College of Population Health Posters

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  Characterizing Smoking-related Litter in Public Parks in Philadelphia

  Russell K. McIntire, PhD, MPH and Ashley Lipshaw, MPH

  Background

  • Cigarettes are the most littered item in the country.
  • Since 1980 cigarette butts have represented 30-40% of all litter collected from coastal waterways and urban areas among major surveys in the U.S.
  • Communities have established smoke free public spaces, including parks, in part to mitigate this source of litter and pollution.
  • In 2014, Philadelphia prohibited smoking on all lands and facilities under the jurisdiction of the Philadelphia Department of Parks and Recreation
  • However, not all parks in Philadelphia have the same environment to deter smoking, as “Smoke-Free” signs are not posted in all parks

  Objectives

  This study reports the results of systematic litter audits at four parks in Center City Philadelphia in order to describe major categories and the proportion of smoking-related litter found at parks.

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  Development of a Disaster Preparedness Interprofessional Education (IPE) Program for Health Profession Students

  Edward Jasper, MD; Mary Bouchaud, PhD, MSN, CNS, RN, CRRN; Dale Berg, MD; Katherine W Berg, MD; and John F McAna, PhD

  • Despite numerous attacks and threats both in the US and around the world, there is no standardized disaster preparedness curriculum for health profession students

  • This project is the development and implementation of an IPE disaster preparedness curriculum with both a mandatory component and additional training as an elective at Thomas Jefferson University (TJU) in Philadelphia
  • Upon completion of the elective component, students are Federal Emergency Management Agency (FEMA) Hospital Emergency Response Team (HERT) certified and become part of the hospital’s disaster response and decontamination team

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  Success and Limitations of Hepatitis C Screening in the Inpatient Setting

  Madalene Zale, MPHc and Priya Mammen, MD, MPH

  This study evaluates the outcomes that a state level mandate for HCV screening with HCV-Antibody-only has on linkage to care and access to treatment, compared to a specific programmatic effort, which includes HCV confirmation.

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  Climate Change and Resulting Floods: Using Social Capital to Strengthen Community Resilience in Eastwick, Philadelphia a known floodplain

  Natasha Bagwe, MD, MPH; Richard Pepino, PhD, MSS; Erin Johnson, MPH, MSN, RN; and Julie Becker, PhD, MPH

  • Climate change will produce intense weather events like increased precipitation and flooding

  • Based on climate projections, Philadelphia will be hotter and wetter, and will experience more frequent and intense weather events (OOS, 2016)

  •Floods are the second most common hazards in our city (OEM, 2017)

  • Vulnerable population such as children, people of color, elderly population and people with disability are severely impacted by climate change

  Poster presented at AHPA conference in Atlanta Georgia, United States.

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  Evaluating Value-Based Frameworks Used for Relapsed or Refractory Multiple Myeloma Regimens: ICER Report, ASCO Value Framework, and NCCN Evidence Blocks

  Laurence M. Djatche, PharmD; Joseph Goble, PharmD; Grace Chun, PharmD; and Stefan Varga, PharmD

  BACKGROUND: With the continuous rise in costs for oncology drugs, the Institute for Clinical and Economic Review (ICER), the American Society of Clinical Oncology (ASCO) and the National Comprehensive Cancer Network (NCCN) have developed value-based frameworks (VBFs) to assist stakeholders in formulary and treatment decisionmaking. While emerging VBFs have the potential to significantly impact therapeutic options for patients, it is important to understand the differences associated with those VBFs within a therapeutic area. OBJECTIVE: To compare ICER, ASCO, and NCCN VBFs across three therapeutic options for relapsed or refractory multiple myeloma (RRMM).

  METHODS: The values of carfilzomib (CFZ), elotuzumab (ELO), and ixazomib (IX) were generated using ICER, ASCO, and NCCN VBFs. Those regimens, used for second or third line treatment of RRMM, were chosen because they share a common comparator in clinical trials, lenalidomide + dexamethasone (LEN + DEX). The ICER 2016 report of treatment options for RRMM was used to obtain results of the comparative clinical effectiveness and the cost effectiveness analysis for those regimens compared to LEN + DEX. ASCO’s 2016 VBF, which incorporates clinical benefit, toxicity and bonus points was used to generate a net health benefit (NHB) score without a scale along with the drug wholesale acquisition cost (WAC) for each regimen compared to LEN + DEX. The NCCN VBF uses a score ranging from 1 to 5, with 1 as the least favorable and 5 as the most favorable, for each of five evidence blocks: efficacy, safety, quality, consistency, and affordability. The 2016 Multiple Myeloma NCCN evidence blocks was used to obtain the value of CFZ, ELO, and IX.

  RESULTS: The ICER VBF suggested with moderate certainty that CFZ, ELO, and IX provide a better NHB in patients with RRMM compared to LEN + DEX. Second-line and third-line treatment costs per QALY for CFZ, ELO, and IX were $199,982, $427,607 and $433,794, and $238,560, $481,244, and $484,582, respectively. The ASCO VBF generated a total NHB of 28.8, 23.7 and 23.0 with a monthly WAC of $17,364, $16,032 and $20,607 for CFZ, ELO, and IX, respectively. The monthly cost of LEN + DEX was $11,616. The NCCN VBF had an efficacy score of 5, 3, and 4 for CFZ, ELO, IX, respectively. Safety, quality, consistency, and affordability scores of 3, 4, 4, and 1, respectively, were the same across regimens.

  CONCLUSIONS: ICER, ASCO and NCCN VBFs suggest CFZ may be the most valued treatment out of the three regimens. However, their applicability in stakeholder’s decision-making remains unclear due to uncertainty and challenges associated with them.

  SPONSORSHIP: None.

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  Borders and Blood Pressure: Understanding the Role of Acculturation in a Hypertension Diagnosis Among Hispanic Americans: 2014 California Health Interview Survey

  Lia Scalzo, MPH; Hee-Soon Juon, PhD, MSN; and Russell K. McIntire, PhD, MPH

  Background:

  In the U.S. Hispanic population overall, heart disease is the leading cause of death. The prevalence of hypertension among Mexican American immigrants is lower than the general population, yet it is on the rise. Health risks among Hispanics vary depending on their length of stay in the US (as proxy measure of acculturation). The purpose of this study was to examine the association between acculturation and the individual's likelihood of being diagnosed with hypertension among Hispanic Americans.

  Methods:

  We used data from the 2014 California Health Interview Survey (CHIS) and performed univariate analysis to examine racial differences in prevalence of hypertension. We also performed a multivariate logistic regression to identify if acculturation was significantly related to hypertension diagnoses, after controlling for sociodemographic characteristics (e.g., age, gender, level of education, marital status), access to care, and health status (e.g., self-reported health status, BMI), among Mexican Americans and all Hispanics, respectively.

  Results:

  Of 3,793 Hispanic American participating in the survey, 81.8% were Mexican Americans and 18.2% were other Hispanics. The prevalence of hypertension among Hispanic was 24.0% (95% CI: 21.5%. 26.7%) which was lower than that of African Americans (39.2%, 95% CI 33.7%, 44.9%) and White (30.2%, 95% CI: 28.5%, 31.9%). In multivariate analyses, acculturation was associated with hypertension among Mexican Americans, but not all Hispanics. For both Mexican Americans and Hispanics, age, health status and BMI were associated with having hypertension: Older people, those with poor health status, and overweight and obese people were more likely than their comparison groups to have hypertension. Those without health insurance were less likely to have hypertension.

  Conclusion:

  The results show a positive association between length of time in the United States for longer periods of time, and a diagnosis of hypertension. These results, along with others conducted around Hispanic American immigration, acculturation and chronic disease prevalence, help medical providers, to understand the effects of acculturation on specific health care needs among immigrants, and offer suggestions to patients which are culturally sensitive and relevant.

  Poster presented at AHPA conference in Atlanta Georgia.

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  Literature Review on Hospital Costs for Patients Undergoing Colectomy

  Brian P.H. Chen, ScM; Hang Cheng; Martha Romney, RN, MS, JD, MPH; and Carine Chia-Wen Hsiao

  Objective:

  This study aims to identify the range of direct hospital costs associated with a minimally invasive or open colectomy procedure across different countries.

  Poster presented at 2016 ISPOR conference in Washington DC.

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  Literature Review on Hospital Costs for Patients Undergoing Hysterectomy

  Brian P.H. Chen, ScM, PharmD; Hang Cheng; Martha Romney, RN, MS, JD, MPH; and Carine Chia-Wen Hsiao

  Objective:

  This study aims to identify the range of direct hospital costs associated with a minimally invasive or abdonimal hysterectomy procedure across different countries.

  Poster presented at 2016 ISPOR conference in Washington DC.

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  Factors Influencing Resection in Locoregional Pancreatic Cancer Patients

  Amy Cunningham, MPH, PhD(c); Brian P.H. Chen, ScM, PharmD; and David Delgado, PhD

  Objective:

  Identify factors associated with resection in a national sample of locoregional pancreatic cancer patients.

  Poster presented at ISPOR conference in Washington DC.

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  Health care providers advice not to smoke and quit attempts among mid-adolescent smokers

  Russell K. McIntire, PhD, MPH

  Background

  • Nearly 1 out of 7 U.S. adolescents is a current cigarette smoker by the time they leave high school. ¹
  • Although almost one third of adolescents who saw a healthcare provider in the past month were advised to quit or avoid tobacco,² research on the influence of provider advice on quit attempts among adolescent smokers has shown mixed results. ³
  • These results may be due to selection bias—adolescent smokers who get advice may be different from those who do not on a range of factors including age of initiation, smoking frequency, attitudes toward smoking, exposure to other anti-tobacco messages, and number of smoking friends.
  • Additionally, the effects of provider advice on quit attempts may be different between the stages of adolescence, namely early adolescence (ages 11-13), mid adolescence (ages 14-16) and late adolescence (ages 17-18), as studies have shown for parental advice not to smoke.⁴

  Research Questions

  1) Does healthcare provider advice make adolescent smokers more likely to try to quit smoking?

  2) Does the effect of health care provider advice on adolescent smoker quit attempts vary among the different stages of adolescence?

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  Use of Propensity Score Matching to Identify a Strong Association Between Health Care Provider Advice Not to Smoke and Quit Attempts Among Mid-Adolescent Smokers

  Russell K. McIntire, PhD, MPH

  Background:

  • Nearly 1 out of 7 U.S. adolescents is a current cigarette smoker by the time they leave high school. ¹
  • Although almost one third of adolescents who saw a healthcare provider in the past month were advised to quit or avoid tobacco,² research on the influence of provider advice on quit attempts among adolescent smokers has shown mixed results. ³
  • These results may be due to selection bias—adolescent smokers who get advice may be different from those who do not on a range of factors including age of initiation, smoking frequency, attitudes toward smoking, exposure to other anti-tobacco messages, and number of smoking friends.
  • Additionally, the effects of provider advice on quit attempts may be different between the stages of adolescence, namely early adolescence (ages 11-13), mid adolescence (ages 14-16) and late adolescence (ages 17-18), as studies have shown for parental advice not to smoke.⁴

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  Erosion of Empathy in Primary Care Trainees

  Jacquelyn McRae, PharmD; G. Calusi; Mengdan Liu; V. Scognamiglio; E. Messina; L. Polenzani; and Vittorio Maio, PharmD, MSPH

  Objective:

  To evaluate if empathy among physician residents (trainees) differs dependent on training year and to assess trainees' characteristics associated with higher empathy scores.

  Poster presented at 2016 ISPOR conference in Washington DC.

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  Did a physician-targeted intervention that reduced potentially inappropriate prescribing to elderly patients also reduce related hospitalizations?

  Jacquelyn McRae, PharmD; Sarah E. Hegarty, PharmD; M. Alcusky; A. Vegesna; S. Varga; S. W. Keith; S. Del Canale; M. Lombardi; and Vittorio Maio, PharmD, MSPH

  Objectives:

  To determine whether a general practitioner focused intervention aimed at decreasing PIM prescribing in the elderly can decrease the risk of PIM-related hospitalizations.

  Poster presented at 2016 ISPOR conference in Washington DC.

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  The Pennsylvania Emergency Department Geriatric Readiness Project

  Adam Perry, MD and Alyssa Sipes, BS

  BE THE ED DOC – Illustrating Geriatric Readiness

  An independent, right handed 81 year old who lives alone trips and falls while walking with her walker. A thorough evaluation at her local ED reveals only a nonoperative right proximal humeral fracture. Her pain is well controlled with immobilization and oral analgesics.

  What is her disposition?

  • Discharge home with shoulder immobilizer and instructions to call orthopedics in the morning.
  • Admit to Telemetry Bed for “Syncope” with orthopedics and cardiology consultations, with subsequent SubAcute Rehabilitation stay.
  • Admit to Observation Status for “Ambulatory Dysfunction”.
  • Discharge home with her daughter, who lives locally, with home care (aids, nursing, PT/OT) and an appointment to see orthopedics in two days.
  • Any of the above, depending on the ED providers and process, and the availability of inpatient and outpatient resources at the time she presents.

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  An Evaluation of a Sexual Health Education Program for Adolescents in a Residential Treatment Program in the Philadelphia Area

  Rachel Powell (student), P. Smith, and Amy Leader

  BACKGROUND

  The US is currently experiencing an epidemic; millions of American adolescents are affected by sexually transmitted diseases (STDs), teen pregnancy and intimate partner violence (IPV), costing the country both socially and economically:

  • Adolescents 15-24 years of age account for 50% of the 20 million new STD cases each year
  • US birth rates are significantly higher than countries in Europe
    • 6.8 times higher than teens living in the UK
    • 13.9 times higher than teens living the EU
  • In 2010 18.7% of adolescents ages 11-17 experienced IPV for the first time
  • Adolescents who are diagnosed with an STD, are teen parents and IPV victims are at greater risk of experiencing physical, reproductive, social and behavioral health problems
  • Collectively STDs, teen pregnancy and IPV cost $33.7 billion annually

  Sexual Health Education Programs are a national priority with the primary focus to help reduce incidence rates of STDS, teen pregnancy and IPV in adolescents. These programs are evidence based and are more effective than traditional abstinence-only programs.

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  A Review of Current Quality Metrics for Evaluating Patient-Centered Medical Homes

  Stefan Varga; M. Lombardi; and Vittorio Maio, PharmD, MSPH

  Objectives:

  This review sought to explore the quality metrics that are currently utilized to assess PCMHs

  Poster presented at 2016 ISPOR conference in Washington DC.

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  Purchase of Loose Cigarettes by Adult Smokers in Philadelphia: Individual-level Correlates and Neighborhood Characteristics

  Russell K. McIntire, PhD, MPH

  Background

  • Philadelphia has the highest adult smoking rate1 and the highest rate of tobacco retailers2 among the 10 largest U.S. cities.

  • Governmental reports have identified high rates of illegal sale of cigarettes in Philadelphia2.

  • Studies have found that a main source of cigarette use in low income communities is single (loose) cigarettes purchased at tobacco retailers or from unregulated street vendors3,4.

  • While studies have shown that loose cigarette use is a problem among urban youth who reside in disadvantaged neighborhoods, less research has been performed among adults on this topic5,6, and no studies focus on Philadelphia.

  • In order to efficiently target tobacco control efforts towards reducing smoking rates in Philadelphia, demographic, geographic, and behavioral factors affecting the purchase of loose cigarettes need to be determined.

  Research Questions:

  1. What are the demographic and smoking-related correlates of having purchased loose cigarettes among adult smokers in Philadelphia?

  2. Are smokers who purchased loose cigarettes more likely to reside in Philadelphia neighborhoods with high poverty rates, compared to smokers who did not?

  3. Are smokers who purchased loose cigarettes more likely to reside in Philadelphia neighborhoods with high tobacco retail density, compared to smokers who did not?

  Poster presented at APHA in Chicago, Illinois.