelphia neighborhood with high preterm birth rates: She would need to make 25 visits to different facilities to get prenatal care, traveling nearly 180 miles and spending more than 19 hours—in just getting to care. Bloch said this type of approach is important to understand specifically what factors can be changed to shift health disparities in preterm births.

How Can We Link Big Data Sets to Provide Public Health Insight?

Combining large-scale data sets can help public health researchers unlock insights into questions unavailable in other ways. For Jennifer Taylor, PhD, an associate professor in Drexel’s School of Public Health, to learn what types of occupational injuries and illnesses are causing harm to firefighters and other emergency responders, answers lie in the linkage among employee rosters, worker’s compensation databases and hospitalization databases. But researchers like Taylor need the ability to match up an individual record in one database to another with certainty. “Often people don’t have the luxury of unique identifiers such as Social Security numbers because they are sensitive personally-identifying information,” Taylor said. At APHA, Taylor and Michael LeVasseur, a data manager on Taylor’s research project team and a doctoral candidate in epidemiology at Drexel, presented a roundtable for work comparing methods of linking data sets. Knowing which methods are most effective and accurate when connecting data sets that may be incomplete or contain some errors, is increasingly important as the reliance on big data in public health research grows. “By linking big data sets together, we get even bigger data, and that tells a more comprehensive and complete worker injury story,” Taylor said.

What Happens When EMTs Experience Assault by Patients?

A recent Drexel MPH graduate working with Taylor, Brittany Barnes, showed a poster for work done at a much smaller and more personal scale, “Expecting the unexpected: Assaults to EMTs/Paramedics,” including in-depth information gathered through interviews and focus groups with these emergency responders. “Most people have no idea that this happens,” Taylor said, and statistics show calls for medical service are increasing at 30 percent annually. When Barnes and Taylor spoke with paramedics in Philadelphia, most de-emphasized the physical injuries they sustained. Instead, “they wanted to talk about the psychological effect of being called to someone’s house and getting beat up,” Taylor said. “That’s not expected, and the impact stays with a person. We’re concerned about what this means for paramedics as their work is already quite high-stress, and now they are dealing with combative patients as well.”

Do Food Stamps Stave Off Harmful Effects of Diabetes?

For people with Type II diabetes, a healthy diet is part of the best medicine to maintain health and stave off complications. But a consistent healthy diet and consistent medical care can both be unaffordable for low-income individuals who live with food insecurity. Darryl Brown, PhD, an assistant professor in Drexel’s School of Public Health, investigated the health care expenditures and outcomes among low-income individuals with diabetes who received federal public assistance to better afford food, and benefit-eligible low-income individuals who did not receive the assistance. Brown and Drexel collaborator and associate professor Mariana Chilton, PhD, report in their poster that the group who received benefits from the Supplemental Nutrition Assistance Program (SNAP, commonly known as food stamps) had better diabetes outcomes and used more health care services for diabetes-associated health issues than the group who did not receive SNAP – despite the latter group being older and sicker. “The SNAP-eligible group who were older and sicker should be using more health care,” Brown said. “That they don’t suggests there’s an access issue, and SNAP benefits are supporting access to care.”