Mark Carrozza - Profile on Academia.edu (original) (raw)
Papers by Mark Carrozza
Context: The Health Resources and Services Administration (HRSA) Health Center Program plays an i... more Context: The Health Resources and Services Administration (HRSA) Health Center Program plays an important role in providing prenatal care in the U.S., serving more than 560,000 primarily low-income women in 2021. Access to early prenatal care, particularly for low-income and racial and ethnic minority women, is affected by a complex set of interrelated factors, including geographic context, rurality, and the maternity care workforce. Objective: This research explores environmental, patient, and workforce factors influencing health center early access to prenatal care and assesses if the relationship between these factors and early access to prenatal care vary by health center rural status. Study Design: In this cross-sectional analysis, we create health center service area measures as proxies for geographic context and use spatial regression techniques. Population Studied: HRSA Health Center Program Awardees and Look-Alikes. Outcome Measure: Early access to prenatal care. Results: We find significant differences in early prenatal care by health center rural status. The results also show that factors at multiple levels significantly influence health center early prenatal care, including service area (social deprivation and usual source of care), patient (the percentage of black patients and the percentage of patients best served in non-English language), organizational (the percentage of virtual visits and prenatal care referral status), and workforce (the number of family physician FTEs). However, the results show that some of these factors vary in influence depending on the rural status of health centers. Conclusions: These findings suggest that geographic context and rural status are important factors contributing to health center access to early prenatal care. Specifically, rural health centers with higher numbers of family physician FTEs and lower percentages of patients best served in non-English have higher rates of early prenatal care, while urban health centers with higher rates of virtual visits have higher rates of early prenatal care. Health center interventions to improve access to prenatal care should be tailored interventions based on their rural status and multi-level factors including patient, organizational, and service area characteristics.
Context: Several studies have documented that multiple factors that contribute, including geograp... more Context: Several studies have documented that multiple factors that contribute, including geography, to preventable hospitalizations. Other studies identified preventable hospitalization hot spots in the Appalachia and Mississippi Delta regions. Objective: To determine if factors associated with preventable hospitalizations are different in the Appalachia and Delta regions (compared to the rest of the US). Study Design and Analysis: Cross sectional approach included hot spot mapping and spatial regime modeling. First, we modeled preventable hospitalizations with hierarchical condition category [HCC] risk scores, social deprivation index [SDI], rurality, hospital beds per 100,000, primary care physicians (PCP) per 100,000, and the percentage of black Medicare beneficiaries as independent variables. We also included a spatial regime variable, which models Appalachia and Delta regions separately, and a Chow test to determine if coefficients for models are significantly different. Setting/Dataset: Centers for Medicare and Medicaid (CMS) public use file (PUF), Robert Wood Johnson County Health Rankings, Robert Graham Center (SDI); US Counties (n=3,141). Outcome Measures: Preventable Hospitalizations (rates of hospital stays for ambulatory-sensitive conditions per 100,000 Medicare enrollees). Results: The model performed better for non-Appalachia/Delta counties (r2 = .33) compared to the Delta (r2 = .17) and Appalachia (r2 = .30) models. All independent variables were significant (and in the expected direction) in the non-Appalachia/Delta model, while only three were significant in the Delta and Appalachia models (SDI, hospital beds, HCC). Chow test revealed that coefficients varied significantly across the models for all independent variables except SDI and PCP rates. Conclusions: Consistent with previous literature, we find that the factors associated with preventable hospitalizations vary by region. Indeed, capturing the effects of hospital capacity, social deprivation, and population illness burden on rates of ACSC admissions is robust across diverse population segments, and point to challenges in characterizing those in regions such as the Delta and Appalachia.
Analytical and Bioanalytical Chemistry, 2013
The National Institute of Standards and Technology administers quality assurance programs devoted... more The National Institute of Standards and Technology administers quality assurance programs devoted to improving measurements of nutrients and related metabolites in foods, dietary supplements, and serum and plasma samples. These programs have been developed in collaboration with the National Institutes of Health to assist measurement communities in their efforts to achieve accurate results that are comparable among different laboratories and over time. Targeted analytes include micronutrients, botanical markers, nutritional elements, contaminants, fatty acids, and vitamin D metabolites.
Economic or policy analysis
Behavioral, psychosocial, and mental illness
Context: Preliminary analyses suggest that regions with high levels of poor mental health and lar... more Context: Preliminary analyses suggest that regions with high levels of poor mental health and larger minority populations have less access to mental health services. This is consistent with literature on disparities in mental health access for minority populations, highlighting the importance of integrating primary and behavioral health care for improving access to care. Objective: To identify priority areas for addressing health inequities in access to behavioral health care. Specific aims include identifying highneed areas based on poor mental health and race/ethnicity and exploring integrative behavioral health care capacity in these areas. Study Design and Analysis: Geographic information systems (GIS) were used to create quartile maps for counties based on race/ethnicity and poor mental health. Co-location mapping was then used to identify areas in the top quartile for both mental health need and large minority populations. Substance Abuse and Mental Health Services Administration (SAMHSA) integrative primary care facilities and primary care and mental health providers were then mapped onto these areas. Setting/Datasets: Centers for Disease Control and Prevention (CDC) PLACES; American Community Survey; SAMHSA Behavioral Health Services Locator; National Provider and Plan Enumeration System (NPPES). Population Studied: U.S. counties excluding Puerto Rico (n=3,143). Outcome Measures: Frequent mental health distress -respondents reporting 14 or more days in the last month where mental health was not good; percent black alone; integrative primary care SAMHSA facilities per 100,000 population; primary care providers per 100,000; mental health providers per 100,000. Results: Co-located counties with poor mental health and larger black populations are concentrated in the southeast and Mississippi Delta region. In addition to having higher rates of poverty, unemployment, and other challenges related to social determinants of health, these counties have less access to primary care, mental health providers, and integrative primary care facilities. Conclusions: This research integrates multiple data sources and uses a co-location mapping approach to highlight disparities for black populations in accessing mental health care services and the potential for increasing integrative behavioral health in high-need areas. Future research will explore co-location mapping methods to identify integrative behavioral health capacity for other minority population groups.
Health care disparities
Context: Identifying priority geographies based on race/ethnicity and mental health distress can ... more Context: Identifying priority geographies based on race/ethnicity and mental health distress can allow for targeted approaches to increase access to care, particularly through the integration of primary care and behavioral health. Spatial social polarization refers to the hyper-concentration of a subgroup within an area. Objective: To explore spatial social polarization and mental health status across urban, suburban, and rural areas in the U.S. Additional aims include identifying priority areas within major metropolitan regions based on spatial social polarization and poor mental health and exploring access to safety net mental health services in these areas. Study Design and Analysis: Spatial social polarization was defined using the index of concentration at the extremes (ICE). We combined race and income spatial polarization for census tracts and stratified them by quintile. Next, we created rate ratios of selfrated mental health status across the five spatial social polarization quintiles using the lowest quintile (wealthy, white) as the reference value and explored these rate ratios across urban, suburban and rural areas. Next, we explored spatial social polarization, mental health, and the availability of mental health services for the three largest metropolitan regions. We used geographic information systems (GIS) to identify priority census tracts based on social polarization and poor mental health and map the location of safety-net mental health facilities on priority areas. Datasets: CDC PLACES; American Community Survey; SAMHSA Behavioral Health Services Locator. Population Studied: U.S. Census Tracts. Outcome Measures: Self-rated mental health status; percent black; percent in poverty. Results: Census tracts with concentrations of poor, black populations have higher rates of poor mental health status when compared to census tracts with wealthier, white populations. Geographic clusters of priority areas were identified in three major metropolitan areas (New York, Los Angeles, and Chicago). The maps and data suggest that these priority areas have less access to safety-net mental health services. Conclusions: Urban neighborhoods (tracts) with high levels of racialized economic segregation and poor mental health, are less likely to have adequate access to mental health treatment resources. Allocation of future resources, particularly integrative behavioral health, should take into consideration the distribution of racialized economic segregation.
Screening, prevention, and health promotion
Context: COVID-19 disrupted care delivery for patients at Health Resources and Services Administr... more Context: COVID-19 disrupted care delivery for patients at Health Resources and Services Administration (HRSA)-supported health centers. Research suggests that many patients are foregoing critical preventive care such as immunizations. Little is known about the characteristics or geographic patterns of health center declines in preventive care. Objective: To explore geographic variation and characteristics of health centers with the lowest flu vaccination rates (2020) [flu shot cold spots] and the largest declines in flu vaccination rates (2017-2020) [missed flu shot cold spots]. Study Design and Analysis: Local Moran's I to identify flu shot cold spots, defined as clusters of health centers with low flu shot rates (2020). Differential Local Moran's I to identify missed flu shot cold spots, defined as clusters of health centers with decreases in flu shot rates (2017-2019 to 2020). We also explored characteristics of health center patients who visited flu shot cold spots and missed flu shot cold spots. Dataset: Health Center Program Awardees and Look-Alikes, Uniform Data System (UDS), 2017-2020. Outcome Measures: Health center flu vaccinations. Results: We found clusters of 2020 flu shot cold spots in the central and southern U.S. Flu shot cold spot health centers have significantly higher percentages of Black patients but significantly lower percentages of Hispanic patients. Differential Local Moran's I analysis reveals clusters of missed flu shot cold spots in urban areas in California, the Pacific Northwest, and the Northeast. Missed flu shot cold spot health centers have significantly higher percentages of Hispanic patients, higher percentages of Black patients (but not significant), and significantly higher percentages of patients in poverty. Conclusions: While COVID-19 impacted flu shot rates across the U.S., several areas were impacted more severely and had significant declines or lower rates. Flu shot cold spots are consistent with overall lower rates based on data from the Centers for Disease Control and Prevention (CDC). HRSA should consider targeted research on health centers identified as flu shot and missed flu shot cold spots to better understand local contexts. Follow-up investigations could also compare geographic variation and characteristics of "bright spot" health centers (i.e., health centers with high flu shot rates), particularly those with increases in flu shot rates in 2020, to that of cold spot health centers.
Behavioral, psychosocial, and mental illness
Calling Your Aunt Bertha for Social Assets: Family Medicine and Social Determinants of Health
Journal of Primary Care & Community Health
Purpose: The sociopolitical determinants of health drive health outcomes and inequities in the Un... more Purpose: The sociopolitical determinants of health drive health outcomes and inequities in the United States. Primary care practices are, increasingly, expected by payers and policy makers to assess patients’ social needs. Resource referral platforms provide physicians with information and referral systems for community resources. One commonly used platform is Aunt Bertha/Find Help (AB/FH). The American Academy of Family Physicians (AAFP) Neighborhood Navigator (NN) tool allows physicians and laypeople to search for resources using AB/FH. We sought to describe what users were searching for and to identify patterns to inform resource allocation. Methods: This was a descriptive study of the AAFP’s NN tool. Searches of NN were analyzed to describe what users were searching for. Results: From 2018 to April 2022 there were 168 135 searches. The most common searches were for food and housing insecurity (22%, 21%) and health care referral (20.6%) with 22% more searches in the winter than t...
IASSIST Quarterly, 1998
The Global Access to Data Resources: Where's the Metadata?
Journal of the American Board of Family Medicine : JABFM
A single self-rated health (SRH) question is associated with health outcomes, but agreement betwe... more A single self-rated health (SRH) question is associated with health outcomes, but agreement between SRH and physician-rated patient health (PRPH) has been poorly studied. We studied patient and physician reasoning for health ratings and the role played by patient lifestyle and objective health measures in the congruence between SRH and PRPH. Surveys of established family medicine patients and their physicians, and medical record review at 4 offices. Patients and physicians rated patient health on a 5-point scale and gave reasons for the rating and suggestions for improving health. Patients' and physicians' reasons for ratings and improvement suggestions were coded into taxonomies developed from the data. Bivariate relationships between the variables and the difference between SRH and PRPH were examined and all single predictors of the difference were entered into a multivariable regression model. Surveys were completed by 506 patients and 33 physicians. SRH and PRPH ratings ...
Home Alone: The Impact of Maternal Employment on Delinquency
Social Problems, 2001
Recently, conservative commentators and parenting experts have been outspoken about the potential... more Recently, conservative commentators and parenting experts have been outspoken about the potential nega-tive effects of maternal employment. Specifically, there appears to be a pervasive belief that delinquency is one unfortunate consequence of maternal work. Using data ...
Does Financial Self-Efficacy Explain Gender Differences in Retirement Saving Strategies?
Journal of Women & Aging, 2003
Research indicates that women remain less financially prepared for retirement than are men. Littl... more Research indicates that women remain less financially prepared for retirement than are men. Little research has examined the gender difference in use of retirement plans. The present research assessed the gender difference in use of employer-sponsored and private retirement plans, and sought to account for this difference. Social status and human capital factors, occupation and industry of employment, and sense of financial self-efficacy were expected to account for gender differences. Findings indicated gender has no relationship with use of private retirement plans. However, females were found to be less likely to use an employer-sponsored plan, and this was largely accounted for by gender differences in occupation.
Journal of Aging Studies, 2002
In 1977, Palmore constructed the first Facts on Aging Quiz (FAQ1) in order to inspire students' i... more In 1977, Palmore constructed the first Facts on Aging Quiz (FAQ1) in order to inspire students' interest in the topic of aging and to provide a short objective test on the subject. After the broad acceptance of this first quiz, Palmore produced a second, retest version Facts on Aging Quiz (FAQ2). The quizzes were designed to measure basic knowledge of physical, mental, and social facts about old age and aging as well as common misconceptions. We test Palmore's proposition that FAQ1 and FAQ2 can be used as alternate measures of knowledge about aging. Our analysis of data from a sample of nurses contradicts his claims that the quizzes are alternate measures.
Toward a Better Way to Measure Customer Satisfaction Levels in Public Housing: A Report from Cincinnati
Housing Studies, 2000
... A 1991 Newcastle, England study approximated the experimental ideal by compar-ing survey resu... more ... A 1991 Newcastle, England study approximated the experimental ideal by compar-ing survey results for one area where a post-repairs inspection ... Davis & Denton (1987, p. 2) note that customersatisfaction surveys can play an important public relations role in that they can ...
GIS, Data Democratization, and Public Health
The web portal uses a combination of state, county, and census tract data to provide social, be... more The web portal uses a combination of state, county, and census tract data to provide social, behavioral, and economic context for detailed local area data such as state and communitylevel health survey data, birth and death certificates, and the location of ...
Family Physicians Are Using Neighborhood Navigator to Address Social Determinants of Health
American Family Physician, 2023
Using State All-Payer Claims Data to Identify the Active Primary Care Workforce: A Novel Study in Virginia
The Annals of Family Medicine
COVID-19
Context: Large numbers of US adults are vaccinated, but COVID-19 vaccine hesitancy remains high. ... more Context: Large numbers of US adults are vaccinated, but COVID-19 vaccine hesitancy remains high. Health centers funded by the Health Resources and Services Administration (HRSA) have played a major role in COVID-19 vaccinations and have the potential to vaccinate even larger numbers of people. Objective: To identify U.S. counties with low COVID-19 vaccination rates and high rates of vaccine hesitancy, explore the characteristics of these counties and health center presence in these areas, and identify priority health centers for targeted vaccine outreach. Study Design: Cross-sectional geospatial analysis of county-level COVID-19 vaccination rates and COVID-19 vaccination hesitancy. Bivariate Local Moran's I using GeoDa software to identify clusters of counties with low COVID-19 vaccination rates and high rates of COVID-19 vaccine hesitancy. Geographic Information Systems (GIS) mapping to overlay health centers with county-level data.
Background: Our. practice-based research network (PBRN) is conducting an outreach intervention to... more Background: Our. practice-based research network (PBRN) is conducting an outreach intervention to increase health insurance coverage for patients seen in the network. To assist with outreach site selec-tion, we sought an understandable way to use electronic health record (EHR) data to locate uninsured patients. Methods: Health insurance information was displayed within a web-based mapping platform to dem-onstrate the feasibility of using geographic information systems (GIS) to visualize EHR data. This study used EHR data from 52 clinics in the OCHIN PBRN. We included cross-sectional coverage data for pa-tients aged 0 to 64 years with at least 1 visit to a study clinic during 2011 (n 228,284). Results: Our PBRN was successful in using GIS to identify intervention sites. Through use of the maps, we found geographic variation in insurance rates of patients seeking care in OCHIN PBRN clinics. Insurance rates also varied by age: The percentage of adults without insurance ranged from 13.2...
Context: The Health Resources and Services Administration (HRSA) Health Center Program plays an i... more Context: The Health Resources and Services Administration (HRSA) Health Center Program plays an important role in providing prenatal care in the U.S., serving more than 560,000 primarily low-income women in 2021. Access to early prenatal care, particularly for low-income and racial and ethnic minority women, is affected by a complex set of interrelated factors, including geographic context, rurality, and the maternity care workforce. Objective: This research explores environmental, patient, and workforce factors influencing health center early access to prenatal care and assesses if the relationship between these factors and early access to prenatal care vary by health center rural status. Study Design: In this cross-sectional analysis, we create health center service area measures as proxies for geographic context and use spatial regression techniques. Population Studied: HRSA Health Center Program Awardees and Look-Alikes. Outcome Measure: Early access to prenatal care. Results: We find significant differences in early prenatal care by health center rural status. The results also show that factors at multiple levels significantly influence health center early prenatal care, including service area (social deprivation and usual source of care), patient (the percentage of black patients and the percentage of patients best served in non-English language), organizational (the percentage of virtual visits and prenatal care referral status), and workforce (the number of family physician FTEs). However, the results show that some of these factors vary in influence depending on the rural status of health centers. Conclusions: These findings suggest that geographic context and rural status are important factors contributing to health center access to early prenatal care. Specifically, rural health centers with higher numbers of family physician FTEs and lower percentages of patients best served in non-English have higher rates of early prenatal care, while urban health centers with higher rates of virtual visits have higher rates of early prenatal care. Health center interventions to improve access to prenatal care should be tailored interventions based on their rural status and multi-level factors including patient, organizational, and service area characteristics.
Context: Several studies have documented that multiple factors that contribute, including geograp... more Context: Several studies have documented that multiple factors that contribute, including geography, to preventable hospitalizations. Other studies identified preventable hospitalization hot spots in the Appalachia and Mississippi Delta regions. Objective: To determine if factors associated with preventable hospitalizations are different in the Appalachia and Delta regions (compared to the rest of the US). Study Design and Analysis: Cross sectional approach included hot spot mapping and spatial regime modeling. First, we modeled preventable hospitalizations with hierarchical condition category [HCC] risk scores, social deprivation index [SDI], rurality, hospital beds per 100,000, primary care physicians (PCP) per 100,000, and the percentage of black Medicare beneficiaries as independent variables. We also included a spatial regime variable, which models Appalachia and Delta regions separately, and a Chow test to determine if coefficients for models are significantly different. Setting/Dataset: Centers for Medicare and Medicaid (CMS) public use file (PUF), Robert Wood Johnson County Health Rankings, Robert Graham Center (SDI); US Counties (n=3,141). Outcome Measures: Preventable Hospitalizations (rates of hospital stays for ambulatory-sensitive conditions per 100,000 Medicare enrollees). Results: The model performed better for non-Appalachia/Delta counties (r2 = .33) compared to the Delta (r2 = .17) and Appalachia (r2 = .30) models. All independent variables were significant (and in the expected direction) in the non-Appalachia/Delta model, while only three were significant in the Delta and Appalachia models (SDI, hospital beds, HCC). Chow test revealed that coefficients varied significantly across the models for all independent variables except SDI and PCP rates. Conclusions: Consistent with previous literature, we find that the factors associated with preventable hospitalizations vary by region. Indeed, capturing the effects of hospital capacity, social deprivation, and population illness burden on rates of ACSC admissions is robust across diverse population segments, and point to challenges in characterizing those in regions such as the Delta and Appalachia.
Analytical and Bioanalytical Chemistry, 2013
The National Institute of Standards and Technology administers quality assurance programs devoted... more The National Institute of Standards and Technology administers quality assurance programs devoted to improving measurements of nutrients and related metabolites in foods, dietary supplements, and serum and plasma samples. These programs have been developed in collaboration with the National Institutes of Health to assist measurement communities in their efforts to achieve accurate results that are comparable among different laboratories and over time. Targeted analytes include micronutrients, botanical markers, nutritional elements, contaminants, fatty acids, and vitamin D metabolites.
Economic or policy analysis
Behavioral, psychosocial, and mental illness
Context: Preliminary analyses suggest that regions with high levels of poor mental health and lar... more Context: Preliminary analyses suggest that regions with high levels of poor mental health and larger minority populations have less access to mental health services. This is consistent with literature on disparities in mental health access for minority populations, highlighting the importance of integrating primary and behavioral health care for improving access to care. Objective: To identify priority areas for addressing health inequities in access to behavioral health care. Specific aims include identifying highneed areas based on poor mental health and race/ethnicity and exploring integrative behavioral health care capacity in these areas. Study Design and Analysis: Geographic information systems (GIS) were used to create quartile maps for counties based on race/ethnicity and poor mental health. Co-location mapping was then used to identify areas in the top quartile for both mental health need and large minority populations. Substance Abuse and Mental Health Services Administration (SAMHSA) integrative primary care facilities and primary care and mental health providers were then mapped onto these areas. Setting/Datasets: Centers for Disease Control and Prevention (CDC) PLACES; American Community Survey; SAMHSA Behavioral Health Services Locator; National Provider and Plan Enumeration System (NPPES). Population Studied: U.S. counties excluding Puerto Rico (n=3,143). Outcome Measures: Frequent mental health distress -respondents reporting 14 or more days in the last month where mental health was not good; percent black alone; integrative primary care SAMHSA facilities per 100,000 population; primary care providers per 100,000; mental health providers per 100,000. Results: Co-located counties with poor mental health and larger black populations are concentrated in the southeast and Mississippi Delta region. In addition to having higher rates of poverty, unemployment, and other challenges related to social determinants of health, these counties have less access to primary care, mental health providers, and integrative primary care facilities. Conclusions: This research integrates multiple data sources and uses a co-location mapping approach to highlight disparities for black populations in accessing mental health care services and the potential for increasing integrative behavioral health in high-need areas. Future research will explore co-location mapping methods to identify integrative behavioral health capacity for other minority population groups.
Health care disparities
Context: Identifying priority geographies based on race/ethnicity and mental health distress can ... more Context: Identifying priority geographies based on race/ethnicity and mental health distress can allow for targeted approaches to increase access to care, particularly through the integration of primary care and behavioral health. Spatial social polarization refers to the hyper-concentration of a subgroup within an area. Objective: To explore spatial social polarization and mental health status across urban, suburban, and rural areas in the U.S. Additional aims include identifying priority areas within major metropolitan regions based on spatial social polarization and poor mental health and exploring access to safety net mental health services in these areas. Study Design and Analysis: Spatial social polarization was defined using the index of concentration at the extremes (ICE). We combined race and income spatial polarization for census tracts and stratified them by quintile. Next, we created rate ratios of selfrated mental health status across the five spatial social polarization quintiles using the lowest quintile (wealthy, white) as the reference value and explored these rate ratios across urban, suburban and rural areas. Next, we explored spatial social polarization, mental health, and the availability of mental health services for the three largest metropolitan regions. We used geographic information systems (GIS) to identify priority census tracts based on social polarization and poor mental health and map the location of safety-net mental health facilities on priority areas. Datasets: CDC PLACES; American Community Survey; SAMHSA Behavioral Health Services Locator. Population Studied: U.S. Census Tracts. Outcome Measures: Self-rated mental health status; percent black; percent in poverty. Results: Census tracts with concentrations of poor, black populations have higher rates of poor mental health status when compared to census tracts with wealthier, white populations. Geographic clusters of priority areas were identified in three major metropolitan areas (New York, Los Angeles, and Chicago). The maps and data suggest that these priority areas have less access to safety-net mental health services. Conclusions: Urban neighborhoods (tracts) with high levels of racialized economic segregation and poor mental health, are less likely to have adequate access to mental health treatment resources. Allocation of future resources, particularly integrative behavioral health, should take into consideration the distribution of racialized economic segregation.
Screening, prevention, and health promotion
Context: COVID-19 disrupted care delivery for patients at Health Resources and Services Administr... more Context: COVID-19 disrupted care delivery for patients at Health Resources and Services Administration (HRSA)-supported health centers. Research suggests that many patients are foregoing critical preventive care such as immunizations. Little is known about the characteristics or geographic patterns of health center declines in preventive care. Objective: To explore geographic variation and characteristics of health centers with the lowest flu vaccination rates (2020) [flu shot cold spots] and the largest declines in flu vaccination rates (2017-2020) [missed flu shot cold spots]. Study Design and Analysis: Local Moran's I to identify flu shot cold spots, defined as clusters of health centers with low flu shot rates (2020). Differential Local Moran's I to identify missed flu shot cold spots, defined as clusters of health centers with decreases in flu shot rates (2017-2019 to 2020). We also explored characteristics of health center patients who visited flu shot cold spots and missed flu shot cold spots. Dataset: Health Center Program Awardees and Look-Alikes, Uniform Data System (UDS), 2017-2020. Outcome Measures: Health center flu vaccinations. Results: We found clusters of 2020 flu shot cold spots in the central and southern U.S. Flu shot cold spot health centers have significantly higher percentages of Black patients but significantly lower percentages of Hispanic patients. Differential Local Moran's I analysis reveals clusters of missed flu shot cold spots in urban areas in California, the Pacific Northwest, and the Northeast. Missed flu shot cold spot health centers have significantly higher percentages of Hispanic patients, higher percentages of Black patients (but not significant), and significantly higher percentages of patients in poverty. Conclusions: While COVID-19 impacted flu shot rates across the U.S., several areas were impacted more severely and had significant declines or lower rates. Flu shot cold spots are consistent with overall lower rates based on data from the Centers for Disease Control and Prevention (CDC). HRSA should consider targeted research on health centers identified as flu shot and missed flu shot cold spots to better understand local contexts. Follow-up investigations could also compare geographic variation and characteristics of "bright spot" health centers (i.e., health centers with high flu shot rates), particularly those with increases in flu shot rates in 2020, to that of cold spot health centers.
Behavioral, psychosocial, and mental illness
Calling Your Aunt Bertha for Social Assets: Family Medicine and Social Determinants of Health
Journal of Primary Care & Community Health
Purpose: The sociopolitical determinants of health drive health outcomes and inequities in the Un... more Purpose: The sociopolitical determinants of health drive health outcomes and inequities in the United States. Primary care practices are, increasingly, expected by payers and policy makers to assess patients’ social needs. Resource referral platforms provide physicians with information and referral systems for community resources. One commonly used platform is Aunt Bertha/Find Help (AB/FH). The American Academy of Family Physicians (AAFP) Neighborhood Navigator (NN) tool allows physicians and laypeople to search for resources using AB/FH. We sought to describe what users were searching for and to identify patterns to inform resource allocation. Methods: This was a descriptive study of the AAFP’s NN tool. Searches of NN were analyzed to describe what users were searching for. Results: From 2018 to April 2022 there were 168 135 searches. The most common searches were for food and housing insecurity (22%, 21%) and health care referral (20.6%) with 22% more searches in the winter than t...
IASSIST Quarterly, 1998
The Global Access to Data Resources: Where's the Metadata?
Journal of the American Board of Family Medicine : JABFM
A single self-rated health (SRH) question is associated with health outcomes, but agreement betwe... more A single self-rated health (SRH) question is associated with health outcomes, but agreement between SRH and physician-rated patient health (PRPH) has been poorly studied. We studied patient and physician reasoning for health ratings and the role played by patient lifestyle and objective health measures in the congruence between SRH and PRPH. Surveys of established family medicine patients and their physicians, and medical record review at 4 offices. Patients and physicians rated patient health on a 5-point scale and gave reasons for the rating and suggestions for improving health. Patients' and physicians' reasons for ratings and improvement suggestions were coded into taxonomies developed from the data. Bivariate relationships between the variables and the difference between SRH and PRPH were examined and all single predictors of the difference were entered into a multivariable regression model. Surveys were completed by 506 patients and 33 physicians. SRH and PRPH ratings ...
Home Alone: The Impact of Maternal Employment on Delinquency
Social Problems, 2001
Recently, conservative commentators and parenting experts have been outspoken about the potential... more Recently, conservative commentators and parenting experts have been outspoken about the potential nega-tive effects of maternal employment. Specifically, there appears to be a pervasive belief that delinquency is one unfortunate consequence of maternal work. Using data ...
Does Financial Self-Efficacy Explain Gender Differences in Retirement Saving Strategies?
Journal of Women & Aging, 2003
Research indicates that women remain less financially prepared for retirement than are men. Littl... more Research indicates that women remain less financially prepared for retirement than are men. Little research has examined the gender difference in use of retirement plans. The present research assessed the gender difference in use of employer-sponsored and private retirement plans, and sought to account for this difference. Social status and human capital factors, occupation and industry of employment, and sense of financial self-efficacy were expected to account for gender differences. Findings indicated gender has no relationship with use of private retirement plans. However, females were found to be less likely to use an employer-sponsored plan, and this was largely accounted for by gender differences in occupation.
Journal of Aging Studies, 2002
In 1977, Palmore constructed the first Facts on Aging Quiz (FAQ1) in order to inspire students' i... more In 1977, Palmore constructed the first Facts on Aging Quiz (FAQ1) in order to inspire students' interest in the topic of aging and to provide a short objective test on the subject. After the broad acceptance of this first quiz, Palmore produced a second, retest version Facts on Aging Quiz (FAQ2). The quizzes were designed to measure basic knowledge of physical, mental, and social facts about old age and aging as well as common misconceptions. We test Palmore's proposition that FAQ1 and FAQ2 can be used as alternate measures of knowledge about aging. Our analysis of data from a sample of nurses contradicts his claims that the quizzes are alternate measures.
Toward a Better Way to Measure Customer Satisfaction Levels in Public Housing: A Report from Cincinnati
Housing Studies, 2000
... A 1991 Newcastle, England study approximated the experimental ideal by compar-ing survey resu... more ... A 1991 Newcastle, England study approximated the experimental ideal by compar-ing survey results for one area where a post-repairs inspection ... Davis & Denton (1987, p. 2) note that customersatisfaction surveys can play an important public relations role in that they can ...
GIS, Data Democratization, and Public Health
The web portal uses a combination of state, county, and census tract data to provide social, be... more The web portal uses a combination of state, county, and census tract data to provide social, behavioral, and economic context for detailed local area data such as state and communitylevel health survey data, birth and death certificates, and the location of ...
Family Physicians Are Using Neighborhood Navigator to Address Social Determinants of Health
American Family Physician, 2023
Using State All-Payer Claims Data to Identify the Active Primary Care Workforce: A Novel Study in Virginia
The Annals of Family Medicine
COVID-19
Context: Large numbers of US adults are vaccinated, but COVID-19 vaccine hesitancy remains high. ... more Context: Large numbers of US adults are vaccinated, but COVID-19 vaccine hesitancy remains high. Health centers funded by the Health Resources and Services Administration (HRSA) have played a major role in COVID-19 vaccinations and have the potential to vaccinate even larger numbers of people. Objective: To identify U.S. counties with low COVID-19 vaccination rates and high rates of vaccine hesitancy, explore the characteristics of these counties and health center presence in these areas, and identify priority health centers for targeted vaccine outreach. Study Design: Cross-sectional geospatial analysis of county-level COVID-19 vaccination rates and COVID-19 vaccination hesitancy. Bivariate Local Moran's I using GeoDa software to identify clusters of counties with low COVID-19 vaccination rates and high rates of COVID-19 vaccine hesitancy. Geographic Information Systems (GIS) mapping to overlay health centers with county-level data.
Background: Our. practice-based research network (PBRN) is conducting an outreach intervention to... more Background: Our. practice-based research network (PBRN) is conducting an outreach intervention to increase health insurance coverage for patients seen in the network. To assist with outreach site selec-tion, we sought an understandable way to use electronic health record (EHR) data to locate uninsured patients. Methods: Health insurance information was displayed within a web-based mapping platform to dem-onstrate the feasibility of using geographic information systems (GIS) to visualize EHR data. This study used EHR data from 52 clinics in the OCHIN PBRN. We included cross-sectional coverage data for pa-tients aged 0 to 64 years with at least 1 visit to a study clinic during 2011 (n 228,284). Results: Our PBRN was successful in using GIS to identify intervention sites. Through use of the maps, we found geographic variation in insurance rates of patients seeking care in OCHIN PBRN clinics. Insurance rates also varied by age: The percentage of adults without insurance ranged from 13.2...